What strategy should be applied for leprosy control?

Leprosy Mailing List – December 20^th, 2011

Ref.:   What strategy should be applied for leprosy control?  
From: V. Pannikar, India

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Dear Dr Noto,

I am fascinated by the on-going discussion on the Brazilian leprosy programme.  I have always admired Brazil for their honesty in providing us with the "true" leprosy situation in the country.  They are ready to accept their shortcomings gracefully and correct them.  The country is vast; the population still on the move, the infrastructure is still trying to reach the unreached areas/populations.

If anybody knows the leprosy situation well, it is the Brazilian scientists, dermatologists and experts, who have dedicated their lives for controlling this disease.  In doing so they have contributed richly to the global fight against leprosy and improved our scientific knowledge in many fields.  In this I will particularly single out the dermatologists and their organizations, who unlike in other countries, have been at the front of fight against leprosy.  In my opinion, Brazil is one of the rare countries where leprosy work is highly respected; taught and young people are still willing to dedicate their lives for.

Regarding the issue of what strategy should be applied for leprosy control?  There is no correct answer, elimination had its own goal and purpose and now we are moving to next steps.  This does not mean that elimination strategy was wrong, if properly understood, in the context of period and situation in 1990's, it was the best.  Today in the second decade of 2000's, the context has changed and new challenges are appearing.  We are seriously looking at other issues like prevention of disabilities (PoD), rehabilitation, stigma etc because we were able to reduce the burden of leprosy prevalence, reduce the cost MDT - free now.  To me the strategies evolved during the last 2-3 decades were a continuum, one benefitting from the previous and still retaining essentials.

The ultimate choice must remain with the national programmes, as long as the essentials are followed, things will work out for the best.  I would fully support the right of the programme to choose and we must support their efforts.

With kind regards,

V. Pannikar