Leprosy research-setting priorities and facilitating collaborations: a personal perspective

In recent years, as the prevalence of leprosy has declined and the tubercul osis epidemic has gained increasing attention, leprosy research has general ly taken a 'back seat' to research in tuberculosis and other emerging and r e-emerging infections. This has resulted as much from perceived differences of scientific opportunities in these fields as from differences of the dis ease burden. At the United States National Institutes of Health (NIH), rese arch priority setting is typically based on a number of factors. In the cas e of leprosy research, the technical difficulties associated with this scie ntific area have clearly lessened enthusiasm for and progress in this field . Today, however, we are confronted by the reality of not having sufficient scientific understanding to explain a stable or increasing number of lepro sy cases detected annually in the face of a dramatically decreasing total n umber of identified cases. We also lack adequate tools for diagnosis and pr evention. At the same time, new molecular and cellular approaches and knowl edge of the complete sequence of the genome of Mycobacterium leprae render leprosy research significantly more tractable than ever before. The combina tion of these factors has led a number of groups, including the National In stitute of Allergy and Infectious Diseases of the NIH, to review the curren t state of knowledge in leprosy research and draft recommendations for futu re leprosy research priorities. It is clear that many of the necessary and exciting research activities can best be addressed through collaborations a mong investigators, with control programmes, and among countries of high an d low endemicity.