WHO Global leprosy strategy 2021–2030
The new WHO global leprosy strategy, entitled ‘Towards Zero Leprosy’, was released on 15th April. This is one of the disease-specific strategies underpinning the WHO Road map for NTDs 2021–2030. The strategy presents the basic direction, goals, challenges and strategic pillars at a global level. National NTD and leprosy programmes are urged to adopt it and to adapt its strategic pillars to their country context. This is a crucial document for ILEP and its member associations, and for all partners working in leprosy.
Vision, goal and targets
‘Towards Zero Leprosy’ is defined in the strategy’s long-term vision as zero infection and disease, zero disability, zero stigma and discrimination. The medium-term goal is the elimination of leprosy, defined as interruption of transmission, and a WHO working group has been developing definitions around this during recent months. It is not expected that this goal will be achieved globally by 2030, though a further 86 countries are expected to do so. The four high-level 2030 targets are:
- 120 countries reporting zero new autochthonous cases.
- 70% reduction in annual number of new cases detected.
- 90% reduction in rate per million population of new cases with grade-2 disability.
- 90% reduction in rate per million children of new child cases with leprosy.
These are set out in more detail in the table below.
Indicator |
2019(reported) |
2020(projected) |
2023(milestone) |
2025(milestone) |
2030(target) |
| Number of countries with zero new autochthonous cases | 34 (18%) | 50 (26%) | 75 (39%) | 95 (49%) | 120 (62%) |
| Number of new cases detected (disaggregated by sex and age) | 202,256 | 184,000 | 148,000 | 123,500 | 62,500 |
| Rate (per million population) of new cases with grade-2 disability | 1.40 | 1.30 | 0.92 | 0.68 | 0.12 |
| Rate (per million children) of new child cases with leprosy | 7.83 | 7.81 | 5.66 | 4.24 | 0.77 |
Strategic pillars
To achieve these targets, the strategy incorporates four strategic pillars, each with a number of key components and a set of relevant indicators. The strategic pillars are:
- Implement integrated, country-owned zero leprosy roadmaps in all endemic countries.
- Scale up leprosy prevention alongside integrated active case detection.
- Manage leprosy and its complications and prevent new disability.
- Combat stigma and ensure human rights are respected.
The first, third and fourth headings are broadly similar to the three pillars of the previous strategy, though there is new material in each case. For example, Pillar 1 now has recommendations to form national partnerships for zero leprosy and multi-stakeholder zero leprosy roadmaps, a reflection of the emergence of the Global Partnership for Zero Leprosy. It also has much stronger reference to data quality, and now includes the monitoring of adverse drug reactions. Pillar 3 includes a section about mental wellbeing and counselling, on which the previous strategy was silent, along with more specific material around self-care. Pillar 4 gives emphasis to the Principles and Guidelines for elimination of discrimination against persons affected by leprosy and their family members, with the full text of the Principles and Guidelines in an appendix, and explains the importance of including leprosy into national human rights policy frameworks.
Pillar 2 is new in that, alongside ongoing active case detection, it adds the scaling up of leprosy prevention in line with the recommendation in the 2018 WHO Guidelines for the diagnosis, treatment and prevention of leprosy. It also refers to the potential of existing or new vaccines, which were not part of the picture when the previous strategy was written.
Aside from what is new in the strategic pillars, there are distinct differences in some of the language, which is consistent with the change in focus in the WHO Road map for NTDs. For example, although the previous strategy referred to the mainstreaming of leprosy within primary and secondary healthcare systems, the new strategy refers constantly to leprosy services being integrated with other health services and, particularly, with other skin NTDs.
The strategy also includes a set of sixteen research priorities for this strategic period, and emphasises that global and national investment in research are essential to achieving zero leprosy.
Adoption and adaptation of the strategy
It is likely that ILEP members working closely with national leprosy control programmes will be asked to advise and support Ministries of Health on the implications of the new strategy for national leprosy and NTD programmes. Five years ago, some countries simply adopted the strategic targets and pillars of the previous strategy as their own country strategy, but the WHO Global Leprosy Programme advises against that. It points out that the 2030 targets in the strategy are global targets. Countries need to set targets that are relevant to their own leprosy situation and baseline data, in order to contribute to the achievement of global targets.
The strategic pillars have been written so as to be relevant to both higher-endemic and lower-endemic settings. However, countries (and ILEP members that are advising them) should closely examine the strategic pillars and the detailed components and content that underlies the pillars, and determine what is relevant for progress towards the country’s own leprosy and NTD targets.
The ILEP Office intends to host online workshops to give ILEP member staff the opportunity to ‘unpack’ the NTD Roadmap and the Global Leprosy Strategy and explore their implications in greater depth.
ILEP’s response to the Global Leprosy Strategy
ILEP has appreciated the opportunities for input into the strategy development process and welcomes the close integration between the NTD Road map and the Global Leprosy Strategy. ILEP also applauds the improvements over the previous strategy. The 2021-2030 strategy is more comprehensive, and ILEP members have appreciated the increased emphasis on integration, the focus on country ownership for sustainability, the inclusion of mental wellbeing, and the repeated references to involvement of persons affected by leprosy. However, no strategy is perfect. Some ILEP members would have liked to see a stronger focus on gender equity, a more thorough research section, and clearer references to logistics including MDT supply, given the supply issues over the past twelve months. There is also concern among some ILEP members over the redefined ‘elimination’ goal and the accuracy of the baseline numerical data.