Residents of Tesfa Hiwot, a community of people affected by leprosy in Ethiopia, enjoy a light moment during the Goodwill Ambassador’s visit in April.
People may be surprised to hear me say that I would like to see an increase in case numbers, but I have my reasons.
For many years we have focused on lowering numbers, using the WHO’s target of reducing prevalence of leprosy to less than 1 case per 10,000 people in order to eliminate the disease as a public health problem. I remain convinced that setting this numerical target was correct. Today, the fact that only Brazil and a few small island nations have yet to achieve it is a mark of its effectiveness. As I have said before, however, ‘elimination’ is only a milestone en route to the ultimate goal of eradicating the disease altogether.
But in many countries that have achieved elimination, there has not been a significant reduction in new case numbers in the years since. One reason, I feel, is that by focusing on reducing numbers we have, without realizing it, come to suffer from a kind of trauma. With attention focused on lowering case numbers, no one has been willing to focus on activities that could result in an increase, fearing the criticism that might come their way. But there is nothing to be ashamed of in seeing patient numbers increase.
When I visited the DR Congo recently, I learned that the health ministry’s action plan for leprosy is to increase the number of newly-detected cases by 50%. To achieve this, they expressed a determination to actively seek out new cases. An action plan such as this will invariably lead to a temporary rise in new cases, but it will also increase early detection and result in a reduction in new case numbers in the long run.
I’ll say it again, but an increase in patient numbers is not something to be ashamed of; it should be commended as a sign of an active program. There are still people suffering from leprosy in places we don’t know about; there are still leprosy hot spots. Let us go all out and find these new cases. That was the spirit behind the 2013 Bangkok Declaration; that was the reason why the Nippon Foundation committed an additional US$20 million to anti-leprosy activities.
- Yohei Sasakawa, WHO Goodwill Ambassador