A/HRC/38/42 Third period of the modern history of leprosy (1981–2010) 39. The third period of the modern history of leprosy began with Sheppard’s findings on a technique that allowed for growing Mycobacterium leprae in vivo. 35 This technique proved the primary resistance to dapsone. Since primary resistance to dapsone might jeopardize the entire leprosy programme, in 1981, a group of experts from WHO developed a multidrug regime (dapsone and rifampicin — a powerful drug from the field of tuberculosis — for all patients, with clofazimine added for multibacillary patients). 40. From 1986 onwards, great efforts were made to expand the delivery of multidrug therapy. Between 1986 and 1990, the coverage of multidrug therapy saw an increase from 1 to 40 per cent.36 In 1991, the World Health Assembly adopted resolution WHA44.9 for the elimination of leprosy as a public health problem (defined as a registered prevalence of less than 1 case for every 10,000 persons) in the year 2000. By the end of 2000, the global prevalence of leprosy declined to less than 1 case for every 10,000 persons. In May 2001, WHO announced the global elimination of leprosy as a public health problem. 37 This was a time of great hope, in which the entire leprosy community believed that large-scale delivery of multidrug therapy would not only eliminate leprosy, but also the accompanying stigmatization and discrimination. 41. However, despite such impressive results on the prevalence of leprosy, trends regarding the transmission and detection of new cases did not follow as expected. It became increasingly obvious that leprosy incidence was linked to the social determinants of health, which required more than just a pharmaceuticalized 38 approach. In addition, stigmatization and discrimination hindered people from being diagnosed and treated, as well as from fully enjoying their civil, political, economic, social and cultural rights. 42. As such, during the first decade of the twenty-first century, awareness of the role played by stigmatization and discrimination as barriers to diagnosis and treatment (which had already been pointed out very clearly by leprosy experts as early as 1984 in New Delhi),39 grew among the key stakeholders. Consequently, this became the decade in which evidence demanded an approach to leprosy as a biosocial phenomenon. The acknowledgement that leprosy remained a medical and social problem in contemporary societies called for an intersectoral approach, which is still to be elaborated and put into practice by leprosy programmes. 43. The first decade of the twenty-first century ended with two historical breakthroughs. First, in 2010, WHO introduced the guidelines for strengthening participation of persons affected by leprosy in leprosy services, acknowledging persons affected by leprosy as powerful agents of change. Second, the General Assembly adopted resolution 65/215 on the elimination of discrimination against persons affected by leprosy and their family members and noted the principles and guidelines for the elimination of discrimination against persons affected by leprosy and their family members that had been developed by the Human Rights Council Advisory Committee. This was the founding moment of the global acknowledgement of leprosy as a deep-rooted human rights issue. 44. After the global elimination of leprosy as a public health problem, its status as a neglected and forgotten disease solidified. As such, the beginning of the twenty-first century is characterized by an alarming lack of expertise to diagnose and treat the disease; and reduced funding for basic, clinical and operational research, as well as for tackling both the medical and social dimensions of the disease. 35 36 37 38 39 Lechat, “The saga of dapsone”, pp. 1–7. D. Daumerie, “Implementation of MDT: successive steps”, in Multidrug Therapy against Leprosy: Development and Implementation over the Past 25 years, H. Sansarricq, ed. (Geneva, WHO, 2004), pp. 45–67. H. Sansarricq, “The study group”, Multidrug Therapy against Leprosy: Development and Implementation over the Past 25 years, H. Sansarricq, ed. (Geneva, WHO, 2004), pp. 31–44. João Biehl, Will to Live: AIDS Therapies and the Politics of Survival (Princeton and Oxford, Princeton University Press, 2007). D.S. Chaudhury, “Global leprosy control: impact of new ideas and priorities”, in XII International Leprosy Congress. Proceedings (New Delhi, Printaid, 1984), pp. 858–860. 9