Enumerating the Temporal Politics of Leprosy Elimination Campaigns

Abstract

The World Health Organization has declared leprosy eliminated as a public health problem in Africa, with “elimination” defined as a prevalence rate of less than one case per 10,000 people. Subsequently, most planning, training, and service provision for leprosy ceased, as did funding for new research despite ongoing uncertainty over how the disease is spread or how to deal with multi-drug resistance. I draw upon archival research, ethnographic fieldwork in Tanzania, and scientific debates to demonstrate the material-semiotic effects of numbers in this “elimination”. I argue that practices of enumeration in leprosy elimination campaigns enact a temporal structure that anticipates leprosy’s immanent disappearance and therefore justifies a whole set of medical, institutional, and political practices built around this expectation. These concerns are explicit for scientists who debate what counts and how to count it: for instance, in a series of correspondences in the Lancet, researchers working for Novartis enumerated an always-immanent elimination, while field researchers in Brazil drew on other arithmetics to caution against the potential problems of this approach. Finally, I discuss the experience of Luka, one of my interlocuters with leprosy in Tanzania, whose existence became a (numerical) problem for his doctors, one that they ultimately resolved by fabricating negative test results in order to record what they already knew: leprosy has been eliminated. I conclude by asking if leprosy elimination campaigns—and the temporal politics enumerating them—may have dire consequences for people with leprosy today, impeding rather than enabling the disappearance of the disease.