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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

COLUMN: Looking Forward to Brussels

The 18th International Leprosy Congress meets this September in 'the capital of Europe'.

Despite advances in medical science, it is a great disappointment to see that an age-old disease such as leprosy is still with us in the 21st century and still affects significant numbers of people around the world.

Leprosy is an intriguing disease with many obscure pathophysiological mechanisms that remain to be elucidated. After a boom in interest in leprosy at the turn of the 20th century, driven by public health concerns, and marked improvements in treatment with the adoption of multidrug therapy (MDT) in the 1980s, leprosy has gradually become a less important subject in medical schools and a low priority on the agenda of health authorities.

Although widespread use of MDT and improvements in patient care during the WHO campaign to eliminate leprosy as a public health problem have led to a reduction in case numbers worldwide, as well as to changes in the epidemiologic features of the disease, it is clear that leprosy continues to be a major problem for a number of countries. This is due not only to the continued transmission of the disease but also because of the potential risk of developing disabilities and deformities, with devastating social and economic consequences.

The Congress is a chance to find out whether scientists have found some answers.

We are once again at a critical point in the history of leprosy. Clinical expertise is progressively being lost and will probably disappear as the number of new cases of leprosy decreases.

HIDDEN CHALLENGES

There are a considerable number of scientific aspects of leprosy that remain unclear and even unknown to scientists and researchers. They represent hidden challenges that need to be addressed. We desperately need to shed light on them if we intend to resolve the burden of leprosy in the world.

To give a couple of examples:

1) Research in infectious diseases is mostly based on the availability of the causative organism. M. leprae has not been successfully and reproducibly cultured in artificial media (in vitro) and its reproduction in vivo is very limited. This is still a challenge for scientists, since the provision of live, viable M. leprae would enhance studies on various biologic mechanisms of this mycobacterium.

2) Leprosy is a multifactorial and multigenic disease. So far, there are no efficient genetic markers (either for the host or the pathogen) that are unequivocally linked to the risk of developing the disease. Advances in this area would do wonders for protective public health measures.

PLATFORM FOR DISCUSSION

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Molecular immunology and genetics are emerging as key areas of research to address these hidden challenges. This September, there will be an opportunity to ask the international scientific community whether they have found some answers when the 18th International Leprosy Congress (ILC) convenes in Brussels.

And if and when they do find answers, there needs to be a way to turn the sophisticated results of basic science into practical applications the field. Here, too, the Congress has a role to play, providing a platform for scientists and health personnel to sit together, exchange ideas and find solutions to their concerns.

Under the capable direction of Professor Cairns Smith, the Scientific Program will reflect the multidisciplinary character of leprosy and bring us up to date on the latest research in different fields. Symposia planned for the 18th ILC include those on chemoprophylaxis, chemotherapy, detection and treatment of reactions, epidemiology, genomics, neglected tropical diseases and leprosy, relapse and drug resistance, and vaccines.

But the Congress will also be a place to consider the history of leprosy, human rights and discrimination, community-based rehabilitation and the role of people affected by leprosy in leprosy services.

Meanwhile, the Brussels-based Damien Foundation, the host institution for the Congress, is doing a wonderful job to prepare for the event and ensure that this important gathering runs smoothly and takes place in an agreeable atmosphere.

The 18th Leprosy Congress will be a major opportunity for all concerned with alleviating the burden of leprosy in the 21st century to share their experiences. On behalf of the International Leprosy Association, I look forward to seeing you there.

For further information about the 18th International Leprosy Congress, visit the Congress website at http://www.ilc2013brussels.org. Alternatively, email your questions to the ILC secretariat at ilc2013brussels@mci-group or fax them on +32 (0)2 743 15 84.

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AUTHOR: Marcos Virmond

Dr. Marcos Virmond is president of the International Leprosy Association.