Hope for 2040 | Physician Liesbeth Mieras on ending leprosy worldwide

Liesbeth Mieras has over 25 years of international experience in the fields of public health and infectious diseases. She is a medical-technical consultant for the Leprastichting and coordinates multiple projects from the organisation’s international offices in Amsterdam. The Sint Antonius Foundation (SAS-P) funds Leprastichting projects in Mozambique and Nigeria, two countries where leprosy is still relatively prevalent, especially in the poorest communities.

How is it possible that leprosy is still common? Other contagious infectious diseases, such as smallpox, cholera and very recently Covid-19 too, have all been largely suppressed.

‘One of the main reasons is that leprosy is poverty-related. Most people have effective immune systems and therefore wouldn’t fall ill if they were infected by leprosy bacteria. Leprosy occurs among the poorest people on the planet, marginalised groups for whom medical help and human rights cannot be taken for granted. Their voices are often not heard. Leprosy is one of the neglected tropical diseases in which far too little is invested to be able to eradicate it. There is insufficient funding to do research into improved detection and treatment. Many policymakers and financiers don’t even know that leprosy is still so prevalent.’

A girl receives her dose of SDR-PEP during the first day of field training in Jigawa, Nigeria. On this day, the trainers went into the field with health workers to examine contacts of people who have had leprosy for symptoms. If they are free of symptoms, they receive SDR-PEP as preventive medication for developing the disease.

How did you become aware of how widespread the problem is?

‘Twenty-five years ago, when I was starting out as a doctor specialising in tropical diseases, I was detached to Mozambique. I partnered with a doctor there who was working for the Leprastichting. At that time, my knowledge of leprosy was absolutely inadequate, so I learned a huge amount during that initial stint. It became clear to me how difficult it is to detect leprosy in time and to treat it. You have to diagnose leprosy based on clinical traits. There are a few cardinal symptoms: numb patches of skin, loss of strength, numbness of hands or feet. There are usually no lab tests available in regions affected by leprosy. So effective diagnosis relies on there being enough healthcare professionals on site, who have been trained to recognise the clinical symptoms.’

The consequences of leprosy are extremely serious, aren’t they?

‘Absolutely. Leprosy bacteria damage nerve and skin cells. If an infection is left untreated, the disease can ultimately lead to permanent disabilities, such as disfigured hands or feet, and blindness. But the social consequences of leprosy can be devastating, too. For a long time, isolation was the only measure that was used to prevent further contagion. In some communities, leprosy still carries the stigma of guilt and shame, other people discriminate against and ostracise patients. The Leprastichting provides information and health education to reduce this stigmatisation. Shame about this disease can hinder early detection, because people don’t get themselves tested. That’s one of the reasons we aim to raise awareness about early symptoms and the fact that treatment is possible. We also emphasise that the disease is not easily passed on, also to reduce stigmatisation.’

Practical training for health workers responsible for the medication for leprosy patients. In the photo, a 'sensitivity test' is practiced in a role-play, in which the feet and hands of the 'patient' are carefully touched with a pen. The patient keeps his eyes closed and indicates when the pen is felt. In this way, the health worker can determine whether the nerves of the patient have been damaged by leprosy. The photo was taken in Jigawa, Nigeria.

Is it possible to be completely cured of a leprosy infection?

‘Leprosy can be treated, and potential disabilities prevented, using a cocktail of antibiotics. It’s a very tough treatment, because patients have to take antibiotics for anywhere from six months to a year. The medication kills the leprosy bacteria and stops the infection. Some people develop immune responses, but even after just a few days, the patient is no longer contagious. And the great thing is that a preventative medication was introduced in 2018, which is an integral part of the projects SAS supports. A single dose of the antibiotic rifampicin reduces the risk of leprosy infection by 60 percent, which is a tremendous step forward. In addition, as we know which other people are most at risk of infection, we are able to actively approach them and offer them the preventative antibiotic. In particular, family members and friends of the leprosy patient are at a higher risk of contagion. Leprosy bacteria grow very slowly. That’s why, say, if you sat next to a leprosy patient on a bus once, you won’t get infected. Infection only takes place if you are exposed to the bacteria for long periods of time, at least three months. Which is why it’s so important to trace the patient’s close contacts and give them the preventative treatment.’

Have you seen the number of leprosy patients decline over the past 25 years in Mozambique?

‘Often, as the healthcare programme improves, we initially find more leprosy patients. Like in the project SAS supports in Mozambique, where the number of patients has increased dramatically. That might seem disappointing, but in fact it shows that we are improving the situation: we are efficient at tracing and diagnosing leprosy patients, who we can subsequently treat. Moreover, since we’ve been able to offer rifampicin, we can also treat people preventatively to reduce the transfer of leprosy bacteria. Meanwhile, we’re conducting additional research into an even more effective preventative antibiotic. In accordance with World Health Organisation (WHO) goals, the Leprastichting is aiming to halt the spread of leprosy and to reach zero new patients by 2040. People will still be living with the consequences of leprosy, but globally there will be no more new patients. I’m hopeful that we will have eradicated leprosy by 2040.’