On July 7, 2017 Novartis Foundation and its partners published two articles that call for a global effort to make leprosy history. The reviews have been published in the Lancet Infectious Diseases, a leading journal in infectious diseases.1
The two articles set out an action-oriented strategy for achieving the global goal of zero leprosy transmission. Leprosy is still present in more than 100 countries,2 where 2–3 million people are estimated to be living with physical disability and stigmatization as a result.3 More than 200,000 new patients are diagnosed with the disease every year and this number has plateaued in the past decade, highlighting continued transmission of leprosy.2
The first article entitled Multidrug therapy for leprosy: a game changer on the path to elimination, reviews the historic success of the widespread free availability of multi-drug therapy (MDT). MDT is not only effective at treating the disease and preventing permanent disabilities, but also stops close contacts of patients who are exposed to leprosy from the risk of infection.4 This has helped reduce the leprosy burden (prevalence) by 99%.5 Novartis has donated MDT since 2000 and will continue to do so through the year 2020, as part of the 2012 commitment under the London Declaration on Neglected Tropical Diseases.6
The article also outlines a strategy to achieve leprosy elimination by interrupting its transmission. The linchpin of the zero-transmission strategy is early diagnosis and prompt treatment of all patients. It argues that leprosy elimination must be redefined as zero transmission in order to achieve zero new infections.7 That definition is based on the new case detection rate for leprosy, rather than its prevalence.8 The paper ends with a call for the global community to join forces in a global coalition, working together to make leprosy history.
Contact tracing and preventative therapy (post-exposure prophylaxis):
Contact tracing identifies and examines people who may have come into contact with an infected person, which helps toward earlier diagnosis or allows for asymptomatic contacts to be administered a preventative therapy.
Initial evidence that contact tracing combined with post-exposure prophylaxis is effective in reducing the risk for contact persons to develop leprosy.
The Novartis Foundation and its partners have established the Leprosy Post-Exposure Prophylaxis (LPEP) program, which is evaluating the feasibility, effectiveness and impact of contact tracing and post-exposure prophylaxis with a single dose of rifampicin.
Current research is directed towards a vaccine that boosts our own immune system, through what is known as T-cell responses.
Administering vaccines to contact persons of leprosy patients in combination with the preventive therapy may increase protection for infected persons to develop the disease.
Developing an easy-to-use diagnostic test that can detect leprosy before symptoms appear is needed to accelerate diagnosis, enable early treatment and ultimately support the interruption of leprosy transmission.
Elimination Investment Case:
Providing a robust analysis of the benefits, risks, and costs of the different available and future approaches and tools to eliminate leprosy, will support policy makers to allocate resources to those strategies that will have the largest impact on the leprosy burden.
For over 30 years, Novartis and the Novartis Foundation have been working with partners around the world to eliminate leprosy. In 2013, the Novartis Foundation launched a new strategy to interrupt the transmission of leprosy. The four-pillar strategy includes early diagnosis and prompt treatment for all leprosy patients, screening and post-exposure prophylaxis for people who have contact with newly diagnosed patients, development of new diagnostic tools and surveillance systems that trigger swift intervention.9 The Novartis Foundation also continues to play a critical role in convening key leprosy stakeholders to advance our common goal of making leprosy history.
“Leprosy is one of the oldest diseases known to us,” says Ann Aerts, Head of the Novartis Foundation. “With the evidence that we now have, it is finally clear what must happen to make this ancient, stubborn and debilitating disease history. It is time to redefine elimination as zero transmission and zero new patients. Our articles set out an action-oriented agenda to achieve this. We realize that zero transmission is an ambitious goal, but we believe that a global effort by a coalition of partners and advocates in the fight against leprosy will be able to achieve this.”
WHO (1995). Leprosy disabilities: magnitude of the problem. Weekly epidemiological record. 70: 269-75.]
Moet, F. J., Pahan, D., Oskam, L., & Richardus, J. H. (2008). Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomised controlled trial. Bmj, 336(7647), 761-764. Available at: http://www.bmj.com/content/336/7647/761.short [accessed 27 June, 2017].