By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
The WHO South-East Asia Region continues to lead global efforts to achieve a leprosy-free world with zero leprosy infection and disease, zero disability, and zero leprosy-related stigma and discrimination. In 2019 more than 200 000 cases of leprosy were detected from 116 countries globally, of which 96% were from 23 high-burden countries. Less than 5% of cases had grade-2 disability (G2D) at the time of diagnosis, equating to a G2D rate of 1.4 per million population – a 40% reduction on the 2014 figure. Globally, the new case detection rate for those aged 0 to 14 years was 7.9 per million children, marking a significant improvement on the 2014 rate of 10.1. To achieve the targets identified in WHO’s new global road map for neglected tropical diseases (NTDs), and to fulfill the guiding principle of the 2030 Agenda for Sustainable Development – “leave no one behind” – both the Region and world must drive rapid and sustained progress.New strategies and tools hold great promise. In 2018 WHO published evidence-based guidelines for the diagnosis, treatment and prevention of leprosy, recommending the provision of single-dose rifampicin to contacts of confirmed cases. WHO estimates that 25 million people globally could benefit from prophylactic interventions, as underscored in WHO guidance issued in 2020 on contact tracing and preventive chemotherapy. In response to the emergence and spread of COVID-19, national leprosy programmes have harnessed and applied technology in innovative ways that could strengthen the quality and reach of leprosy services moving forward, for example through e-learning, telemedicine and m-health. Leprosy diagnosis and treatment must continue to be included in the basic health services that countries provide in their quest to achieve universal health coverage (UHC), one of the Region’s eight Flagship Priorities.
A core pillar of the Global Leprosy Strategy 2016–2020 was to end leprosy-related stigma and discrimination, on which countries in the Region have made significant progress. India has in recent years repealed five different personal laws and acts, and Nepal and Sri Lanka have initiated similar processes. Globally, WHO and its partners have identified a total of 127 discriminatory laws that are still in place in 22 countries, impeding last-mile efforts to achieve leprosy targets, despite the elimination of the disease as a public health problem more than two decades ago. In recognition of and accordance with resolution 29/5 of the United Nations Human Rights Council, all countries in the Region and globally must make concerted efforts to identify and repeal such laws, for the health and human rights of all.
The implementation of WHO’s soon-to-be-launched Global Leprosy Strategy 2021–2030 will mark a bold new era in our battle against leprosy, which will no longer focus on the elimination of leprosy as a public health problem at the national and sub-national levels, but rather on achieving zero leprosy infection and disease, zero disability, and zero leprosy-related stigma and discrimination at all levels. To do that, the Strategy aims to drive sustained reductions in the world’s 23 high-burden countries, while interrupting transmission in countries that currently report very few cases. Crucially, the Strategy redefines the burden of leprosy to not only include persons in need of physical treatment and rehabilitation, but also persons suffering from the mental health impact of leprosy. At present, just 35% of leprosy-endemic countries globally report the availability of counselling services for persons affected by leprosy, highlighting the need for targeted action.
There is not a moment to lose. The 2020 launch of the global roadmap on NTDs provides additional momentum to the Region’s Flagship Priority on eliminating NTDs and other diseases on the verge of elimination, as well as our quest to achieve UHC and deliver on the overarching promise of the 2030 Agenda for Sustainable Development – leave no one behind. WHO remains committed to ensuring all countries in the Region and world can accelerate progress towards achieving zero leprosy infection and disease, zero disability, and zero leprosy-related stigma and discrimination. The healthier, more equitable Region and world that we envision is the healthier, more equitable Region and world that together we must create.