Jimmy Carter, Who Has Died at Age 100, Spared Millions of People from Guinea Worm, a Debilitating Parasite

Jimmy Carter, who has died aged 100, saved millions of people from Guinea worm

Who Charles Schmidt edited by Lewis asked

Former President Jimmy Carter toured the villages of Ghana in the late 1980s when he met people with Guinea worm disease. This tropical disease eventually involves infection with parasitic worms that crawl out of a person’s skin, and the 39th president of the United States marveled at the plight of people infected by them. “Once a little baby, two or three meters long, comes out of his body, through his skin, you will never forget…” he said later. he wrote. “Within minutes, (former first lady) Rosalynn and I saw over 100 victims, including people with maggots being pulled from ankles, knees, worms, legs, arms and other parts of the body.”

Carter died on Sunday, December 29 in Plains, Georgia after admission to hospital care In mid-February 2023. His efforts to eradicate this terrible disease improved the lives and well-being of many of the world’s poorest. Guinea worm cases were average 3.5 million per year around the world during Carter’s tour of Ghana. But to a large extent thanks to the effort The Carter CenterThe non-governmental organization (NGO) founded by former president and former first lady Rosalynn Carter, who died in November 2023, has virtually eradicated the disease. Surveillance data In 2022, there are only 13 cases globally, spread across Chad, Ethiopia, South Sudan and the Central African Republic, according to Centers for Disease Control and Prevention scientists Sharon Roy and Vitaliano Cama working with the Carter Center. If the caseloads are reduced to zero, it will only become a guinea worm the second human disease in history (after smallpox) eradicated. These efforts are a credit to Carter’s “bold vision, leadership and ability to generate political will to help eradicate Guinea worm in affected countries,” says Cama.

The Carter Center initiated the eradication of Guinea worm disease in 1986, five years after the World Health Organization (WHO) aimed to eliminate it worldwide 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 fleas die in the human gut, Guinea worms—which are impervious to stomach acid—survive and begin to molt. Over the course of a year, the pregnant female worm will grow into an adult that migrates to the surface of the host. A blister soon forms, and when it bursts, the worm begins to exit the body. To ease the burning pain that this causes, infected victims will often submerge their affected body parts in water, in some cases the same wells or lakes that other people drink from. Underwater worms respond by releasing eggs that hatch into larvae, which are consumed by copepods, and the parasite’s life cycle begins again.

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There is no vaccine or treatment for Guinea worm disease, and people cannot develop immunity against it. The traditional strategy for extracting the emerging worm has been to wind it around a stick, pulling a few inches a day. It is important not to pull too quickly, because if the worm breaks, the remains in the body can cause secondary infections. But the best defense is prevention.

To advance the path to eradication, the Carter Center organized NGOs, ministries of health and donors around one central goal: to provide clean drinking water to affected villages. Some simple interventions were very effective. Village volunteers and supervisory staff built protective walls around wells and other water sources to prevent people from entering and breeding new infections. The Carter Center supplied villages with fine-mesh cloths that filter fleas from drinking water, as well as filter straws for personal use. The stagnant water was treated with a larvicide called temephos (which is considered acceptable for use in drinking water by the WHO), and ruminal infections were monitored and investigated.

Over time, more and more countries joined the effort. Meanwhile, former President Carter “personally met with leaders of nations where Guinea worm was endemic,” says Kashef Ijaz, the Carter Center’s vice president for health programs. In 1995, Carter’s four-month “Guinea worm ceasefire” in Sudan’s civil war. The cessation of hostilities allowed health workers to distribute 200,000 cloth filters to impoverished areas, along with vaccines and medicines for other diseases such as river blindness, measles and polio.

“Sometimes the Guinea Worm Eradication Program provides the only point of contact local people have with any public health system,” says Jordan Schermerhorn, a global health specialist based in Austin, Tex. He spent more than a year working between 2016 and 2017. A technical adviser at the Carter Center in southern Chad, he often travels by motorcycle to remote areas where people live in mud huts spread across a barren landscape. He and his colleagues visited each town in their jurisdiction about once a week to check for new cases and learn how to protect people from infection.

By then, the eradication program had been highly successful: in 2016, only 25 human cases were documented worldwide. However, the program has also tackled an emerging problem: Scientists, who once thought Guinea worms only infect humans, have found them in other species. . They were worms first found in dogs and then in cats and baboons. More recent evidence suggests that frogs and fish can also carry the worms, although it is not clear whether these animals transmit them. Carter Center staff have responded by asking the public to report and leash infected dogs and to avoid eating improperly prepared fish. They hypothesize that these are the ways most people and animals are being infected today.

Matthew Boyce, an assistant professor of health policy and management at Texas A&M University, says it’s unclear whether Guinea worm is expanding its range or whether its findings in other animals simply reflect widespread disease surveillance. “It could be a classic case of ‘the more you look, the more you find,'” he says. There is still no definitive evidence that these animals can transmit the disease in the absence of a human host, something that may be difficult to completely eradicate. However, the WHO has advanced from 2020 to 2030 At a news conference in 2015, Carter said he hoped the last Guinea worm would die before he did However, Ijaz remains confident that elimination is still an achievable goal. “The last mile is the hardest,” he says. “We have to stay committed and more focused than ever.”