Three Million Leprosy Patients Are Still Waiting to Be Discovered

At the end of 2005, India reached the control target of less than one patient per 10,000 population, the elimination target of leprosy set by WHO. Many thought it would not be possible. It was a major milestone, an epoch-making achievement comparable to the development of a drug regimen to treat leprosy. It was a major milestone, one that was achieved by several other countries in the following years.

However, this accomplishment gave rise to a sense of relief in the fight against leprosy, and we began to see a slackening of effort. Leprosy was given lower priority and government budgets were cut. This has caused delays in discovery and as a result, many newly discovered patients will already have some form of disability.

According to the WHO data, the number of new patients discovered annually has remained between 200,000 and 250,000 for the past decade. Furthermore, the number of new patients among children has not decreased. However, in countries where leprosy is widespread, there are many hot spots, areas with extremely high prevalence rates that are difficult to access. According to some estimates, the number of unconfirmed patients may be as high as 3 million worldwide.

To reassess this situation, The Nippon Foundation and WHO co-hosted a conference, the International Leprosy Summit, in Bangkok in July 2013, attended by the health ministers or representatives of 17 leprosy-prevalent countries. Together we announced the Bangkok Declaration to renew political commitment to early detection and early treatment.

However, the discovery of new cases also means that the prevalence rate temporarily goes up, and since there is still a strong sense that a high number of patients is a national disgrace, progress has been slow. India and Indonesia, however, have actively faced these challenges and expanded their efforts to discover new cases to achieve the target at the sub-national level.

In India, the Leprosy Case Detection Campaign (LCDC) to discover new patients in each state has been under way since last year and has shown great results. Meanwhile, grassroots activities have also become firmly established, such as door-to-door visits by volunteers from the government-led Accredited Social Health Activists (ASHA) project and the community-led Mitanin Program.

In Indonesia, to do away with the dark image of leprosy and associated discrimination, these efforts to promote early detection include televised song and dance performances. To make it easier for possible cases to come forward and facilitate early diagnosis, local health centers now conduct regular campaigns to treat a range of dermatological problems, not leprosy alone.

For the patients, early detection should be a good thing, but unfortunately it is not quite that simple yet in real life. Far from showing relief at early detection and the very real possibility of being completely cured with MDT, many of the patients that I have met appeared worried. They feared being subject to discrimination even after being cured and despaired at having contracted a disease considered to be a curse. This also shows just how deeply rooted misconception and prejudice are when it comes to leprosy.