This is how we finish off Guinea worm

Dr Tedros Adhanom Ghebreyesus

Director-General, World Health Organization

Jason Carter

Chair, Board of Trustees, The Carter Center

In the past 200 years, humankind has made incredible progress against many threats to health: vaccines, medicines and other innovations have saved millions of lives from feared killers, from malaria to cancer. But only one human disease – smallpox – has ever been eradicated.

A massive campaign has now driven polio to the brink of eradication, but less noticed by the rest of the world, we stand on the threshold of consigning another disease to the history books: Guinea worm.

While Guinea worm is largely unknown to people in high-income countries, it has afflicted people in Africa, Asia and the Middle East for millennia.

Last year there were just 15 reported cases of Guinea worm disease, compared with an estimated 3.5 million in 1986, when The Carter Center and the World Health Organization launched the Guinea Worm Eradication Program. Since then, our two organisations have worked closely with governments, the US Centers for Disease Control and Prevention, and partners including the United Arab Emirates, which hosted the Guinea Worm Summit in Abu Dhabi in late March.

The official name of Guinea worm is Dracunculus medinensis, which derives from the Latin for “little dragon,” and for good reason. People contract the disease by drinking untreated water that contains tiny fleas that harbour larvae, which grow in the intestine into worms up to one metre long. About a year later, they emerge through painful blisters on the skin. Those infected can’t work or go to school while a worm is emerging. Extracting a worm from the body can take a week or longer and is an excruciating process.

There is no vaccine to prevent infection and no medicine to treat it. But what pharmaceuticals couldn’t do, the Guinea Worm Eradication Program has accomplished with humble water filters, a basic larvicide, and the partnership of millions of people, in some of the world’s poorest countries, who made simple changes in their behaviour. 

Of course, simple doesn’t mean effortless or trouble-free. Progress has been bumpy, complicated by poverty, the remoteness of affected communities, storms, floods, droughts, conflict, and, most recently, a pandemic. In 1995, former US President Jimmy Carter had to negotiate a ceasefire to enable health workers safe passage in the midst of Sudan’s civil war. Through all this, the communities in which we work have taken ownership and continued their unceasing efforts. 

Today, Guinea worm disease remains endemic in just five countries: Angola, Chad, Ethiopia, Mali and South Sudan. Two other countries – the Democratic Republic of the Congo and Sudan – are on the path to being certified free of the disease. Although Cameroon is certified, it is addressing recent cross-border infections.

At the Summit in the UAE, we joined Ministry of Health representatives to discuss the Abu Dhabi Declaration on the Eradication of Guinea Worm Disease.

The declaration reaffirms that the governments of the endemic countries and we, their partners, will work urgently for eradication by 2030. It calls for active leadership nationally and locally, sufficient budget support, robust implementation of interventions, transparent communication, rapid provision of safe water everywhere and safety for health workers.

Preventing the spread of Guinea worm from one country to another is also critical to accelerate the global interruption of transmission a nd requires strengthening cross-border surveillance and collaboration. Several countries have made commendable efforts in this direction, with support from WHO.

We applaud the leaders of the countries who made these commitments, but they can’t do it alone. Now other global leaders need to marshal the sustained funding to finish the job. The last mile of disease eradication is complex, and momentum can wane as the numbers get close to zero, especially as other urgent health crises emerge. But if we fall short of eradication, the disease could return to its former levels, which would bring needless suffering and economic challenges to poor communities.

We stand tantalisingly close to a monumental victory for public health – and for humanity. The eradication of Guinea worm will be the fulfilment of President Carter’s vision and the culmination of decades of difficult and often dangerous work in partnership with some of the poorest, most isolated, most marginalised people on Earth. 

The real heroes in the Guinea worm story are the thousands of volunteers in more than 23,000 villages who do the hard work in their own communities. Defeating this scourge is a triumph of persistence and people, more than technology and medicine. Village by village, across sub-Saharan Africa and parts of Asia, citizens have mobilised and organised to safely treat water sources, distribute filters, and spread the word on how to change behaviours to protect themselves and their children. 

The victory will be theirs when, sometime before the end of the decade, 15 cases become zero. To get there, all of us must do our part to travel the last mile in eradication and move toward a world free of Guinea worm and the terrible suffering it brings.