Our Progress Towards Zero Transmission
Photo credit: Ruth Towell
Our goal is to detect and treat cases of leprosy early. This early treatment prevents the transmission of leprosy (people stop being infectious when they start treatment) and makes it less likely that patients will develop complications and disability.
We have several key interventions that help us to find and treat cases of leprosy early, including community engagement, contact screening and active case finding, health system strengthening and distributing preventative antibiotics.
© Ruth Towell
Many leprosy-endemic countries do not have strong health systems. This means that a government’s leprosy programme will be under-staffed and under-resourced. Our team in Mozambique have overcome these challenges by grounding the government’s leprosy control programme in the community through their ‘Mission Zero’ project.
This decentralised approach to leprosy work has meant connecting the health ministry services and teams at different levels with leaders within local communities. These leaders include health workers, community focal points, community volunteers, community leaders, faith leaders, traditional healers and persons affected by leprosy. This has enabled us to strengthen health systems in Mozambique.
Because they live in the community, these local leaders are trusted and hold influence over the networks they represent and the wider community. These leaders are organised into a total of 68 ‘leprosy committees’ across eight districts.
The leprosy committee members receive training on leprosy, and are involved in leprosy awareness, case identification and referrals to government health units. They also support patient follow-up, encouraging patients to finish their Multi Drug Therapy treatment and aiding health services in screening the contacts of newly diagnosed cases.
The impact of this approach has been remarkable. The number of new cases diagnosed in Mozambique doubled from 495 in 2021 to 1,045 in 2023.
This decentralised model also led to a successful PEP pilot. PEP (Post-Exposure Prophylaxis) in the leprosy world means distributing preventative antibiotics to people at risk of leprosy. The success of this pilot has led to the Ministry of Health adopting PEP in the National Leprosy Control Programme across the country.
Across The Leprosy Mission in 2023, our engagement with communities has meant that these communities are aware of leprosy and ready to intervene. This has included engaging with Organisations of Persons Affected by Leprosy, churches, and inter-faith groups.
In 2023 in Sri Lanka alone we saw 2,075 churches engaged in raising awareness of leprosy. As well as this, we had 844 mosques, 1,096 Hindu temples and 1,890 Buddhist temples also supporting this effort. We saw 65 different faith leaders involved across 33 mobile screening clinics.
One of the best ways to find new cases of leprosy is to screen the people who live or work near a newly diagnosed person. In 2023, we have conducted this work most thoroughly in Bangladesh, DR Congo, Sri Lanka, India, and Mozambique.
In Bangladesh alone we have screened 483,586 contacts.
This is a growing area of work in the leprosy world, with government Health Ministries starting to see the value that contact screening can have. However, there are challenges in completing this work. After promising starts in Nigeria, Chad, and Ethiopia, contact screening efforts have been limited by insecurity and conflict.
Another challenge we have is with government health systems. Many of these systems do not have integrated data, making it hard to monitor and manage contacting screening. We will work with our partners to support governments in improving these systems.
Thanks to research conducted by The Leprosy Mission in the early 2000s, we now have a way to prevent leprosy. By distributing a single dose of the antibiotic Rifampicin to people at risk of developing leprosy, we can significantly reduce the likelihood they will develop leprosy. This is known as PEP (Post-Exposure Prophylaxis).
In 2023, our teams distributed thousands of doses of PEP to people across the world. This includes 27,655 people in Bangladesh, 1,911 people in DR Congo, 558 people in Mozambique, and 629 people in Nepal.
In the years to come, we will support more governments to rollout PEP, ensuring that the number of people receiving preventative medication keeps going up.
We are also working with partners to explore more effective antibiotics for preventing leprosy. This includes the PEP++ research project, where we are working on a combination of antibiotics that will be more effective than a single dose of Rifampicin. We are also working alongside our partners to explore the use of an entirely new antibiotic, Telacebec. This antibiotic is hugely promising and could could cure leprosy faster and more effectively than anything we have seen before.
During the pandemic, we saw the number of new cases of leprosy fall. This was because lockdowns and travel restrictions made it hard for health workers to visit communities and diagnose people. In 2023, we began to see the number of new cases of leprosy return to pre-pandemic levels in some countries.
The number of cases of leprosy diagnosed through TLM projects went from 10,949 in 2019 to a low of 7,966 in 2020. That number was 10,875 in 2023. Most of these cases were detected in DR Congo, India, Nigeria, and Sri Lanka. However, there was a decrease in new cases found through our projects in Ethiopia and Myanmar, which was caused by insecurity in these countries.
We still have some way to go to make up for the time we lost during the pandemic.
In 2023, we diagnosed 749 children with leprosy through our programmes. When children are diagnosed with leprosy, it tells us that there has been recent transmission within a community. This is because leprosy is a very slow-moving disease, with an incubation period of years rather than days or weeks. Leprosy among children represents recent transmission, as children have only been exposed to leprosy in recent years. Whereas an adult new case could have been infected 20+ years ago.
This information tells us that we still have work to do to find and stop leprosy. We also know we need to start collecting data based on the age of children so that we can identify recent transmission. No new child cases for five years would tell us we have interrupted transmission in that community.
When someone is diagnosed and they already have leprosy disabilities, this tells us that we did not find them fast enough. If someone is found and treated for leprosy quickly, they have a much smaller chance of facing complications like disabilities.
Around 15 percent of the new cases of leprosy that our teams diagnosed in 2023 had visible disabilities at their time of diagnosis.
To change this, we need to diagnose leprosy faster. That means engaging governments and communities so that they are actively searching for new cases of the disease. It also means developing a point-of-care diagnostic test.
The current method of diagnosing leprosy is too slow and makes it harder for us to find, diagnose, and treat people quickly.
The 2B or not 2B project is a project aimed at proving the efficacy of a field-friendly diagnostic test. It is a project funded by The Leprosy Mission and is taking place in Nepal and Bangladesh in collaboration with the University of Leiden in the Netherlands. The project was approved in 2023 and work is getting underway on implementing this research project in 2024. We hope it could mean great things for the years ahead.
