04.07.2012: Please don’t use the ‘e’ word – it creates a false impression
“Elimination as a public health problem” (i.e. fewer than one case per 10,000 population) is a political rather than scientific term. This is something that has been relied on as an indicator for leprosy, leading the general public to wrongly assume that leprosy is ‘no more’.
Earlier this year the WHO NTD Strategic Technical Advisory Group endorsed a proposal by Dr Mark Eberhard of the United States Centers for Disease Control and Prevention.
He presented a draft document entitled ‘Practical guidelines for control, elimination and eradication of NTDs’. He noted that there are many concepts and definitions in this area, and stressed the need for scientific rigour in using these terms.
He spoke about the principal differences between control, elimination and eradication; and the use of the phrase “elimination as a public-health problem”. The group endorsed his recommendations and agreed that this term should be used only where necessary for political (rather than scientific) reasons.
“Elimination as a public health problem” (i.e. fewer than one case per 10,000 population) is a political rather than scientific term. This is something that has been relied on as an indicator for leprosy, leading the general public to wrongly assume that leprosy is ‘no more’. There is so much that is still not known about this disease and taking this term out of the equation more accurately reflects that governments and NGOs are still in the control phase of leprosy -- far from having defeated it.
LEPRA’s chief executive in India Dr Ranganadha Rao commented saying: “Use of the term elimination has created a very wrong impression in terms of leprosy which has had a negative impact on public perception of the world’s leprosy situation. We are pleased that this recommendation has been endorsed by STAG, especially the appreciation that elimination in leprosy is a political term, not rooted in science.”
This is a major step forward and should clarify a now very confused area. However there are already several programmes for Neglected Tropical Diseases such as visceral leishmanisis in India, which are purusing elimination as a public health problem. We hope that we in the leprosy world will be able to take this up and use it as a means of setting more realistic objectives.
Posted by admin 15:41 04.07.2012
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Anjaiah’s leprosy went undiagnosed despite repeated consultations with his doctor.
LEPRA Patient
We in Ghana had an experience with Yaws, an infectious skin disease affecting mostly children, which was thought to have been eliminated in the 70s and subsequently lost focus only to stage a come back in the 80s.
That is my fear with regard to Leprosy
now that we have reached the elimination point.
Already it has lost focus. Although treatment is available, leprosy control activities have come, virtually, to a stop.
In some areas, no new cases are reported not because there are no new cases, but because no one is looking for them. And where new cases are reported, they are cases such as seen in the 70s.
Considering the forgoing, the future looks, really, grim after elimination.
The writer worked as a Leprosy Control Officer from 1970 to 2009.