A history of research and innovation at The Leprosy Mission: A legacy that has made defeating leprosy possible
Today, The Leprosy Mission is known and respected as a leading player in the world of leprosy research. With three research centres in India, Bangladesh, and Nepal, and an emerging research hub in Nigeria, The Leprosy Mission is playing a central role in developing the innovations of tomorrow that will bring us to a world without leprosy.
However, it is the innovations of yesterday that have put the goal of defeating leprosy within sight.
In 2024, The Leprosy Mission is celebrating 150 years since it was founded by Irish missionary, Wellesley Bailey. For many of those years, The Leprosy Mission’s leading thinkers have been innovating and developing new ideas for the cure and treatment of leprosy.
In the coming pages we will walk through years gone by to examine how this has happened and where The Leprosy Mission had a role to play.
As with anything in the leprosy world, there are inextricable links to our partners and the individuals who have worked across a number of leprosy organisations. Although we are proud of our research and innovation heritage, none of this would have been possible without other organisations and their teams, all of whom have moved us closer to a world without leprosy.
The earliest evidence of leprosy in human history comes from around 4,000 years ago. Throughout those 4,000 years, it was a disease that was poorly understood and was never curable or treatable.
As recently as the 1820s and 1830s, scientists in Norway began to believe the disease could be treated because, unlike TB, leprosy did not kill people. It was believed at the time that diseases were more treatable if they were less deadly. Unfortunately, understanding of infections was very limited at the time and there was no success.
It took Armauer Hansen’s discovery of the leprosy bacillus in 1873, one year before the creation of The Leprosy Mission, for things to begin to change.
In the decades following the discovery of leprosy’s causative agent, the very first treatment for leprosy with any real success was developed.
This treatment was chaulmoogra oil. The Leprosy Mission started early experiments with this treatment in the 1920s; oil was extracted from the Hydnocarpus tree and injected into patients.
Injections were painful and the results were far from dramatic, with the treatment proving ineffective in many cases, but for the first time in human history, some people began to show some clinical improvement.
This was so profound a moment that The Leprosy Mission began to ban the term ‘asylum’ to refer to its centres for persons affected by leprosy and instead named them ‘hospitals’.
For decades since our inception, we had only been able to offer refuge and a long-term caring home for those affected by the disease, but with the arrival of chaulmoogra oil, we developed into a medical mission. Plantations of Hydnocarpus trees began to spring up around leprosy colonies and hospitals.
It was in the 1920s that The Leprosy Mission added a new goal to its mission: to aid in the attempt to eradicate leprosy.
Many people point to the development of MDT (multi drug therapy) in the 1980s as the big moment in leprosy history, but it is in fact the 1950s that holds claim to that title.
In the 1950s, the antibiotic Dapsone became the first effective cure for leprosy. This treatment was pioneered by Dr Robert Cochrane, a man who spent time working with The Leprosy Mission, as well as with our partners, Lepra.
Experiments with Dapsone were also conducted by doctors of The Leprosy Mission in Nigeria and India. For the first time, a person diagnosed with leprosy had a reasonable hope of being cured.
Around this time, Dr Stanley Browne, another man with close ties to The Leprosy Mission, led the way on the development of Clofazimine. This was an antibiotic that was first trialled as a cure for TB, but was shown to be more effective in leprosy.
The challenge with Clofazimine was that it was more expensive and had a shorter shelf life than Dapsone, which led to Dapsone becoming the default treatment option for leprosy.
Today the WHO-certified treatment for leprosy is multi drug therapy, a combination of three antibiotics: Dapsone, Clofazimine, and Rifampicin.
This cocktail of antibiotics was certified in the early 1980s because there were serious drug resistance problems when using Dapsone alone. The treatment had become ineffective and a combination with the two other more expensive drugs that were already known to work against leprosy became necessary.
There was never a clinical trial for this specific regimen – something that would be unthinkable today – but a committee of leprosy experts came together in Geneva in the Autumn of 1981 to agree a solution to the Dapsone resistance problem. By February 1982, they had published their recommendations and MDT became the standard treatment for leprosy; this has stood the test of time, as the same regimen is still in use 40 years later.
Among those in Geneva for those meetings was Dr Michael Waters, who spent much time working for The Leprosy Mission.
