India close to declaring victory in battle against leprosy

It has struck fear and disgust into people for millennia, been ascribed to the wrath of God, and has plagued millions of lives. But the pain and disfigurement inflicted by leprosy are in rapid retreat in what many claim to be its birthplace and major stronghold: India.

Just four years after the launch of a campaign to provide effective drug treatments and tackle prejudice in the slums and remote villages inhabited by a population of more than one billion, the World Health Organisation expects India to meet its target for effective elimination - one case per 10,000 of population - by the end of next year.

Once such a low infection rate is reached, the disease will disappear naturally, the WHO says. In India, the nationwide figure is now 2.4 sufferers per 10,000 people, down from 25.9 in 1991 and 57.6 a decade earlier. In 17 states, the elimination target has already been reached, while 75 per cent of leprosy patients are now concentrated in seven of the country's poorest and most ill-governed states - among them Uttar Pradesh, Bihar and Orissa. Some leprosy organisations, however, accuse the WHO of being over-optimistic and point to the 350,000 so far unregistered cases detected last year - a reduction of 23 per cent on 2002 - that don't appear in the WHO figures. New cases may be expected as health officials begin to look deeper, but they also mean leprosy will remain a significant problem for years to come, warned Doug Soutar, programmes director of the British-based charity Lepra.

'The WHO's criteria for elimination is as a public health problem rather than total eradication in the way smallpox has disappeared,' Mr Soutar said. Lepra fears funds will dry up and the disease will slip from the world's radar if too much is made of reaching the UN's targets. Government interest could wane.

'We don't want to see the WHO announcing in 20 years' time that leprosy is a re-emerging disease,' Mr Soutar said.

Dr D. C. Agrawal, general secretary of the Indian Leprosy Association, is also worried about complacency. 'Unless we develop a vaccine and defeat the ignorance attached to the disease it will never be totally eradicated.'