The Last Mile: Jimmy Carter and the Battle to End Guinea Worm Disease
Global Eradication without a Drug or Vaccine
Eradication of a disease is the definitive strategy for its prevention.
"I would like to see Guinea worm completely eradicated before I die," former President Jimmy Carter said at a press conference in 2015. While that didn't happen, it should occur in the next few years. In 2016, Carter told the Associated Press, “It’d be the most exciting and gratifying accomplishment of my life.”
When Jimmy Carter left the White House in January 1981, he was eager to transition from politics to humanitarian service. The world would soon discover that the 39th president had a tenacious drive for change far beyond his term in office. One of his most remarkable contributions to global health was his work to eradicate Guinea worm disease, a parasitic affliction that had plagued humanity for millennia. Guinea worm disease is known as dracunculiasis or “affliction with little dragons.”
Former President Jimmy Carter fought to eradicate Guinea worm disease.
The Beginning of the Mission
In 1986, Peter Borne, whom Carter had appointed as director of the Office of Drug Abuse Policy, visited the Carter Center. Bourne had been an Assistant Secretary-General at the United Nations, where he established and ran the "International Drinking Water and Sanitation Decade," a 10-year program that would provide clean drinking water to more than 500 million people worldwide. As part of the program Bourne launched, in collaboration with the Centers for Disease Control and Prevention, a global campaign to eradicate the waterborne disease caused by the Guinea worm. Carter noted that Borne came to the Carter Center because he couldn't get anyone else to tackle this problem. Borne convinced the former President to help. Carter recalled, "It's a despicable disease. And it was in such remote villages that no one wanted to take on the task. So we decided to take it on." That decision became the catalyst for one of the most ambitious and successful disease eradication programs in history.
A Personal Encounter in 1988
Jimmy Carter first saw Guinea worm disease in person in 1988 when he visited a village in Ghana during a mission with The Carter Center. There, he saw firsthand the devastating effects of the disease. Guinea worm is caused by the parasite Dracunculus medinensis and is transmitted through contaminated water. After being ingested, the worm grows inside the human body, eventually emerging through painful, blistering sores, often incapacitating its victims for weeks or even months.
In the village, Carter met a woman writhing in agony as she tried to extract the worm from her chest—a process that could take weeks and involved winding the worm slowly onto a stick to avoid breaking it. Carter recalled how this visit reinforced his commitment. “Villagers of all ages were too weak to walk or permanently scarred and crippled. As a result, a community would go hungry because its farmers were too sick to work the fields … Encountering those victims firsthand, particularly the teenagers and small children, propelled me and Rosalynn to step up the Carter Center’s efforts to eradicate Guinea worm disease.”
The Challenge of Eradicating Guinea Worm Disease
Guinea worm disease is one of humanity’s oldest known afflictions, with references dating back to ancient Egyptian medical texts. Unlike diseases that require complex vaccines or treatments, Guinea worm could be eradicated through education, clean drinking water, and simple preventive measures. However, the challenge lies in reaching remote, underserved communities and changing entrenched behaviors.
When the Carter Center took on Guinea worm eradication, there were an estimated 3.5 million cases across 21 African and Asian countries. The Center’s strategy was straightforward but monumental in scale:
Educate communities about the disease and its prevention.
Distribute simple tools like water filters.
Train local volunteers to monitor cases and promote safe water practices.
One of the most innovative tools was the introduction of pipe filters—straw-like devices that individuals could use to drink water safely, filtering out the Guinea worm larvae. Additionally, health workers taught people to boil or filter water and avoid recontaminating water sources.
A Hands-On Leader
What set Jimmy Carter apart in this mission was his hands-on approach. He and Rosalynn Carter visited many villages, met with community leaders and health workers, and demonstrated how to use water filters. His commitment inspired others to act, from government officials to grassroots volunteers.
One notable example of Carter’s persistence occurred in Sudan during the 1990s. At the time, civil war was raging, making it nearly impossible to deliver humanitarian aid. Carter brokered an extraordinary “Guinea Worm Ceasefire” in 1995, persuading warring factions to pause hostilities so health workers could distribute supplies and provide education in affected areas.
The Final Push
Over the decades, the Carter Center’s Guinea worm eradication program achieved staggering results. By 2000, cases had dropped to fewer than 100,000, and by 2010, they were in the hundreds. As of 2023, only a handful of cases remained, achieving a 99.99% reduction. Although not officially confirmed, as of 2024, there were only 7 cases, marking Guinea worm disease as one of the few diseases on the brink of complete eradication.
As Guinea worm disease approaches eradication, the global health community stands at a critical juncture. The last cases are often the hardest to eliminate, requiring intensified surveillance and intervention. However, when this milestone is achieved, it would mark only the second human disease, after smallpox, to be eradicated.
Several organizations and individuals contributed to the success of the Carter Center Guinea Worm Eradication Program. However, Jimmy Carter provided the leadership and commitment. Carter’s fight against Guinea worm disease is a testament to the transformative power of prevention and the enduring impact of a life dedicated to service. His legacy reminds us that even amid immense challenges, change is possible when we approach problems with vision, determination, and humanity.
Excellent article Dr. Davis!