In response to this new treatment regimen, The Leprosy Mission agreed a £5 million budget for the roll out of MDT through a major implementation programme.
As more persons affected by leprosy were released from treatment, caring for people with lasting disabilities became increasingly important. From the late 1980s, under the theme ‘care after cure’ The Leprosy Mission rapidly increased its programme of social, economic, and physical rehabilitation.
New projects focused on training, the formation of self-help and self-care groups, community inclusion, and livelihoods development. All of this was possible because of MDT.
Although the development of MDT led to millions of people being cured, it did not play a major part in stopping transmission, as people continued to transmit the disease prior to treatment.
Leprosy transmission fell in the latter part of the 20th century for many reasons, but contributing factors include rising living standards and the implementation of the BCG vaccine in infancy for TB. It is only more recently that the effect of BCG on leprosy has become more widely recognised.
Some evidence for the effect of BCG vaccine is that it was manufactured in the Soviet Union and was implemented rigorously there. With this approach, combined with thorough case finding initiatives, leprosy numbers declined rapidly in the Soviet Union over the second half of the 20th century.
Leprosy was believed to be a disease that rotted the flesh of those who were infected. This is a myth that was only dispelled in the middle part of the 20th century and was so pervasive that it maintains its resonance in popular culture until today.
This myth was dispelled by Drs Paul and Margaret Brand, two clinicians working out of India. During their time in India, their research led to four important discoveries:
The leprosy bacilli do not cause flesh to rot, but can damage some of the nerves leading into the hands and feet. It is this nerve damage that results in paralysis, loss of sensation and subsequent tissue damage
Loss of sensation in the hands and feet can lead to injuries, and then to total neglect of the wounds because they cause no pain. The wounds become infected if they are neglected, causing damage to the tissues and bones
Tissue damage can be minimised through proper care of wounds and simple changes in lifestyle to avoid injuries
If deformities are not prevented, reconstructive surgery can address some of the difficulties, e.g. by moving good muscles to take the place of paralysed muscles and thus correcting the clawed hand
Paul was an orthopaedic surgeon who is responsible for the reconstructive techniques that are still used by our surgeons today in both the hands and the feet.
It was Margaret, an ophthalmologist, who developed the techniques related to eye surgery.
Between the two of them, this couple changed the way we think about leprosy and the way we think about leprosy treatment. Since their innovative work, countless lives have been changed by function being restored to hands, feet, and eyes.
In 1992, Paul Brand became the president of The Leprosy Mission.
Although Paul Brand’s name is more widely known that Margaret’s, her contribution should not be underestimated.
She was a quieter person than Paul and her name is less well known, but they were a great team whose discoveries were made in partnership.
The names of Paul and Margaret Brand, Stanley Browne, and Robert Cochrane are well known in leprosy circles and their legacy will be a world without leprosy.
But there are giants working in the field today who will leave a dramatic legacy of their own.
Among them is Prof Jan Hendrik Richardus, who led The Leprosy Mission’s work in Bangladesh and ran the COLEP Study, which developed the case for PEP, the revolutionary method of preventing leprosy, which is providing such impetus and excitement in the sector today.
Another name is Dr Wim van Brakel, who now works for our partners NLR, but spent a number of years as a research coordinator for The Leprosy Mission. He has made a significant contribution to our understanding of reactions, nerve damage, and leprosy-related stigma. He has been a central part of the team that have recently developed a tool to help countries verify whether they have truly eliminated leprosy.
Dr Sundeep Chaitanya is a researcher working out of Cambridge University with ties to our partner, American Leprosy Missions. Sundeep is leading the way on new diagnostic tools, but it was his upbringing in one of The Leprosy Mission’s hospitals which has inspired his career.
Then there are the researchers and doctors that work for The Leprosy Mission today, whose innovations we write about in each edition of The Leprosy Mission’s Research Magazine. Dr Joydeepa Darlong, Dr Indra Napit, and Dr Paul Tsaku, as well as their teams, have all made important contributions and, over the coming years, as we head towards our 2035 goal of ending leprosy transmission, they will leave a tremendous legacy.
We are grateful to all of the partners and supporters who have played a role in developing the treatments, cures, diagnostics, and preventive tools that made zero leprosy transmission a possibility. Thank you.
Article written in collaboration with Dr Paul Saunderson.
Cover photo credit: Sarbina Dangol
