Jimmy Carter made eradicating Guinea worm disease a top mission

JARWENG, South Sudan (AP):

Noble Prize-winning peacemaker Jimmy Carter spent nearly four decades waging war to eliminate an ancient parasite plaguing the world’s poorest people.

Rarely fatal but searingly painful and debilitating, Guinea worm disease infects people who drink water tainted with larvae that grow inside the body into worms as much as three feet long. The noodle-thin parasites then burrow their way out, breaking through the skin in burning blisters.

Carter made eradicating Guinea worm a top mission of The Carter Centre, the nonprofit he and his wife, Rosalynn Carter, founded after leaving the White House. The former president rallied public-health experts, billionaire donors, African heads of state, and thousands of volunteer villagers to work towards eliminating a human disease for only the second time in history.

“It’d be the most exciting and gratifying accomplishment of my life,” Carter told The Associated Press in 2016. Even after entering home hospice care in February 2023, aides said Carter kept asking for Guinea worm updates.

Carter died Sunday at age 100.

Thanks to the Carters’ efforts, the worms that afflicted an estimated 3.5 million people in 20 African and Asian countries when the centre launched its campaign in 1986 are on the brink of extinction. Only 14 human cases were reported across four African nations in 2023, according to The Carter Centre.

The World Health Organization’s target for eradication is 2030. Carter Centre leaders hope to achieve it sooner.

That meant recently returning to Jarweng, in a remote area of South Sudan in northeastern Africa. The village of 500 people hadn’t seen Guinea worm infections since 2014 until Nyingong Aguek and her two sons drank swampy water while travelling in 2022. A fourth person also got infected.

“Having the worm pulled out is more painful than giving birth,” said Aguek, pointing to scars where four worms had emerged from her left leg.

The centre’s staff and volunteers walked house-to-house distributing water filters and teaching people to inspect dogs, which can also carry the parasite.

“If someone’s hurt, The Carter Centre will help,” said villager Mathew Manyiel, listening to a training session while checking his dog for symptoms.

In the mid-1980s, global-health agencies were otherwise occupied and heads of state largely overlooked the illness afflicting millions of their citizens. Carter was still defining the centre’s mission when public-health experts who had served in his administration approached him with a plan to eliminate the disease.

Only a few years had passed since the WHO declared in 1979 that smallpox was the first human disease to be eradicated worldwide. Guinea worm, the experts told Carter, could become the second.

“President Carter, with a political background, was able to do far more in global health than we could do alone,” said Dr William Foege, who led the US Centres for Disease Control’s smallpox eradication programme and the CDC itself before becoming The Carter Centre’s first executive director.

Those who worked closely with Carter suspect that Guinea worm’s toll on poor African farmers resonated with the former president, who lived as a boy in a Georgia farmhouse without electricity or running water.

“Nobody was doing anything about it, and it was such a spectacularly awful disease,” said Dr Donald Hopkins, an architect of the campaign who led the centre’s health programmes until 2015. “He could sympathise with all of these farmers being too crippled from Guinea worm disease to work.”

There is no vaccine that prevents Guinea worm infections or medicine that gets rid of the parasites. Treatment has changed little since ancient Greece. Emerging worms are gently wound around a stick as they are slowly pulled through the skin. Removing an entire worm without breaking it can take weeks.

So instead of scientific breakthroughs, this campaign has relied on persuading millions of people to change basic behaviours.

Workers from the centre and host governments trained volunteers to teach neighbours to filter water through cloth screens, removing tiny fleas that carry the larvae. Villagers learned to watch for and report new cases — often for rewards of $100 or more. Infected people and dogs had to be prevented from tainting water sources.

The goal was to break the worm’s life cycle — and, therefore, eliminate the parasite itself — in each endemic community, eventually exterminating Guinea worm altogether.

The campaign became a model for confronting a broader range of neglected tropical diseases afflicting impoverished people with limited access to clean water, sanitation, and healthcare. Expanding its public-health mission, the centre has supplied training, equipment, and medicines that helped 22 countries eliminate at least one disease within their borders.

Mali became the latest in May 2023 when the WHO confirmed that it had ended trachoma, a blinding eye infection. Haiti and the Dominican Republic are working to eliminate malaria and mosquito-borne lymphatic filariasis by 2030. Countries in Africa and the Americas are pursuing an end to river blindness by 2035.