Structure of the 15th international leprosy congress
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To the Editor:
Having attended the 15th International Leprosy Congress it is essential that we consider its structure and program, regarding positive as well as negative experiences. I hope that this letter will be discussed in the Journal and, in this way, will contribute to adjustment and revision when the program for the next Congress is drawn up. My main points are as follows:
Presentation and discussion of MDT. I appreciate, of course, the tremendous impact of the extensive application of multidrug therapy (MDT) during recent years including the World Health Organization's intense work on this matter. The decrease in prevalence figures of leprosy is impressive.
However, a Congress of this kind should not only present descriptions of the current situation regarding, in this case, MDT and prevalence figures of leprosy, it should also be a forum for discussion and in-depth consideration of current problems and questions. In my view there was insufficient room for the latter in Beijing.
We are still faced with important questions regarding MDT and its effect. This concerns for example: a) occurrence of reactions in a significant percentage of individuals after cessation of MDT (including their importance for the individual patient and for the attitude of patients concerning treatment); pathogenesis of these late reactions; transmission of infection and b) how will different mechanisms affect the incidence at a time when the prevalence figures have decreased so remarkably? These are but a few examples. A lot of people would feel more certain about the impact and future application of MDT if questions such as these would have been discussed and considered in depth.
Sustainability of leprosy services under the new conditions of low prevalence is also a burning question. There is an extensive infrastructure in the leprosy-endemic countries, and it would be a great loss if this structure would be lost. How should it be used to be retained? I am surprised that this question was discussed only to a limited extent and not in depth.
Balance between leprosy research and other matters. To obtain a proper balance between presentation of current activities in leprosy research and current issues more related to therapy, disease control, social aspects and rehabilitation are essential. This is, of course, difficult.
In my view, more time and effort should have been given to the presentation and discussion of current developments in leprosy research.
Dr. Stewart Cole gave a truly excellent talk, but was only given 15 minutes under the title "Genome Projects." This was deeply disappointing considering the development in this area and the profound importance of in-depth studies and comparison between the genomes of Mycobacterium tuberculosis , which has been completed, and M. leprae which is quite close to completed.
Dr. Patrick Brennan talked of his concern relative to the brain drain from leprosy research being evident during recent years which is a very serious issue. The 15th International Leprosy Congress should have been used more actively to counteract this tendency! One way to do this would have been to put more emphasis on the recent remarkable developments-such as our increased knowledge of the protein antigens of M. leprae and an in-depth comparison of the genomes of M. tuberculosis and M. leprae and what is expected to result from this type of work.
Allocation of "Oral Presentation of Accepted Papers." The way this was done represents my most serious criticism concerning practical arrangements during the Congress. The same view was expressed to me by many of the participants.
To take a few examples: Control and Eradication: All five sessions in one day; Epidemiology: All three sessions in one day. My own key areas of Immunology, Microbiology, Pathology: All five sessions in one day.
It was expressed to me by people involved in preparing for the Congress that the new format of the workshops had interfered, causing major problems. This is no excuse or, at most, should have caused problems for only one day. In addition, the workshop attendance was limited and closed and should hardly have been allowed to affect the rest of us in such a way.
This is a personal experience, but amply illustrates the point: I presume that the combined subjects of Immunology, Microbiology, and Pathology are quite important related to our basic understanding of leprosy and, thus, to our hope of coping with the disease. Being Co-Chairman of Microbiology II on Tuesday, this decided what I could do since there were no other oral presentations referring to these subjects on any other day of the Congress!
If the wish is to decrease the contribution of basic scientists to the program and their attendance at the International Leprosy Congresses in the future, I am afraid this is just the way to do it. Hopefully, this was not the intention.
The structure of the program needs to be fully revised regarding this matter for the next Congress.
Attendance at sessions with oral presentation of accepted papers. To take but one example, our session contained 14 papers; four of them were not presented.
Others who were specifically indicated in the program to present oral papers did not show up in other sessions as well, so this poor attendance was an unfortunate general observation. This "No Show" makes it very difficult, or almost impossible, to benefit from trying to go from one session to another to listen to papers of interest.
In this age of continuously improving electronic communication my specific suggestion is as follows: a) As of now, papers are accepted for oral presentation based on submitted abstracts from individual authors with an evaluation of their quality, b) The presenting author is informed about this decision, but c) within a defined date, e.g., 2 months prior to the Congress, the author is asked to confirm and guarantee that the paper will be presented at the indicated session. If this cannot be guaranteed, the paper will be transferred to a poster session where a "no-show" is far less damaging. If such a procedure is established, the number of authors who will not show up would be significantly lower, and people may then go safely from one session to another assuming that they will be able to benefit from those sessions, d) If unforseen absentees are still a problem, the Chairperson of the sessions should be instructed and required to use the "free" time for discussion, thus making every effort to keep to the timetable so people can go from one session to another.
Training sessions. I was several years ago involved in primary discussions leading to the introduction of Training Sessions at the International Leprosy Congresses.
It was good to learn and see that training sessions continue to be an important part during the 15th Congress. They were well attended with great interest, and it is essential to uphold this activity.
List of participants. If a list of participants, including addresses, could be prepared at the next Congress, this would be of great benefit and stimulate further contact and interaction between participants after the Congress.
- Morten Harboe, M.D., Ph.D.
Institute of Immunology and Rheumatology
University of Oslo
Fr. Qvams gate 1
N-0172 Oslo, Norway