LEPROSY CONTROL - GENERAL

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QUEST FOR DIGNITY EXHIBIT OPENS AT UNITED NATIONS
(Excerpts from T.L.M.’s “Keeping in Touch” Vol.4, Issue 1)
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On the 30th. October, 1997, The Leprosy Mission’s General Director, Trevor Durston, attended a major event in New York to mark the opening of the IDEA/WHO Exhibition :-

“Quest for Dignity - A Victory over Leprosy / Hansen’s Disease”

United Nations Secretary General Kofi A. Annan , formerly opened the multi-media exhibition in the lobby of the UN Headquarters in New York. With the Secretary General, were Dr. Hiroshi Nakajima, Director General of WHO, Dr. P.K. Gobal and Mr. S.K.Jung, Joint Presidents of IDEA, and Mr. Yohei Sasakawa, President of the Nippon Foundation (The Sasakawa Foundation provides drugs for many of TLM’s Multi-Drug Therapy programs. What made the event particularly moving was the presence of 35 - 40 people affected by leprosy , who were overjoyed to be a part of the quest to replace old stereotypes with modern realities.

For the many thousands of health personnel working in the field, the main problem now is to ensure that the MDT drugs reach every last affected person in every remote village. In spite of the remarkable progress that has been made in curing more than 8.5 million people, about 2 million cases still remain to be detected and treated before the WHO goal of eliminating the disease as a public health problem by the year 2000 is attained. Where there were 122 countries with prevalence rates above one case per 10,000 popuulation in 1985, there are now only 55 ! WHO’s elimination goal calls for the prevalence of leprosy to be reduced to less than one per 10,000 world-wide by the year 2000

LEPROSY - THE PRESENT SITUATION - DECEMBER 1997

It has to be admitted that, since the introduction of Multi-Drug-Therapy (MDT), in 1982, there has been a remarkable improvement in the situation, with MDT making an enormous effect upon the program of controlling this disease.

As well as the recognised success of MDT as a treatment for the disease, with the minimum of relapses, MDT has brought with it a change in the definition of a “Case of Leprosy”. This has led to a major review of leprosy registers. Together, these have resulted in a large reduction of quoted registered cases from 5.3 million in 1985 to less than 1 million in 1996.

In all this outstanding success, THE LEPROSY MISSION INTERNATIONAL (TLM) has played a significant role and we thank TLM for these statistics.

During the same period, the World Health Organisation has maintained an extremely effective campaign to promote leprosy work among governments and NGO’s, and to ensure that there has been a plentiful supply of free drugs available. These measures have brought success as the WHO has concentrated on the goal of reducing the number of registered cases of leprosy to below 1 per 10,000 population.

This goal and its near achievement has hit the international headlines , and has, in some circles, suggested that leprosy is on the way out. While much has been achieved, the fact remains, however, that the number of newly detected cases has remained fairly constant over the same period of time at around 600,000 each year. Also, in addition to the 890,000 registered cases in 1996, there may be over 4 million people who have had leprosy and live with impairment or disability.

Thus the total burden of leprosy, while consistently dropping, is not doing so as fast as the official statistics suggest. It can be estimated that the number of people who have the disease and so need medical treatment, or have had the disease and so need follow-up and long-term care, is around 5 milion.

ARRESTING TRANSMISSION:- Presently, the most effective method of arresting the transmission of leprosy is early detection and proper treatment. Major efforts have been put in by governments and NGO’s alike, to develop new programmes to seek out and treat in their earliest possible stages.

The WHO has recently recommended new drug regimens which could reduce treatment times, and thus reduce the number of defaulters.

While no specific vaccination has yet been identified, it has been recently shown that some protection is given after a second BCG injection. However, widespread vaccination campaigns are not considered worthwhile.

Research continues to develop specific skin tests to identify immunity levels to mycobacterium leprae, and thus identify people most at risk in the community.

LOW ENDEMIC AREAS:- As a result of these successes, more countries and regions are becoming low endemic, and increasingly the challenge is to run effective leprosy programmes in areas where cases are scattered and few. There is a growing drive to integrate leprosy services into primary health care programmes, or to set up specialised programmes dealing with combined health care issues like leprosy and T.B.. This approach is now widely recognised as the only way to ensure the long-term sustainability of leprosy services.

CHANGING INTERNATIONAL PROFILE:- Since 1991, the WHO has been working towards the year 2000 as the target date to achieve the prevalence goal of less than 1 case per 10,000 population. In the intervening years, WHO has made it increasingly obvious that there could be a dramatic scaling down of leprosy unit facilities after that date.

While it is expected that many governments will still maintain a commitment to leprosy, it is difficult to see how they will have the same dynamic without the present pressure from the WHO. Already, governments rely heavily on the NGO sector for assistance in leprosy work and this can be expected to increase.

At the same time, there is a noticeable increase in international networking among NGO’s. This is not limited to groups cooperating through
the INTERNATIONAL FEDERATION OF ANTI-LEPROSY ASSOCIATIONS - (ILEP) and other leprosy-focused NGO’s, but embraces organisations and networks which are involved in work among the disabled n general, or T.B. sufferers.

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