Eliminating a disease is undoubtedly a positive achievement, typically signalling that a country is one step closer towards ridding itself of said disease entirely. However, this news brings with it the dangers of policymakers and populations becoming complacent – allowing for a potential resurgence.
The qualification for the classification of elimination is a reduction of disease cases to less than one in 10,000. Critically, this does not mean that the disease is entirely gone and that there are no remaining cases. Rather, it means that the number of cases is so low that chances of transmission are relatively small.
Lack of awareness of this definition is the core of the danger of resurgence. Elimination is often conflated with eradication, which is defined as the absence of any new cases of a disease within a country. Without knowledge of the difference between the two, many may believe that the disease is gone for good. The announcement of elimination can even influence funding to fight the disease. As the disease is no longer seen as the threat to public health it once was, funding from government and non-government bodies alike may fall.
“The announcement of elimination can even influence funding to fight the disease. As the disease is no longer seen as the threat to public health it once was, funding from government and non-government bodies alike may fall.”
Leprosy in India is a clear example of this. The disease was declared eliminated in 2005 in India., However, the disease is far from being eradicated and, in recent years, cases have resurged. The ongoing challenge of eradicating leprosy provides a clear example of inequalities within the Indian healthcare system. Some cases simply fall through the cracks due to the limited reach of infrastructure into rural areas.
Adivasis, a tribal people who form 8.6 percent of the population, bear the burden of 18.8 percent of all new leprosy cases. In states such as Gujarat and Tripura these people account for to two thirds of new leprosy cases.
Despite the announcement of elimination in 2005, the rates of leprosy in many areas now exceed the levels that qualify for the classification of elimination. The proportion of districts with prevalence exceeding one in 10,000 population has increased to 18.8 percent, up from 15.3 percent in 2012. This reflects the pitfall of disease elimination in a country as vast and geographically diverse as India, as rates of a disease may fall low enough that elimination can be declared at the national level while still occurring in significant numbers in some regions.
The Union Budget Speech, 2017 set out a goal of eradicating leprosy in India by 2018. With many states now having cases exceeding elimination standards, this is not a goal that is likely to be achieved. Complacency may well be one of the factors causing the steady increase in disease incidence since the declaration of elimination.