A Global Leprosy Forum held on May 26 during the World Health Assembly in Geneva brought together key partners and health ministers from several nations, who all renewed their determination to build on progress in fighting the disease.

 The forum was chaired by Dr. S.K. Noordeen of the Leprosy Elimination Alliance, with opening remarks delivered by Dr. Margaret Chan, WHO assistant director-general for communicable diseases and the director-general's representative for pandemic influenza.

 Speaking on behalf of the late Dr. J.W. Lee, Dr. Chan noted the success achieved by the elimination strategy, but said this was not a time to relax or be complacent. “As with any control program, the final phase is the most difficult phase. We need to put in that extra effort.” She also called for greater attention to be paid to the physical, social and economic rehabilitation of persons affected by leprosy and to human rights violations.

 Yohei Sasakawa said he spent a third of each year overseas in his capacity as WHO Goodwill Ambassador for Leprosy Elimination. The three main purposes of his trips were to talk with politicians to make sure that leprosy is a high priority, to solicit the cooperation of mass media and to provide encouragement to those working in the field. In particular, he said, cooperation from mass media is extremely important because it lets the general public know that the disease is curable, free drugs are available and there is no place for discrimination.

 Seeking to make clear his stance on the elimination issue, Sasakawa said, “One very important point I would like to stress ― the use of the word ‘elimination’ of leprosy. I regard it as a milestone along the road to eradication. But I am aware that there are some who may misunderstand this and feel that if elimination is achieved, then this movement will have been completed. I will continue to visit various countries, especially those that have yet to achieve the elimination goal, and I will emphasize that elimination is an important step toward eradication.”

 Newly reappointed as goodwill ambassador, he noted that his new mandate includes a reference to tackling the social aspects of leprosy, and said this would give a boost to his efforts to get the UN Human Rights Council to adopt a resolution on stigma and discrimination. “I am hopeful that a resolution will be adopted and guidelines issued to each member nation, and that this will lead to an integrated approach covering both medical and social aspects of leprosy.”

　

 Addressing his country's recent success in achieving elimination at the national level, India's health minister Dr. Anbumani Ramadoss said this was only an intermediate goal, adding he was confident that India could achieve eradication in the next 10 to 15 years. Dr. Filomeno Fortes of Angola's health ministry said that many challenges remain despite achieving elimination, and that leprosy would continue to be a public health priority for Angola.

 Congratulating India and Angola on their success, Dr. Jarbas Barbosa of Brazil's health ministry said Brazil was making up for lost time, and would join in marking the elimination milestone this year or next. Representing the health ministry of Tanzania, a country close to achieving elimination, Dr. Gabriel Upunda admitted that more had to be done to educate not only the general community but health workers too, to ensure that persons with leprosy were accepted and given appropriate support. Meanwhile, Dr. Kyaw Myint, Myanmar's health minister, said his country was emphasizing efforts to sustain elimination and minimize the health, social and economic consequences of the disease.

　

　

 Rigo Peeters, president of the International Federation of Anti-Leprosy Associations (ILEP), said that while the elimination strategy had been effective in reducing prevalence in the short term, “it was based on unsustainable vertical approaches to leprosy control,” and that it was important to move beyond elimination now that a new WHO strategy for reducing the leprosy burden and sustaining leprosy control activities was in place.

 Four key elements must be pursued to further reduce the leprosy burden, he said:

　

　

 Alluding to efforts by certain countries to achieve elimination at the sub-national level, ILEP's president said, “The elimination strategy has been extremely successful. But its pursuit at sub-national level risks becoming counterproductive, will disturb field workers, and distort global reporting, making it difficult to interpret current data.”

　

 Drugs used to treat leprosy are being provided free of charge by the Novartis Foundation for Sustainable Development. Dr. Klaus M. Leisinger, the foundation’s president, noted there had been a lot of skepticism initially as to whether the elimination goal was a realistic one.

 “My comment four years ago, which is still valid today, was that asking if one can eliminate leprosy is like asking if there is life after death. We will not know until we get there,” he said. “But we do know that the only way to cure leprosy and reduce the disease burden is to detect all patients and treat them with MDT. [T]his is the essence of the elimination strategy.”

 Describing leprosy elimination as a major public health success story, he said it proves that “with the necessary political will on all sides, the right strategy and appropriate tools one can move mountains.”

 The effort to realize a world without leprosy will require a concerted effort to sustain the gains made so far, he said. “We must retain a sense of urgency as we only have a small window of opportunity to do so in view of other pressing health problems.”

 “Sometimes I worry that we have wasted a lot of time and energy in a rather academic discussions around ‘elimination’. But let us not look back. Diverting energy and time to such discussion would have a high price tag attached ― one that is not paid by us ― but by the patients and their communities. Irrespective of whether one believes in elimination or not, or whether its focus is at national or sub-national level, the strategy remains the same ― to provide patients and communities with easy and uninterrupted access to diagnosis and treatment.”

　

 In drawing the meeting to a close, Dr. Noorden directed participants' attention to a poster on neglected diseases near the WHO library, bearing the words “Hidden successes and emerging opportunities.”

 It was particularly appropriate for leprosy, he said, because ‘hidden successes’ suggests how the enormous achievements that have been made sometimes go unrecognized, while ‘emerging opportunities’ reflects the growing numbers of people now talking about moving from elimination to eradication.

 He concluded with the following observations: