An aerial view of Makogai Island, Fiji, which served as a home for leprosy patients from around the South Pacific until 1969.
In 1991, the World Health Assembly set the goal of eliminating leprosy as a public health problem, defining elimination as a prevalence of less than 1 case per 10,000 population. With a goal to aim for, countries achieved elimination one after another, aided by multidrug therapy and sustained support from the WHO and NGOs.
After 2011, Brazil became the only country with a population of over 1 million yet to reach elimination. Now even Brazil is close. This has been possible because WHO set a clear numerical target; without one, results cannot be achieved.
Since 2003, I have visited leprosy-endemic countries 270 times and held 314 meetings with government leaders as Goodwill Ambassador. Being able to explain to them the elimination goal with its numerical objective means they can quickly decide what needs to be done and take action.
Now the elimination target has shifted to the sub-national level. Progressively achieving elimination at state or provincial level and below will eventually lead to a truly leprosy-free world. Numerically targeted elimination is both an important tactic as well a course of action.
In the decade since India achieved elimination in 2005, however, there has been no significant progress against leprosy. Annual new case numbers worldwide have leveled off. National-level elimination seems to have engendered a sense of complacency. Regrettably, the term has given rise to the misunderstanding that our work is done. Far from it.
Elimination of leprosy at the national level is only a milestone; it is not the end of the road. Does it not clearly state in the Bangkok Declaration, issued at the end of the 2013 International Leprosy Summit, that governments are urged to achieve leprosy elimination at sub-national levels?
As they aim for this, they should not be concerned if case numbers increase. It is only to be expected that strengthening efforts at elimination will lead to more cases being diagnosed. Our fight against leprosy is still only at the midway point.
- Yohei Sasakawa, WHO Goodwill Ambassador