Different historical approaches to leprosy in the Asia‐Pacific

Leprosy, or Hansen disease, is a greatly feared infection of Mycobacterium leprae whose neuropathy induces disfiguring injuries subject to great social stigma. Historically, Australia largely confined its few leprosy patients to remote leper colonies (leprosaria) or in quarantine hospitals. The Philippines and the Dutch East Indies (now Indonesia) had much larger infected populations in the early 20th century and required alternative approaches. The US military government of the Philippines chose actively to identify and confine all leprosy patients to segregated colonies on remote islands. Although intended to eliminate transmission by quarantine, the lack of effective chemotherapy to render patients non‐infectious meant that the census of patients (≈5000) at the primary facility on Palawan climbed to the point that the colony could not be funded from the Health Department's budget. The Dutch government in the East Indies knew large leper colonies were unaffordable, so focussed segregation only in the capital Batavia and on plantations in Sumatra with the objective of minimising infection in the expatriate population. Neither approach was satisfactory largely due to resource constraints. Improved chemotherapy remains the best hope for the eventual elimination of leprosy.