Jimmy Carter’s greatest victory was in the worm-killing business

Former US President Jimmy Carter has died at the age of 100. While there are many aspects of Carter’s life that deserve spotlights, few may be as noteworthy as his efforts to help eradicate one of the world’s most feared parasites, the Guinea worm (Dracunculus medinensis).

Carter dead at her home in Plains, Georgia on Sunday, nearly two years after she began hospice care. Although he served only one, often much criticizedterm as the 39th president of the United States, his achievements stretch far beyond those four years. Chief among these successes is the Carter Center The Guinea worm eradication programwho is now inches away from total victory.

The Guinea worm is a parasite with such a long history that it is referred to in the Old Testament. U freshwater nematode it typically infects people through the consumption of drinking water containing copepods—small crustaceans—which are themselves infected with worm larvae.

The larvae reach our intestines, where they fully mature and mate. The males then die and the pregnant females – which grow up to three feet (100 centimeters) long – migrate to a place under our skin, usually along our legs. About a year after infection, the females cause the formation of a blister. When this blister breaks, the worm slowly emerges from our skin, inducing a painful burning sensation that prompts the infected to cool their wound in the nearest water source. The female then releases thousands of larvae into the water, restarting the whole process.

This infection is not only unpleasant to suffer, it is often debilitating. The worm can take days or weeks to extract safely and painfully, during which people cannot work or go to school. And if the worm breaks during removal, it can trigger secondary infections that eventually lead to permanent disability.

While freshwater sanitation made Guinea worm disease less of a global problem at the end of the 20th century, about 3.5 million people contracted these infections annually in Africa and Asia. during the 1980s. In 1986, Carter’s nonprofit organization, the Carter Center, began a public health campaign to eradicate Guinea worm. And it was a clear success. Last year, there were only 14 cases of Guinea worm cases reported in humans; since November, they were there only 7 cases in 2024.

Carter and his organization don’t deserve all the credit, of course. The World Health Organization and other major groups have also played a significant role, while community leaders and residents in endemic areas are the driving force behind eradication efforts on the ground. Since there is no vaccine or drug for Guinea worm, the eradication campaign has largely relied on physical interventions such as durable straws that filter infected copepods from drinking water, as well as meticulous surveillance of potential cases.

Not everything went well for the campaign. Guinea worm was a suitable candidate for eradication because worms rely primarily on human hosts to complete their entire life cycle. For a long time, we thought that only humans could act as this final link in the chain, but it became evident a decade ago that the species can also mature in other animals. especially dogs. So while the annual human cases have been low in recent years, there have been thousands of annual infections reported in animals in the last decade.

This latest development has hindered the Guinea worm eradication timeline. Until infections in people and animals reach zero and stay at zero for several years, the worm could persist. But health officials and communities in endemic areas are adapting. Annual animal cases recently reported dropped from 886 cases in 2023 to 448 so far this year, an indication that efforts on the ground are mitigating the spread of the parasite among animal hosts.

Jimmy Carter said in 2015 that he hoped to see the Guinea worm completely eradicated before his death. Unfortunately, it didn’t happen. But Carter certainly left behind a monumental public health legacy that will last long after his death.