WHO Warns Against Complacency in the Fight Against Leprosy

The fight against leprosy has made great progress in the past two decades but complacency may now be threatening the last push toward a world free of this debilitating disease, the World Health Organization (WHO) warned on the opening day of the International Leprosy Summit.

The three-day summit, held July 24-26, 2013, organized by WHO and the Nippon Foundation, brought health ministers from eight countries and global experts to discuss the current leprosy situation and strategies for further reducing the disease burden and realizing a leprosy-free world.

The development of multidrug therapy in the 1980s effectively cured 16 million people in the past 20 years. But in many countries where the disease is endemic, new case-detection rates have been either static or showing increases. Globally, every 2 minutes, a new case of leprosy is detected and 7 out of every 10 cases is a child. Misinformation about leprosy is common and the disease continues to be shrouded in stigma with communities shunning patients even after they are cured.

Our challenge is to sustain the quality of leprosy services and to ensure that all persons affected by leprosy, wherever they live, have an equal opportunity to be diagnosed early and treated by competent health workers, says Dr. Samlee Plianbangchang, regional director, WHO South-East Asia. While weve covered a lot of ground in reducing the disease burden in all endemic countries, there is no room for complacency. The final battle against leprosy is yet to be won.

Yohei Sasakawa, chairman of the Nippon Foundation and WHO Goodwill Ambassador for Leprosy Elimination, agreed with Plianbangchangand cautioned that the remaining challenges are becoming increasingly more difficult and complex.

The target populations are living in difficult to reach areas such as urban slums, border areas and ethnic minority areas. Moreover, available resources in each country have declined, Sasakawa says.

He called on all parties involved to make political commitments and contribute resources and expertise to the fight against leprosy. To this end the Nippon Foundation will be committing $20 million for the next five years, Sasakawa announced.

Since 1995, WHO has been providing free multidrug therapy (MDT) to all patients worldwide. This was initially funded through The Nippon Foundation and, since 2000, through the MDT donation provided by the Novartis Foundation for Sustainable Development. Nearly 16 million people have been cured of leprosy using MDT and more than 10 million people have been prevented from developing visible deformities.

The number of highly endemic countries has gone down from 122 in 1985 to less than 20. However, despite significant progress, leprosy continues to be a health concern in these endemic pockets.

In 2012 there were 232 850 new cases of leprosy reported, with 94% of these cases restricted to 15 endemic countries - many of them in South-East Asia and Africa. This represents an increase of 6224 cases since 2011. Additionally, the number of people with leprosy who sought treatment only once theyd already developed visible deformities increased from 13079 in 2011 to 14409 in 2012. This is indicative of the need to detect cases early to prevent deformities among new cases.

Significant gender inequities remain in reaching leprosy-affected persons, especially when it comes to case detection. Although the distribution of disease is likely to be even between women and men, leprosy is detected in a lower percentage of women.

In order to bridge these gaps, and ensure that leprosy work continues on the path to further reduce the global disease burden, more work needs to be done. WHO is advocating prompt treatment with MDT and allocating more resources to facilitate early case detection. This can be accomplished by training existing health workers to recognize and treat leprosy, which will help detect new cases earlier and remove leprosys status as a special or feared disease. Community awareness is also important in encouraging health seeking behaviour among the general public.

Lastly, discrimination and stigma remain a huge issue for leprosy-affected persons. Many countries still have outdated laws from the 1800s which, for example, list leprosy as grounds for divorce or forbid persons with leprosy from running for office or obtaining a drivers license -- even after they have been treated. Several countries, however, have led the way in repealing these laws. In 2011 Bangladesh enacted a bill repealing discriminatory laws directed against persons with leprosy and the United Kingdom removed visa restrictions in time for the 2012 Olympic Games. Discriminatory laws and regulations against leprosy-affected people continue, depriving them of many legal rights and social entitlements, and in fact jeopardizing their basic human rights, cautions Plianbangchang.