When doctors first began trying to eradicate Guinea worm disease nearly four decades ago, more than 3.5 million people were infected. Last year, that number dropped to 13.
Now the Carter Center, which has spearheaded the fight against the disease, says it is in the final — and perhaps most difficult — phase of completely eradicating it in humans.
If all goes according to plan, it will be the second human disease to be eradicated after smallpox, and the first to be eradicated without a vaccine or treatment.
“For me, the most important thing is knowing how many fewer people are suffering from this disease than they did before — because it’s a terrible disease,” Dr. Donald R. Hopkins, special counsel for guinea worm eradication at The Carter Center, told as it happens Hosted by Neil Koxall.
The disease has already been eradicated in 17 countries. In 2022, six human cases were reported in Chad, five in South Sudan, one in Ethiopia, and one in the Central African Republic.
What is it and how do you get it?
Guinea worm disease is a parasitic disease that mostly affects some of the poorest people in the world. Hopkins described it as a “terrifying phenomenon”.
People are most often infected by drinking water contaminated with near-microscopic fleas that carry Guinea worm larvae. Larvae hatch in the body. After the guinea worms mate, the male dies.
The host will not know it has been infected until a year later, when it develops extremely painful blisters, from which the adult female worm emerges.
During that time, the person may have a fever, nausea, diarrhea, and vomiting. And if the wound becomes infected, the person can become disabled or, in rare cases, die.
These worms can be up to a meter in length, and take anywhere from a couple of days to several weeks to remove. To relieve the burning pain, people often immerse the affected area in water.
“The worm at that stage is a long uterus filled with hundreds of thousands of microscopic larvae. These immature forms of the worm are then discharged into the water, where they are picked up by tiny water fleas,” Hopkins said. “And the cycle continues.”
There is no cure, but the disease is almost entirely preventable by filtering the water in the house using a cloth.
The problem, Hopkins says, is helping people make the association between water and worms, given the long delay between infection and symptoms.
He said, “People often don’t associate the act of drinking contaminated water with this worm that they have. And people have fantasized about all sorts of other reasons to explain the presence of these worms,” including magic, curses, or simply ignoring them. as a normal phenomenon.
A ‘sea of misery’ affecting livelihoods
Hopkins, who lives in Chicago, is the former vice president and director of health programs at The Carter Center, a nongovernmental organization founded by former US President Jimmy Carter and his wife, Eleanor Rosalynn Carter.
He has been involved in Guinea worm eradication since the Carter Center program began in 1986, and has traveled to rural communities across Africa to treat and educate people.
In those early days, he says, it was not uncommon for more than 60 percent of the community to fall ill at once.
He said it can be incredibly exhausting. He had a patient who had a blister in his mouth that made it impossible to eat. He met young children crying in pain, afraid of what was happening to their bodies.
“In a few unusual cases, people appeared who had dozens of worms at the same time and were overwhelmed by the secondary infections,” he said.
“It’s just a sea of misery. And again, knowing this could be prevented makes it all the more painful as an outsider just watching that.”
He said he forbids children from going to school. Because it is a seasonal disease, it often struck just as people were preparing to plant or harvest crops.
“So it supports the building blocks of rural communities – health, agriculture and education,” he said.
Build confidence and make progress
Hopkins says he and his colleagues faced many obstacles in the fight against Guinea worm disease, including from potential donors and fellow scientists.
“It was mainly a disease of the rural population, the poor and the neglected,” he said. “Even in countries where infection occurred, the disease was uncommon in urban areas… It was therefore not a priority.”
For the past 37 years, The Carter Center has worked to educate people about the connection between drinking water and Guinea worm disease, showing them how to filter water at home using cloth.
They also helped improve access to potable water by building boreholes, because the water coming from underground could not be infected with the emerging worms.
The center has also partnered with chemicals company BASF, which is donating large quantities of the larvicide Abate, which kills worms in water, but has no harmful effect on humans or wildlife.
“The biggest challenge is just helping people understand that they don’t have to keep suffering from this infection,” Hopkins said.
“Once you earn their trust by respecting them and showing them empathy, by indicating that you’re there to help them…then things start to change. And then it starts to build up, so to speak.”
The last stretch may be a long road
But the hardest part may come.
For the WHO to consider a disease to be eradicated, there must be no reported cases for at least three years.
“Getting to zero is going to be slow,” Adam Weiss, current director of the Carter Center’s Guinea Worm Eradication Program, told The Associated Press.
This is because the places that still exist are difficult for doctors and volunteers to reach due to local insecurity and conflict.
“If we get our foot off the gas in terms of trying to accelerate to zero and provide support to those communities, there is no doubt that you will see an increase in Guinea worm,” Weiss said.
“We’re continuing to make progress, even if it’s not as fast as we all want it to be, but that progress is continuing.”