Dr. Roch Christian Johnson
President, International Leprosy Association
Medical Director, Fondation Raoul Follereau
From the latest Weekly epidemiological record on leprosy (Hansen’s disease) published by the World Health Organization (WHO), the impact of the COVID-19 pandemic on the fight against leprosy has been clearly highlighted. Indeed, WHO reports a reduction of 27.7% in the recorded prevalence and of 37.1% in the number of new cases compared to 2019. These reductions are probably attributable to consequences of the COVID-19 pandemic .
Most of the countries where leprosy is endemic have been confronted, like other countries in the world, with the COVID-19 pandemic. However, their largely underfunded health systems are unable to cope with the pressures induced by the management of this pandemic. Containment and social distancing measures are difficult for the most vulnerable, including leprosy patients. For them, accepting confinement often condemns them to finding nothing to eat. Hygiene measures are very difficult to comply with due to poor access to water and soap. The economic consequences induced by the pandemic penalize in the very short term the demand for care, the education of children, and the financing by the government of vital sectors such as education and health.
One of the important principles that should guide the organization of post-pandemic leprosy services should be the involvement and full participation of persons affected by leprosy at all levels of the organization of the services dedicated to them. These services must include the following essential elements.
Access to early detection and diagnosis
Early detection must take place in strict compliance with barrier measures against COVID-19. Health authorities as well as all stakeholders in endemic countries should provide necessary information to persons affected by leprosy and their families for this purpose. Awareness campaigns should be dedicated to the precautions to be taken to ensure early and safe screening for patients and their families.
Patient care and case management
The provision of treatment, in particular MDT, must be ensured for all patients diagnosed. This is of utmost importance. Sufficient stocks of drugs must be anticipated and made available. New technologies should be used to monitor treatments. Care should be taken to provide the patient with the necessary information and medication to prevent and anticipate complications that may arise during and after treatment. Basic hygiene, sanitation, and water services should also be made available to patients and their families in order to ensure safe care in this post-pandemic period.
Services for persons living with a disability and/or psychosocial consequences of leprosy
Persons affected by leprosy, especially those with disabilities, may face stigma leading to social exclusion and mental disorders such as depression and anxiety. Persons affected by leprosy can be helped by socio-economic rehabilitation services and self-care groups. However, the main COVID-19 control measures such as social distancing and self-isolation directly interfere with these services. Post-pandemic leprosy services should therefore pay particular attention to these problems by providing appropriate care as well as the information and services necessary for patients and their families.
Access to vaccination and prevention services
Vaccination and prevention services for COVID-19 must now be part of the services offered to patients with leprosy, and this with strict respect for their dignity. Sufficient information should be provided to them in order to have their own participation in decisions concerning their health. Care should be taken to avoid discrimination in access to prevention services for patients and their families. Health personnel should be trained in this regard to provide patients with useful information and appropriate care for this purpose.
Governments and all stakeholders should ensure that the basic services mentioned above are provided to patients with a view to reducing the negative effects of this pandemic on leprosy control.
World Health Organization. “Global leprosy (Hansen disease) update, 2020: impact of COVID-19 on global leprosy control.” Weekly epidemiological record 96, no. 36 (Sept. 10, 2021): 421-444. https://www.who.int/publications/i/item/who-wer9636-421-444.