Leprosy Mailing List, March 7th, 2009
Ref.: Praises and criticisms about the so called leprosy “elimination” policy
From: Bendick C.,
Dear Salvatore,
I am interested in the "elimination" because it is an important matter for a dermatologist working in the tropics to understand. Moreover, there seems to be a longstanding and ongoing debate on this topic. But I am neither a leprologist nor an epidemiologist, so certain aspects may have escaped my understanding.
Praise:
- The elimination campaign has contributed to keep the topic of "leprosy" alive and to launch information campaigns worldwide and particularly in affected countries.
- MDT coverage was increased.
- Detection of leprosy cases was increased.
- Number of patients with permanent disabilities was diminished (?).
- Leprosy related morbidity and mortality were markedly decreased.
Criticism:
- To define "elimination" as a prevalence of <1/10.000 is debatable.
- Elimination should have targeted incidence instead of prevalence.
- Despite elimination on a worldwide scale, ca. 5 million new leprosy cases are expected between 2000 and 2020.
- In 2020 there will be appr. 1 million patients with leprosy-related disabilities.
- Not enough work is done to stop transmission of M.leprae.
- Not enough efforts are undertaken to consider prophylactic therapy of subclinical cases.
- Not enough work is done on the question of non-human reservoirs of M.leprae.
- Achieved elimination gives us the false impression of leprosy not being a problem any more, thus funds may be cut, knowledge diminishes and disabled patients are marginalized.
-No young Doctors are interested in this field anymore.
Please correct me if I am wrong or if I have missed important points.
Thanks and best regards from
Christoph
Dr. med.
BP 1006
Tel. +855 12 914294
Fax: +855 23 430129
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