Further comments on leprosy vaccination
To the Editor:
We would like to make several points with reference to the Letter to the Editor entitled "Comments on Leprosy Vaccination" by Dr. L. Kato (1). The comments and views expressed by Dr. Kato arc interesting and, unfortunately, true.
Without a doubt efficient and prompt multidrug therapy (MDT) is promising. There remains an urgent need for even more potent antileprosy drugs which will enable even shorter treatment and even faster cure. Nevertheless, it is universally understood that MDT alone is not enough for leprosy control. However, we do believe that we can cover the maximum number of multibacil-lary (MB) leprosy patients in a much shorter time with presently available, short-term MDT. This will enable us to save manpower and financial resources to apply to intensive health education and early case detection in order to hopefully more rapidly interrupt transmission (2). Nevertheless, there is no substitute for an effective and specific vaccine against leprosy. Until such time as a leprosy vaccine has been proven, however, we cannot afford to allow widespread coverage of controversies in the design of research trials of potential antileprosy vaccines to jeopardize our field control programs. Recently, in our country coverage of leprosy vaccine trials in the lay press have become regular features. Frequently the leprosy researcher who is being interviewed, in his enthusiasm for his own project, is led to criticize other projects. While we do not presume to render judgment on the scientific merits of candidate antileprosy vaccines, we arc concerned that the controversies reported in the lay press may have a destructive effect on field-level leprosy control programs. On the one hand, these reports raise false hopes that antileprosy vaccine and its benefits, resulting in leprosy patients not cooperating with their regular treatment in light of the availability of a vaccine. On the other hand, controversy and criticism of other candidate antileprosy vaccines could easily result in individuals not accepting trials of these vaccines. In the absence of scientifically valid field trials comparing the candidate vaccines, the best antileprosy vaccine can never be determined. If media exposure of controversies in vaccines continues to be widespread, the negative attitudes it causes in society at large will definitely have an adverse effect on our well-established antileprosy programs. Without cooperation and the much-needed participation of society as well as patients, achieving leprosy control will be impossible.
With all due respect, appreciation, and admiration for the noble efforts of researchers in vaccine development, we would like to plead that they limit their vaccine propaganda in the lay press and initiate no scientific controversy in the open press. We feel that if this confuses laymen, it may ultimately lead to mass noncooperation from the public in our various field activities. Controversial findings should, of course, be published, but we feel these controversies should be restricted to the leprosy journals. Such an action by antileprosy vaccine researchers will be of great help to our field programs. We feel workers are very much concerned about the potentially bad effects of this media coverage. We do not take the liberty of interfering with anyone's freedom of expression but do strongly believe that if this freedom of expression in the lay press has an adverse effect on our leprosy control efforts, then it should be our concern. We solicit the cooperation of researchers attempting to develop a safe and effective antileprosy vaccine and sincerely wish them complete success in the very near future.
We are grateful to Dr. L. Kato for opening this subject in this journal and inspiring us to share our views.
- A. B. Prabhavalkar
Public Relations Advisor
- Jayadas Chacko
Program Director
- Dr. R. K. Kharkar
Medical Superintendent
Maharashtra Lokahita Seva Mandal
1/1 Himalaya Apts.
Santacruz (E)
Bombay 400055, India
REFERENCES
1. Kato, L. Comments on leprosy vaccination. (Letter) Int. J. Lepr. 57(1989)693-694.
2. Li, H.-Y., Yu, X.-L, Zhang, M.-S., Duan, C.-X., Huang, W.-B., Zhang, S.-B., Zhu, K. and Ma, J.-F. Short-term multidrug therapy in multibacillary leprosy-review of 80 cases in two provinces of China (1983-1988). Int. J. Lepr. 57(1989)622-627.