Elimination of a disease sounds attractive, but as the recent re-emergence of polio has shown, it is difficult to accomplish. As part of its roadmap for reducing the burden of neglected tropical diseases, the World Health Organization has identified five diseases for elimination by 2015 and a further eight by 2020.1 Although setting these ambitious targets has the potential to focus money and resources, unless the targets are realistic they can have unforeseen consequences. We use the experience of the 1991 campaign to eliminate leprosy to show how targets can end up causing harm to patients.