Leprosy is very much a disease of the past, mentioned in the Bible, Quran, and countless medieval tomes. It is also very much a disease of the present, with more than 210,000 people diagnosed with the disease last year alone, mainly across Asia, Africa, and Latin America. More than 1 million people are currently visibly and irreversibly damaged by leprosy.
Given that effective treatment for leprosy (also known as Hansen’s disease) has been in existence for several decades, its continuing global burden represents “unfinished business” by world health leaders. That’s the theme for the 19th International Leprosy Congress, taking place this week in Beijing. This meeting represents an important moment for all attendees, from academics to non-governmental organizations, policymakers, and private foundations, to redouble our efforts and finish the fight against this debilitating disease.
Since the first international leprosy conference was held in 1897, great progress has been made in fighting the disease. Thanks to the availability of free multi-drug therapy — more than 16 million people have received treatment since 1981 — the number of people with leprosy has drastically declined.
But we need to do more.
Leaders and attendees at the congress must set clear priorities for the going the last mile toward a leprosy-free world. We need to carefully invest our resources and commit our efforts to develop effective and scalable interventions for accelerating the diagnosis and treatment of leprosy.
This disease is caused by Mycobacterium leprae, a slowly growing bacterium that can be transmitted from person to person but is usually not highly infectious. Although we do not yet fully understand how the bacterium is transmitted, we do know that close and frequent contact with an infected person increases the risk of transmission. Symptoms can take as long as 20 years to appear, so there is often no manifestation to indicate that someone has been infected. That’s why contact tracing, which aims to identify people who may have come into contact with an infected individual, is so important.
During 30 years of combating leprosy worldwide, we at the Novartis (NVS) Foundation have learned that the ideal strategy combines early diagnosis and prompt treatment of people with leprosy plus contact tracing and screening individuals who have been in close contact with them. Close contacts should be immediately given preventive treatment to diminish their risk of developing the disease.
There are significant challenges to implementing this approach in remote parts of the world, especially in Southeast Asia where almost three-quarters of individuals with leprosy are detected each year. But through new partnerships and innovative interventions, we can turn this approach into standard practice.
Since 2014, the Novartis Foundation has been involved in developing and implementing the Leprosy Post-Exposure-Prophylaxis program with several members of the International Federation of Anti-Leprosy Associations and academic partners. Through this program, we have worked to introduce contact tracing for individuals newly diagnosed with leprosy in Cambodia, Indonesia, India, Nepal, Myanmar, Tanzania, and Sri Lanka and provide preventive treatment to their contacts. This program has provided close to 30,000 doses of the antibiotic rifampicin to family members, neighbors, and other close contacts of individuals newly diagnosed with leprosy, thereby reducing their risk of developing the disease by up to 50 to 60 percent.
Although operational evidence on the impact of this program won’t be conclusively assessed until 2018, there is no doubt that contact tracing and the subsequent administration of preventive treatment at such a scale is an essential pillar of the strategy to defeat leprosy.
Without effective, affordable, and rapid diagnostic tools however, taking appropriate action against leprosy remains challenging. Marcos Virmond, the president of the International Leprosy Association, has emphasized that improving technologies to detect infection in the early stages of the disease is a top priority in the research agenda.
Digital innovation in this area opens up great opportunities. In the Philippines, the Novartis Foundation has collaborated with the Department of Health to pilot the first mobile-based Leprosy Alert Response Network and Surveillance. This digital tool allows frontline health workers to speed the process of diagnosing leprosy by sharing images of suspected lesions on patients with specialists in a leprosy reference center.
This early-detection system should be combined with new diagnostic tools, which we and other leaders in the field are working to develop. While this research is still in progress, we hope to soon be able to rapidly identify individuals who might have leprosy. In the meantime, extensive contact tracing remains the key weapon to reduce transmission and work toward the final elimination of leprosy.
The gathering in Beijing is the ideal occasion to regain momentum in the fight against leprosy and to streamline efforts from all sectors. Working together in strong public-private partnerships to interrupt leprosy transmission, we can eventually reach the end goal of zero new leprosy cases worldwide.
Ann Aerts, MD, heads the Novartis Foundation, which focuses on ensuring quality health care in low- and middle-income countries.