Global Leprosy Strategy 2021–2030

Overview
Erwin Cooreman MD MSc DTM&H
Team Leader, Global Leprosy Programme
World Health Organization

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Overview of
presentation
Part 1: Process of development

Part 2: The strategy

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Part I

Developing post-2020 Global Leprosy Strategy

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 WHO
technical
guidance on
leprosy

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 2021-
2016- 2030
2020

2011-
2006- 2015
2010

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Global Leprosy Strategy
• Leprosy has traditionally had global leprosy strategies
• Basis for countries to develop National Leprosy Strategy
• NTD Roadmap (2012-2020): very limited visibility of leprosy
• NTD Roadmap (2021-2030):
• Leprosy is one of the 20+ NTDs
• Each NTD is given fairly detailed profile
• Significant contribution to the following SDGs:
• SDG 3 – healthy lives and well-being and UHC (‘leaving no one behind’)
• SDG 10 – reduced inequalities
• SDG 17 – partnerships
Global Leprosy Strategy 2021-2030: Overview
Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Development process (1/2)
• Nov 2018: Request for input on 2030 targets for 2021-2030 NTD
Roadmap and Global Leprosy Strategy sent to WHO TAG-Leprosy “Reduction in the number of children
and partners with leprosy by 90%”
• Jan 2019: Input from delegates at First International Dermacon, How strongly do you support this target?
Bengaluru, India 90 47%

Number of respondents (n=181)

• Feb 2019: Online survey of NLPs and other partners on possible 80
2030 targets conducted by GPZL over two iterations and results 70
shared online 60
• March 2019: ILEP meetings 50
22%
• Apr 2019: Update and notable developments shared during WHO 40
NTD-STAG meeting 30
12%
• Apr 2019: First draft strategy presented during ‘Global training of 20
6%
NLP managers from priority leprosy-endemic countries’, Bangkok, 10 3% 1% 2% 3% 5%
Thailand. Inputs sought from NLPs present 0
0
• Apr-May 2019: Inputs sought on first draft strategy by email from The average response was 8.5
technical experts in leprosy
1 2 3 4 5 6 7 8 9 10
• Jun 2019: Summary of draft strategy presented during
‘International Leprosy Training Programme for Developing
Countries’, Tai’an, China.

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
Development process (2/2)
• Jul-Sep 2019: Process slowed pending consultation and completion of NTD Roadmap
2021-2030.
• Sep 2019: GPZL partners invited to comment on leprosy pages of NTD Roadmap.
Leprosy pages consolidated with partners during the 10th NNN Conference,
Liverpool, United Kingdom
• Oct 2019: WHO symposium during 20th International Leprosy Congress, Manila, the
Philippines
• Nov 2019: Strategy outline discussed during ‘Training of NLP managers from hyper-
endemic countries’, Pohnpei, Federated States of Micronesia
• Nov 2019: Further inputs received from WHO TAG-Leprosy
• Dec 2019: National Leprosy Conference, Dhaka, Bangladesh
• Feb 2020: Overview presented at ‘Informal consultation on defining criteria to
declare elimination of transmission of leprosy’, Mexico City, Mexico
• Jun-Aug 2020: Detailed write-up of final draft ready for consultation
• Sep 2020: Sharing of draft with stakeholders
• Oct 2020: Global consultation (virtual)

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Table of contents
• Foreword
• Development process
• Strategy “at a glance”
• Overview and context
Part II • Achievements and current situation
• Major challenges
• Vision, goal, targets and pillars
The strategy • Strategic Pillar 1
• Strategic Pillar 2
• Strategic Pillar 3
“Towards Zero Leprosy” • Strategic Pillar 4
• End notes and references
• Annexes
• Leprosy profile of NTD Roadmap
• Principles and Guidelines for the elimination of
discrimination …

