Twenty-five years of multidrug therapy for leprosy

Overview

A history of the development and implementation of multi-drug  therapy  for  leprosy  has  recently  been  published  by WHO.  The  document,  which  includes  first-hand  accounts from many scientists and public health professionals who were  personally  involved  in  these  events,  sets  out  several lessons for other control initiatives that are attempting to bring  high-quality  interventions  to  areas  where  health infrastructures are weak. The article below provides a brief summary of this history.

The history of control programmes for leprosy, whichbegan in the second half of the previous century, has beenremarkably brief for such an ancient disease. It has alsobeen remarkably successful. In a dramatic progression ofscientific breakthroughs, public health setbacks, and jointlydevised solutions, one particular achievement stands outas the turning point for leprosy control. This was a newtriple-drug treatment regimen, known as multidrug the-rapy (MDT), worked out by a WHO study group and recom-mended in 1981. Simple, standardized, and well-suited tofield conditions, MDT also proved spectacularly effective. Itrevolutionized both the prospects for controlling leprosyand the organization of services for doing so, eventuallyfacilitating the integration of leprosy control into generalhealth services. Its introduction and subsequent widespreaduse transformed leprosy from a passively accepted perennialproblem to one that could be aggressively attacked, with sus-tainable results, and eventually eliminated. A retrospectiveanalysis of reasons for this success yields several lessons ofvalue when designing control programmes for other diseas-es that are strongly associated with poverty.