Sustainable development of leprosy elimination by 2030 in China

Leprosy is a curable chronic infectious disease, which occurs in more than 120 countries, with more than 200,000 new cases reported every year.¹ WHO released the second blueprint Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030 (NTD Road map 2030) for neglected tropical diseases prevention, control, and elimination, which calls for multisectoral collaboration and accelerated programmatic actions to eliminate leprosy, as the number of countries with zero new autochthonous leprosy cases is projected to increase from 50 in 2020 to 120 in 2030.

In China, a total of over 8500 cases of leprosy were diagnosed and treated nationwide from 2011 to 2022.² Guided by the National Plan for the Elimination of Leprosy Threats (2011–2020), efforts have been vigorously made towards leprosy prevention and control, focusing on epidemic-prone areas and high-risk populations. The current number of leprosy cases has decreased by approximately 70% in 2022 compared to the year 2010.² However, China still faces challenges in achieving leprosy elimination. As of the end of 2022, the leprosy incidence rate in 46 counties was higher than 1 per 100,000. There were 302 newly diagnosed leprosy cases, with a wide and uneven geographical distribution in 2022.² Among them, 194 counties reported locally acquired new leprosy cases. Some regions face the risk of epidemic fluctuations or rebounds. Currently, China has nearly 80,000 cured patients diagnosed with leprosy who are facing issues related to relapse, deformities, rehabilitation, and other medical and living challenges, necessitating long-term care.² The issues related to proactive case detection, symptom monitoring, health system optimization, stabilizing health workforce, and maintaining the capacity for prevention and control should not be neglected. Achieving the goal of comprehensive leprosy elimination still requires greater efforts.

To address these challenges and respond to the calls of the NTD Road map 2030, China has recently issued the Comprehensive Plan for the Sustainable Development of Leprosy Elimination (2024–2030) on January 23, 2024, which is jointly formulated by twelve sectors.² The plan sets the goal of achieving comprehensive elimination of leprosy hazards by 2030, with zero counties having a leprosy incidence rate greater than 1 per 100,000, and the occurrence of new Grade 2 disabilities at the completion of leprosy treatment being zero. Considering the characteristics of leprosy prevalence and the epidemic situation in various regions, the government has classified 31 provinces into three categories, and specific strategies will be implemented accordingly (Table 1). The plan has outlined six key areas for leprosy prevention and control, including optimising the prevention and control system, enhancing team capacity; strengthening case detection to interrupt disease transmission; standardising case management to improve treatment outcomes; intensifing disability prevention to promote comprehensive rehabilitation; improving health education to eliminate social discrimination; and optimising information management to enhance monitoring capabilities.

Table 1.

Classified strategies for comprehensive elimination of leprosy by 2030 in China.

Classification of region	Provinces	Strategy	Key tasks
The first category	Jiangxi, Hunan, Guangdong, Guangxi, Sichuan, Guizhou, Yunnan, Tibet	Continue to intensify efforts, comprehensively promote the decisive battle	Strengthen case detection and treatment, interrupt disease transmission, and comprehensively enhance leprosy disability prevention and rehabilitation levels
The second category	Jiangsu, Zhejiang, Anhui, Fujian, Shandong, Henan, Hubei, Hainan, Chongqing, Shaanxi, Gansu, Xinjiang	Strengthen monitoring and intervention to prevent fluctuations and rebounds	Enhance the construction of monitoring systems, focus on historically high-risk epidemic areas and key populations such as mobile populations, consolidate and expand the achievements in eliminating hazards
The third category	Beijing, Tianjin, Hebei, Shanxi, Inner Mongolia, Liaoning, Jilin, Heilongjiang, Shanghai, Qinghai, Ningxia	Ensure effective monitoring and early warning, actively consolidate achievements	Ensure effective monitoring, early warning of imported leprosy cases, rehabilitation of leprosy disability cases, and maintain the favorable situation of eliminating hazards

It's worth noting that the plan introduces several innovative measures, such as optimising and promoting the use of the leprosy teleconsultation system, electronic health applications for symptom monitoring, and follow-up of close contacts. These initiatives aim to facilitate the early detection of patients. The plan also advocates for the widespread application of molecular biology diagnostic techniques and other new technologies in leprosy prevention and control professional institutions at the city level and above, effectively addressing the early diagnosis of cases. To address the risk of dapsone hypersensitivity syndrome in new patients diagnosed with leprosy before treatment, the plan recommends the detection of relevant risk factors and promoting precise treatment. Additionally, the plan proposes preventive treatment for high-risk groups among close contacts of newly diagnosed cases to reduce the incidence of disease among close contacts and interrupt disease transmission.

Given the substantial burden in many countries,^3,4 there is an urgent need for cross-sectional collaboration to combat leprosy and other NTDs, in order to achieve the targets of NTD Road map 2030 on time. The experience in sustainable development of leprosy elimination in China might provide valuable insights for other countries or regions. Moreover, the application of new technologies such as artificial intelligence and innovative measures can also be considered as good tools to accelerate the global leprosy elimination.⁵

Declaration of interests

I declare no competing interest.