Thursday, August 27, 2015

What Does Jimmy Carter Have Against Worms?

One of former President Jimmy Carter’s greatest achievements was made after he left politics. Carter declared war on an insidious infection that was ravaging millions of people, especially children, in underdeveloped nations:  the guinea worm.

A guinea worm is not the type of friendly worm you might imagine.
People become infected when they drink water contaminated with water fleas (copepods) carrying guinea worm larvae. These larvae are impervious to digestion, and the unfortunate victim will soon experience a living nightmare.

Once in your gut, the guinea worm larvae are released from the copepod. Then they turn down the lights, crank up the Marvin Gaye, and get it on in those romantic intestines of yours. A worm is born and, about a year later, it is fully grown and ready to have babies. This adult worm now needs to get out of your body.

Now, if you were an intestinal worm, you'd figure there's a natural opening nearby that provides an easy exit...but the guinea worm does things differently. Why? Because it hates us. Rather than being expelled with waste, the guinea worm travels to your foot or leg and decides to make its getaway much more dramatic by bursting through your skin. Surprise!

The good news is – as horrible as it sounds – a guinea worm infection is not lethal. The bad news is that you can’t just yank the thing out like a slippery spaghetti noodle. It must be painstakingly extracted bit by bit over a long period of time, being wound around a stick.
Removal of a guinea worm is excruciatingly painful and terribly slow. Some of the worms take weeks to extract and the patient often has to miss school and/or work.
As if that weren’t bad enough, the worm also causes a distressing burning sensation at the exit site. This makes the unfortunate victim want to soak the infected part of his/her body in the water. When the worm contacts the water, it releases its larvae, which go on to infect copepods to perpetuate the worm's life cycle. The problem is, in many developing countries, the drinking water often comes from the same source that serves as a bath, laundry, and toilet. This proved to be an extremely successful mode of transmission – over 3 million people a year were getting infected in the mid-1980s.
Guinea worms can grow up to 3 feet in length before emerging from their human host!
Since the guinea worm doesn’t affect developed countries, most researchers don’t bother studying it. And since the people who need treatment can’t afford medicine, no pharmaceutical company could justify investing in research to find drugs or vaccines to defeat this worm. But Carter and his colleagues figured that if they could stop transmission they could stop this worm.

With remarkable efficiency and just a few hundred million dollars (far less than the economic damage the worm causes), Carter’s organization was able to educate would-be victims about the worm and how it is spread. Through simple hygienic measures that many take for granted – filtering the drinking water, treating water with insecticides that kill copepods, reporting infections (and in some cases, giving money to snitches who rat the infected people out) – Carter and his organization achieved one of the greatest global health victories in our time.

Last week we heard the sad news that Jimmy Carter will be undergoing treatment for melanoma in his brain. At a press conference, Carter mentioned that his final wish was to have the last guinea worm die before he did. He may very well get his wish.

Thanks to the campaign that Carter led, the number of guinea worm infections has gone from over 3 million in the 1980s to only 17 cases in 2015 so far.
Well wishes to you, Mr. Carter. You’ve saved millions of lives.


Contributed by:  Bill Sullivan, Ph.D.
Follow Bill on Twitter.

Barry M (2007). The tail end of guinea worm - global eradication without a drug or a vaccine. The New England journal of medicine, 356 (25), 2561-4 PMID: 17582064


  1. I've always thought Carter was, by far, a better president than he was given credit for. He inherited a broken situation created by ego-maniacal charlatans whose lust for power far exceeded their desire to govern. Men who had financed their rise to power by selling off the seed corn and betrayed the electorate by sowing discord. They had set the course of the ship of state toward the rocks and a crash was inevitable. Carter did a more than most people know to mitigate and blunt the damage while building for the longer term but he could not change the outcome that had been baked in over a decade. He was a good president and effective even as he presided over disappointment. He accepted the blame that was not rightly his with dignity and without a lot of excuses.

    If it had ended there he would have been a sad story of a good president who made the best of a lousy hand. But he did not stop there. He has gone on to do great things. He has done more to benefit mankind after he left office than most ex-presidents have done in their entire lives.

  2. The fight has taken far longer than expected, and the World Health Organization requires at least a year of intense surveillance after the last worm is dead before declaring a disease eradicated.