Another cause for serious concern is that the coalition that stands against leprosy is not as solid as it should be. In 1999, the Global Alliance for the Elimination of Leprosy (GAEL) was formed to inject new energy into the elimination campaign, bringing together WHO, the governments of the major endemic countries, the Japanese Nippon Foundation, the Novartis Foundation for Sustainable Development, the Danish Development Cooperation Agency (Danida), and the International Federation of Anti-Leprosy Associations (ILEP). Quite soon, major contrasts emerged between some of the GAEL partners, namely between WHO and ILEP, who always remained critical of the “elimination”-focussed strategy. The clash was so strong that ILEP was expelled from the alliance at the end of 2001.Later on, probably in response to the increasing pressure to achieve leprosy control, WHO invited an independent team of experts led by Richard Skolnik, former Director of the Center for Global Health at George Washington University (Washington, District of Columbia, United States), to evaluate the GAEL. The evaluation report, published in 2003, recommends that WHO should take leprosy activities beyond 2005, dropping the “elimination” goal in favour of “an explicitly broad-based approach to the control of leprosy, the avoidance of nerve damage, and the rehabilitation of those in need”. The team also explicitly called for the reconstitution of a refined alliance, where “collaborators will have to work more openly, collegially, and inclusively”.
There are signs that this new alliance is emerging. “The process of dialogue and collaboration with WHO headquarters in Geneva has already been reestablished and is improving constantly,” says Sunil Deepak, president of ILEP and medical director of the Italian leprosy NGO Associazione Italiana Amici di Raoul Follerau (AIFO). Deepak adds, “We are very optimistic about further strengthening of this collaboration”. Feenstra confirms that stakeholders are exploring new ways of dialogue. “WHO is currently, in collaboration with its partners, ILEP, The Nippon Foundation and Novartis, developing a new strategy for the period 2006–2010 for sustaining quality leprosy control activities,” he says.