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Former president Jimmy Carter was touring villages in Ghana during the late 1980s when he first encountered people with Guinea worm disease. This tropical disease involves an infection with parasitic worms that eventually emerge through a person’s skin, and the 39th U.S. president was shocked by the plight of people infected by them. “Once you’ve seen a small child with a two- or three-foot-long live Guinea worm protruding from her body, right through her skin, you never forget it…,” he later wrote. “In just a few minutes, [former first lady] Rosalynn and I saw more than 100 victims, including people with worms coming out of their ankles, knees, groins, legs, arms, and other parts of their bodies.

”Carter died Sunday, December 29, in Plains, Ga., after entering hospice care in mid-February 2023. His efforts to eradicate this horrific disease improved the lives and well-being of many of the world’s poorest people. Guinea worm cases were averaging 3.5 million per year globally around the time Carter first toured Ghana. But thanks in large part to the efforts of the Carter Center, a nongovernmental organization (NGO) founded by the former president and former first lady Rosalynn Carter, who died in November 2023, the disease has been nearly stamped out. Surveillance data put the global tally at just 13 cases in 2022 spread across Chad, Ethiopia, South Sudan, and the Central African Republic, according to Sharon Roy and Vitaliano Cama, scientists at the U.S. Centers for Disease Control and Prevention, who work with the Carter Center. Should caseloads dwindle to zero, Guinea worm will become only the second human disease in history (after smallpox) to be eradicated. These efforts are a credit to Carter’s “bold vision, leadership and ability to create political will for supporting Guinea worm eradication in affected countries,” Cama says.

The Carter Center set out to eradicate Guinea worm disease in 1986, shortly after the World Health Organization (WHO) targeted it for global elimination and five years after Carter left office. The disease is spread by drinking stagnant water infested with tiny fleas called copepods that contain Guinea worm larvae. While the fleas die in the human gut, Guinea worms—which are impervious to stomach acid—survive and start mating. Over the course of a year, a pregnant female worm will grow into an adult that migrates toward the host’s skin. A blister soon forms, and when it bursts, the worm begins to slither its way out of the body. To relieve the burning pain this causes, infected victims will often dunk their affected body parts into water—in some cases, the same ponds or lakes that other people drink from. The submerged worms respond by releasing eggs that hatch into larvae, which are consumed by copepods, and the parasitic life cycle starts anew.

There aren’t any vaccines or treatments for Guinea worm disease, and people cannot develop immunity against it. The traditional strategy for extracting an emerging worm has been to wind it around a stick, tugging on it a few centimeters per day. It’s important not to pull too fast, because if the worm breaks apart, remnants in the body can cause secondary infections. But the best defense is prevention.

To move toward eradication, the Carter Center organized NGOs, national health ministries, and donors around a single overarching goal: to provide affected villages with clean drinking water. A few simple interventions proved highly effective. Village-based volunteers and supervisory health staff built protective walls around wells and other water sources to block people from wading in and seeding new infections. The Carter Center supplied villages with fine-mesh cloths that strain fleas out of drinking water, as well as filtered straws for personal use. Stagnant water was treated with a larvicide called temephos (which the WHO considers acceptable for use in drinking water), and rumored infections were tracked down and investigated.

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Photo by John Angelillo/UPI/Alamy Stock Photo

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