As a curable disease, the principal requirement to eliminate leprosy is to maintain high coverage of multi-drug therapy, as well as high levels of patients complying with and completing the treatment.
This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities. The aim is to eliminate leprosy by the year 2000.
In 1991 the member governments of the WHO pledged their commitment to eliminate leprosy as a public health problem by the year 2000. Estimates for 1996 indicate that there are about 1.3 million cases of leprosy in the world. 87 countries having a significant number of cases. Of these 95% live in five countries. In the top 16 endemic countries, the prevalence rate is still 4.5 per 10,000, i.e., 5 times higher than the elimination target (below 1 case per 10,000 population). It is estimated, however, that over 330,000 leprosy cases have yet to be detected, about 50% of them living in Asia. The widest gaps between registered and estimated cases are reported particularly in countries with poor service coverage.
In 1996 it was reported that for the first time since global statistics on leprosy were collected, the number of patients registered for treatment in the world has fallen below 1 million. More importantly, almost all registered cases now have access to multidrug therapy (MDT). The prevalence of leprosy worldwide was reduced by 28% between 1995 and 1996, compared with 27% between 1994 and 1995. This reduction has been observed in all endemic countries and regions, with the exception of Guinea, Sudan and Madagascar. Over the past 10 years, the leprosy problem was reduced by 83% worldwide, although the reduction in the American Region was only 60%. These reductions can be explained by the conjunction of the following factors: wider implementation of MDT; fixed duration of treatment; and updating of the leprosy registers.