The World Health Organization (WHO) is piloting new approaches to overturn the “slow decline” of new leprosy cases almost 16 years after the disease was “eliminated as a global public health problem”1. These new approaches, part of WHO’s Global Leprosy Strategy 2016–2020, aim to reinvigorate control efforts and avert disabilities, especially among children affected by the disease in endemic countries.
“Leprosy is not declining at the pace we would like to see,” said Dr Erwin Cooreman, Team Leader, Global Leprosy Programme housed in WHO’s Regional Office for South-East Asia in New Delhi, India. “Our new strategy involves leadership and coordination, and focuses not only on medical or public health interventions but also on personal and social aspects – factors that are important for a disease that is still so stigmatized.”
The 19th International Leprosy Congress (Beijing, 19–21 September 2016) supported the new strategy, which results from a global consultative process. One of its three core pillars2 is to achieve zero leprosy cases among children.
“This indicator is an important benchmark to measure success in cutting transmission and detecting cases early,” added Dr Cooreman. “Any child diagnosed with leprosy should trigger an investigation. We should encourage wider active case-finding in high-risk communities while contact tracing should become routine practice.”
Leprosy is an infectious but highly curable disease. The causative organism, Mycobacterium leprae, affects the skin, mucosa of the upper respiratory tract, peripheral nerves and also the eyes. Left untreated, leprosy causes progressive and permanent damage.
Much has been achieved since the introduction in 1995 of multidrug therapy (MDT), which is made available through WHO free of charge to all patients worldwide. MDT provides a simple yet highly effective cure for all types of leprosy. Integration of basic leprosy services into the general health services of endemic countries has enhanced access to diagnosis and treatment. More than 16 million leprosy patients have been treated with MDT over the past 20 years.
Today, efforts focus on promoting early detection of cases to reduce the disease burden (particularly disabilities) and interrupt transmission. These efforts will ultimately contribute to eliminating leprosy at sub-national levels.
Global leprosy situation in 2015
In 2015, a total of 210 758 new cases were reported from 106 countries in all WHO regions, representing a 21% drop from the number of cases reported in 2005.
Most patients continue to be detected in a few countries: India bears 60% of the global case load, followed by Brazil and Indonesia.
Some 95% of all leprosy cases are found in 14 countries, each reporting 1000 or more cases.
In 2015, more than 14 000 (8%) of new leprosy cases had visible deformities, meaning that many patients are being reached late for treatment. Leprosy was diagnosed in almost 19 000 children (11% of all new cases), indicating that active transmission in communities still occurs. Globally, most national programmes reported cure rates exceeding 90%.
19th International Leprosy Congress and the way forward
The theme of the 19th International Leprosy Congress – Unfinished business: stopping transmission, preventing disability, promoting inclusion – echoed the concerns of the global community about this ancient disease that once affected millions of people.
Today, leprosy is a focalized disease that is increasingly limited to “hot-spots”.
To reach all patients, leprosy treatment must be optimally integrated into general health services and political commitment sustained in all countries for many more years to come. Partners in the fight against leprosy need to ensure that human and financial resources continue to be made available.
The age-old stigmatization associated with the disease remains an obstacle to self-reporting and early treatment. The image of leprosy must be changed at global, national and local levels. A new environment must be created to ensure zero discrimination and promote inclusion, whereby patients will not hesitate to come forward for diagnosis and treatment at any health facility, and health workers will not shy away from providing necessary care and support.
Participants and panellists called for more work to be done in the communities where the disease continues to occur.
The Congress was hosted by the Chinese Leprosy Association. In his speech on behalf of the President of China, Vice President Li Yuanchao said that China would continue to support other countries to improve development and innovation and contribute to eliminating the disease worldwide.
At least 1300 experts and representatives from 100 countries attended the conference, including Brazil, India and the United States of America. Representatives from WHO, national leprosy programmes, the International Federation of Anti-Leprosy Associations, other international organizations and nongovernmental organizations also attended the conference.
1 Elimination of leprosy as public health problem (that is, a prevalence of less than 1 case per 10 000 population) was achieved globally in 2000.
2 Pillar I: Strengthen government ownership, coordination and partnership; Pillar II: Stop leprosy and its complications; Pillar III: Stop discrimination and promote inclusion.