By: Alanna Shaikh
Here’s the thing about leprosy. It’s totally, completely, absolutely treatable; World Health Organization (WHO) provides free drugs to make treatment even easier. Leprosy progresses slowly – like 20 years slowly and it is not infectious. So what the heck? Why can’t we just eliminate leprosy already? Why do people still get this disease? Why does it go untreated long enough that we still see ?
WHO pronounced the elimination of leprosy as no longer a public health threat, in 2000. That means that the disease has a prevalence of less than one case per 10,000 people[1], largely because multi-drug therapy for leprosy is really effective. (And, as I previously mentioned, free as the result of donations from Novartis and the Novartis Foundation for Sustainable Development.)
But “not a public health threat” doesn’t mean “gone”. The 2008 disease burden for leprosy was 213,086 cases. Not a big number, I admit, but not zero. I want zero. Why can’t we have zero?
The reasons we are not at zero are, of course, depressingly familiar. Though the drugs to treat leprosy are free, transportation and administration costs are not. You need a functional health system to diagnose leprosy, start patients on treatment, and make sure that they are able to finish their treatment.
Pockets of endemic leprosy are found in Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. Which is surprising, on the face of it – these aren’t the poorest of the poor countries as the developing world goes. But most of these nations face substantial income inequality and have large populations of extremely poor people. And while leprosy isn’t terribly infectious, its transmission factors are aligned with poverty – poor nutrition, contaminated bedding, close quarters, and co-infection with HIV.[2]
So, poverty and weak health systems are two of the big reasons we have not eliminated leprosy. There are two more. One of which is a little less frustrating – animal reservoirs. Two kinds of large primates can carry leprosy infections.[3] So even if we eliminated leprosy in the human population, it could come back through contact with animals.
And, finally, the infuriating reason we’re not done with leprosy yet: stigma. That’s right –leprosy is embarrassing and communities will probably reject the afflicted. So people avoid thinking about leprosy, learning the symptoms, or getting treatment. WHO recommends education about leprosy for patients, health care providers, and the population at large as a method to reduce the stigma around leprosy. The human race is really frustrating sometimes but education and awareness can go a long way.
[1] At this prevalence, apparently, diseases do not tend to manage resurgence and start the slow slide to disappearing on their own. We can certainly hope, but I will believe it when I see it.
[2] Random and interesting fact: the BCG vaccine against tuberculosis also provides some protection from leprosy.
[3] Also, apparently armadillos. Not sure what to make of that.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network. All opinions expressed here are Alanna’s own and not those of any employer or the US government.