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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

REPORT: Expert Gathering

18th International Leprosy Congress convenes in Brussels to tackle "hidden challenges".

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Brazil as No.1: the largest number of delegates to the 18th Congress came from Brazil, followed by India.

Over 840 delegates from 83 countries converged on Brussels for the 18th International Leprosy Congress, held from September 16 to 19. Hosted by the Damien Foundation, the Belgium-based NGO that celebrates its 50th anniversary next year, the congress takes place every five years and is the main scientific meeting in the field of leprosy.

With "Hidden Challenges" as its theme, the 18th Congress came at a significant juncture in the history of leprosy control. Although good progress has been made against the disease since the introduction of multidrug therapy in the 1980s, in recent years there has been noticeable stagnation in case detection. Globally, annual new case numbers hover around 200,000 to 250,000 - or just where they were at the time of the previous congress in Hyderabad in 2008. Concern that the situation had become static is what prompted The Nippon Foundation and the WHO to organize an International Leprosy Summit in Bangkok in July to reinvigorate commitment at the political level.

But political commitment alone is not enough. With fewer cases of leprosy, it becomes more difficult technically for countries to manage their leprosy programs. "The challenge now is for the scientific community to come up with innovations and this is an opportunity to see what they have in the way of new ideas," said Professor Cairns Smith, in charge of the Scientific Program, at the outset of the congress.

One particular intervention that received a lot of attention was chemoprophylaxis: a one-drug treatment given to household contacts of people diagnosed with leprosy. Trials over the last few years have shown this can reduce the risk of developing leprosy by about 50-60%. A special session hosted by the Novartis Foundation for Sustainable Development made the case for chemophrophlaxis as part of a contact-centered strategy that could bring new case numbers down. It was apparent, however, that not all delegates were ready to give their endorsement.

At the cutting edge of genome research, Professor Steward Cole of UPCOL noted the "fantastic technological progress" that has been made in understanding more about the m.leprae bacillus. There is "a need to exploit this for the benefit of patients," he said, including by targeting pre-clinical cases of leprosy.

His research in the United States has also raised the possibility that leprosy is a zoonosis. "There is strong evidence to suggest that exposure to infected armadillos could lead to leprosy," he told the congress.

Meanwhile, Dr. Julie Jacobson of the Bill and Melinda Gates Foundation looked at another important area for leprosy programs moving forward: opportunities to improve leprosy control within the context of neglected tropical diseases and potential synergies with other NTD programs.

MULTIDISCIPLINARY FLAVOR

Leprosy is not only a medical condition. It also has long-term physical and social consequences. These aspects too were given a thorough airing in Brussels, with sessions on everything from prevention of disability to stigma reduction and leprosy and human rights.

Indeed, one of the remarkable aspects of the congress, which is proud of its tradition as a scientific forum dating back to 1897, is the wide range of subject matter it now covers. Hence delegates could hear a paper on the effect of tactile sensors in detecting the pressure threshold of anesthetic hands as well as one on the diversity and richness of patient literature in Japan.

While few in number, delegates included people affected by leprosy, and there were discussions on what role they can play in leprosy control activities. "But this talk of greater participation must go beyond tokenism," warned Kay Yamaguchi of Sasakawa Memorial Health Foundation in a pre-Congress workshop on community-based approaches to patient detection and improving services.

In a welcome development for researchers and historians alike, International Leprosy Association (ILA) President Dr. Marcos Virmond announced that every issue of the International Journal of Leprosy and Other Mycobacterial Diseases, which was published between 1933 and 2005, has been digitized and that "this wonderful body of knowledge" can be accessed online from the ILA website.

In a break with past precedent, the ILA decided to hold its next congress in three years' time, in order to "keep up with the fast pace of change." The 19th Congress will be held in China in 2016 and the 20th Congress in the Philippines in 2019.

Dr. Virmond, who is a reconstructive surgeon from Brazil, was elected to serve a further term as ILA president. Speaking on the final day of the congress, he said he had been hoping for some more answers from scientists on how they were going to assist programs in the field, particularly in the area of rapid diagnostic tests. "We could not get a clear position on that," he said.

Nonetheless, he felt delegates would be going home reinvigorated by the congress. In any case, he confidently predicted, scientists will continue to study leprosy long after it no longer poses a problem, "because there is still so much to understand about this intriguing disease."