Task Force for Global Health

End Child Leprosy by 2030: Break Transmission and Eliminate Stigma Highly Ranked

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Project Summary

Leprosy has plagued humankind for over 2,000 years, causing suffering and stigma for the world’s poorest and most marginalized. More than 210,000 new cases (16,000+ in children) are reported annually. Over 3 million people live with disabilities due to delayed treatment. Leprosy is treatable but, until now, not preventable. With a bold new approach — tracing the contacts of diagnosed persons and giving preventive antibiotics (PEP) — we can, for the first time, prevent leprosy. We’ll do what was previously unthinkable: break the chain of leprosy transmission once and for all. Working with the 8 countries that have 90% of the world’s cases, we’ll measurably reduce stigma, (a barrier to early diagnosis), through peer networks. We’ll scale up PEP to treat 23 million individuals. We’ll reduce the number of people who develop leprosy by 50% in five years, targeting the end of child leprosy by 2030 and, subsequently, all transmission.

Problem Statement

Leprosy disproportionally impacts the world’s poorest and most marginalized individuals. Leprosy transmission is not fully understood and the disease may take years to manifest. Child cases (where transmission has been recent) are the best evidence of active transmission. For this reason, WHO’s draft 2030 targets include a goal of zero child cases by 2030. PEP is a major breakthrough in leprosy prevention. WHO advised countries to implement PEP (including contact screening and case detection) immediately. The sooner PEP and anti-stigma activities can be fully scaled up in the 8 countries where 90% of cases occur, the more rapidly the risk for transmission is blocked for future generations. Some models indicate that if PEP and contact screening are implemented, leprosy transmission (indicated best by new child leprosy cases) could be completely eliminated within 15-20 years. However, PEP will not be successful without reducing stigma, which delays care-seeking, often leading to late diagnosis and a lifetime of disability. The problem is a lack of sufficient and coordinated resources necessary to scale up PEP and peer networks in the 8 countries where they’re needed. Finding and treating cases on this large scale requires a powerful global campaign driven by adequate funding and experienced partnerships. Some countries have begun this work on their own and simply require technical assistance. Others require broader support. Implementing PEP and anti-stigma initiatives is a monumental — but time-limited — task. The evidence, implementation partnerships, technical support and political will are strong. The community is aligned and ready.

Solution Overview

We will break the chain of transmission for leprosy in 5 years, setting the stage for no new child cases by 2030 and ultimately — after more than 2,000 years — ending the transmission of leprosy. We’ll do so by:•Scaling up a new high-impact strategy to prevent the spread of leprosy through case finding, contact tracing and preventive treatment (PEP). •Fostering sustainable peer-led networks for persons affected by the disease to increase understanding and inclusion, reduce stigma and discrimination and encourage health-seeking. Our target is breaking the chain of transmission in the 8 countries (India, Brazil, Indonesia, Nepal, Bangladesh, Ethiopia, Mozambique and Nigeria) where 90% of cases occur. With case finding, contact tracing (for cases identified over the past 5 years) and PEP for up to 23 million contacts, and special follow-up for close family members, we’ll reduce the number of new cases by 50% and, in doing so, reduce disability and the population at risk of contracting leprosy Within five years, community-led networks will empower persons who have experienced leprosy to advocate for their own rights, decreasing stigma and discrimination and increasing social participation and care-seeking in at-risk populations. Persons affected by leprosy will continue their livelihoods, and there will be measurable improvements in people’s understanding that leprosy is caused by bacteria, is treatable, and is not a cause for shame. Governments, in turn, will benefit from healthier populations and the economic and social benefits of ending child leprosy first and then complete transmission soon after.

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