R: [Ip-health] Leprosy, WHO and Novartis

[Sunil Deepak]

Thanks for sharing the article from Guardian about WHO's new partnership
with drug companies, which started this reflection.

My name is Sunil and I work in the Medical support department of an Italian
NGO called AIFO, based in Bologna. AIFO is an anti-leprosy organization, in
the sense it started mainly for supporting leprosy control projects, though
at present it is also involed in primary health care and rehabilitation of
persons with disabilities.

The reason I am writing to you is to ask for your opinion on a question
related to drug company (Novartis) and WHO. In 1991, WHO general assembly
decided to fix the objective to eliminate leprosy by the year 2000, where
elimination was defined as reducing the prevalence to less than 1 case per
10,000 population. Since leprosy required treatment lasting 2-3 years, it
was decided to focus on prevalence, as number of cases registered for
treatment. In the last ten years, the treatment has been shortened to 1 day
to 1 year, depending upon the clinical diagnosis. At the same time, the
treatment coverage has been increased to almost 100%, so the prevalence
calculated on last day of the year has fallen drastically. 

Still it was not possible to reach the leprosy elimination goal by 2000 and
it has been postponed to 2005.

During the same period, the incidence (new case detection) of leprosy has
remained fairly stable - or rather it has increased - probably due to better
case detection coverage. In fact if during eighties, there were about
550,000 new cases each year, over the last five years, these have been above
700,000. (Last available data from WHO for 2000 is for 719,000 new cases).

Initially, it was hoped that by reducing the prevalence and maintaining good
control services for 5-7 years, there would be a fall in new cases. However,
different studies having very good field coverage for more than 10-12 years
from different parts of the world seem to show that this expected fall in
new cases is not happening. Many reasons have been advanced for this,
including the hypothesis that transmission of disease happens before there
are clinical signs. At the same, it needs to be remembered that there is no
serological test for early diagnosis of leprosy or any vaccine or any
chemoprophylaxis, etc.

At the same time, in 2001, leprosy unit of WHO has launched a campaign
called 'The final push' with two key messages - by 2005, all the cases of
leprosy will be cured; and that after 2005, there won't be any problem of
leprosy. In all technical materials, it does say that there may be new cases
of leprosy after 2005, but the numbers are minimized and these progress
reports, don't mention the data about new cases. In any discussions about
new cases, it is implied that new cases are not really new but it is NGOs
which are over-diagnosing or giving double treatment and have a vested
interest in maintaining that leprosy still exists.

As you can understand from the above brief presentation the difficulties in
any dialogue with leprosy unit of WHO, which dismisses any objections or
concerns raised by NGOs or field staff as irrlevant or untrue. At the same
time, this position is strongly supported by the Swiss drug company
Novartis, which has agreed in 2000 to supply free drugs for all leprosy
affected persons in the world till 2005, through WHO. Novartis foundation is
also supporting information-education campaign activities for elimination of
leprosy by the year 2000. 

Could any one of you comment on this situation and why WHO/Leprosy unit and
Novartis are behaving in this way?

Sunil

Dr. Sunil Deepak
AIFO, Bologna, Italy 



>>>
Date: Thu, 07 Feb 2002 13:08:34 -0500
From: Mike Palmedo <mpalmedo@cptech.org>
To: "ip-health@venice.essential.org" <ip-health@venice.essential.org>
Subject: [Ip-health] Guardian on WHO and pharma

http://www.guardian.co.uk/Archive/Article/0,4273,4350592,00.html

Unhealthy influence 

There is a danger that WHO's new partnership with drug companies will
skew its health policies

>>>