In 1954, French humanitarian Raoul Follereau established the last Sunday of January as a special day to commemorate the suffering that victims of leprosy or Hansen’s Disease go through.

This suffering is not simply limited to the direct effects of the infecting micro-organism – the bacteria Mycobacterium leprae which causes significant damage of the nerves, respiratory tract, skin and eyes – but also suffering resulting from the wrongful stigmatisation of the victims.

The bacterium Mycobacterium leprae in not itself highly contagious. The excessive fear of contagion of past communities, leading to the 19th to early 20th-century legal forceful segregation of the victims, was related more to the fact that the neural damage led to the loss of parts of a person’s extremities from repeated injuries or infection through unnoticed wounds, reminiscent of the body’s deterioration after death; a reminder of our eventual demise.

Leprosy is today curable with multi-drug therapy, a therapy regimen that was first investigated on a national level in Malta in the 1970s. Malta was the first country to eradicate the infection within its borders, having ensured that all victims were effectively treated until the disease was completely cured.

However, the chronic effects caused by the neural damage cannot be reversed, leaving the victim with a lack of ability to feel pain and thus inability to react to repeated injuries or infection through unnoticed wounds.

With the adoption of the multi-drug therapy regimen, provided free of charge by the World Health Organisation, the incidence and prevalence of the infection has gone down significantly in the developed world and continues to go down (see graph).

Annual number of new cases diagnosed.

However, cases are relatively still common in the developing world where those affected are stigmatised and often excluded from the community, making it difficult for them to receive the appropriate medical care they require to stop the destructive processes brought about by the Mycobacterium.

Most new cases occur in 14 developing countries, with India accounting for more than half of them. Leper colonies aiming to segregate these victims still exist in India, China, the African continent and Thailand, in spite of the low infectivity of the disease and the potential of full eradication of the infection.

Developed countries too report regular cases of leprosy. The US report about 200 new cases annually, many of which are the result of infection transmitted by other host animals such as armadillos, red squirrels and non-human primates.

While in Malta we do not have other potential host animals that can serve as a reservoir of the disease, migration opens our shores to potential entry and sporadic cases have been reported in recent years among incoming migrants.

We do have to be vigilant and ensure that our healthcare professionals remain alert to the early features of the infection so that timely appropriate treatment can be given.

Stigmatisation makes it difficult for these victims to be diagnosed early enough to treat the disease early and prevent the chronic adverse effects of neural damage

Leprosy is one of the oldest recorded diseases in the world. Contagious skin disorders are mentioned in the Leviticus of the Old Testament. While often assumed that this text refers solely to leprosy, it does in fact refer to a wide range of infective and non-infective skin conditions that could include conditions such as vitiligo, psoriasis, ringworm, etc.

The Leviticus text (Leviticus 13:1-46) concentrates on the lesions associated with ritual impurity referring to the condition as tsaraath, a term that was erroneously equated to leprosy when translating the Hebrew texts into Greek.

The Leviticus served as a guide to the temple priests to help identify those deemed impure and hence excluded from entering the temple. It presents a simple scheme of observational diagnosis, not simply of leprosy, but rather the chronicity of the skin pathology whether this presents as a scab or discolouration, an ulcer, a burn, a rash sore, a boil, a burn or loss of hair. The key elements determining ritual impurity and potential ritual contagion were based on chronicity and extension of the lesion.

In spite of the curability of the disease caused by Mycobacterium leprae, the victims of this infection continue to be stigmatised by their communities – a stigmatisation that has its roots in superstition and irrational fear of contagion.

This stigmatisation makes it difficult for these victims to be diagnosed early enough to treat the disease early and prevent the chronic adverse effects of neural damage. The stigmatisation and the chronic effects leads to unemployment and inability to sustain themselves in their communities.

The 2021-2030 Global Strategy for Leprosy of the World Health Organisation aiming for ‘zero leprosy’ has four strategic pillars:

• Implement integrated, country-owned zero leprosy road maps in all endemic countries;

• Scale up leprosy prevention alongside integrated active disease detection;

• Manage leprosy and its complications and prevent new disability; and

• Combat stigma and ensure human rights are respected.

The victims of this infective disorder deserve to be treated. While the infection is not common in the developed countries, it is in our interest to support the initiatives being undertaken in countries where leprosy remains endemic to support the WHO Global strategy. Every little bit helps.

The Raoul Follereau Foundation [Malta] – Order of Charity, a registered voluntary organisation affiliated with the Grand Priory of the Maltese islands of the Military and Hospitaller Order of St Lazarus, has been supporting Maltese-managed missions working with the victims of leprosy in ameliorating their general health and lives since its inception in 1970. In the outgoing year alone, the foundation has supported these missions to the tune of €20,000.

For more information on how to help, visit www.saintlazarusmalta.com/ngo-order-of-charity.

Charles Savona-Ventura is a Grand Hospitaller, the Military and Hospitaller Order of Saint Lazarus of Jerusalem.