Jimmy Carter's Triumph Over The Guinea Worm

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Hey, Emily Kwong here, former US President Jimmy Carter passed away Sunday at his home in Plains, Georgia. He was 100 years old. And during his lifetime, he did a lot for science and for treating one disease in particular. Here to talk about it with me is science reporter Jason Bobian. Hey, Jason.

Hey, Emily. Hi. So how are you doing with the Carter news? Look, he had an amazing life, both in politics and out of politics. So I think it's great to be able to celebrate Carter. Yeah. And he's probably going to be remembered more for the work that he did after he left the White House rather than those chaotic four years that he spent in Washington in the late 1970s. Yeah. I mean, I wasn't alive, but it does appear that way.

It was, it was a very chaotic time. And so I was thrilled when I got word you wanted to chat about two of my favorite subjects, Jimmy Carter and Guinea Worms. Oh yeah, we at Shortwave, we will see any opportunity to discuss worms. So no brainer. As you should. Right here at the beginning, let's be clear. Jimmy Carter, he did a lot of things in his post-presidential time. His legacy goes well beyond his battle with Guinea Worms.

You know, he became an advocate for a habitat for humanity. He was out there actually swinging a hammer with them, building houses in the US and in other places. He was a major champion for human rights. He continued to work on peace in the Middle East. You know, he was working on elections. He helped negotiate some really sticky political stalemates in Central America. And for all of that work, he was recognized not just in the US, but globally.

The Nobel Committee in Norway has decided to award the Nobel Prize for 2002 to Jimmy Carter for his decades of untiring effort to find peaceful solutions to international conflicts, to advance democracy and human rights, and to promote economic and social development.

Jason, I remember when this happened. It was like, wow, this guy is like still out there still doing things. Yeah. And that was in 2002. Yeah. And he had two more decades ahead of him. And one of the things that he worked on was trying to eradicate this really horrible disease called guinea worm.

We're going to talk about that today on the show and how science was central to former President Carter's drive for a better world. I'm Emily Kwong, you're listening to Shorewave, the science podcast from NPR.

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Okay, so Jason, former President Jimmy Carter was known for many things, including fighting disease around the world. Right. But how did he end up waging a war on guinea worms?

So the World Health Organization has a list of so-called neglected tropical diseases. These are diseases in need of more research, more treatment. Key, however, had a former employee from the White House who got involved with working on clean water. And this guy came

gave this pitch to Carter and Carter was like, this is doable. He was driven by this worldview of the need to ease suffering to help the less fortunate. So taking on neglected tropical diseases that were being overlooked and ignored, this was right up his alley.

And I think he's almost done that, right? Like nearly managed to eradicate Guinea worm. Yeah, he has. And it wasn't just him, but you have to look back. It was the mid 1980s. Carter decides to start focusing on wiping out Guinea worm. At that point, the World Health Organization estimated that there were like 3.5 million cases of Guinea worm disease globally.

Almost all of these were in really remote parts of sub-Saharan Africa and Asia. Last year, the WHO says there were only 13, one, three cases of getting warm globally. Wow. Yeah, pretty impressive. He was very successful in leading that. It seems like I'm looking this up.

There were only 13 cases of Guinea worm in 2023 and just three cases in the first half of last year. So from three and a half million to basically a handful, that's amazing. It is amazing. And I was talking to Paul Farmer about just how impressive this was. And he gave us much of the credit to Carter. Yeah. And you're talking, of course, about Paul Farmer, global health legend. That's right. Paul Farmer, co-founder of Partners in Health. So the subject of Tracy Kidder's incredible book, Mountains Beyond Mountains.

A farmer, like Carter, was also a crusader his entire life for healthcare equity around the world. And I was talking to farmer, obviously, before farmer died last year. But Farmer was saying that in the overall history of human medicine, there hasn't been a lot of progress in entirely eradicating specific diseases. All we've got behind us is smallpox. That's the only human disease has ever been eradicated.

And if, you know, Guinea worm is right behind, that's going to be thanks to Carter. I mean, there were millions of cases when he got involved in the, you know, after his presidency in the mid-80s. And now, you know, we're down to fewer than 100 last year. That was farmer back in 2019. Yeah. So, you know, even from 2019, we've gone from a fewer than 100 down to just 13. It really is on the verge of being wiped out as we speak.

Let's back up a step to focus on the guinea worm itself and this disease it causes. What are these worms and how does their disease affect people? So I know we all like to respect all forms of life, but guinea worms, they're really gross. And you know what? It felt like it is Jason. I almost think of them as like evil. You know, that's my sort of my scientific assessment. These are evil worms. From our resident worm scientists. Okay.

