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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy
Patients under treatment for leprosy display blister packs of MDT at an awareness-raising rally in Nampula Province, Mozambique, in July.

MESSAGE: Small Island States and Leprosy

From July 20 to 23 I visited the Union of Comoros in Africa. The union consists of three islands located between Madagascar and Mozambique. The prevalence rate of leprosy is especially high on the island of Anjouan, where it is above 9 per 10,000 population, while the percentage of child cases is alarmingly high at almost 40%.

The health ministry has been taking measures through the WHO, but because the country’s population is less than 1 million, it falls outside the WHO’s leprosy elimination framework. One gets the sense that it has been left behind by elimination activities. The same is true of the Pacific island states of Kiribati, which I visited in 2015, as well as the Marshall Islands and the Federated States of Micronesia. In total, there are 58 small island developing states in the world with a population under 1 million, of which 38 are UN member states.

Small island states have several distinctive characteristics. First, their small physical size and population. Second, their territory tends to be scattered across the ocean. Third, surrounded by water, they are isolated and far away from major markets.

These factors raise the cost of initial interventions, which, coupled with the fact that governments do not have sufficient funds, make it difficult to allocate appropriate personnel and implement countermeasures against the disease. On top of this, leprosy’s low position on the list of health priorities contributes to further delays.

However, while these factors can be regarded as constraints on leprosy control, they can also be seen as advantages. For example, the small scale of these countries means that it should be possible to have a visible impact with less support than would be required for a country with a high population and prevalence rate.

Small island states are not so highly prioritized within the WHO Global Leprosy Programme’s support framework. As we wait for Brazil to pass the milestone of eliminating leprosy as a public health problem, is it not now time to consider concentrating our efforts on supporting these small island states? We must not overlook the patients in these countries confronting the disease.

- Yohei Sasakawa, WHO Goodwill Ambassador