III. “TAKE HOME LESSONS” FROM THE CONGRESS
Prof. M.F. Lechat
Professor Emeritus, Universite Catholique de Louvain
President Emeritus, International Leprosy Association
For the last five years, since the 14th Congress in Orlando, work on leprosy has been dominated by the continuation of what I would call the Great Chemotherapeutic Initiative, MDT, in the context of the 1991 Resolution of the World Health Assembly on the "Elimination of Leprosy as a public health problem".
The rationale underlying this approach is that the clinical patient is the only reservoir of M. leprae and the only source of infection for secondary cases. Therefore, by effectively treating these patients, transmission should be gradually reduced and ultimately interrupted. Incidence should thus, in the long term, be reduced to zero. Multiple Drug Therapy, as recommended by a WHO Study Group in 1981, has proven to be an effective treatment, with the major advantage that it prevents the emergence of drug-resistant strains of the bacillus. It should therefore be asked to do the job.
This strategy was made possible by the confluence of several orders of opportunity：
not only the scientific opportunity (the natural history of the disease at the present state of knowledge) , but also technological (MDT and the blister pack) , political (commitment of the governments) and financial (support from a number of NGO's) opportunities.
Under the leadership of WHO, full use has been made of this unique window of opportunity. Objectives were defined in terms of targets (prevalence) and timeframes. Guidelines were developed. Efficient systems for the analysis of epidemiological trends and the monitoring of drug distribution were set into place. Imaginative and innovative approaches were devised in order to reinforce or supplement current leprosy control activities centered on MDT, such as the Leprosy Elimination Campaigns (LEC) and the Special Action Projects (SAPEL).
As made clear at the Congress, the elimination program as defined has proven highly successful. Prevalence of registered cases has been considerably reduced worldwide, the elimination threshold of 1 per 10,000 population having already been attained in many countries. In a number of countries, however, including large ones, some lead-time should be given after the deadline of Year 2000 to allow for the full implementation of the program.
The ongoing elimination program has also an important added value. It helps developing capacity building and managerial skills at the country level, as shown through a large number of reports from national leprosy programs.