That's right. I'm a journalist with a degree in English, so I'm making that definitive statement. Strong word choice. Chosen clearly for a reason. Why do you say that? Okay. So guinea worms, they're parasites. They spread through contaminated drinking water, but they've come up with this little evolutionary trick and their life cycle goes like this. But guinea worms larvae, they are born in stagnant pools of water.

They live in there. They're tiny. You can't see them. People come along who don't have access to clean drinking water. They end up drinking the water with these larvae, then inside the human, they reproduce. The male worms die off inside the people. The females migrate to the person's legs and then over the course of a year,

They cause these massive lesions, and it takes months before they start to emerge. And it's incredibly painful. These open wounds at times, if it's on someone's foot, they might not be able to walk. And here's their evil little trick. The worms cause this intense burning sensation under the skin right when they're about to release their eggs. And in an effort to extinguish that burning sensation,

They plunge their leg into water oftentimes a stream or a pond. And at that point,

All the worms, all their little eggs go out into the water and the whole cycle starts over again infecting more people. That is menacing. That is horrible. And admittedly, the science person in me wants to say very clever from an evolutionary point of view. Yeah. So the key from an eradication point of view is to break that reproductive cycle. Right. Also, is it only inside humans that you get that reproductive cycle?

So this is one of the tragedies of this epic battle against Guinea Worm. You know, for decades, it was believed that humans were the only reservoir, basically the only hosts for this, this worm. And that the parasite needed that year long period inside the human body to grow and reproduce. Unfortunately, as the numbers of cases dropped dramatically,

Researchers found that the worms were also turning up in some stray dogs and chads and fish, some other animals. So unfortunately that complicates the eradication efforts because there's no longer just this one single place where you need to look. That said, the number of guinea worms that have been found in animals is quite small. Jason, you mentioned that one of the ways to get to the bottom of this whole disease is by improving access to drinking water. Was that the main strategy of Carter and others in trying to eradicate this disease? Yeah.

Clean drinking water is key. And, you know, obviously there are a lot of other great benefits to making sure people have access to clean drinking water. Yeah.

And if you can break that reproductive cycle of the warm, living in stagnant water and reproducing and then spreading back into the water supply, yeah, you can defeat the parasite. But getting people better water supplies, you know, particularly in remote parts of some of the poorest countries in the world, it doesn't happen overnight. So education was a big part of the campaign against Guinea worm, just letting people know what this cycle is, letting people know that they have the worms to not plunge their leg into a pool where

people might later be drinking, you know, they were also tracking where these parasites are turning up. They were testing water, you know, because obviously if health officials know where the cases are occurring, then they can focus more efforts and resources in those areas. And at one point, a number of places in Africa were offering rewards of $100 for any worms that anyone could turn in. This was at a time when things had gotten fairly low in terms of the numbers of cases that were occurring.

And Kenya was even offering 100,000 Kenyan shillings. But I should point out that that was when they had pretty much wiped out the disease entirely. Okay. So was Jimmy Carter's role in all of this? Because he wasn't out there handing a $100 bill bounties for each guinea worm, right? Like, why is it that Paul Farmer and others are accrediting Carter with nearly eradicating this parasite?

You know, the thing about Carter is that he did get out there to many of these places where guinea worm continued to be a problem, but you're absolutely right. You know, this war against this worm was not hand to hand combat between Carter and the worms.

But what he did was he looked at this health problem and he said this neglected tropical disease is fixable. We can solve this and he made it a priority to keep global resources focused on it. And Carter would be the first to tell you that he didn't do this alone at all. There's thousands of healthcare workers out there in the field.

really grove guinea worm to the brink of extinction. And Paul Farmer points out that Carter's role was staying on top of it and keeping the focus for years and decades on this fight. And as Farmer said, convincing people. When you take on a problem like this, like guinea worm or aqua circuses,

You have to sweet talk the ministry officials, the political figures, the nurses, the doctors, the community activists, the farmers, the people who are, you know, most at risk. Carter's had to sweet talk all those people. And, you know, that's something that's been very inspiring to many of us. You know, as I said, guinea worm eradication was just one of many things that Carter worked on in his post-presidential life.

But this project was incredibly important to him, and I should note that when he was diagnosed with cancer in 2015, he was still single-mindedly focused on eradicating guinea worm. I would like to see guinea worm completely eradicated before.

before I die. I'd like to put a last guinea worm to die before I do. I'd like the last guinea worm to die before I do. I mean, it's just a great line. Yeah. And he didn't completely kill off the last guinea worm, but Carter did come incredibly close. Jason Mobian and Pierre correspondent, thank you for telling us about the public health legacy of Jimmy Carter. You're absolutely welcome. Thank you.

This episode was produced by Burley McCoy. It was edited by our managing producer Rebecca Ramirez and fact-checked by Anilosa. The audio engineer was Patrick Murray. I'm Emily Kwong. Thanks for listening to Shorewave from NPR.

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