global leprosy strategy 2021 2030 overview

Global Leprosy Strategy 2021-2030: OverviewGlobal consultation of NLP managers, partners and affected persons, 26-30 October 2020

Global Leprosy Strategy 2021–2030

Overview

Erwin Cooreman MD MSc DTM&H

Team Leader, Global Leprosy Programme

World Health Organization


Overview of presentation

Part 1: Process of development

Part 2: The strategy


Part I

Developing post-2020 Global Leprosy Strategy


WHO technical

guidance on leprosy


2006-2010

2011-2015

2016-2020

2021-2030


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


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 and partners

• Jan 2019: Input from delegates at First International Dermacon, Bengaluru, India

• Feb 2019: Online survey of NLPs and other partners on possible 2030 targets conducted by GPZL over two iterations and results shared online

• March 2019: ILEP meetings

• Apr 2019: Update and notable developments shared during WHO NTD-STAG meeting

• Apr 2019: First draft strategy presented during ‘Global training of NLP managers from priority leprosy-endemic countries’, Bangkok, Thailand. Inputs sought from NLPs present

• Apr-May 2019: Inputs sought on first draft strategy by email from technical experts in leprosy

• Jun 2019: Summary of draft strategy presented during ‘International Leprosy Training Programme for Developing Countries’, Tai’an, China.

3% 1% 2% 0

6%3% 5%

12%

22%

47%

0

10

20

30

40

50

60

70

80

90

The average response was 8.5

Nu

mb

er

of

resp

on

de

nts

(n

=18

1)

“Reduction in the number of children with leprosy by 90%”

How strongly do you support this target?

1 2 3 4 5 6 7 8 9 10


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)


Part II

The strategy

“Towards Zero Leprosy”

Table of contents

• Foreword

• Development process

• Strategy “at a glance”

• Overview and context

• Achievements and current situation

• Major challenges

• Vision, goal, targets and pillars• Strategic Pillar 1• Strategic Pillar 2• Strategic Pillar 3• Strategic Pillar 4

• End notes and references

• Annexes• Leprosy profile of NTD Roadmap• Principles and Guidelines for the elimination of

discrimination …


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


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


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.


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


Four strategic pillars

1. Implement integrated, country-owned zero leprosy roadmaps in

all endemic countries

2. Scale up leprosy prevention alongside integrated active case

detection

3. Manage leprosy and its complications and prevent new

disability

4. Combat stigma and ensure human rights are respected

Towards Zero Leprosy


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


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


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


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


Key research areas

Diagnostic tests for disease

and infection

Improved under-

standing of trans-mission

Improved under-

standing of the

mecha-nisms of leprosy

reactions

Optimized case

detection through

integrationespecially

in low-endemic settings

More effective drugs/ drug

combi-nations, or

shorter regimens

Improved preventive approaches

Effective models of

care

Digital health

applica-tions

Inclusive approaches

in community-

based rehabili-

tation and stigma

reduction


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

Documents