Jimmy Carter Fought To End Guinea Worm Infection

This week, the world celebrated the life and legacy of former President Jimmy Carter. Among Carter’s many post-presidency accomplishments was the founding of the Carter Center in Atlanta, Georgia, with his wife, Rosalynn. The mission of the Center includes a “fundamental commitment to human rights and the alleviation of human suffering,” along with a commitment to “improve health.” One key public health contribution of the Center was leading an international program with multiple partners to eradicate Guinea worm disease, also known as dracunculiasis.

Thus far, only one human disease, smallpox, has been eliminated from human populations. In 1986, the World Health Assembly called for the eradication of Guinea worm. At the start of the Carter Center-led program in 1986, the disease was endemic in 20 African and Asian countries, with approximately 3.5 million cases. That number has declined by over 99.9% to only 14 human cases in 2023 and seven thus far reported for 2024; however, the disease remains endemic in five countries, Angola, Chad, Ethiopia, Mali, and South Sudan and animal cases, although declining, remain a challenge.

What Is Guinea Worm?

Guinea worm is a roundworm, Dracunculus medinensis, (meaning “little dragon from Medina”) that causes an incapacitating illness that frequently occurs in areas with low socioeconomic conditions and lack of clean water. Humans are infected when they ingest water contaminated with small crustaceans (called copepods) that carry the roundworm’s larvae. Once ingested, the copepod is digested in the gastrointestinal tract and the larvae emerge and penetrate the lining of the intestines. Male and female worms grow and migrate inside the body. About a year after infection, a fully mature, gravid female worm migrates to the skin, usually in the lower extremities. In a dramatic event reminiscent of the 1979 “Alien” horror movie, where John Hurt’s chest explodes as an alien emerges, the female worm causes a blister to form, which ruptures upon contact with water and the worm emerges. The female worm then releases free-swimming larvae into the water, where they infect the small copepods and the whole cycle starts over when humans drink the water.

Why Guinea Worm Is A Problem

It takes several days for the worm to fully emerge. This causes significant incapacitation from local pain, arthritis and local or systemic infection, which can last for several weeks. Individuals may be unable to walk or work during this time.

How The Decline In Cases Was Achieved

The key to eradicating Guinea worm is providing access to clean water without the crustaceans. This can be achieved by adding larvicides to the water. One simple method, especially when combined with educating the population is to use a fine-meshed cloth to filter the water before drinking. This effectively removes and prevents the ingestion of the infected copepods. The other important aspect of education is to encourage local residents to avoid entering water when the worm is emerging. This prevents spread by denying larvae access to water and therefore to the copepods.

How Guinea Worm Is Treated

There are no curative treatments or vaccines for Guinea worm disease. The main management is preventive and to minimize incapacitation and complications after the worm erupts through the skin with the application of wet compresses, medicines for pain control and preventing bacterial infection. It may take several days for the worm to fully emerge, because it can be as long as 32 inches, but it is important not to break the worm as it emerges, which can lead to an allergic reaction or increase infection risk. Therefore, it is common to take a stick and slowly wrap the worm over multiple days as it emerges.

The practice of wrapping the worm around a stick dates back centuries. In fact, the origin of the symbol for medicine, the Caduceus, is believed to originate with the practice of extracting the Guinea worm. It shows two serpents wrapped around a central stake. Similarly, the rod of Asclepius has a single serpent wrapped around it.

In developed societies, we may take for granted access to clean water, but Guinea worm demonstrates the variety of diseases caused by contaminated water, beyond just diarrheal and other illnesses, and the importance of clean water for survival and productivity. The impact of President Carter’s focus on health, and in particular Guinea worm, will continue long after his death. Hopefully, we can one day add Guinea worm to smallpox as two diseases thus far eliminated from the human population. Now that would indeed be a great legacy.