Viet Nam nears zero leprosy, thanks to last-mile, mobile efforts

Reducing stigma, improving prevention, early detection and treatment, and caring for people with leprosy are helping Viet Nam move towards zero leprosy by 2030, with the support of the World Health Organization (WHO), and the Sasakawa Health Foundation and other members of the Global Partnership for Zero Leprosy.

In a remote hamlet in north-western Viet Nam, health-care workers in a mobile health team were completing their last health checks for the day.

^{WHO technical officer Dr Vu Quang Hieu asks villagers about their health, to identify any people with leprosy or other conditions the mobile team can treat. Credit: WHO Viet Nam}

The doctors and nurses were screening and treating people for skin conditions like scabies and ringworm, which are common, and leprosy, which is less common. In the team were staff from the National Hospital of Dermatology and Venereology (NHDV), health care workers from provincial, district and commune levels and local authorities, and WHO in Viet Nam. They had set up two-day clinics in two communes in mountainous Quynh Nhai district in Son La Province, which borders Lao People’s Democratic Republic.  

About 500 people, three-quarters of the residents of Chieng Bang and Chieng Khay communes, seized the opportunity to come to the free health screening clinic near their homes. People in this district mostly belong to the Thai ethnic group, and live in scattered communities far from health stations, earning a living from livestock, cultivating fish in cages on a hydropower reservoir, growing cinnamon or fruit, or from manual labour. 

^{About 500 people, making up three-quarters of people in Chieng Bang and Chieng Khay communes, seized the opportunity to come to a free health screening clinic near their homes to check for skin conditions and noncommunicable diseases. Credit: WHO Viet Nam}

Taking a half-day off work, they patiently queued outside the communal house. Many brought babies or children along too.

The mobile team selected this area because leprosy cases had been high here in the past. Although leprosy is curable and treatment in the early stages can prevent permanent disability, many people here struggle to access basic health care and information. For example, they might not know they should seek care if they notice changes to their skin. 

As health care workers were seeing their last patients at Chieng Bang commune, a woman came forward with unusual symptoms.

She had numbness in both of her legs and her ears were swollen. Both symptoms suggested she had the early stages of leprosy. Laboratory analysis of a skin sample later confirmed the diagnosis. As a result, the woman was able to receive the recommended 12-month course of multidrug therapy (MDT), under the care of a local health-care worker, and has now recovered. Her health will continue to be monitored. WHO provides a year’s supply of MDT free of cost; it has been donated annually by Novartis since the year 2000. MDT treats leprosy faster than single medications. By including multiple drugs that target different aspects of the infection, MDT also helps prevent antimicrobial resistance (AMR), which reduces the power of the usual leprosy medicines, making the disease harder to treat and cure.

The team also traced close contacts of the woman, including household members, and gave them a single dose of a medicine to prevent leprosy, to reduce their risk of infection.

^{As well as screening people for leprosy and other skin diseases, the mobile health clinic offers diagnosis and treatment for noncommunicable diseases like hypertension. Credit: WHO Viet Nam}

Leprosy spreads through close contact with an infected person, so the team thought it likely there were other people with undetected leprosy in the area. This discovery underlined the need to continue targeted, ongoing active case finding. Active case finding involves searching for people with undiagnosed leprosy in high-risk communities, rather than waiting for people to seek help. This is one of WHO’s areas of support for Viet Nam’s leprosy programme, along with helping understand the patterns of spread, and supporting the development of the national strategic plan for leprosy 2024-2030.

The outreach clinic was primarily focused on skin conditions like scabies and ringworm, which are usually the result of lack of adequate water, sanitation and hygiene at home – for example, many households are poor and without soap – as well as the barrier of having to travel for hours on basic mountain roads to visit health-care facilities. Schools face similar challenges with water, sanitation and hygiene, with the risk of skin conditions spreading among children.

^{Children in Chieng Bang and Chieng Khay communes face a higher risk of skin conditions like scabies and ringworm because of a lack of adequate water, sanitation and hygiene at home – and at school. Credit: WHO Viet Nam}

In Viet Nam, the number of new cases of leprosy, also known as Hansen’s Disease, has dropped recently, from 748 cases in 2011, to 45 in 2024.

In 1995, Viet Nam achieved leprosy elimination certification at a national level; with very few cases, the disease was no longer defined as a significant public health threat.

Now the goal is even more ambitious – aiming for zero transmission, zero disability, and zero stigma and discrimination by 2030. The approach has four pillars: a national road map, scaling up leprosy prevention alongside active case detection, managing leprosy and its complications, and combating stigma.

Around the world, leprosy still occurs in more than 120 countries, with around 200 000 new cases reported every year, although there is now a gradual reduction in cases globally.

This neglected tropical disease (NTD) is believed to be transmitted through droplets from the nose and mouth of someone with untreated leprosy, following prolonged, close contact. It does not spread through casual contact like shaking hands, hugging, sharing meals or sitting next to each other.

Leprosy, if left untreated, can lead to permanent disability such as loss of feeling in limbs, muscle paralysis and blindness.

People affected by leprosy can face stigmatization and discrimination, as another woman experienced decades ago.

Lo Thi Coc, who was cured of leprosy in 1997, still bears the visible marks of the disease on her body. Despite the passage of time, her eyesight remains poor, and deformity in her legs continues to cause her pain, especially when the weather changes.

^{Although Lo Thi Coc was cured of leprosy in 1997, the pain of being stigmatized lingers, she tells WHO technical officer Dr Vu Quang Hieu.
Credit: WHO Viet Nam}

The emotional impact of Ms Lo’s experience lingers. She vividly recalls that people in her home commune of Chieng Khay feared she could transmit the disease to others. People even thought she was cursed.

“It was really difficult for me and my family back then. We were already poor, and no one wanted to have anything to do with us,” she said.

Ms Lo once contemplated fleeing to the forest to spend the rest of her days there, but her son's unwavering support and company changed her mind.

“Life was better when I got treated. I can now do simple chores around the house, hold my grandchildren, feed the cattle and walk freely to the local market without anyone looking at me with fear.”

Over recent years, groups including health care workers, community-based organizations, the Viet Nam Women’s Union, dermatologists and private hospitals have worked hard to dispel the stigma that stops people from coming forward for diagnosis and treatment. Information campaigns have improved people’s knowledge of how leprosy is transmitted and cured, and that there is no benefit to stigmatizing people with leprosy or casting them out of the community.

To build local capacity, the two-commune visit also included training for more than 50 health-care workers and local community leaders to look out for and treat leprosy and other health conditions.

WHO Representative in Viet Nam Dr Angela Pratt said WHO was proud to support Viet Nam’s impressive progress in reducing the physical and mental toll of leprosy, with the support of the Sasakawa Foundation and other members of the Global Partnership for Zero Leprosy and WHO Member States.

“WHO commends the work of the NHDV, under the leadership of the Government, to support dedicated health-care workers and community leaders in remote communities who are working hard to reach zero leprosy, and integrate leprosy care with other health services. “We are particularly grateful for the generous support of the Sasakawa Health Foundation and Novartis in this work. Now we need to sustain and increase domestic and international investment to end leprosy transmission for good. This will require very targeted efforts to identify and tackle the last remaining cases of leprosy in Viet Nam, like the woman from Chieng Bang commune who was diagnosed by our outreach team just recently. This is what it means to ‘leave no one behind’.

“Achieving zero leprosy by 2030 – that is, zero transmission, zero disability, and zero stigma and discrimination – in Viet Nam is now within sight. We need to make sure that no one again will have to suffer emotionally and physically, like Ms Lo did, from this preventable and curable disease.”