A new five-year strategy aims to increase momentum for a leprosy-free world.
The WHO launched its latest global leprosy strategy in April this year, built around the three main pillars of strengthening government ownership, coordination and partnerships, stopping leprosy and its complications, and ending discrimination and promoting inclusion.
Developed over 18 months in consultation with national leprosy programs, technical agencies and NGOs, as well as patients and communities of people affected by leprosy, Global Leprosy Strategy 2016-2020: Accelerating towards a leprosy-free world sets the goal over the next five years of reducing to zero the number of child cases with disabilities related to leprosy, reducing the rate of newly diagnosed leprosy patients with visible disabilities to less than 1 per million, and ensuring that all remaining legislation that permits discrimination on the grounds of leprosy is abolished.
Concerning the strategy’s special focus on children as a way to reduce disabilities and transmission, Dr. Erwin Cooreman, team leader of WHO’s Global Leprosy Programme, said it was a shame that children were still contracting leprosy and deformities in the 21st century “as it reflects our collective failure not to detect these children early, as most of them are contacts of known leprosy cases.”
|The new strategy puts more emphasis on human and social aspects affecting leprosy control.|
Interventions necessary to achieve the strategy’s targets include detecting cases early before visible disabilities occur, targeting detection among higher risk groups through campaigns in highly endemic areas or communities, and improving health care coverage and access for marginalized populations.
“While campaigns were organized many years ago, this had become taboo with the integration of leprosy services into the general health services, since it was assumed that all patients would self-report in a decentralized and integrated setting. This assumption did not come true in many settings. Especially in areas of known high-endemicity, we are again advocating for active case finding,” Dr. Cooreman said, while acknowledging that campaigns are labor intensive and costly and so would have to be judiciously designed.
Other strategic interventions that endemic countries are urged to incorporate in their own national plans include screening of all close contacts of persons affected by leprosy, especially household contacts, and — pertaining to the third pillar — incorporating specific interventions against stigma and discrimination.
“This pillar may not be the immediate responsibility of ministries of health and we don’t expect ministries to take charge of this. But it is important that national leprosy programs understand the importance of this pillar and play the role of advocate with the relevant ministries as well as with partners who may be better placed to take the lead,” Dr. Cooreman said.
The strategy recognizes that the stigma surrounding leprosy and discrimination against persons affected by the disease continues to act as a barrier to better and earlier diagnosis and effective control.
It also notes that many patients experience social exclusion, depression and loss of income as a result of leprosy, and that their families suffer as a result.
Therefore, it goes further than previous strategies in calling for the abolition of all discriminatory laws and promoting policies that facilitate the inclusion of people affected by leprosy in society, positively advancing their role and designed to restore their dignity.
“The vision is a leprosy-free world — a world without Hansen’s disease, transmission of infection or disabilities due to leprosy, a world without stigma and discrimination linked to leprosy. Nobody will disagree with these aspirations. While we all would wish this to be realized soon, we all understand that this will happen beyond the life of the current strategy,” said Dr. Cooreman.
“Let’s be a bit more pragmatic and aim for a realistic goal of further reducing the global as well as local leprosy burden and go for elimination at sub-national levels. In the Operational Guidelines that WHO is developing to accompany this strategy, a list of indicators will further elaborate this goal,” he said.
Of the 213 899 new cases in 2014, 94% were reported from 13 countries — Bangladesh, Brazil, Democratic Republic of Congo, Ethiopia, India, Indonesia, Madagascar, Myanmar, Nepal, Nigeria, the Philippines, Sri Lanka and the United Republic of Tanzania. India, Brazil and Indonesia account for 81% of the newly diagnosed and reported cases globally.
(Note: Mozambique, which had over 1,000 cases, did not report in 2014.)