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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

REPORT: A Big Step Forward

Bangkok summit refocuses political commitment on tackling leprosy.

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WHO Regional Director for Southeast Asia Dr. Samlee: "The final battle against leprosy is yet to be won."

Compared with public health challenges such as malaria, TB and HIV/AIDS, leprosy ranks as a relatively minor problem in most countries today - especially given the progress that has been made since the introduction of multidrug therapy (MDT) in the 1980s. With just one major country (Brazil) still to eliminate the disease as a public health problem, the challenge in countries where leprosy remains endemic is to continue to reduce the incidence and prevalence of the disease and to sustain leprosy services.

But leprosy's so-called last mile is proving a tough challenge. Having "eliminated" leprosy, many countries have been shifting their health priorities elsewhere. There are fears that a sense of complacency may undermine the efforts required to bring an end to leprosy and its consequences.

At the same time, there are still unanswered questions about the disease - a full understanding of the route of transmission, for example - and the need to develop new tools and tests that would make it possible to diagnose leprosy earlier and recognize and manage leprosy reactions more effectively.

Against this backdrop, health ministers or their representatives from 17 countries* that annually report more than 1,000 new cases of leprosy gathered in Bangkok for an International Leprosy Summit. Organized jointly by the World Health Organization and The Nippon Foundation, and hosted with the cooperation of the Thai government, the July 24-26 meeting was called to renew political commitment to tackling leprosy.

The summit duly delivered, with ministers and other partners endorsing the Bangkok Declaration towards a Leprosy-Free World (see page 4). In it they pledge to reaffirm their commitments and strengthen their involvement "in order to ensure a leprosy-free world at the earliest."

To get the wording right and produce a document that delegates felt accurately reflected the ambitions of the summit, a small group worked through lunch on the first day to revise the declaration to everyone's satisfaction, following lively exchanges on the floor. "This declaration is very important. I think it will prove to be a tipping point," said Dr. Jarbas Barbosa, Brazil's vice minister of health surveillance.

"This declaration is very important. I think it will prove to be a tipping point."

NO ROOM FOR COMPLACENCY

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(L-R) Myanmar Health Minister Dr. Pe Thet Khin with the WHO's Dr. Sumana Barua and Dr. Hiroki Nakatani.

At the opening session, some 100 participants heard Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia, say, "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. While we've 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."

They also heard Nippon Foundation Chairman and WHO Goodwill Ambassador for Leprosy Elimination Yohei Sasakawa announce that his foundation would donate $20 million over the next five years toward the fight against the disease. He cautioned that the remaining challenges were becoming more difficult and complex, while urging governments to "reaffirm your strong determination to achieve a leprosy-free world."

During the summit, program managers gave overviews of the situation in their countries, while experts looked at the remaining technical and operational challenges. The meeting also featured a brainstorming session led by Professor Cairns Smith, chairman of the International Federation of Anti-Leprosy Associations (ILEP) Technical Commission, on what should be the goal of the WHO's next five-year global strategy for leprosy, which is due to come into effect in 2016.

TASKS AHEAD

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The Goodwill Ambassador pledges his commitment.

The summit noted that the challenges facing the high-burden countries include reducing Grade 2 disabilities in new cases through early case detection, access to equitable and quality health care, and promoting leprosy, wherever appropriate, as an integral part of neglected tropical diseases.

The summit also acknowledged the commitment and contribution of partners and the need to strengthen partnerships further; the importance of involving communities of people affected by leprosy in anti-leprosy activities, including efforts to reduce stigma and discrimination; the need for adequate resources to support program implementation; and also the need to support research in leprosy.

In a statement from one of the partner organizations present, ILEP President Rene Staheli said, "Leprosy is not the worst killer disease in these countries; leprosy is not the main challenge on the health agendas; but it is a political decision whether to set the agenda to finish leprosy, or not."

With the issuing of the Bangkok Declaration, it is to be hoped this decision has now been taken and all involved will indeed move forward to achieve their publicly-stated goal "at the earliest."

FOOTNOTE

* Angola, Bangladesh, Brazil, China, DR Congo, Ethiopia, Indonesia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, South Sudan, Sri Lanka, Sudan and Tanzania.