As he faced the multitude of news cameras and reporters during a 2015 press conference grappling with a potentially fatal cancer diagnosis, former U.S. President Jimmy Carter, then 90, said he had one more goal to fulfill.
"I'd like the last Guinea worm to die before I do," he told a reporter, referring to the waterborne parasite that can grow up to 80 centimeters long inside the body, eventually erupting painfully out of the host’s skin and sometimes taking days to extract.
More than six years later, Carter, now 97, has battled through brain cancer and other health setbacks to see his Carter Center mark a milestone in the fight to rid the world of the once-neglected tropical disease the global nonprofit began dedicating resources to fighting in 1986.
"We are pleased to mention that there are only 14 human cases in the world through the end of 2021, and none logged so far in 2022," said Adam Weiss, director of the Carter Center’s Guinea Worm Eradication Program. During a recent Skype interview with VOA, he said it was the lowest number of recorded cases in human history.
Victory is close
The milestone places the effort tantalizingly close to eradication of the disease. Only one other disease has been eliminated: smallpox.
"Every year, more than 3 million people were suffering from Guinea worm," Weiss told VOA. "Today, to be able to say it is in only 14 human beings on a planet of almost 8 billion people is remarkable."
Remarkable in part, said Weiss, because the 14 cases in 2021 were also a 48% drop from the previous year — a time when the world has been dealing with the coronavirus pandemic.
"The national programs that operate the Guinea worm program have remained almost entirely operational throughout the pandemic,” he told VOA.
Much of the Guinea worm eradication effort in endemic countries isn't staffed by foreign nationals, but instead relies on local villagers and community members to manage education and prevention efforts at local water sources.
"We built a formidable force at the community level," said Makoy Logora, director of the Guinea worm eradication effort with the Ministry of Health in South Sudan. "We ensured that we have a program that was anchored within the structure of a community. We work every day to ensure that there is ownership at the community level."
South Sudan at one point accounted for almost 80% of global infections. The effort to fight Guinea worm prevailed over civil war and sporadic unrest in South Sudan to reach the point of only four recorded cases in 2021.
"I want to believe if we can do it in South Sudan, it can be done anywhere," Logora told VOA during a recent Skype interview from his office in South Sudan’s capital, Juba.
Mali, Ethiopia, Chad and parts of its border area with Cameroon are among the last strongholds of Guinea worm on the planet. If the remaining endemic countries can get rid the parasite completely, Guinea worm disease would become the first disease in human history eradicated through prevention and not vaccination.
While the effort has met dramatic success in recent years, Weiss said it has also experienced setbacks.
"What we've seen in the last 10 years or so is infections occurring in domestic animals, so we’ve experienced a setback in the global campaign in 2012 when we started to see that occurring," he said.
But only a small number of cases were recorded in animals in 2021, and the fight against the worm seems to be nearing the finish line. As the number of Guinea worm cases globally dwindles, Carter’s age is also advancing, and Weiss said everyone involved in the effort would like to see the goal of zero cases reached soon.
"You know, President Carter as our big boss but also as our North Star, trying to keep us focused — it adds a layer of pressure and also a layer of responsibility that we all have," said Weiss. "I would like nothing more than to see it happen in his lifetime."