Global leprosy statistics: a cause for pride, or frustration?

Global statistics on leprosy are published annually in the Weekly Epidemiological Record (WER) of the WHO, most recently on 11 August 2006. They make challenging reading, including between the lines : : : .! The recent report begins with a comment that the new Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities (plan Period: 2006– 2010) has been ‘endorsed by all partners’, emphasizing the need for ‘high quality diagnostic services and treatment services using multidrug therapy, and ensuring that they are equitably distributed, affordable and easily accessible.’ Importantly, though the word elimination is mentioned, it is not emphasized, and is used mainly with reference to continued progress towards the elimination target ‘within the next few years’, with no year specified. Importantly, it is acknowledged that eradication is not possible with current tools. Given the many unrealistic comments about leprosy in recent years, that is a useful public recognition. Leprosy will continue for many decades in today’s major endemic countries, even under the most favourable projections, and one is not going to eradicate armadillos from the New World. Leprosy is not an eradicable disease. Data from 115 countries and territories are reported. Among the absentees are all the nations of Europe, the USA, Australia, and several developing countries, all with endemic autochthonous (or, considering northern Europe, imported) leprosy. However, the major leprosy endemic countries are there; and 12 of the initial absentees, including the USA (but still no European nation – why not?) were reported in a supplementary WER note on 15 September. The August 11 report tells us that leprosy declined by about a quarter in the world over the year 1995 – more precisely, that there were 296,499 new cases reported in 2005 [down 111,292 (27%) from 407,791 in 2004] and that the registered prevalence was 219,826 on January 1, 2006 [down 66,237 (23%) from 286,063 the previous year]. We are told that only