Carter's mission to eradicate worm changed lives

As Americans prepare to honour the late former US President Jimmy Carter with a state funeral, one of his greatest achievements will be remembered in Africa and Asia.

Carter made eradicating Guinea worm disease 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.

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 a metre long. The noodle-thin parasites then burrow their way out, breaking through the skin in burning blisters.

Thanks to the Carters' efforts, the worms that afflicted an estimated 3.5 million people in the world's poorest countries 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.

In the mid-1980s, 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.

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.

There's no vaccine that prevents Guinea worm infections or medicine to get rid of the parasites. Treatment involves emerging worms being wound around a stick as they're slowly pulled through the skin, over days, sometimes weeks.

The campaign relied on persuading millions of people to change basic behaviours.

Workers from the Center and host governments trained volunteers to teach people 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 campaign became a model for confronting a broader range of neglected tropical diseases afflicting impoverished people with limited access to clean water, sanitation and health care.

Carter's fundraising enabled the Center to pour $500 million into fighting Guinea worm. He persuaded manufacturers to donate larvicide as well as nylon cloth and specially made drinking straws to filter water.

Pakistan in 1993 became the first endemic country to eliminate human cases. By 1997, the disease was no longer found in Asia. By 2003, cases reported worldwide were down to 32,000 — a 99 per cent decline in less than two decades.

Nigeria, which once had the most cases in the world, reached zero infections in 2009.

But total success has been hampered by historic flooding and years of civil war that have displaced millions of people who lack clean drinking water across central Africa.

"These are the most challenging places on planet Earth to operate in," said Adam Weiss, who has directed the campaign since 2018.

Even after being diagnosed with brain cancer, Carter remained focused: "I'd like the last Guinea worm to die before I do," he told reporters in 2015.

Carter died on Sunday at age 100.