Is there a role for a vaccine in leprosy control?

‘Morbidity control’ is a recurring theme of a recent WHO report entitled “Global strategy for further reducing the leprosy burden and sustaining leprosy control activities: 2006–2010”. While the approach seems rational, based on our current tools for controlling leprosy (i.e., timely detection of new cases, treatment with effective chemotherapy, prevention of disabilities and rehabilitation), it also seems resigned to accepting a future with leprosy. Should we accept the ‘morbidity control’ paradigm or are there other approaches to be pursued that may provide new insight into leprosy control and possibly lead to interventions moving us along the path to eradication? I think most agree it is prudent to continue to support those strategies that are in place today but to insist on stringent evaluation of leprosy services and their results to ensure that integration of leprosy services is having the desired effect on the disease. Concomitantly, we must continue to pursue the search for new tools that, when applied appropriately, inform control practices leading to improved services and, eventually, the eradication of leprosy. At the top of my list of areas for continued and renewed study are the subjects of nerve damage, transmission and vaccines. In this commentary I will focus on the subject of vaccines. I will describe recent advances that are driving renewed interest in vaccine development for pathogens like M. leprae as well as address when and where a leprosy vaccine might be applied in a global strategy to eradicate leprosy.