Brazilian Hansen’s Disease Congress and “Elimination” Goal

Leprosy Mailing List – December 9^th, 2011

Ref:     Brazilian Hansen’s Disease Congress and “Elimination” Goal
From:  M L Wan-Del-Rey de Oliveira, Rio de Janeiro, Brazil

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Dear Salvatore,

To the surprise of all foreign (and Brazilian) hansenologists invited for the recent Brazilian Hansen´s Disease Congress the video-message from Ministry of Health (MOH) reintroduced and emphasized the old elimination goal based on the period prevalence rate of the disease.  Such decision was not discussed with the Brazilian hansenologists.

In fact, this elimination goal is an anachronism after the consensus of the most important hansenologists worldwide, regarding the new focus on case detection and grade 2 of physical disability among new cases (WHO Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities 2006 – 2010 and the Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy 2011 – 2015).  But for the Brazilian technicians the most provocative declaration showed in the same video was “Brazil did not eliminate leprosy due to incorrect strategies done in the recent decades”.

During the Assembly of Hansenology Society at the congress, one member manifested the need of a note from the Society, against such type of communication.  But another said that this kind of speech is nothing new among new managers and politicians referring to previous administrations.  So the conclusion was that we must be complacent with this.

Of course, the responsible for this video-message knows that this non-achievement of the elimination goal in Brazil was related to the fact that the new cases comprise a number so high that it is impossible to have less than one per 10,000 inhabitants up to now.  But it also can be neutralized if not all new cases detected during the year be included or if no priority for cases detection was done.

The strategies triggered by MOH/Brazil, since the MDT implementation in 1986 was the same: early diagnosis, promptly MDT treatment, contacts surveillance and the reinforcement of decentralizing through the Primary Health Care/SUS.  Therefore, the results depend upon the effectiveness of these services in performing these actions.  It is also influenced by the improvement of economic and social situation of the poorest and most endemic regions.

Recently, MOH announced the funds transference to the 160 most endemic municipalities.  I want to remind this MOH representative that the same strategy was done in 1997/98 under his previous direction, comprising 280 most endemic municipalities.  I had a high regard of him at that time, because Tuberculosis, Dengue and Malaria (also neglected diseases) received a budget for this program.  So we presented a plan to him asking five millions to do the same for Hansen´s Disease and he so authorized.  Later this plan was given greater potential by the following plan with the participation of Novartis and CONASEMS (Council of Municipal Secretariat of Health) in 1998-2002.

The technicians presenting at the Maceió Congress know very well the field situation of Hansen´s Disease, as well as the partners in the field of Hansen’s Disease Control like universities, state Foundations and ILEP members working in Brazil.  Many scientific presentations corroborate that the later strategies are helping in controlling the disease and the decrease observed in a country was a result of their continuous and intensive work.  And it is in accordance with the disease behavior and dependent of the quality of actions performance in a Brazilian SUS scenario.  Many presentations at the Congress showed that the strategic spotlight on child rate and household contacts examination results in a better disease surveillance in the field.

There are many dedicated technicians who should be stimulated to continuing their work in order to reduce and further “eliminate” the Hansen´s Disease transmission focus.  MORHAN could also collaborate with this doing a real social control at municipal level.  The many young doctors, nurses, physiotherapist, social assistants and basic, social and operational researchers among others at the Congress bring a comfortable assurance  that the strategic spotlight on child rate and household contacts examination aggregated all these people in the common objective of a world without Hansen’s Disease.  This is most important than any ephemeral, authoritarian and political speech.

Best regards,

Dr. Maria Leide Wan-Del-Rey de Oliveira

Rio de Janeiro, Brazil