The mere mention of “leprosy” has evoked fear and dread among people across the world for centuries. The adversities suffered by leprosy patients are multi-faceted, ranging from medical, social and psychological to economic and legal. Caused by a slow-growing bacteria called Mycobacterium leprae (M. leprae), leprosy primarily affects patients’ skin and peripheral nerves, leading to disfigurement and nerve damage.
Indian research contributed to the development of Multi-Drug Therapy or MDT, now recommended by WHO, which led to the shortening of treatment and higher cure rates. Challenges to complete elimination include lack of a simple and accurate diagnostic test, long duration of treatment and most importantly, the social stigma which prevents patients from seeking care.
Though the incidence of this disease has decreased substantially, the fight against leprosy is still far from over. In India, though we achieved leprosy elimination (<1 new leprosy case per 10,000 population) in 2005, 60 per cent of the world’s leprosy patients are in our country. Further, a sample survey for leprosy conducted by the Indian Council of Medical Research (ICMR) in 2008-2011 estimated that there may be 2,50,000 new cases every year.
This has led us to strengthen and modify the National Leprosy Eradication Programme (NLEP), so that it focuses on both prevention and cure, especially in endemic regions. A Leprosy Case Detection Campaign was launched in March 2016, involving house-to-house screening and referral of patients for diagnosis. Till date, 68 million people have been screened in 50 districts and seven states, resulting in 65,000 suspected cases detected and over 4,000 confirmed ones. ASHAs or Accredited Social Health Activists under the National Health Mission have been involved in the leprosy programme for the past seven years, helping in detecting cases and completing treatment.
While the physical effects of leprosy cause pain, disfigurement and loss of function, the social stigma accompanying leprosy results in isolation, depression and loss of livelihoods. In the past, many patients would be admitted to asylums and sanatoriums, forced to leave their homes to live in designated colonies. Fighting such discrimination, Mahatma Gandhi famously said the ultimate measure of success would be the day the disease would be eradicated.
Our fight against leprosy has to be measured against sensitivity displayed by society. Removal of the stigma is vital. Only then will those affected come forward for treatment and care. We cannot deny their dignity and privileges. More than laws, our attitude to leprosy has to change, doing away with discrimination. That is half the battle won.
To successfully arrest and eradicate leprosy from our nation, it is necessary that we devise a clear strategy. The modified strategy will ensure that we approach individuals on a door-to-door and person-to-person basis to complete detection and screening. To certify that no one is left out, the government will cover 163 endemic districts and revisit ones surveyed in preceding stages. Alongside, we plan to increase the number of active case detection days and initiate a drive to encourage patients to approach nodal centres for detection, with or without financial incentives. We will also build champions for the disease who will spread awareness and prevent stigma.
While charting our way ahead, we will also consider new inputs to be integrated into our programme. Though slit skin smear is considered the simplest diagnostic technique, newer molecular-based methods have been developed by the ICMR and are being introduced in the programme. On-ground infrastructure will also be improved and care-givers will be trained specifically. A follow-up system will be established to monitor deformities after treatment completion.
The government stands committed to these actions. As a first step, we will be launching a novel vaccine, developed in India, on a pilot basis in five districts in Bihar and Gujarat. If it yields positive results, the leprosy vaccine programme will be extended to other high-prevalence districts. With concerted efforts from health and community organisations, members of civil society and most importantly, with a holistic approach, I am certain our country will be able to defeat leprosy.
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