Feature Neglected tropical diseases

Leprosy and the rhetoric of elimination

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6142 (Published 18 October 2013) Cite this as: BMJ 2013;347:f6142

This article has a correction. Please see:

  1. Talha Khan Burki, journalist, London
  1. t_burki{at}yahoo.co.uk

India was officially deemed to have eliminated leprosy as a public health problem in 2005—but the country still bears at least half the global burden. How can control programmes be re-energised? Talha Khan Burki reports

Scholars no longer believe that leprosy originated in India—the genetic evidence points instead to eastern Africa1—but the subcontinent certainly has an ancient association with the disease. A 4000 year old skeleton showing indications of leprosy was unearthed in Rajasthan in the 1990s, and the Sushruta Samhita, a Sanskrit medical text dating from 600 BC, contains the earliest surviving reference to leprosy.

More than 2500 years later the association between India and leprosy remains. The country accounts for more than half the global burden: the health ministry reports about 127 000 new cases every year.2 Despite leprosy being a notifiable disease, surveys suggest that this figure is an underestimate, although it is tricky to say by how much. Some people with leprosy, usually among the very poorest, may never make it to a clinic. Others will be diagnosed and treated but not included in the official figures, particularly the relatively small proportion who attend private dermatologists.

Underestimating leprosy

Paul Fine, professor of communicable disease epidemiology at the London School of Hygiene and Tropical Medicine, wrote in 2006, “Since 2002, annual case detection in India declined from 473 658 to 161 457. This is a decline of 312 201, or 66%! . . . Over the same 3 years, the global detection figures declined from 620 638 to 296 499, a decline of 324 139 or 52%! Thus, 96% of the global decline is accounted for by India. Does anyone believe this reflects trends of actual leprosy in India, or around the world?”3

India has long been suspected of deliberately underestimating its leprosy burden so as to attain the “elimination” target …

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