Leprosy is one of the world's oldest and most dreaded diseases. The Bible tells of King Uzziah, who was afflicted with it, and isolated, until he died. When Aaron and Miriam spoke against Moses, the Lord descended on them and struck Miriam with leprosy. The disease is believed to have existed in Egypt in 4000 B.C. and in India and Japan by 1000 B.C.
Leprosy is a bacterial infection of the skin and nerves that takes years of incubating before emerging as a patch of discolored, numb skin. Throughout history, lepers were shunned and isolated in colonies or, in modern times, leprosariums. Once there, the leper was confined for life. Untreated, leprosy can lead to wasted and mutilated limbs. Treated with modern drugs, it can be cured in as little as three months and, caught early, leave no permanent disability.
Leprosy, curse of kings and beggars, is a disease that could soon be eliminated, thanks to a global alliance announced this month between representatives of countries where it is endemic, the World Health Organization, the Nippon Foundation, the pharmaceutical giant Novartis and the International Federation of Anti-Leprosy Associations. The alliance's aim is to eliminate leprosy by 2005.
The first breakthrough in leprosy management occurred in the 1940s with the development of dapsone, a drug that arrested the disease. Two more drugs, rifampicin and clofazimine, were developed in the '60s by companies that eventually merged into Novartis. The three drugs form a multi-drug therapy that kills the germ, cures the patient and prevents drug resistance.
As a result, 10 million leprosy patients have been cured during the past 15 years, and the number of countries where leprosy remains a public health problem has dropped from 122 to 24. Today, leprosy remains most prevalent in Angola, Brazil, the Central African Republic, the Democratic Republic of Congo, India, Indonesia, Guinea, Madagascar, Mozambique, Myanmar, Nepal and Niger. These countries have 90 percent of the world's cases.
Leprosy afflicts 1.4 people per 10,000 worldwide. "These people are less infectious than those with many other infectious diseases," says David Heymann, head of infectious diseases at WHO. "Now they are diagnosed early and treated in the community. They don't run away when you try to treat them. But there are between 2.5 million and 2.8 million cases remaining. There is no excuse for this when drugs that can treat it are available.
"The last people in any eradication program are those who don't have access to health services. You go 100 miles, and the last 10 miles are the hardest. That's where we are now. The hope is once you get leprosy down to the level of 1 per 10,000 that it will gradually disappear," Heymann says.
What's going to make that goal possible is a $30 million contribution of drugs from Novartis over the next six years. In addition, the Nippon Foundation and the Sasakawa Memorial Health Foundation will contribute $24 million toward fieldwork. The two foundations enabled the WHO to give free treatment to all leprosy patients in 80 countries since 1995.
The Novartis contribution is particularly significant because it is coming from a pharmaceutical company -- a business and not a foundation -- and one that began researching leprosy 50 years ago. Since taking over the WHO two years ago, Director-General Gro Harlem Brundtland has made a special effort to develop partnerships with private-sector companies.
"We have to do more" than donate drugs, says Klaus M. Leisinger, executive director of the Novartis Foundation for Sustainable Development. "It's not only a medical problem. We have to do more for social marketing, teaching people that leprosy is just another normal disease if you go early [for treatment]. If you wait, if you're afraid of the diagnosis, then you develop the mutilations and the stigmatization."
The Novartis Foundation, he says, developed a pilot social marketing project in Sri Lanka that used jingles and billboards to convey the message that leprosy can be cured. "We are now doing it in Brazil and Madagascar in an effort to bring patients to the drugs," Leisinger says. "Wherever one is doing state-of-the-art social marketing, we can turn around people's perception of the disease. That has been proven."
He notes, however, that with more than 800,000 new cases diagnosed in each of the past two years, there must be a "significant hidden caseload" of people who are spreading the disease.
"This final push should ensure early treatment, and we should improve the demand for treatment and dispel the fear of leprosy. If we don't have the flanking measures, the systematic planning, if we don't have the national task forces to spearhead implementation of what we know has to be done, then the availability [of treatment] will be just in the [affected nation's] capital. We need it where the patients are: This is in the rural areas, where the thinking about the disease is that it's a curse from God or a punishment."
Leprosy is easy to diagnose, Leisinger says. "This is why we put a lot of emphasis on training health staff. The more people who can diagnose it, the more patients we can treat." Drugs are given to patients in aluminum-foil "blister packets," with each day's dose marked.
"Leprosy is a biblical disease, but today we can eliminate it," Leisinger says. "It's a task of a civil society, not the task of a single actor."
The Novartis company is putting a fortune, and the foundation is putting its development expertise, behind this final push to stamp out a disease that has caused human suffering hard to imagine. It is showing how a giant company can be a good citizen.