Leprosy: urgent need to end stigma and isolation
Myanmar, 6 February 2003 - The world is making great progress towards the goal of eliminating leprosy as a public health problem. But serious concerns remain in several countries, including India, Nepal and Brazil. This was the message delivered at the opening of the annual gathering here of leprosy endemic countries and partners sponsored by the World Health Organization (WHO).
Myanmar itself, despite many obstacles in terms of resources, security problems and geography, is close to meeting the target of leprosy elimination. The country has managed to bring down the number of cases from more than 53 per 10,000 population in 1987 to very slightly over one per 10,000 at the end of 2002.
Elsewhere, however, a combination of lack of political commitment and social and organisational problems remain, holding back progress.
The global health community agreed in 1999 to create the Global Alliance to Eliminate Leprosy (GAEL) with a target of eliminating leprosy as a public health problem by the year 2005. Elimination has been defined as less than one case per 10,000 people. Much progress has already been made towards this goal, and almost all of the countries where leprosy was a major public health problem at the end of the 20th century are now on track to hit the elimination goal.
Among the 122 countries where the disease was considered endemic in 1985, 108 have now reached the goal of elimination at the country level. Today, 90% of cases are found in India, Brazil, Nepal, Madagascar, Mozambique and Myanmar (in order of importance).
GAEL brings together key partners working to detect and treat all persons affected by leprosy and thereby eliminate the disease from all countries by 2005. Key to reaching this goal is to diagnose and treat leprosy just like any other disease, without stigma or isolation.
"Diagnosing and treating leprosy through the public health system is vital if we are to avoid continuing stigma and prejudice against leprosy patients," says Dr David Heymann, Executive Director in charge of Communicable Disease Programmes at the World Health Organization. "Continuing to treat leprosy patients through expensive and separate programmes has been shown to be the wrong approach - for health systems and for the patients they look after."
In recent years access to leprosy diagnosis and treatment within general health services has been greatly improved. Mass media campaigns have also helped create awareness of the availability of free and effective treatment as well as to dispel fear about the disease.
The reasons why India and one or more other countries may miss the 2005 deadline are complex and include the delay in improving access to - and coverage of - leprosy treatment particularly in highly endemic areas. The continued existence of specialized leprosy services also tends to hinder the full integration of leprosy services into the primary health care system.
This conflict of interest has been encountered in many countries but is gradually being brought under control as more and more countries appreciate that the only effective and sustainable way to diagnose and treat leprosy is within the communities where it is found, using the staff and resources of the local primary health centres.
This is also a point of contention between several international non-governmental organizations (NGOs) and GAEL. Some of the NGOs do not believe that leprosy can be treated through the public health system, just like any other disease. GAEL says, however, that this approach does work and will continue to work.
Since 1995, leprosy patients in all countries have had access to free drug treatments, first through a donation by the Nippon Foundation and now through the Novartis Foundation for Sustainable Development. This highly effective multi-drug treatment has contributed greatly to the success of bringing down the rates of leprosy infection around the world.
"Novartis is fully committed to ensuring that every leprosy patient in the world receives high quality drugs free of cost. We will continue our support to the programme as long as it is required," said Dr Daniel Vasella, Chairman and Chief Executive Officer of Novartis.
The Nippon Foundation, which has been supporting the programme for the last 28 years, reaffirmed its commitment to support this global effort to eliminate leprosy at the meeting.
"The elimination of leprosy as a public health problem is only the first stage of humanity's fight against this age-old disease," said Mr. Yohei Sasakawa, President of The Nippon Foundation and Special Ambassador for the Global Alliance. "This is an honourable mission that calls for a united effort by all the stake-holders. We have reached the last mile of our 100-mile journey. But this last mile will be the most difficult to travel. We must keep moving and not falter."