India "eliminates" leprosy, but many still suffer

By Jonathan Allen                 Nov 21, 2006                                   

NEW DELHI (Reuters) - Tens of thousands of leprosy sufferers in India are being neglected due to the pressure of reaching a
World Health Organization target in reporting the disease, health experts said.

The WHO and India declared leprosy had been "eliminated as a public health problem" in 2005, but critics say that assertion is misleading in a country which is home to more than half of the world's new infections of the nerve-destroying disease each year.

As the WHO's 2005 "elimination" deadline loomed, India reported a far larger decline in leprosy cases than any other country -- from 473,658 new cases in 2002 to 161,457 last year.

"That's biologically not possible for a disease that has a two to 11-year gestation period," Diana Lockwood of the London School of Hygiene and Tropical Medicine, told Reuters.

The fall coincided with a raft of new measures from the WHO covering how leprosy is recorded, including a halt to actively look for sufferers.

"It's very cynical but I've heard people say the easiest way to eliminate leprosy is to stop looking for it," said Doug Soutar, British-based general secretary of the International Federation of Anti-Leprosy Associations.

In 2003, a leading research institute under the state-funded Indian Council of Medical Research examined over 350,000 people in the northern city of Agra and found leprosy prevalence 40 times higher than official figures.

But G.P. Dhillon, who heads India's leprosy elimination program, denied there was under-reporting. "If people know of any such cases they must tell me," he said.

He said the falling numbers were evidence of India's success in fighting the disease, for which a highly-effective cure was available for free from the WHO.

NUMBERS NOT EVERYTHING

Even within the WHO, there is disagreement over the importance of its own elimination target -- less than one case in every 10,000 people -- and the accuracy of India's figures.

Derek Lobo, its consultant covering India, said the apparent rapid decline was due to a near 30 percent over-reporting of cases in the early 2000s with health workers under pressure to reach high diagnosis targets, a flaw that has now been fixed with the new detection strategy.

But Vijay Pannikar, head of the WHO's global leprosy program based in New Delhi, disagrees.

"Numbers are not important," he said, adding that India's priority should instead be to find and treat everyone with leprosy before they are disfigured for life, however many people that may turn out to be.

In 10 districts in the southern state of Andhra Pradesh, leprosy has been on the rise, creeping up towards the WHO benchmark, and the head of the state's leprosy program this month ordered "urgent action" to stay below the target.

"They are obsessed with the target, that's all that matters," a senior official with a large leprosy NGO in India said. He asked not to be identified as his organization follows a policy of not publicly criticizing the government.

"If we report too many cases, someone comes and says we are not doing well," he said.

The head of India's leprosy program said that that should not be happening.

"If new cases are coming, don't hesitate to register them," Dhillon said. "We have to keep working until we've reached elimination in all our states and all our districts."