The nearly three-decade effort to eliminate one devastating disease, leprosy, illustrates the special challenge posed by the final stretch before the finish line. Over the past 30 years, more than 15 million leprosy patients have been treated and the incidence of the disease has declined significantly – a tremendous public health success. Since 2000, Novartis has helped fight the disease by donating Novartis multidrug therapy to leprosy patients worldwide through the World Health Organization.
Babu (pictured) is screened for early signs of leprosy during a Novartis Comprehensive Leprosy Care Association (NCLCA) workshop in Mumbai, India.
But progress against the disease – which can result in disability and carries a severe social stigma – has slowed in recent years. The number of new leprosy patients reported annually is about 230 000 and has remained stable over the past seven years. Most new cases are concentrated in a few countries, such as India, Brazil and Indonesia. At the same time, public health officials have understandably been shifting their focus to diseases affecting more people, such as HIV/AIDS and tuberculosis.
“When you reach the last mile, people kind of forget about the disease,” said Dr. Ann Aerts, Head of the Novartis Foundation for Sustainable Development, which is playing a leading role in the effort to eliminate leprosy.
To regain momentum and put the disease back on the global health agenda, the Novartis Foundation invited leprosy experts in 2013 to discuss future approaches to curbing the disease. These experts agreed that leprosy transmission can be halted through several measures. One is early diagnosis and treatment. Another is tracking down and testing family members, neighbors and others who have had close contact with leprosy patients in the past. This is particularly important because the disease is transmitted through close and frequent personal contact. Because leprosy is caused by slow-growing bacteria, symptoms can take up to 20 years to appear.
With this feedback from experts, the foundation adopted a new leprosy strategy with a greater focus on interrupting transmission of the disease.
The “new face” of leprosy: early detection is essential to treat leprosy effectively. If treated early, leprosy only leaves light spots on the skin.
But challenges still exist. For one, knowledge of leprosy among healthcare workers is declining, given the relative rarity of the disease. The foundation is therefore exploring ways to use technology such as e-learning programs to refresh the leprosy knowledge of healthcare workers.
And while finding people who have had close contact with leprosy patients can be painstaking work, it is proving to be an effective way to identify and treat new patients as soon as possible. In Cambodia, the foundation has worked for more than a year with the government and a local partner to pilot this novel way of identifying new patients. The approach accounted for about 60% of the total number of new patients detected in Cambodia in 2012, the most recent year for which numbers are available.
As a next step, the Novartis Foundation plans to evaluate the effectiveness and feasibility of administering preventive drug treatment to people who have had close contact with leprosy patients, even if they do not show signs of infection.