Jimmy Carter, who has died at the age of 100, helped save millions from the debilitating parasite Guinea worm.

Jimmy Carter, who saved millions from Guinea worm, dies at 100

Written by Charles Schmidt Edited by Tanya Lewis

Former President Jimmy Carter first encountered people suffering from Guinea worm disease while visiting a village in Ghana in the late 1980s. This tropical disease involves infection by a parasite that eventually emerges from the human skin. The 39th President of the United States was shocked by the plight of people infected with the parasite. “Once you see a small child with a live Guinea worm, two or three feet long, sticking out of its body through its skin, you will never forget it…” he later wrote. “(Former First Lady) Rosalyn and I saw over 100 victims in just a few minutes, some with worms coming out of their ankles, knees, groins, legs, arms, and other parts of their bodies. It also included people who

Mr. Carter passed away on Sunday, December 29, in Plains, Georgia, after entering hospice care in mid-February 2023. His efforts to eradicate this terrible disease have improved the lives and well-being of many of the world’s poorest people. At the time of Carter’s first visit to Ghana, Guinea worm infections were averaging 3.5 million cases a year worldwide. But thanks to the efforts of the Carter Center, a nongovernmental organization (NGO) founded by former president and first lady Rosalynn Carter, who passed away in November 2023, the disease has been nearly eradicated. According to Sharon Roy and Vitaliano Cama, scientists at the U.S. Centers for Disease Control and Prevention who are collaborating with Carter, surveillance data shows that global cases in 2022 will spread to Chad, Ethiopia, South Sudan, and the Central African Republic. There were only 13 cases. center. If the number of infected people is reduced to zero, Guinea worm will become the second human disease in history (after smallpox) to be eradicated. These efforts are the result of Carter’s “bold vision, leadership, and ability to generate the political will to help end Guinea worm in affected countries,” Cama said.

The Carter Center began eradicating Guinea worm disease in 1986, five years after Carter left office, shortly after the World Health Organization (WHO) made it a target for global eradication. The disease is spread by drinking stagnant water infested with tiny fleas called copepods, which contain Guinea worm larvae. Although fleas die in the human intestines, Guinea worms survive unaffected by stomach acid and begin mating. Over the course of a year, the pregnant female worm develops into an adult worm and migrates toward the host’s skin. A blister quickly forms, and when it ruptures, the bugs begin to crawl out of the body. To relieve the burning pain caused by this, infected people often soak the affected area in water. In some cases, they may be immersed in the same pond or lake that others are drinking from. Once submerged, the worms respond by releasing eggs, and the hatched larvae are eaten by copepods and a new parasitic life cycle begins.

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There is no vaccine or treatment for Guinea worm disease, and people cannot develop immunity to it. The traditional strategy for removing emerging bugs was to wrap them around a stick and pull them a few centimeters per day. It is important not to pull the worm out too quickly, as the debris inside its body can cause a secondary infection if it breaks apart. However, the best defense is prevention.

To move toward eradication, the Carter Center organized NGOs, national health ministries, and donors around one overarching goal: providing clean drinking water to affected villages. Several simple interventions have proven to be highly effective. Village-based volunteers and supervising medical staff have built protective walls around wells and other water sources to prevent people from entering and spreading new infections. The Carter Center supplied villages with fine cloth to strain fleas from drinking water and personal filter straws. The stagnant water was treated with an insecticide called Temephos (which the WHO considers acceptable for use in drinking water), and the rumored infectious disease was tracked and investigated.

Over time, more and more countries joined this effort. Meanwhile, former President Carter “met privately with leaders of countries where the Guinea worm is endemic,” said Kashef Ijaz, deputy director of health programs at the Carter Center. In 1995, Carter brokered a four-month “Guinea Worm ceasefire” during the Sudanese civil war. The cessation of fighting has allowed health workers to distribute 200,000 cloth filters to impoverished areas, along with vaccines and treatments for other diseases such as river blindness, measles and polio.

“Guinea worm eradication programs may be the only point of contact between local populations and any kind of public health system,” says Jordan Schermerhorn, a global health expert based in Austin, Texas. Schermerhorn spent more than a year in 2016 and 2017 working as a technical advisor for the Carter Center in southern Chad, where he often travels by motorcycle to remote areas where people live in mud huts on barren land. . She and her colleagues visited each village in their jurisdiction about once a week to check for new cases and educate people on how to protect themselves from infection.

By this point, the eradication program had been a huge success. In 2016, only 25 human cases were recorded worldwide. But the program also faces new challenges. Scientists once thought that Guinea worm only infected humans, but now they are discovering it in other species as well. . The bug was first discovered in dogs and later in cats and baboons. More recent evidence suggests that frogs and fish may also carry the bug, but it is not clear whether these animals transmit the bug. In response, Carter Center staff urged villagers to report and tether infected dogs and to avoid eating undercooked fish. They hypothesize that these are the routes by which most people and animals are infected today.

Matthew Boyce, assistant professor of health policy and management at Texas A&M University, said it’s unclear whether Guinea worm is expanding its range or whether its findings in other animals simply reflect expanded disease surveillance. He says it’s unclear. “This may be a classic case of ‘the more you look, the more you find,'” he says. There is still no conclusive evidence that these animals can transmit the disease in the absence of a human host, which may make it difficult to completely eradicate them. Despite this, WHO has extended the target date for Guinea worm disease eradication from 2020 to 2030. Carter said at a 2015 press conference that he hoped the last of the Guinea worms would die before he died. Although that did not happen, Ijaz believes eradication remains an achievable goal. “The last mile is the hardest,” he says. “We must remain dedicated and more focused than ever.”