The Challenge

While the aim of riding the world of Leprosy is a worthy goal, the enormity of the challenge must not be underestimated. Leprosy is a complex mycobacterial disease whose manifestations and complications are determined by the immune response. Many patients experience immune mediated nerve damage, which may occur before, during, or after treatment. Lepromatous disease has a mean clinical incubation time of 10 years.

It was hoped that having effective antibiotics would permit disease control and thus the concept of leprosy elimination developed. “Leprosy elimination by the year 2000” was first proposed in 1986 and at the 44th World Health Assembly in 1991 modified by the addendum “as a public health problem,” defined as less than one case per 10 000 population. The leprosy elimination campaign has had some notable successes but also illustrates the epidemiological, medical, and political problems of the elimination concept.

It will take more than just a movement of people joining hands and proclaiming that Leprosy is defeated, as happened with tuberculosis and malaria. These diseases were celebrated as defeated in the 1960s and so governments and health authorities became complacent. In 1975 the World Health Organization had to admit that its victory bulletins were premature, as both Malaria and TB were on the increase. There is now a high incidence of both Malaria and tuberculosis in South Asia, and the diseases are far from eradicated and are back with a vengeance.

It will take sustained will and enduring vigilance once the target threshold prevalence is reached, and continued health and social education in perpetuity. There will be setbacks and challenges on the way, and other needy causes to support. There will be ebbing of support once politicians start to believe that the cause no longer serves them.

But in the fullness of time if sufficient people in the world believe in the vision of a world free from Leprosy and if active efforts continue with energy and vigor, then united we can achieve that goal.

For more on the challenge see the 2002 paper in the BMJ from Diana N J Lockwood, senior lecturer London School of Hygiene and Tropical Medicine, from which exercepts have been taken for this editorial.
Leprosy elimination—a virtual phenomenon or a reality?
For a Time editorial from 1975 to understand how complacency proved costly, see Malaria on the March Monday, 01 December 1975