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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

INTERVIEW: Going the ‘Last Mile’

Dr. Ann Aerts outlines Novartis Foundation’s evolving strategy against leprosy.

What drives Novartis’s commitment to tackling leprosy?

We have a legacy in leprosy, since two of the three drugs of MDT came out of the labs at Ciba-Geigy and are still working well. Our aim at the foundation is to have a transformational impact on the health of the poorest populations and the fight against leprosy is very important to us and the company.

Where does leprosy fit into the foundation’s overall activities?

We have two main axes to our programs. One is disease elimination, and leprosy is the main part of that; the other is health impact focused on improving access to healthcare and exploring innovative healthcare solutions.

How has the foundation’s strategy for leprosy changed since you took over?

The new strategy focuses on interrupting leprosy transmission through early diagnosis and prompt treatment, tracing and prophylactic treatment of contacts of newly diagnosed patients, strict surveillance and response, and development of diagnostic tools.

Is the goal of zero transmission realistic?

For now it is probably utopian, but I believe it is realistic. It needs to be accompanied by socio-economic development, which would have a huge effect on communities with a lot of cases of leprosy.

How did your new strategy emerge?

In 2013 we hosted an experts’ meeting, bringing together leading experts in leprosy and other disease control programs. We launched the new leprosy strategy based on the consensus reached by the group. One of the key conclusions from the meeting is that we really have to apply contact tracing, as is done in TB in low-endemic countries, and offer preventive treatment. Based on that, we have embarked on a program with pilot areas in six countries where we will consider every new leprosy patient and do contact tracing around him/her and offer a preventive treatment to all the contacts. Trials have shown that preventive treatment has proven to be efficient in reducing the risk of developing leprosy in the following years by half. We aim to gather enough data to demonstrate whether this approach will have an impact on the incidence of leprosy.

What are some of the other elements?

We are also doing research for biomarkers to develop a diagnostic test because we are convinced that if we want to eliminate leprosy we will need an objective measurement of who is infected and who is at risk of developing the disease. Another part of our work is supporting three universities to develop mathematical modeling to better guide the efforts to leprosy elimination. The models should help us understand the potential impact and cost-effectiveness of new interventions compared to intensified routine programs. We are also looking at innovative ways to accelerate the clinical diagnosis, such as using mobile phones. We want to make it easier for even unskilled health workers in remote areas to consult someone who has the expertise to confirm a diagnosis.

You have made no mention of a vaccine.

There is important work being done by other players; if a new vaccine were to be found, it would have to prove to provide better protection than BCG.

“You really need to invest in the end, because the end is the most difficult part.”

Why did you feel the need to seek advice from other disciplines?

I transitioned from Novartis to the Novartis Foundation and seeking multi-disciplinary and multi-sectoral input is the company’s approach. We are constantly challenging ourselves and gaining as much expert input as we can from outside, and I felt we needed that in leprosy. The challenge in leprosy is that there is limited evidence on strategies for going the ‘last mile’. I was constantly challenging the experts: why do you do this and not what is documented as evidence? That’s where I thought there was definitely a role for the Novartis Foundation, as we are coming from a science-based, evidence-driven organization.

What else is needed to defeat a disease like leprosy?

You need to have partnerships, you need the involvement of the local community and you really need to invest in the end, because the end is the most difficult part. I heard a Japanese saying that “the last mile is only half way,” and it’s absolutely correct. Think of the investment made in India to eradicate polio: going from village to village, from house to house. We may be obliged to do something similar for leprosy, and for that you need huge political commitment. You also need people like Mr. Sasakawa to continue to advocate for leprosy. If this kind of voice can ensure that governments do not forget leprosy, then that is definitely an advantage where we can all go the last mile.

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PROFILE: Dr. Ann Aerts

Dr. Ann Aerts is Head of Novartis Foundation. She assumed her post in 2013. Since 2000, Novartis has provided free multidrug therapy (MDT) to leprosy patients worldwide through the WHO and has guaranteed its drug donation through 2020.