FORGING THE CHAIN

R
86
FROM THEORY
TO REALITY
It is interesting how often a promising new medical
tool, as efficient as it may appear, turns out to be less
effective than expected.
Before 2004, the only way to treat Buruli ulcer was
to work on the consequences – to use radical surgery
to carve out the flesh that had been infected and
damaged.
After many trials, it was demonstrated that a combination
of known antibiotics, when administered early
in the course of infection, could cure patients. This
alternative to surgery was enthusiastically embraced.
WHO and its partners convened an international meeting
in March 2009 in Cotonou, Benin, and issued the
Cotonou Declaration on Buruli Ulcer calling for a new
treatment strategy based on early diagnosis and rapid
treatment with antibiotics.
But then the question arose of how to diagnose
cases early? The lesions of the disease just after infection
are too ambiguous to be identified with certainty
by health workers, and there is no accurate biochemical
test.
A possibility for such a test was identified and
supported by WHO based on detecting the toxin
(mycolactone) produced by the invading bacteria. The
concept was shown to be workable and preliminary
efforts to develop it yielded promising results.
But it may take significant efforts to go from a
preliminary diagnostic tool to one that can be manufactured
efficiently and used effectively in the field.
Financial support for concluding the process has yet
to be found.
Antibiotics are now used to treat Buruli ulcer, but
the promise of the therapy is not fully realized because
of continuing problems with diagnosis. As has been
the case before, resources are found and committed
to developing a new and better treatment with the
result that additional resources are required to truly
take advantage of it. The actual investment needed
proves to be greater than originally anticipated and the
funding (not surprisingly) dries up, stalling the achievement
of the full potential of a breakthrough.