Elimination Campaigns

Background:

In the mid 1980's the widespread use of MDT was so successful that it became possible to envision the elimination leprosy as a public health problem. As a result, the Forty-forth World Health Assembly, in May 1991, adopted resolution WHA44.9 which committed Member States to attaining the goal of global elimination of leprosy as a public health problem by the year 2000. The key force in the leprosy elimination effort is the Global Alliance for the Elimination of Leprosy, which was created in 1999. This program is based out of India and supported by national programs in major endemic countries such as Nepal, Brazil, Myanmar, Mozambique, and Madagascar. Agencies making a signficant contribution to the Gloabl Alliance inculde: WHO, The Nippon Foundations, the International Federation of Anti-Leprosy Associations (ILEP), Novartis and Novartis Foundation for Sustainable Development, Danish International Development Assistance (DANIDA) and the World Bank.

The overall strategy set forth by the WHO for the elimination of Leprosy focuses on:

  • MDT, which, when combined with early detection, is the best way of dealing with leprosy and its consequences.
  • Reducing the disease burden in terms of prevlance to <1 case per 10,000 which will lead to reduction in transmission of infection and reduction of disease incidence.
  • Preventing disabilities due to leprosy by acheiving early diagnoses and treatment through effective detection and management of cases.
  • Changing the negative image of leprosy.
  • Working closely in partnership with goverments and agencies interested in leprosy.

Novartis pharmaceutical company donates all the MDT drugs for WHO's campaign and so leprosy treatment is completely free for patients worldwide. The largest obstacle left, therefore, is delivery these drugs to all areas in need. In order to help accomplish this, a total of 79 special projects such as Leprosy Elimination Campaigns (LEC) and Special Action Project for Elimination of Leprosy (SAPEL) were implemented between 1996 and 2001 in 10 countries covering 36.8 million people. These aspects of the campaign are designed to detect new leprosy cases and cure them by building community participation and strengthening elimination activities at the community level. The focus of these programs is to reach everyone in need of MDT, especially those in remote, hard to reach places.

Achievements:

The various campaigns to eliminate Leprosy have been extremely successful. The goal set forth by the 44th World Health Assembly in 1991 to eliminate Leprosy by 2000 was reached on a global level (averaging all prevalence rates worldwide, prevalence is <1/10,000).To date, WHO member states have succeeded in decreasing the level of leprosy in the world by 90% since the WHA resolution in 1991. Over 12 million people have been cured of leprosy in the past twenty years. However, Leprosy is still a public health problem in 14 countries in the world. 90% of the cases are concetrated in six countries of these countries: India, Brazil, Myanmar, Madagascar, Mozambique, and Nepal.

In regards to the accomplishment of reaching the global elimination by 2000 goal, WHO Director-General, Dr. Gro Harlem Brundtland, said: "Together , we can take pride in this victory in reducing to very low levels one of the most dreadful diseases to have ever afflicted mankind. Today, no one should have to suffer the stigma, deformity and disability wrought by this curable disease."

Future of the Campaign: The Final Push to Eliminate Leprosy

The efforts of the campaign have now turned to targeting leprosy at the national level, focusing on the six "hot-spot" countries. These countries have committed to improving their leprosy control activities. For example, India, which contains 70% of the world's cases, is "maximizing the availability of resources for leprosy through the World Bank and other Alliance partners... so that better services will be delivered to communities that are most affected by the disease," according to Dr. Chandreshwar Prasad Thakur, Union Minister for Health and Family Welfare, Goverment of India.

In the final push for elimination, information, diagnosis and treatment with multidrug therapy are essential. Reaching the remaining patients with MDT drugs in places that haven't been reached before because of poor coverage of leprosy services, lack of infrastructure, isolation or war is the key to elimination in the last 14 countries. Information campaigns in high-risk areas are important so that patients who have been ostracized historically by the disease can come forward and recieve treatment. The high levels of stigma associated with the disease in all of the "hot spot" nations is a major barrier to elimination that needs to be overcome. To this end, the Social Mobilization for the Elimination of Leprosy (SMEL) organization has been developed. Their strategy involves mass media information campaigns in urban/suburban areas and village mobilization efforts in rural areas. Ultimately, the sustained elimination of leprosy can only be acheived if leprosy diagnosis and treatment services are incorporated into the basic health care package offered at the most local levels. Commenting on this, Mr. Terry Vasey, president of ILEP said, "unless services are truly integrated into general health services, there is danger that anti-leprosy activites will not be sustainable. The fight against the disease must be continued as long as people are unnecessarily handicapped and stigmatized because of leprosy."

 

The King and Queen of Cambodia hand the last dose of MDT treatment to leprosy patients, symbolizing that their country has reached their goal of eliminating leprosy.

http://www.wpro.who.int/sites/leprosy/elimination/