Leprosy Mailing List – January 12, 2025
Ref.: (LML) Money for defeating HD
From: Joel Almeida, Mumbai, India
Dear Pieter and colleagues,
Brazilian colleagues have long been at the forefront of generating reliable scientific knowledge about HD (leprosy), its causes and consequences. Brazil is also a world leader among emerging economies in enlightened social safety nets. The best known of these is the Bolsa Familia program. According to the World Bank, which contributes finance to the program, ninety-four percent of the funds reach the poorest 40 percent of the population. Studies prove that most of the money is used to buy food, school supplies, and clothes for the children.
Success has sparked adaptations in almost 20 countries—including Chile, Mexico, and other countries around the world, such as Indonesia, South Africa, Turkey, and Morocco. More recently, New York City announced its "Opportunity NYC" conditional transfer of income program, modelled on Bolsa Família and its Mexican equivalent. (Knowledge and good practices can certainly flow in all directions).
Now Brazilian colleagues and collaborators have provided evidence of the substantial impact of Bolsa Familia on the incidence rate and mortality from TB.
https://doi.org/10.1038/s41591-024-03381-0
Of course, TB and HD are notably different in that HD bacilli have a propensity for nasal mucosa rather than lungs, as well as for nerves/perineural locations in cooler parts of the body. TB spreads despite directly killing people. HD spreads because it does not directly kill people. Nevertheless, the importance of safety nets against extreme poverty is relevant to both diseases.
The World Bank is not concerned only with Brazil and the Bolsa Familia program. Under its President (Ajay Banga, originally from an HD endemic country) it is placing great emphasis on enhancing opportunity in the African continent. An overview of the challenges facing Africa is available in this interview with the WB President. It was done in Abidjan, Ivory Coast, Oct 2024. African leaders from several countries were present.
https://youtu.be/T9dI9ZRCZrI?si=fCWa1lp1K9EFGJdx&t=46
Health Care is a priority for the World Bank, along with education. The scale of the challenges mean that huge investment is required to beat disease, lack of schooling, lack of jobs and extreme poverty. Several trillion dollars of investment are needed in the coming years. It is in the interests also of the affluent countries to help boost health, schooling and jobs in emerging economies. That is where desperate immigrants originate, and where future customers live.
The replenishment of the World Bank's International Development Association (concessional finance provider to the Indian Leprosy Elimination Program from 1993 to the early 2000s) occurs every 3 years. The current replenishment round ends in January 2025. So far the replenishment has been reasonably successful, although much more is needed. This last push for replenishment can make substantial concessional (including free) finance available for health care in the African continent.
The dream of every person at risk of HD can be that the accessible local health facility is capable of reliable services to prevent the visible deformities of HD, and to promote respect for those who experience(d) HD and their families. The training, supplies and supervision can be publicly financed on a scale that is much larger than patchwork efforts. Change is afoot, and it is for us to ride the tide of opportunity so as to stop HD and its adverse consequences.
Every citizen of an affluent country can encourage their elected representatives to contribute to the IDA replenishment, which is also able to match and multiply contributions by raising private funds on the bond markets. Jan 2025 is an important month.
With all sincerity,
Joel Almeida
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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