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Complete elimination of leprosy still elusive

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7282.318/e (Published 10 February 2001) Cite this as: BMJ 2001;322:318
  1. Rohit Sharma
  1. Mumbai

    The first meeting of the Global Alliance for Elimination of Leprosy (GAEL), held in New Delhi last week, called for a “final push” to eliminate leprosy from countries where it is endemic by 2005.

    The World Health Organization (WHO) had hoped to eliminate the disease—that is, to reduce it to less than 1 case per 10 000 population—by the year 2000. But the rate was still hovering at around 1.25 globally in January 2000.

    Some experts at the meeting thought that it would be impossible to reduce it to less than 1 per 10 000 in certain areas where it was endemic, even though countries might be able to reduce it to that level for the country as a whole.

    The alliance was formed in 1999 in Abidjan, Côte d'Ivoire, at the WHO's initiative and consists of the leprosy endemic countries, the International Federation of Anti-Leprosy Associations, the Nippon/Sasakawa Memorial Health Foundation, and the pharmaceutical company Novartis, and the WHO.

    Despite the fact that it has not been able to achieve its target by the year 2000, the WHO claims that there have been significant achievements. In the past 15 years 11 million people with leprosy have been cured, the prevalence has dropped by 85%, and leprosy has been eliminated in 98 countries.

    Leprosy currently affects over one million people, said the WHO, and two to three million people are permanently disabled as a result of the disease. It estimates that some 2.5 million additional leprosy cases will need to be detected and treated between 2000 and 2005.

    Leprosy continues to be a public health problem in 24 countries of Asia, Africa, Latin America, and the Pacific region. Eleven countries hold the key for its complete elimination: Brazil, the Democratic Republic of Congo, Guinea, Ethiopia, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal, and Tanzania. India alone accounts for 67% of the prevalence worldwide.

    “Leprosy elimination will be achieved at the national level by 2005, but we will still have some states and districts with high endemicity,” said Dr Narayan Singh Dharmashaktu, deputy director general for leprosy with India's health ministry.

    Similar views were echoed by Gerson Fernando Mendes Pereira, coordinator of the technical area of sanitary dermatology at the Brazilian health ministry. “Although we can eliminate leprosy at the national level in Brazil by 2005, we are not sure if we can really eliminate it in north and northeastern Brazil from places like Piauí, Tocantins, Pará, and Maranhão since geographical access there is a big problem,” Mr Pereira told the BMJ.

    Although elimination of leprosy remains elusive, its total eradication is not even on the agenda. “There is no deadline for final eradication, and indeed it is not even 100% sure that the disease will disappear,” said Dr David Heymann, executive director of communicable diseases at the WHO, Geneva.

    “Our deadline is to decrease prevalence to less than 1 by 2005,” said Dr Heymann. “If we are able to sustain that level then we anticipate that leprosy will gradually disappear, as it did in industrialised countries, since there will not be a sufficient pool of infected persons to transmit the disease effectively.” This is just a hypothesis, and we do not know how long it might take to occur, he added.

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