In Conversation with Dr Pannikar, Team Leader, Global Leprosy Programme

Mr Vijaykumar Pannikar, who has been Team Leader of the World Health Organization’s Global Leprosy Programme since March 2005, retires at the end of November 2009. In a rare free moment, Dr Pannikar kindly agreed to an interview. Here follow his thoughts and reflections shared during that conversation.

After obtaining a degree in medicine, one of your first roles was as a Medical Officer at the Dr Bandorawalla Leprosy Hospital in Pune. Had you hoped to work with people affected with leprosy?

No. I actually wanted to be a physicist and space scientist. Medicine was my parent’s choice.  Once I got in then I decided to do something different from my colleagues who all went on to become surgeons and physicians.

My second love was teaching and that lead me to join a medical college as a lecturer in anatomy.  During this period, I met the chief trustee of the non-governmental organisation (NGO) which was running Dr Bandorawalla Leprosy Hospital in Pune.  They were desperate to get a doctor to look after some 500+ resident persons affected by leprosy and daily out-patient department services. Their last one had met an unfortunate death - allegedly at the hands of inmates!  It was a challenging situation for me. I decided to join until they found another resident doctor.

Once I had joined and started to understand the feelings, aspirations, hopes and sorrows of those incarcerated there (some for more than 50 years), I fell in love with all the inmates to the extreme chagrin of my family and friends.

What do you consider your most significant contribution to anti-leprosy work during your career?

As I mentioned my love of teaching and love for persons affected by leprosy made my work a pleasant experience.  In my opinion, being the Team Leader of the first chemotherapy field trials on WHO-recommended multi-drug therapy (MDT) in early 1980 till I left in 1990 was a major piece of work (or undertaking).

In your opinion, what has been the most important scientific finding about leprosy so far?

I think the introduction of MDT is probably the most important thing that has happened in the history of controlling leprosy. It provided a cure and with it has brought hope to what was once a hopeless situation.

What could research still reveal, for example in the development of a vaccine combined with knowledge obtained from genome-mapping, in the prevention of nerve damage and other areas?

We must strive to get a tool to prevent leprosy if we want to achieve eradication. It could be a vaccine or an oral drug, which can be given to populations in the endemic areas or those at risk. It would be naïve to think of eradication without a preventive tool.

At the close of the National Leprosy Programme Managers’ Meeting held in New Dehli, 20^th – 22^nd April 2009, to discuss the finer details of the global leprosy strategy for the years 2011-2015 you quoted the Reinhold Niebuhr Serenity Prayer: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference…”.Can you elaborate on how such an approach has assisted you in leading the Global Leprosy Programme?

In fact, my favourite prayer of all time comes from Upanishads, collectively known as Vedanta or end of Vedas (800-2000 BC).  It is in our ancient language Sanskrit and goes as follows:

Asato Ma Sat Gamayah, Tamaso Ma Jyotirgamayah, Mrityo Ma Amritam Gamayah, Om Shanti Shanti Shanti. (Brihadarnayaka Upanishad 1.3.28)

It means: God lead us
From unreal to real, from darkness to light and from death to immortality.

I have found that the Serenity Prayer has given the same message about finding the truth.

And the truth is that there are things we can improve and there are those we have to accept as they are.  I learned that if you want to know the difference between what can be changed and what cannot, you need to discuss with others, debate and use the wisdom generated to make one’s decision.  A meeting or workshop, for me, must have this as its basic objective and I use it all the time.  If we start doing what is possible, we will find that in the end nothing is impossible.

The Enhanced Global Strategy for Further Reducing the Disease Burden Due to Leprosy for the period 2011-2015 is a remarkable example of a strategy that has been developed by consensus and widely endorsed. How did you manage the participation and contributions of so many stakeholders?

I think the answer is in the previous section. As a doctor and as a teacher I always found time to listen to others and say as little as possible.  It has helped me throughout my life.

One of the key elements of the Enhanced Global Strategy that will guide anti-leprosy work for five years from 2011 is to foster supportive working relationships with partners at all levels. Could you comment on why collaboration and partnership are now more important than ever?

The priority for leprosy is dwindling very fast in many areas, such as political, financial and even professional commitment.  There is a real danger that governments, NGOs and even WHO will withdraw from leprosy work or, at least, drastically reduce support. Unless a dedicated group of individuals and organizations join together and raise their voices for continued support for people affected by leprosy, leprosy will really become a neglected disease and affected people will become destitute. Joining hands will give us the courage, strength and the wisdom we need.

Are there any elements of partnership that you personally consider more important than others? Is there an element without which partnerships would founder? 

Partnership is more than money. To me it is the vision that is most important.  The vision of where we want to go and how. Without a vision we will not achieve our dream.

Since your engagement with the Global Leprosy Programme there has been more widespread involvement of people affected by leprosy for example in helping to increase awareness about issues relating to leprosy and in raising the profile of the work of national leprosy programmes. Are there specific contributions they made to the new global leprosy strategy that might have been missed otherwise?

Global Strategy has always included the voices and aspirations of affected persons.  However, previously we included what we perceived as their needs, wishes and aspirations based on our own experiences and so on. I am sure it is true for all organizations. We all want a better quality of life for people affected by leprosy.  I only made this involvement more formal by listening directly to them. My wish is that this will continue and be strengthened further.

What about the community? Can they not be a significant partner in promoting acceptance of people affected by leprosy and in increasing awareness of facts about leprosy?

