The Brazilian Society of Dermatology (BSD), as a national scientific community, rendered solidarity with the international scientific community, against this march of WHO for leprosy elimination. We should learn with malaria that required decades to re-initiate its control and give up the elimination idea.
In Brazil, Brazilian Society of Dermatology (BSD) took officially, to the Ministry of Health, the stand of non-agreement with the modifications that are being made in the national politics for leprosy elimination. The Ministry answer was exactly as that of WHO that acts in the Global Alliance for Leprosy Elimination, that is, the BSD was summarily excluded from the meetings of national politicy formulation, for questioning the present technical changes, without any scientifically acceptable support.
The Sanitary Dermatology National Coordination was extinguished and a National Program of Leprosy Elimination was created. WHO is a reliable and competent institution that deserves our entire respect, but in the case of leprosy, its legitimacy is questionable in the world scientific community. In our Country, history repeats itself: the Ministry of Health is a reliable and competent institution that deserves our entire respect, but in the case of leprosy, it is losing legitimacy in the national scientific community.
In its Leprosy Elimination Project Status report WHO Dec 2003, WHO asserts that the bigger problems reside in the fact that in Brazil there is a vertical program. In the least, this reflects its ignorance in relation to the definition of vertical, since in the Country there is never so much as ONE care unit that works only with leprosy. According to WHO, in Brazil, another obstacle would be the fact that the program is handed to dermatologists. However, only three of the 27 Brazilian states have dermatologist in the program and, in the Ministry, for more than seven years, there is not one dermatologist in the national team. Observe that the homework was done when two dermatologists were in the Ministry of Health, when the house was settled and the prevalence diminished from 19 to 4/10,000 inhabitants.
The excess of simplification in the assistance to the leprosy patient caused specialists in the whole world, including Brazilian, to be separated from technical formulations of national and international politics of a complex disease. Bacilloscopy was withdrawn from routine, under the argument that our network was enable to perform such a test, the same network that performs up till now the same test for tuberculosis, and the same network that performs, in the whole country, CD4 & CD8 counting, as well as the evaluation of HIV viral burden as tests for therapy guiding.
BSD congregates 5,080 members, and it is already taking all measures so that its associates do not comply with the orientations that are being given by the Ministry of Health, since this entity re-affirms that these measures have no scientific support. Otherwise, the editorial of the last issue of the International Journal of Leprosy (Editorial Scollard David The 6th WHO TAG Report: Validation and Non-existing patients IJ Leprosy Jan 2005) recommends explicitly to the ministries of health of endemic countries not to obey WHO recommendations. The last issue of the Bulletin of the WHO, March 2005 Lockwood & Suneetha in Leprosy: too complex a disease for a simple elimination paradigm expresses, exactly, the mistaken trajectory of WHO in relation to the leprosy control actions.
At determining the elimination goal, without hearing Brazil, WHO has chosen a mistaken indicator to monitoring the endemic disease. Now, WHO recommends an self-supervised treatment, where the patient, at being diagnosed, receives, at a time, medication for 12 months of treatment, and he is told that he does not need more monthly consultations for monitoring the evolution of the treatment, even knowing that the destruction of M. leprae increases extremely the antigenic burden generator of neural prejudice.
In the era of the evidence-based medicine, it is imperative that health politics be formulated over this foundation.
Leprosy is already considered as a neglected disease (conférence sur les maladies négligées, Berlin, Dec 2003), In the present rhythm, it will be soon considered as a forgotten disease (P. Bobin, Bull ALLF, Janvier, 2005).
We sincerely wish Dr. Pannikar success in his new challenge as leader of WHO Technical Leprosy Team, and we trust that he will convene a meeting of the Leprosy Expert Committee, bringing WHO and the international scientific community together again.
1. Lockwood DN, Suneetha S. Leprosy: too complex a disease for a simple elimination paradigm. Bulletin of the World Health Organization 83: 230-235, 2005.
2. Meima A, Smith WC, van Oortmarssen GJ, Richardus JH, Habbema JD. The future incidence of Leprosy: a scenario analysis. Bulletin of World Health Organization 82:373-380, 2004.
3. Meima A, Smith W, Cairns S, van Oortmarssen GJ, Richardus JH, Habbema JD. The future Incidence of Leprosy: a scenario analysis Public Health. Rotterdam University – ILJ Volume 70: número 4, Dec, 2002.
4. Oliveira MLW, Talhari S, Penna GO, Gonçalves HS. Editorial – O Compromisso da SBD com a eliminação da hanseníase no Brasil: Somos também responsáveis pelo fracasso dessa meta? Sociedade Brasileira Dermatologia, volume 80, número 1, janeiro-fevereiro, 2005.
5. Scollard D. Editorial. The 6th World Health Organization. TAG Report: Validation and “Non – existing patients” IJ Leprosy Jan, 2005.
6. Secretaria de Saúde do Estado de São Paulo. Relatório da Reunião de Trabalho para Avaliação da hanseníase no Estado de São Paulo, 2004.
7. Warwick JB, Lockwood D. Leprosy – Seminar. The Lancet, April 2, 2004.
8. World Health Organization. Leprosy Elimination Project – Status report – WHO December, 2003.
Sinésio Talhari; Gerson Penna
Sociedade Brasileira de Dermatologia. Rio de Janeiro, RJ