India declared elimination of leprosy as a public health problem many years ago, but the ground reality speaks a different story
On December 31, 2005, the government declared leprosy eliminated as a public health problem in India. This was a highly controversial decision that has come to haunt all efforts relating to leprosy since.
As Manoj Verma, a senior health worker associated with the treatment of leprosy for several years, says, “A serious health problem cannot be solved merely by eliminating it in government papers. When we see increasing number of cases, even new cases in villages, how can we accept the government’s claim?”
Dr. Anurag Bhargava and Dr. Biswaroop Chatterjee wrote in a paper, The Elimination of Leprosy as a Public Health Problems in India — The Truth Behind the Myth, “The whole strategy of elimination was based on unrealistic targets, entirely questionable assumptions and evidence which had invited....criticism, scepticism and opposition. The International Federation of anti-Leprosy Associations in fact raised several issues about the elimination strategy...The campaign for leprosy’s elimination in India is without parallel for its violation of scientific and ethical norms.”
Around 2000, international pressures had started mounting that India should make such an announcement of elimination of leprosy so that a wider announcement at the world level could also be made. However, there was no historical precedent of any infectious disease being eliminated based on drug treatment alone without vaccine. Therefore the original idea of ‘elimination of leprosy’ was changed to ‘elimination of leprosy as a public health problem’. In this highly arbitrary exercise, a norm of less than one case per 10,000 persons was fixed.
The next step was to issue several directives which would make it possible to show lesser number of leprosy cases on registers with or without any actual decrease. Conditions having no justification were enforced, for example separating patients who don’t have voters’ card! In numerous ways, officials went ahead to show that the target of less than one leprosy case per 10,000 population had been achieved by the end of 2005 and on this basis, an announcement of elimination was made on December 31, 2005.
It was a clear case of tailor-made statistics, or data to fit a decision that had already been taken. This was confirmed by a survey taken up some time earlier in Agra which showed a prevalence rate as high as 34 per 10,000 with a new detection rate of 28/10,000.
Somewhat similar exercises to hide the actual prevalence of the disease were seen in some other countries as well, but nowhere was the cover-up as big as in India. Several leprosy experts condemned this effort in various countries. International leprosy expert P. Feenstra said, “Over the last years, the elimination target has become more and more a political target (rather) than an epidemiological or program quality target. For many the indicator — the prevalence of patients registered for treatment — has become the goal in itself, and the actual goal — reduction of leprosy transmission and incidence — has practically got out sight.”
B. Naafs from the Netherlands in a paper titled Treatment of Leprosy, Science or Politics pointed out that the spread of the myth about elimination will “jeopardise adequate leprosy control and treatment.”
What is most important now is that harm done to the treatment and identification effort should be undone. Remedial action should be taken up urgently, so that research on leprosy, identification of new cases and proper treatment get high priority keeping in view the real needs of patients.