In this Nov. 4, 2010 photo, children collect drinking water from a pond using filters provided to them by The Carter Center's guinea worm eradication program in the remote village of Lengjak, in Awerial County, Lakes State, Southern Sudan.Maggie Fick/The Associated Press
“I would like to see Guinea worm completely eradicated before I die,” Jimmy Carter said back in 2015.
With his death on Sunday at the age of 100, the former U.S. president’s wish didn’t come true. But it’s tantalizingly close.
So far in 2024, there have been only seven cases of the parasitic Guinea worm disease detected worldwide, down from more than 3.5 million in 1986 when Mr. Carter began his seemingly quixotic quest.
When Guinea worm is wiped off the planet, it will become only the second human disease in history that has been eradicated, after smallpox. It’s a remarkable achievement, but it’s just one small part of Mr. Carter’s legacy.
Most remarkable of all, eradication will be achieved without the benefit of a vaccine, treatment or even a diagnostic test. Just old-fashioned, low-tech measures, coupled with community involvement – public health at its finest.
Guinea worm is usually spread by drinking stagnant water infected with tiny crustaceans called copepods (or water fleas) that contain Guinea worm larvae. When the copepods are ingested, the person’s stomach acid breaks them down while the Guinea worms can procreate and survive, eventually breaking through the infected person’s digestive tract and migrating to exit the body through the skin. There, a blister forms and bursts, causing searing pain.
Guinea worm is also known as dracunculiasis, Latin for “affliction with little dragons.” To relieve the pain caused by the blisters, sufferers often dunk their infected parts in water, releasing more eggs and starting the cycle anew.
The only treatment is to grasp a worm that has emerged from the skin and extract it slowly using a small stick. While Guinea worm is not fatal, it can be debilitating.
The parasitic disease has been around for millennia and was once commonplace. In 1940, there were an estimated 48 million cases worldwide, but improvements in sanitation solved the problem. Today, Guinea worm persists only in the world’s most misery-stricken countries such as Chad, Angola and South Sudan, where clean drinking water is a rarity.
When the Carter Center was founded, the ex-president was determined to tackle issues that others didn’t want to address, including neglected tropical diseases.
The only way to tackle Guinea worm in some of the poorest, most remote parts of the world was by using simple and cheap prevention measures. The Carter Center initiative focused on four approaches: supply fine mesh cloth and mesh-lined straws that filtered out copepods; treat stagnant water with the larvicide temephos; build protective walls around wells and ponds to keep infected people from bathing in them; and investigate each case detected to better understand and address the cause.
It is estimated that at least 80 million cases of Guinea worm were averted as a result. Eradication is within reach, though the fairly recent discovery that animals like dogs and baboons also carry Guinea worm complicates the task.
Most important of all, however, was that communities were invested in the programs. They were run locally, not by outsiders. The Carter Center just provided the expertise and money – about US$500-million since 1986.
While Guinea worm gets all the attention, the Carter Center has been simultaneously tackling other neglected tropical diseases, including: onchocerciasis (or river blindness), a parasitic worm disease contracted from the bite of a black fly which causes blindness and unbearable itching; trachoma, a bacterial infection that causes the eyelashes to grow inward, causing irritation of the cornea, intense pain and blindness; schistosomiasis (or snail fever), contracted through contact with contaminated water housing the larvae of the parasitic flatworm, the infection of which damages internal organs like the bladder, liver and colon; and lymphatic filariasis (elephantiasis), a parasitic worm that lodges in the lymphatic system, causing gross swelling of body parts like the arms and legs.
Again, the approach has been to invest in simple, low-tech solutions like mosquito nets and building latrines. Mr. Carter once self-deprecatingly called himself “the most famous latrine builder on Earth.”
Programs to address these infections are important but also provide a touchpoint with public health that creates a ripple effect, allowing children to be vaccinated, women to get maternal care and more.
Mr. Carter had a remarkable life, marked by a dramatic presidency focused on peace and a post-presidency that set a standard for humanitarianism. He literally changed the lives of hundreds of millions of people.
Through his actions, Mr. Carter also reminded the world that no disease is too obscure to address and that no person, no matter how poor, should be forgotten. He was, in many ways, the embodiment of the principles of public health.
In these selfish, every-man-for-himself times, when self-aggrandizement passes for leadership, Mr. Carter’s impact and humility are worth recognizing and celebrating.