Jimmy Carter made eradicating Guinea worm disease a top mission

JARWENG, South Sudan (news agencies) — Nobel 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 3-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 Center, 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 toward 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 media 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 center 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 Center.

The World Health Organization’s target for eradication is 2030. Carter Center 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 traveling 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 emerged from her left leg.

The center’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 Center 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 center’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 U.S. Centers for Disease Control’s smallpox eradication program and the CDC itself before becoming The Carter Center’s first executive director.

Those who worked closely with Carter suspect 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 center’s health programs until 2015. “He could sympathize with all of these farmers being too crippled from Guinea worm disease to work.”

There’s 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’re 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 behaviors.

Workers from the center and host governments trained volunteers to teach neighbors 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.