As an African, Dr. Bide Landry is justly proud of the achievements his continent has made in tackling leprosy. When the WHO first committed to the idea of globally eliminating the disease as a public health problem in 1991, few thought that Africa would be up to the challenge. But time has proved the doubters wrong. Africa as a whole reached this milestone in 2000, and by 2007 every country had done so.
But as well as being proud, Dr. Bide, the leprosy point man at the WHO's Africa regional office, is also concerned. Although every country in Africa has achieved elimination, leprosy is still there. High morbidity diseases and high mortality diseases are attracting more attention, while program capacity and financial support at the country level are decreasing. Political commitment is also waning as leprosy is no longer seen as a public health problem. Health workers trained in leprosy are losing their knowledge and motivation as they see fewer cases. Meanwhile, the stigma attached to leprosy remains strong, and is difficult to root out.
To make sure that leprosy continues to disappear and does not make a comeback, there needs to be an effective surveillance system, says Dr. Bide. There must be a focus on pockets of leprosy where new cases are being observed. He also favors a regional target, one that suits Africa yet supports globally agreed strategic goals. "We need to have more advocacy, we need more political commitment. We need more visible success to show politicians," he says.
These and other issues are to be discussed at the National Leprosy Program Managers Meeting for the WHO's African Region, which takes place in Brazzaville, ROC, this month. "In my opinion," says Dr. Bide, "we should consider the eradication of leprosy as an important and ambitious target, not a dream. But in the current context, it is a long way off." He anticipates some lively discussions when the meeting begins.