We have a cure, so why is SE Asia still a hotbed of leprosy?

The introduction of a multi-drug therapy by the World Health Organisation in the early 1980s made the disease “curable” and significantly cut the global burden. The 44th World Health Assembly in 1991 called for the “elimination of leprosy as a public health problem” with a target of reducing prevalence to less than 1:10,000 of the world population. Most countries achieved this by 2005. 

The number of new cases, however, has remained fairly constant over the past 10 years. Nearly 214,000 new leprosy cases were reported in 121 countries in 2014. The WHO Southeast Asia Region accounted for 72 per cent of that global caseload. Not less than 7 per cent of new cases presented with visible deformities. Every 10th patient was a child and many were afflicted with permanent visible deformities. The epidemiological picture points to continued transmission of infection and delayed detection of the disease which leads to deformities in adults and children.

Breaking the chain of transmission is now the core challenge towards eliminating the disease and fulfilling the vision of “a world free of leprosy”. The last mile in eliminating leprosy can be completed only with inclusive approaches along with adequate health and social coverage for patients and communities affected by the disease. 

The fear of acquiring leprosy and ending up with permanent deformities is the main source of the stigma attached to the disease. Discrimination against sufferers surface time and again at home, in schools, at the workplace, and even in healthcare settings. This further perpetuates the stigma. Leprosy is still a legal ground for divorce in some countries. In others those affected are sometimes denied welfare measures. Prevailing stereotypes and the fear of being identified as a sufferer continue to act as barriers to seeking treatment. 

The WHO has prioritised the goal of a world free of leprosy. The Bangkok Declaration of 2013 was milestone in this journey, with governments and non-state actors joining hands to pledge more resources to eliminate the disease as a health problem. 

With treatment now available, it is unacceptable for any child to be permanently and progressively disfigured by leprosy left untreated. In consultation with national leprosy programmes and other stakeholders, the WHO developed the Global Leprosy Strategy 2016 2020: Accelerating Towards a Leprosy-Free World, to guide efforts over the next five years. The strategy is initiating action to prevent transmission, ensuring accountability in implementation, and promoting inclusion of patients and affected communities. It aims at zero deformities among child leprosy patients. 

The reach-out to communities focuses on breaking the cause-and-effect chain of social stigma, which causes delay in seeking treatment, which causes deformities. Ensuring government stewardship is the best guarantee for rolling out equitable and sustainable services across countries.

World Leprosy Day arrives tomorrow as reminder for governments, civil society actors and affected communities that, by joining hands, they can eliminate leprosy and its vicious consequences of deformities and discrimination. Every person has a role and every institution a responsibility towards preventing deformities among children due to leprosy and freeing the world of this ancient scourge. 

 

Poonam Khetrapal Singh is regional director of the WHO Southeast Asia Region.