Raelynn MEas

This chronic and often neglected disease of the skin and soft tissue typically begins painlessly. It usually begins as a small dermal papule or a subcutaneous nodule that may be easily overlooked. Without early treatment, it can extend to cover 15% of a person’s body surface, even destroying nerves and blood vessels. This disease often forms large, extensive ulcers that eat away flesh and bone, leading to permanent disability, social isolation, destroying the lives of those afflicted.

The Global Crisis

Buruli ulcer was first described in 1948, and is now recognized as a necrotizing cutaneous disease classified by the World Health Organization as one of the skin-related neglected tropical diseases. Buruli ulcer has been reported in 33 different countries, with the largest number of endemic cases in tropical and subtropical regions, including Central and West Africa, such as Benin, Ghana, Nigeria, Togo, and Liberia, among others. Cases have also spread to Australia, Japan, Central Papua New Guinea, and South America. The disease can affect any age group and demographic, however, children between the ages of 5-15 and poor rural communities are disproportionally affected.

What is most troubling is that after more than 75 years since its discovery, the mode of transmission remains unknown. Researchers suspect that it may follow infected mosquito bites, exposure to contaminated water, or contact with aquatic environments, but definitive proof remains unidentified, leaving prevention strategies out of reach and communities defenseless.

Systemic Failure

In endemic communities, this disease unleashes devastating social and economic struggles. In Central Cameroon, more than half of affected families were forced to withdraw financial support from their sick relatives due to high medical costs, leaving patients isolated and abandoned when they needed help the most. Health systems in rural areas often fail to effectively assist patients due to the high cost of laboratory machines and undertrained health workers. Oftentimes health care workers unfamiliar with the disease misdiagnose cases or report the disease too late. Additionally, environmental conditions also play a role. DNA evidence confirms the bacteria’s presence in the same contaminated water sources that communities depend on for bathing, washing clothes, and farming. Suspected insect vectors, including water bugs and mosquitoes, may also be silently transmitting the pathogen through bites. This is not just a disease. It’s a failure of systems.

Progress So Far

There have been a few recent advancements to provide better treatment options for Buruli ulcer. Efforts have been made to develop new molecules for treatment, with promising results emerging from the findings. Antimicrobial drugs have all shown effective results in eliminating M. ulcerans infections through different mechanisms. While there is no effective vaccine for BU, these emerging treatments offer hope for faster, more convenient treatment options. Additionally, there have been more community-based projects to tackle this disease, such as medical screenings, health education programs, and media campaigns. In 2010, medical items were donated to the Cameroonian company OBOM for the management of Buruli ulcer cases in suspected Buruli ulcer patients with nodules. These projects aim to raise awareness of Buruli ulcer and improve access to early detection and treatment in affected communities. However, there is still so much neglect and stigma, which is inhibiting full control of the disease.

What We Still Don’t Know

“We know the cause of the disease, but we need to know much more about how it is transmitted and spread.”

– Mr. Samuel Nuamah Donkor, Ghana Minister of Health, June 8, 1999

25 years after Minister Donkor called for urgent research into transmission, we still don’t know exactly how M. ulcers spread to humans, which insect vectors are most important, whether direct water contact, contaminated soil, or bites are the primary routes of exposure, efficient ways to lower the number of reports from areas where this disease hits most, how it spread to different areas of the world, and how to predict outbreaks before they begin.

The Breaking Point

The disease was first discovered in 1948. In the 1960s, more than 220 Rwandan refugees fell ill in a single settlement. In 1999, Ghana’s Health Minister stood before West African leaders and listed every challenge we face. Now it’s 2025, and Buruli ulcer continues to destroy lives. Although there has been some success, real progress remains limited. This is not just a medical failure. It’s a system failure. The medicine works, antibiotics exist, and early detection can save lives, but the systems meant to protect people are absent when and where they are needed most. If the root causes are identified, stronger strategies for prevention can be developed. Leaders must choose long-term commitment over repeated neglect, and researchers must focus on uncovering the still-unknown mode of transmission. These efforts could unlock effective prevention strategies and protect future generations.