In 1980, the World Health Organization (WHO) succeeded in its campaign to rid the world of smallpox. It has never let anyone forget the fact since. And rightly so. Given the effort it took to eradicate this scourge, the WHO richly deserves to make certain that smallpox, though gone, is not forgotten. Lep­rosy, however, appears to have endured the opposite fate. This ancient blight is forgotten, but not gone - an unhappy predicament for its sufferers and for the WHO, which is still fighting against it.
So far, the WHO is committed to "elimi­nating" leprosy but not to "eradicating" it. That might seem a strange distinction to a layman, but in the argot, elimination is de­fined as a reduction in the number of cases in a population to below one per 10,000 peo­ple; eradication implies that no cases exist at all. The WHO Leprosy Elimination Programme, inaugurated in 1991, aimed to com­plete its task by 2000.
The campaign has made a lot of progress. It has reduced the number of people with the disease from more than five million to less than one million, and eliminated leprosy from 98 coun­tries. But several South-East Asian and Afri­can states, as well as Brazil, still report from four to six cases of leprosy per 10,000 people. So at the Asian Leprosy Congress in Agra, the target date for global elimi­nation was postponed to 2005.
A pity. But on the face of it, a five-year delay in "eliminating" a scourge that has horrified people since biblical times is a mere blip. There is, however, a fear that having al­lowed the deadline to slip once, the project's momentum may be lost - and even that the eventual result may be worse than if no grand plans had been laid in the first place.
The WHO originally accepted the idea of "eliminating" leprosy because in 1989, a sym­posium of experts decided that eradicating the disease was not feasible. In 1998, a work­shop convened by the Centers for Disease Control (CDC) in Atlanta, Georgia, echoed that advice. However, it added a new worry: that eliminating leprosy might not be possi­ble either. Given the current state of knowl­edge of the biology of the disease, these epi­demiologists argued, an elimination cam­paign could not guarantee to stop trans­mission, and thus keep the caseload down.
That is because a lot of basic information about leprosy is still missing. Doctors can­not, for example, diagnose it before a patient starts to show symptoms. Nor do they know how likely a treated patient is to relapse. More significantly, they remain unsure ex­actly how the disease is transmitted, how it infects the human body, and at what point a carrier of the bacterium may infect others.
As a result, and despite its success in treating those already infected, the cam­paign has not had much impact on the rate of new infections. That figure still exceeds 650,000 a year, or around 4.5 cases per 10,000 individuals in the worst-off countries; it has shown little sign of falling in the past 15 years.
The solution should be more research. Given the recent unraveling, by the Pasteur Institute in France, of the genome of Myco­bacterium leprae, the organism that causes the disease, science is better poised to carry out such research than ever before. But the loudly proclaimed 2000 deadline caused re­search funding to tail off. Funding bodies as­sumed that basic research into leprosy was becoming irrelevant, since the problem was being solved where it counted - in the field. So they turned their attention elsewhere. In 1990, for example, the International Federa­tion of Anti-Leprosy Associations spent $6.5m on research projects. By 1998, its spending had declined to $3m. A lot of nifty public-relations work is going to be needed to repair the damage.Fortunately, public relations is some­thing that leprosy officials seem to be good at. They have already been pretty successful at "rebranding" the infection as "Hansen's disease", at least in medical circles. The Han­sen in question, a 19th-century Norwegian doctor, did not, of course, recognize leprosy for the first time - the usual reason to dub an illness after an individual. But he did iden­tify Mycobacterium leprae, and that is good enough cover for the spin-doctors. Indeed, the Brazilian government went so far as to ban the "L" word completely, even in the names of aid organizations such as the British group LEPRA. Cynicism aside, there may be good med­ical reasons for abandoning the old term. Most illness attracts sympathy for the vic­tim. Leprosy often elicits repugnance. In some clinics, therefore, patients are now told only that they are suffering from a "skin in­fection", and may complete their recovery without ever learning the details. Indeed, there is evidence that not telling people the whole truth gives better results than leveling with them - perhaps because they can take their medicine openly, without having to lie to their family and friends to avoid the stigma of being branded a leper.
Rebranding may also come to the rescue of the Leprosy Elimination Programme. The latest talk is not of elimination, but of "very good control" - accepting, and being honest about, the fact that the disease will be around for the foreseeable future. As one participant in the CDC workshop remarked, "a number of us would like to eradicate the word elimination."
This would alter expectations again since "control" is not, like elimination and eradication, a euphemism for abolition. And that might backfire. For although the elimi­nation campaign put research funding on the back burner, it did, with its promise of an achievable goal, galvanize efforts in the clinic and the surgery. The WHO programme has already spent $50m and has another $50m pledged - but on the understanding that there is a clear end in sight. If the language changes again, and particularly if the 2005 deadline also proves a mirage, the WHO may have to work hard to keep the money flow­ing; 1980 was, after all, a long time ago. 

Q.1. What is implied by the phrase, "forgotten but not gone"?