Karl Philipp Puchner
German Leprosy and TB Relief Association, Germany
Title: Eliminating leprosy: A marathon rather than a sprint?
Biography
Biography: Karl Philipp Puchner
Abstract
Statement of the Problem: After introduction of the groundbreaking Multi-Drug Therapy (MDT) in the early 1980s, WHO pushed for the elimination of leprosy by 2000. However, despite intensive efforts over 3 decades and undisputable progress, elimination of leprosy as a public health problem (PHP) at global level is still beyond reach. In this paper we review the epidemiological dynamics of leprosy, the control strategies applied in the past as well as their evolution and adjustment to the new state of evidence. Furthermore, inherent challenges and remaining obstacles in the undertaking of leprosy as a PHP are analyzed. Finally, taking the gradual shift towards integrative health policies and practices into account, we reflect on the
meaningfulness and timeliness of the set elimination targets for leprosy and other Neglected Tropical Diseases (NTDs).
Methodoly: Critical review of articles both on related operational research and basic science, opinion papers and epidemiological data on leprosy and other NTDs.
Findings: While trends in detection of new cases exhibit a plateau in the last decade, there is evidence of ongoing leprosy transmission in endemic settings. MDT has made enormous progress possible, yet seems to be insufficient for achieving the final push. Other recent innovations, though contributing further to the control of leprosy, are unlikely to lead alone or combined to elimination, as lack of basic biomedical tools and critical knowledge gaps remain. Emerging evidence about animal reservoirs, regional re-emergence and MDT resistance complicate further the feasibility of near-term elimination of leprosy. Universal health coverage and integrative medicine undoubtedly strengthen NTDs control ultimately, yet may jeopardize near-term disease specifi c elimination milestones.
Conclusions: Despite undeniable progress, near-term achievement of leprosy elimination as a PHP remains unlikely. In face of the pursuit of horizontal approaches in global health, meaningfulness of individual NTDs elimination targets might need critical reevaluation.