No programme will succeed unless it has the blessings of the community. I believe that in this competitive environment, leprosy will not get noticed with our limited and often crude efforts to create community awareness. A professional mass campaign will be too expensive and unsustainable. I think we should institutionalise IEC activities as part of control programmes and focus on small groups in endemic areas.  Of course, when the objective of the IEC is for fund raising then professional approach will be beneficial.

Could the internet, with its ability to create super-communication, play a role in helping to eliminate discrimination against people affected by leprosy and help bring about changes in behaviour towards them?

Certainly. I am perplexed that we still are shying away from using this wonderful technology. It can be useful in IEC, stigma reduction and most importantly in telemedicine. Many problem cases can benefit if experts are willing to answer questions and suggest management of difficult cases. As the coverage and accessibility to the internet expands it will become an important tool.

Is there a danger that some could be left behind for lack of, or lack of access to, new technology?

This is particularly true for developing countries where development is as unevenly distributed as the wealth. I do not know if this problem can be solved by us as this is a wider issue of overall development and its fair distribution by governments.

How much of a threat is there of a steep rise in cases of leprosy in urban settings where populations are predicted to rise rapidly in coming years? 

The global population is already largely urban. In fact, more than 50% of it is urban.  And this will continue to increase. In many ways the urban environment is relatively more polluted than the rural population. The risk of diseases, particularly communicable diseases, is higher due to the population density. Therefore, in my opinion, the spread of any communicable disease will be much faster and wider in such a setting. 

In addition, urban health services remain disorganised in most of the developing countries, resulting in poor access and questionable quality of services.

All these factors make control of leprosy in urban settings a formidable challenge.

In an article drafted jointly with Dr Pieter Feenstra and published in Leprosy Review in 2005*[1], the partnership between WHO and ILEP was noted to have often been exemplary to other disease control initiatives. Can you expand on this? Are there any aspects you would like to single out?

Most partnerships are limited to financial arrangements; some are linked to common objectives and others to joint working arrangements.  To me ILEP and WHO share more than all of these. We share a common vision for the world. It will not be diminished or influenced by money or activities.

What are your thoughts on the direction of the ILEP/WHO programme of collaboration as regularly reviewed under official relations?

Partnership also brings responsibility and accountability. We must work together and show to others the results of our collaboration. The most important area is in long term activities such as surveillance of drug resistance and national capacity building.

How prominent a role do you see ILEP playing in the coming years?

In my opinion, ILEP was there before, and will need to be there after other partners move out.  I wish to see a strong ILEP with a clear vision and policy to see the end of leprosy in the 21^st century.

In your lifetime, how much further do you predict we will come in realising our dream of a world without leprosy? Please explain your reasoning behind this.

I do not have a definition for the term “A world without leprosy”.  To some it is eradication, which is impossible given the currents tools and current research agenda.  To others it may mean a discrimination-free or even disability-free. To me all are valid dreams. However, each one will need special efforts and joint efforts by all partners.

Which people affected by leprosy have inspired you in your life?

Each and everyone I met and listened to in my travels around the world. They all are wonderful people.

What will be the first thing you do on your first day of retirement? Do you have any other plans you’d like to share with our readers?

First I want to correct a life-long mistake that is to be near my better-half who never complained but felt neglected. My first day’s plan is to join her in cooking and having meals together.

I am moving to a very small village in Tamil Nadu (population about 3000).  My family and I will carry out some free medical work, spend time teaching children and generally be useful to our new community, including paying visits to NGO leprosy centres around us.

Dr Vijaykumar Pannikar 

• Dr Pannikar has been actively involved in leprosy work for over thirty years. He worked during the 1970s and 1980s at both the Dr Bandorawalla Leprosy Hospital in Pune and the Schieffelin Centre in Karigiri before becoming a key figure in the Global Leprosy Programme of the World Health Organization at first as part of the team in Geneva and then taking over as the Team Leader of the Global Programme from 2005 up until his retirement, based at the South-East Asia Regional Office in New Delhi.
• Dr Pannikar has played a crucial and active part in the global achievements of the WHO Leprosy Programme and, in particular since 2005, he has been extremely influential in giving guidance and direction to National Leprosy Programme Managers and NGOs in ensuring that the achievement of leprosy elimination could be built upon through collaborative partnerships and efforts to ensure the sustainability of leprosy control world-wide. In the WHO Global Leprosy Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities 2006-2010 he has steadfastly championed the process of integration of leprosy control into general health services, the collaborative partnerships required to mobilise expertise and resources and has continued to stress the crucial need for approaches based on equity and social justice.
• During 2009 he has overseen the successful adoption of the Enhanced Global Strategy for Further Reducing the Disease Burden Due to Leprosy 2011-2015. This Strategy has, with Dr Pannikar’s insistence and perseverance, been developed consensually and in collaboration with governments, NGOs and people affected by leprosy themselves. He has also set in train the procedures and processes which have helped reaffirm the political commitment to leprosy control and have asserted the important role that persons affected by leprosy have to play in leprosy services, especially in the areas of advocacy, awareness and rehabilitation. Mr Douglas Soutar, General Secretary of ILEP, says “Dr Pannikar’s commitment and his unshakeability in what he believes is the way forward for sustainable leprosy control and is evidence of a humanity and spirit that Gandhi himself would have been proud of”.

Photo:
Dr V Pannikar during National Leprosy Programme Managers Meeting in New Delhi on Leprosy Control Strategy in April 2009 © ILEP