In 1982, shortly after losing the presidential election to Ronald Reagan, Jimmy Carter established the Carter Center with the goal of advancing the cause of human rights and alleviating human suffering through global peace and public health programs. As part of its mission to improve global health, the Carter Center partnered with organizations including the Centers for Disease control (CDC), World Health Organization (WHO), and UNICEF. Beginning in 1986, the organization began efforts to reduce worldwide incidence of guinea worm disease, a tropical parasitic infection that had, at the time, affected over 3.5 million people annually across more than twenty African countries.
Guinea worm disease (GWD), also known as Dracunculiasis, is caused by parasitic infection by the nematode Dracunculus medinensis. Historical cases of the disease have been recorded as early as 1550 B.C., and the remains of a calcified guinea worm were once discovered inside the abdomen of an Egyptian mummy. The worm was given its more common name after explorers noted high rates of infection among people living off the coast of Guinea in West Africa. Although guinea worm disease has historically been endemic to African countries, the disease was also commonly found in India and Middle Eastern countries in the mid 20th century. India was officially declared disease-free by the WHO in 2000, as a result of massive public health campaigns and water purification efforts led by the Carter Center, WHO, CDC, and UNICEF. Yemen, the last Middle Eastern country with recorded cases of guinea worm disease, was likewise declared disease-free in 2004.
Parasitic infection by the guinea worm in humans begins after consuming contaminated water that contains infected water fleas, a secondary host of the worm. In contaminated water sources, water fleas consume guinea worm larvae and enter the gastrointestinal tract when consumed. Inside the stomach, the water fleas are dissolved, and larvae migrate through the intestinal wall and mate. After mating, female larvae grow into full-sized adults, and can measure up to 3 feet in length. Early detection of the disease is nearly impossible, as symptoms do not arise until a year after infection, when the female worm is ready to exit the body. At this time, a painful blister appears on the affected individual’s body, most commonly on the legs or feet. When the blisters bursts, the worm begins migrating outside of the body; the pain associated with this usually leads the affected person to submerge their leg in water, allowing the guinea worm to release hundreds of thousands of larvae, allowing their life cycle to continue. Because there currently exists no treatment or cure for guinea worm disease, the only method of extraction is to slowly wrap the worm’s body around a stick or piece of gauze, a painful and painstakingly slow process that can take days or weeks.
In order to combat the spread of guinea worm, the Carter Center has largely focused on two aspects of the worm’s live cycle—consumption of larvae from contaminated drinking water, and prevention of contamination of current drinking water sources. By monitoring local outbreaks and by relying on elderly men to act as guards for water sources, the center has been able to prevent infected individuals from spreading larvae into sources of drinking water. In addition, the center supplies villages with filtration materials in an attempt to sanitize possible contaminated sources of water. So how close are we to complete eradication of the guinea worm? At the end of 2015, the Carter Center reported 22 cases across four African countries—Chad, Ethiopia, Mali, and South Sudan. Should the Carter Center succeed in completely eliminating all cases of guinea worm across the globe, guinea worm disease would become the first globally eradicated parasitic disease, and the center’s success would be a testament to the effectiveness of coordinated global health campaigns despite the absence of effective drugs or treatments.