Whither "world without leprosy"?

R Ganapati, VV Pai

 Bombay Leprosy Project, Sion-Chunabhatti, Mumbai, India

Correspondence Address:
R Ganapati
Director,Bombay Leprosy Project, 11 VN Purav Marg, Sion-Chunabhatti, Mumbai
India

Sir,

India contributes 77% of patients to the global pool of active leprosy cases. One to 1.5 million out of 2 to 3 million leprosy-disabled in the world are reported to live in India.[1]

Dr Yo Yuasa, who was the President of the International Leprosy Association for two terms, exhorted everyone to work towards a "world without leprosy " at the International Leprosy Congress, Beijing in 1998.[2] He defined this state as "a world without leprosy-related problems, both medical and social, emphasizing the point that it is not the disease per se but its related problems, mostly social but some medical, which require attention".

This slogan was however, pooh-poohed by the WHO and WHO-influenced governments and program managers, who were obsessed with the term "elimination". The target year for the mean prevalence rate of leprosy to reach 1 case per 10,000 population was 2000 AD, but this has now been revised to 2005 AD.[1] Unfortunately, by then the world will also be free from so-called leprologists. The enormous funds still needed to do justice to the clinical problems related to leprosy and the rehabilitation of patients would also have dried up.

The pool of leprosy patients with reaction, neuritis and its sequelae, and those needing rehabilitation will far outnumber the active cases needing MDT. Basic care of leprosy patients is supposed to be undertaken at primary health centers with which anti-leprosy infrastructure is "integrated". However, most patients and health providers are not even aware of the techniques available to prevent the adverse results of complications and of the palliative care of irreversible disabilities, let alone the concept of community-based rehabilitation. Moreover, there is no evidence as yet of the much-talked about secondary level and tertiary level referral centers easily accessible to patients living in areas deprived of even basic health services.

Has not the jargon "elimination" of leprosy outlived its utility? Though it is rather late, should we not eliminate this word and devise a more patient-friendly term that truly reflects the sincere attempt at the eradication of all ills afflicting the persons who have contracted leprosy, especially the progressive forms of the disease for no fault on their part?

1.	World Health Organization, The Final push towards Elimination of Leprosy - Strategic Plan 2000-2005, CDS/CPE/CEE/2000. [Google Scholar]
2.	Yuasa Yo. A reflection on 'Working Toward a World Without Leprosy' (a message from the ILA President). ILA Forum 1998;5:14. [Google Scholar]