Roadmap towards zero leprosy, Pakistan

The World Health Organization recently redefined leprosy elimination as a phased process, with the first milestone being the interruption of transmission, achieved when no new child cases (defined as younger than 15 years) are reported for five consecutive years. In Pakistan, the well-functioning leprosy programme, with effective case management, context-specific active case-finding strategies and a robust data management system, has contributed to a decrease in new cases. Between 2001 and 2023, new adult cases dropped by 75% (from 878 cases to 220 cases annually) and child cases by 83% (from 93 to 16). To support the country's goal of no new child cases by 2030 and ultimately eliminate the disease, the nongovernmental organizations Marie Adelaide Leprosy Centre and Aid to Leprosy Patients, with support from the German Leprosy and Tuberculosis Relief Association, have developed a zero leprosy roadmap. As part of this roadmap, the leprosy elimination strategy emphasizes improving active case-finding and providing post-exposure prophylaxis for contacts of leprosy cases, who are at the highest risk. Other key activities include establishing a monitoring and evaluation system for leprosy elimination, upgrading the health information management system to DHIS2, and training general practitioners and dermatologists to improve their capacity for accurate diagnosis and referral. The strategy also emphasizes improved counselling for new cases and the active involvement of individuals affected by leprosy in policy discussions. The roadmap offers globally relevant, scalable strategies for leprosy elimination in low-endemic settings. Lessons from Pakistan's experience can inform and inspire similar efforts in other countries.