In 2023, 184 out of 221 countries and territories reported on leprosy to the World Health Organization (WHO) [1]. Congratulations to all who contributed to the combined efforts of national leprosy programs and WHO for this remarkable achievement.  

Globally, 182,815 new cases were detected in 2023 – a 5% increase compared to 2022 – which yields a case detection rate of 22.7 per million population. The number of new child cases rose slightly, from 10,302 in 2022 to 10,322 in 2023, pointing to ongoing transmission. It is prudent to note that in 110 countries zero child cases were reported and these countries need technical assistance to pursue their journey towards “interruption of transmission” and “elimination of leprosy disease.” 

The number of new cases with visible deformities (grade 2 disabilities, G2D) increased by 175 cases, from 9,554 in 2022 to 9,729 in 2023. The global G2D rate of 1.2 per million population calls for accelerated active case detection and improved contact examination to diagnose leprosy before visible deformities occur. New child cases with G2D is a sensitive indicator pointing to continued transmission and delayed detection. Among 2023’s 9,729 new G2D cases, 266 were child cases (under age 15).  

Nearly 72% of new cases are in the 11 countries of the South-East Asia Region (SEAR). This high percentage justifies positioning the Global Leprosy Programme in the WHO Regional Office for South-East Asia rather than in WHO headquarters in Geneva. However, SEAR has made significant progress in reducing its regional leprosy disease burden: Compared to 2014, the number of new cases in 2023 decreased by 15% and the number of new cases with G2D went down by 54%. Trends for the past ten years in the Region of the Americas (AMR) show that while the number of new cases decreased by 27% compared to 2014, the number of new cases with G2D has been hovering around 2,000.   

In the African Region (AFR), the number of new cases detected in 2023 (21,043) is 11.6% higher than the number reported for 2014 (18,597). Increase is also noted in the number of new G2D cases: from 2,726 in 2014 to 3,026 in 2023. Moreover, nearly half of the global total of new child cases with G2D are in AFR for the second year in a row: 133/278 (48%) in 2022 and 131/266 (49%) in 2023. WHO Goodwill Ambassador Yohei Sasakawa is rightly emphasizing the need to consolidate political will in support of the zero-leprosy strategy in countries on the African continent. 

Only a few countries have reported on prevailing antimicrobial resistance (AMR) in leprosy; hence additional investment is needed for establishing systematic AMR surveillance, particularly in global priority countries. The need for this investment becomes especially important in the context of 13,777 retreatment cases, including 3,644 relapses. 

The update mentions that over 100 laws that allow discrimination on the basis of leprosy still exist and countries have been working on repealing them.

Information about acute and long-term stock-outs of multidrug therapy (MDT) was missing in the update. As uninterrupted MDT is the basic tenet for elimination of leprosy, reporting on MDT supply is recommended. Also, to prevent stock-outs, the timing of reporting epidemiological data and making requests for MDT should be synchronized. 

The editorial portion of the update highlights the accomplishments of Jordan and Maldives. In August 2024, Jordan became the first country to receive WHO verification of “elimination of leprosy disease” according to the process outlined in the Leprosy Elimination Framework, and in October 2023, Maldives became the first country to adopt the tools of the Framework in pursuit of verification at the subnational level for “interruption of transmission.” The example of these two countries should inspire others to heed the words of the update’s subtitle: “Elimination of leprosy disease is possible – Time to act!” 

[1] World Health Organization, “Global leprosy (‎Hansen disease)‎ update, 2023: Elimination of leprosy disease is possible – Time to act!,” Weekly Epidemiological Record, vol. 99, no. 37 (Sept. 13, 2024): 497–522, https://iris.who.int/handle/10665/378893.