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Current challenges
• Delay in detection
• Dwindling leprosy expertise
• Meaningful engagement of relevant stakeholders
• Deeply embedded stigma and discrimination
• Significant research gaps
• Limited access or referral to essential care
services
• Routine surveillance systems not in place
• Weak health information systems
• Migrations
• Expansion of AMR and adverse events monitoring
• Zoonotic transmission in some areas
Global Leprosy Strategy 2021-2030: Overview
Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Vision, Goal, Targets
• Vision: Zero leprosy
• Zero infection and disease, zero disability, zero stigma and discrimination
• Goal:
• Elimination of leprosy (interruption of transmission)
• Global targets for 2030
• 120 countries reporting zero new autochthonous cases
• 70% reduction in annual number of new cases detected
• 90% reduction in rate (per million) of new cases with grade-2 disability
• 90% reduction in rate (per million children) of new child cases with leprosy
Impact indicator 2020 2023 2025 2030
Number of countries with zero new cases 50 75 95 120
Annual number of new leprosy cases detected 184,000 148,000 123,000 63,000
Rate (per million pop.) of new cases with G2D 1.3 0.92 0.68 0.12
Rate (per million children) of new child cases with leprosy 7.81 5.66 4.24 0.77

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Paradigm shift: ‘elimination’
• ‘Elimination as a public health problem’ → ‘elimination’
• Elimination:
• Interruption of transmission
• Absence of disease in autochthonous population
• ‘Eradication’ currently not feasible because of zoonotic reservoir and transmission
in some areas
• Will require:
• Strong surveillance system, also post-elimination
• Further research required:
• Role of other transmission pathways: zoonotic, other?
• Role of other pathogens: M. lepromatosum?
• Etc., etc.
Global Leprosy Strategy 2021-2030: Overview
Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
Expected new case detection

Current global trend:

-1.5%/year

2021-2025: Optimize
use of existing tools
including contact
tracing, PEP, and
active case finding

2026-2030: Introduction
of new tools including
diagnostic test, improved
preventive regimen,
vaccine

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Four strategic pillars
1. Implement integrated, country- 2. Scale up leprosy prevention
owned zero leprosy roadmaps in alongside integrated active case
all endemic countries detection

Towards Zero
Leprosy

3. Manage leprosy and its

4. Combat stigma and ensure
complications and prevent new
human rights are respected
disability

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Pillar 1: Implement integrated, country-owned
zero leprosy roadmaps in all endemic countries
• Political commitment with adequate resources for leprosy in
integrated context
• National partnerships for zero leprosy and zero leprosy
roadmaps engaging all stakeholders
• Capacity building in the healthcare system for quality services
• Effective surveillance and improved data management systems
• Monitoring of antimicrobial resistance and adverse drug
reactions

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Pillar 2: Scale up leprosy prevention
alongside integrated active case detection
• Contact tracing for all new cases
• Preventive chemotherapy scaled up
• Integrated active case-finding in targeted populations
• Existing and potential new vaccines

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Pillar 3: Manage leprosy and its
complications and prevent new disability
• Early case detection, accurate diagnosis and prompt
treatment
• Access to comprehensive, well-organized referral facilities
• Diagnosis and management of leprosy reactions, neuritis
and disabilities
• Monitor, support and training in self-care
• Mental well-being through psychological first-aid and
therapeutic counselling

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Pillar 4: Combat stigma and ensure human
rights are respected
• Adoption of “Principles and guidelines for elimination of
discrimination against persons affected by leprosy and their
families”
• Inclusion of organizations and networks of persons affected by
leprosy
• Amendment of discriminatory laws
• Systems to monitor stigma reduction in communities
• Access to social support and rehabilitation

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Key research areas

Optimized Inclusive
Improved More
case approaches
under- effective
Diagnostic Improved detection in
standing drugs/ Digital
tests for under- through Improved Effective community-
of the drug health
disease standing integration preventive models of based
mecha- combi- applica-
and of trans- especially approaches care rehabili-
nisms of nations, or tions
infection mission in low- tation and
leprosy shorter
endemic stigma
reactions regimens
settings reduction

Global Leprosy Strategy 2021-2030: Overview

Global consultation of NLP managers, partners and affected persons, 26-30 October 2020
 Summary
• The Global Leprosy Strategy 2021-2030 provides basic directions, goals,
challenges and strategic pillars at a global level
• Countries – both high and low-burden – should adopt the strategy and
then adapt its targets and strategic pillars to their specific national and
subnational contexts

• To ponder upon…
• “A vision without a strategy remains an illusion” Lee Bolman
• “Without strategy, execution is aimless. Without execution, strategy is useless.”
Morris Chang
• “Perfect moves hold you back from moves at all” Anonymous
• “A vision and strategy aren’t enough. The long-term key to success is execution.
each day. Every day.” Richard M. Kovacevich
Global Leprosy Strategy 2021-2030: Overview
Global consultation of NLP managers, partners and affected persons, 26-30 October 2020