‘Zero Leprosy’ and other endgame strategies: Rhetoric vs. realism in public health campaigns

ABSTRACT

For over half a century, many public health campaigns related to infectious disease have focused on disease ‘eradication,’ rather than ‘control’ or ‘management.’ In this article, I will focus on the example of a recent global leprosy (Hansen’s Disease) control campaign, Triple Zero. Drawing on examples from other public health initiatives, this article explores how the language of ‘zero disease’ or ‘endgame strategies’ is appealing to certain audiences but how it can also be misleading and have unexpected and unintended consequences. Depending on the specific characteristics of the disease, the disease vectors, and the circumstances of transmission, ‘zero’ disease is rarely an achievable goal. In addition, when a disease is said to reach ‘zero,’ it is important to consider the possible implications for people with social, physical, or emotional sequeläe from the disease and who still may require follow-up treatment and care.

KEYWORDS:

• Leprosy
• Hansen’s disease
• medical anthropology
• public health campaigns
• infectious disease

Acknowledgments

I would like to thank the NGO representatives, physicians, social scientists, and people who have been affected by leprosy, some of whom are also activists and researchers themselves, with whom I have discussed some of my ideas for this paper. Thanks especially to Dr. Reinaldo Belcher, Dr. Claudio Salgado, Dr. Carlos Franco-Paredes, Dr. Jessica Fairley, Mathias Duck, and Dr. Judith Justice. Thanks to Dr. Richard Parker for sharing his co-authored paper (Kenworthy et al., 2018) with me, as it validated many of my thoughts on this topic. Thanks to Georgia State University anthropology M.A. candidate Megan Sarmento for help with proofreading and editing.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

I have received funding from the Sasakawa Health Foundation (part of the Nippon Foundation) and the American Leprosy Missions for attendance at international conferences in the past. I was also part of a sub-group of researchers, social scientists, physicians, and others working on the Global Partnership for Zero Leprosy. I participated in a working group on disability and an ‘operational excellence group’ on the topic of stigma reduction.