Leprosy - for long burdened with stigma

17. Century B.C.
In the Hammurabi Code, the Written Law of the Babylonian King Hammurabi, the concept of leprosy first appears in legal regulation for the exclusion of sufferers from society.

600 B.C.: Leprosy is mentioned and named in Indian Sanskrit as "kushtha", "eating away"; 200 B.C. also in the Hebrew Original of the Old Testament as "tsaraath".

Late Middle Ages
Widespread prevalence in Central Europe up to the 17th Century with 20,000 leproseries.

The Norwegian Doctor G.A. Hansen discovers the mycobacterium leprae.

First application of the drug dapson against Lepra.

First application of the new agents clofazimin and rifampicin.

Until the late seventies, a widespread primary and secondary resistance to dapson develops, as a result of which this drug becomes useless as monotherapy.

First treatment with the MDT system, a drug cocktail of rifampicin, clofazimin and dapson.

WHO resolves to eliminate leprosy as endemic disease by the year 2000. An elimination as endemic disease is defined as less than 1 registered case of affliction per 10,000 inhabitants.
Recommendation on the standard MDT treatment during 24 months for MB patients and 6 months for PB patients.

Free of charge MDT dispensing by WHO thanks to the Nippon Foundation.

Shortening of the length of the treatment for MB patients from 24 to 12 months.

WHO gives the call for the "Global Alliance for the Elimination of Leprosy as Endemic Disease" until the year 2005. An affliction frequency of under 1 case of affliction per 10,000 inhabitants remains the elimination aim.

In the year 2000, 500,000 new leprosy patients worldwide were detected, the aim of elimination as endemic disease is not achieved in many countries.

The Basel-based pharmaceutical group Novarti, commits itself to dispense the anti-leprosy drugs worldwide for five years free of cost.

Even in the year 2003, almost 500,000 new leprosy patients are detected. The international leprosy relief organisations doubt the possibility of a rapid elimination of the disease in the concerned countries.

Newly developed countries do not achieve the aim of elimination at the national level even in 2005 (Angola, Brazil, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, Tanzania, Central African Republic). Approx. 85% of all new leprosy patients in the world live in these countries.

Novartis extends its contract with WHO: All anti-leprosy medicines will continue to be dispensed by the group of companies free of charge until 2010.

A dramatic reduction of the number of new cases has occured: During 2005 another 300 000 new cases are registered by WHO. This represents a reduction by 25% within a year, mainly because of the numbers registered in India. There the number of new cases sinks by 35% from 260 063 to 169 709 cases. But many experts doubt that these figures are correct.

A new strategy for the continuation of the fight against leprosy (2006 - 2010) is developed by WHO in cooperation with the leprosy relief organisations of the world.

The new strategy by WHO wants to continue the fight against leprosy by stressing the control measures.

The numbers of new cases published by the WHO indicate a stagnation. App. 250'000 new cases were found in 2008, about the same as in the two previous years.

In 2009 WHO has registered 244'796 new cases of leprosy, only 4211 less than the previous year. This seems to confirm many experts' opinion that only adequate medical treatment will lead to a slow recline of this disease.

93% of all new cases of leprosy are registered in 16 countries, particularly in Indie (133'717), Brasil (37610) and Indonesia (17'260). 13 more countries have registered between 1000 and 5500 new cases in 2009. These are Bangladesh, the Democratic Republic of Congo, Ethiopia, Nepal, Nigeria, Tanzania, Myanmar, Sudan, the Philippines, Madagascar, Mozambique, Sri Lanka and China.

For the period of 2011-2015 WHO has adopted a new strategy. The so called «elimination» of the disease is no more at the centre. The main goal is to reduce the burden of disabilities due to leprosy. WHO has realised that the eradication of leprosy requires more than a «last effort», it rather seems to be a true marathon. Without new resources, i.e. a vaccination, leprosy can only be eradicated by a sustainable improvement of the living conditions of the poor.