Mexico WHO consultation report on ‘Elimination’

In March, the WHO Global Leprosy Programme held a 3-day informal consultation in Mexico City, entitled Defining Criteria to Declare Elimination of Leprosy. ILEP was represented by Dr Wim van Brakel and Geoff Warne.

In the new global NTD Roadmap, the goal for leprosy has changed from ‘elimination as a public health problem’ to ‘elimination’, defined as interruption of transmission. This informal consultation was called to discuss what criteria should be used to verify that the transmission of leprosy has indeed ceased in a country.

Two-thirds of the 40 delegates were from the Americas, bringing a valuable perspective to those of us more accustomed to the Asian and African perspective. Useful case studies demonstrated the changes in age profile of new cases, and the number of child cases, in countries where new case numbers were approaching zero and where transmission was thought to have ceased some years earlier.

One of the issues in leprosy has been that countries were able to assert ‘elimination as a public health problem’ without the need for dossiers of evidence. The process of verification of genuine elimination will require a detailed dossier supporting the country’s claim. A taskforce group will specify the standard content of the dossier and the relevant indicators. These will include epidemiological indicators, qualitative indicators of the capacity of the health and social services to provide care and promote social participation, and surveillance arrangements. The dossier is then reviewed by an expert panel, on whose recommendation WHO formally verifies elimination.

A full report on the consultation, including conclusions and recommendations, can be seen here.