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Letters Response

J Barbosa and colleagues reply to Diana N J Lockwood and colleagues

BMJ 2014; 348 doi: (Published 19 March 2014) Cite this as: BMJ 2014;348:g2114
  1. J Barbosa, secretário de vigilância em saúde1,
  2. S Barua, team leader2,
  3. D Daumerie, project manager, neglected tropical diseases, neglected tropical diseases control3,
  4. H Nakatani, assistant director-general3,
  5. S Noordeen, former director, WHO Leprosy Elimination Programme4,
  6. R Castália, secretaria de vigilância em saúde, Departamento de Vigilância Epidemiologica1
  1. 1Ministério da Saúde, Brasilia, Brazil
  2. 2Global Leprosy Programme, WHO South East Asia Regional Office, Mahatma Gandhi Marg, New Delhi, India
  3. 3HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM), World Health Organization, 1211 Geneva 27, Switzerland
  4. 4Chennai, India
  1. daumeried{at}

We wish to clarify some of the points raised in Diana N J Lockwood and colleagues’ article on the hazards of setting targets to eliminate disease with particular reference to leprosy.1

We disagree with the view that the leprosy elimination target is harmful, given the robust evidence available and the active commitment of affected countries and the global community.

Leprosy reached its current low prevalence and low number of new cases as a result of two major developments. These were the introduction of World Health Organization multidrug therapy in 1981 and the commitment of leprosy endemic countries in 1991 (World Health Assembly resolution 44.9) to eliminating leprosy as a public health problem (reducing prevalence to <1 case/10 000 population globally by 2000).2 During the past 20 years there has been a global decrease in disease prevalence and new case detection of 94% and 65%, respectively.

Although some countries did not meet the target, this is not uncommon in public health practice—target dates for eradication of smallpox, poliomyelitis, and dracunculiasis have been moved more than once. Leprosy can definitely be eliminated because transmission has been interrupted in several communities and countries.

The statement that endemic countries can achieve elimination only by sleight of hand and manipulating data lacks scientific evidence. This railing accusation against the ministries of health of Brazil, India, and others serves only to support the fallacious argument of the authors, who try, without evidence, to show that it is impossible to reduce the burden of a disease like leprosy.

Brazil was neither under pressure nor reported to have achieved elimination in 2005; these statements are inaccurate and not supported by published sources.

During recent years, the slowing down and stagnation of new case detection and consequent smaller leprosy burden compared with other diseases has reduced countries’ political commitment.

To analyse the relevant issues, WHO organised an international leprosy summit in Bangkok in 2013 to bring together ministers of health of the top 17 endemic countries in collaboration with the Nippon Foundation, with the participation of the International Federation of Leprosy Associations, technical experts, and other stakeholders.

At this summit, through the Bangkok Declaration,3 ministers reaffirmed their political commitment to using vigorous and innovative approaches to reduce the leprosy burden further. They also committed to achieving the WHO target of reducing the number of new leprosy cases with grade 2 disability to fewer than one case per million population by 2020.4 5

Efforts to control, eliminate, or eradicate neglected tropical diseases have gathered momentum in recent years. In early 2012, WHO defined several targets and milestones for the control, elimination, and eradication of such diseases by 2015 and 2020.6 The WHO roadmap details specific targets; defines terminology for control, elimination, and eradication; and specifies epidemiological criteria to facilitate measurement of progress towards achievement of targets.

The elimination of leprosy requires targeted, focused, and intensive implementation of antileprosy activities. Several countries have achieved elimination at subnational levels within a reasonable time period. It is for other countries to learn from such experiences.

The enormous progress made resulted from a unique partnership between endemic countries, international organisations, and civil society, andit must continue to free future generations from this disabling and stigmatising infectious disease.


Cite this as: BMJ 2014;348:g2114



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