A leprosy dialogue in Brazil hosted by Novartis Foundation provides lots of talking points.
|Dr. Rosa Castalia: integration benefits leprosy.|
Putting leprosy back on the global agenda was one of the goals of a two-day leprosy dialogue organized by the Novartis Foundation and co-hosted by Brazil’s Ministry of Health and the Nippon Foundation on August 6-7 in Brasilia.
With an estimated 3 million undiagnosed leprosy cases in the world today, the necessity to refocus attention on the disease is clear.* And it was no coincidence that the venue chosen for the dialogue was Brazil, which reported 31,064 new cases in 2014 and is the last major country yet to achieve the WHO’s goal of eliminating leprosy as a public health problem.
Welcoming participants as well as those watching the live webcast of the first day’s proceedings, Novartis Foundation head Dr. Ann Aerts said she was delighted to be able to show the region and the world some of the innovative and dynamic initiatives that Brazil was taking against leprosy.
In 2011, Brazil introduced a strategic action plan for the elimination of Neglected Tropical Diseases (NTDs) and poverty-related infections. As part of that strategy, in 2013 it launched a campaign for school-based de-worming and leprosy screening, and more diseases are being added each year.
“Putting leprosy together with other diseases benefits leprosy. It keeps the disease funded and visible,” said the health ministry’s Dr. Rosa Castalia, who also noted that disease control is taking place against the backdrop of a core government initiative to eliminate extreme poverty from Brazil.
Dr. Castalia announced that Brazil is closer to the elimination goal than official figures indicate. As data for the National System of Notifiable Diseases is input at the municipal level, this leads to delays in updating the information. As a result, patients who have been cured may still be in the system at year’s end, when prevalence is calculated. The ministry is asking municipalities to tackle the issue, she said.
“We shouldn’t worry that Brazil hasn’t yet achieved elimination, but recognize that it is on the right track to achieve it sooner or later,” said Dr. Ruben Santiago Nicholls of the Pan-American Health Organization. “There is a lot that other countries can learn from Brazil.”
Presentations from some of Brazil’s Latin American neighbors with comparatively few cases of leprosy showed the challenges countries face when the disease is not considered a priority. In Peru, awareness is low and there is a need to train health professionals to be able to diagnose new cases. “Dermatologists ask if the disease still exists. They don’t think of leprosy,” said Dr. Valentina Guizado.
In Bolivia, which saw 118 cases in 2013, it was a similar story in that many doctors don’t know to suspect the disease. “When I took a course on leprosy, it lasted only 90 minutes,” said Dr. Gilda Fernandez, the national leprosy program manager, whose program operates on a budget of just US$14,000. “We need to train health staff to recognize leprosy, monitor contacts and involve community leaders,” she said. “Unless we involve community leaders, we won’t reach the marginalized.”
From the floor, representatives of the Movement for the Reintegration of People Affected by Hansen’s Disease (MORHAN) emphasized the importance of social policies in the fight against leprosy. “If we don’t fight against discrimination, leprosy will remain hidden,” said national coordinator Artur Custodio.
Concerning hidden cases, Dr. Claudio Salgado, vice president of the Brazilian Society of Leprosy, sounded a somber note. Speaking of Para state, where he has done leprosy surveillance work over a number of years, he said hidden endemicity was “extremely high” because basic health units had difficulty diagnosing the disease. He estimated that 4% of schoolchildren in the state have leprosy, which means that there are 80,000 cases yet to be diagnosed, he said.
Goodwill Ambassador Yohei Sasakawa attended the meeting and delivered one of the keynote speeches. He said he was delighted to partner with Novartis Foundation and the health ministry to make progress toward the “final mile” in leprosy.
While that final mile may take a long time to cover, events such as this generate momentum in the right direction, however challenging the remaining obstacles sometimes seem.
* “The Missing Millions: A Threat to the Elimination of Leprosy” PLoS Neglected Tropical Diseases 2015 9(4)