The mere mention of ‘leprosy’ has been hunting people across the world for centuries. Leprosy patients face multi-faceted problems, spanning from medical, social and psychological to economic and legal. Leprosy is known to primarily affect patients’ skin and peripheral nerves and is mainly caused by a slow-growing bacteria called Mycobacterium leprae (M. leprae), resulting in disfigurement and nerve damage.
Research in India has played a significant role in developing the medicine to shorten the treatment and increase the cure rates, that is, Multi-Drug Therapy or MDT, which is now recommended by the WHO. The complete eradication of the disease faces many challenges such as the lack of a simple and accurate diagnostic test, long duration of treatment and most importantly, the social stigma which prevents patients from seeking care.
Although the cases of leprosy have decreased to a greater extent, the fight to eradicate it completely will take much more efforts and time. In India, even as we claimed to have achieved leprosy eradication (<1 new leprosy case per 10,000 population) in 2005, 60 per cent of the world’s leprosy cases are reported in our country. Further, it is estimated by the Indian Council of Medical Research (ICMR) in 2008–2011 that there may be 2,50,000 new cases every year.
With an aim to focus on both prevention and cure, National Leprosy Eradication Programme (NLEP) has been strengthened and modified to work especially in endemic regions. In addition, a Leprosy Case Detection Campaign was initiated in March 2016, involving house-to-house screening and referral of patients for diagnosis. Till date, 65,000 suspected and over 4,000 confirmed cases have been detected after screening 68 million people in 50 districts and seven states. Accredited Social Health Activists (ASHAs) under the National Health Mission for the last seven years have been working to detect and treat patients.
In addition to the pain, disfigurement and loss of function, the leprosy patients also goes through social stigma that results in isolation, depression and loss of livelihoods. In the past, many patients were forced to leave their homes live in selected colonies, or they would be admitted to asylums and sanatoriums. In view of such discrimination, Mahatma Gandhi famously said the ultimate measure of success would be the day the disease would be eliminated.
Sensitivity presented by our society plays an important role in fighting this disease as stigma often force people to not reveal their condition to anyone. Half the battle will be won once the attitude of people for patients changes, discrimination ends and steps are taken to preserve their dignity and privileges.
We need to devise and implement a clear and effective plan to make our country free of this curse. The government has planned to run a door-to-door and person-toperson complete detection and screening programme to ensure no one is left out. In addition, many initiatives have been devised by government such as covering 163 endemic districts and revisiting ones surveyed in preceding stages, increasing the number of active case detection days and initiating a drive to encourage patients to approach nodal centres for detection, with or without financial incentives and to motivate survivors of the disease to spread awareness and prevent stigma.
New inputs and ideas will be integrated and assessed while carving out a move to move ahead with the fight against leprosy. Apart from developing newer molecularbased methods in addition to slit skin smear diagnostic technique, on-ground infrastructure will also be improved, care-givers will be trained and a follow-up system will be established to monitor abnormalities after treatment completion.
As the government stands committed to these actions, a novel vaccine, developed in India, will be launched on a pilot basis in five districts in Bihar and Gujarat. If the results come out to be positive, the leprosy vaccine programme will be will used comprehensively in other high-prevalence districts.