Praises and criticisms about the so called leprosy “elimination” policy

Leprosy Mailing List, March 7^th, 2009

 

Ref.:    Praises and criticisms about the so called leprosy “elimination” policy

From:  Bendick C., Phnom Penh , Cambodia

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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 Cambodia (where leprosy is “eliminated”)

 

Christoph
 

 

Dr. med. Christoph Bendick
University of Health Sciences
BP 1006
Phnom Penh
Cambodia
Tel. +855 12 914294
Fax: +855 23 430129