By Betsy McKay

When President Jimmy Carter was diagnosed in 2015 with cancer in his liver and brain, he said that he would like to see the last Guinea worm die before he did.

That just about came true.

There were 3.5 million cases of the parasitic worm disease in 1986, when the 39th U.S. president took up the cause of eradicating it. In 2023, there were 14 human cases, and 11 from January through early December 2024, according to a provisional count.

"We're not there yet, but thanks to him we're very close," said Dr. Donald R. Hopkins, former vice president of health programs and now special adviser on Guinea worm eradication to the Carter Center, the human-rights nonprofit the former president founded in 1982 with his wife, Rosalynn Carter.

Carter died Sunday in Plains, Ga., after entering home hospice care in February 2023. The former first lady died in November 2023.

Sparing millions of the world's poorest people from Guinea worm and five other preventable tropical diseases is one of the greatest accomplishments of Carter's post-presidency. Guinea worm -- a parasite that invades human bodies and can grow to 3 feet long -- could become the second human disease after smallpox to be eradicated, due in large part to a nearly four-decade campaign led by the former president and the Atlanta-based Carter Center.

River blindness, whose elimination Carter championed, is no longer a threat in most of the Americas and many once-heavily affected areas of Africa. The eye disease is caused by a parasite spread by infected black flies. The Carter Center also leads campaigns against lymphatic filariasis, trachoma, schistosomiasis and malaria, diseases that are nearly nonexistent in the developed world but that haunt communities and local economies in poor areas of Africa, the Americas and Asia.

Carter considered leading a global health initiative as president, but it didn't work out, Hopkins said. Economic malaise at home and foreign-policy quagmires abroad took precedence.

His decision as an ex-president in the 1980s to take on diseases of the poor marked a tipping point in global public health, said Dr. William Foege, former executive director of the Carter Center who persuaded the ex-president to make disease-fighting a pillar of his human-rights work.

"He made global health important," Foege said.

Carter said when announcing his cancer diagnosis that while his presidency was the high point of his life, the work of the Carter Center, including its health initiatives, was "more personally gratifying." The peanut farmer who grew up in and later returned to his home in rural Georgia relished bumping over miles of dusty roads on other continents to meet with people the Carter Center was helping to protect from disfiguring, painful infections.

"Going into the villages and learning about the people and what the actual needs are, then meeting those needs with a superb Carter Center medical staff, I think, has been one of the best things that ever happened to me," he said.

Guinea worm disease is caused when people drink water contaminated with larvae. The larvae spawn worms that, when mature, burn holes in the skin and emerge slowly, causing so much pain that people who have them can't work or go to school. The disease is stopped by teaching people to filter drinking water and prevent those with an emerging worm from entering water sources.

Carter used his clout to persuade heads of state and other politicians to devote time and money to beating back Guinea worm and the other diseases the Carter Center worked on, preventable illnesses that he argued were setting back their communities and economies. The Carter Center became involved in Guinea worm eradication in 1986, when Carter raised the issue with the president of Pakistan and agreed to help the country rid itself of the disease.

"Once the head of state became interested, everyone became interested," Foege said. "If I went to Africa, I could get an appointment with the minister of health, but I couldn't get an appointment with the minister of finance or the head of state."

Carter's high-level powers of persuasion are particularly missed today as the Carter Center and its partners are making the final push to eradicate Guinea worm and beat back river blindness, said Dr. Frank Richards, who formerly ran several Carter Center health programs and helped pioneer disease elimination efforts.

The last cases of diseases are often in difficult-to-reach areas, he said. Remaining river blindness cases in the Americas are concentrated in an Amazon rainforest area on the border between Venezuela and Brazil, and reaching it requires cooperation from both countries, he said.

Richards said the final stages of an eradication effort require political will, "and keeping your eye on the ball when cases have gotten down." Carter was able to keep political leaders focused on the goal, he said.

Among Carter's recruits to Guinea worm eradication were Gen. Amadou Toumani Touré, the former head of state of Mali. On a car ride to Bamako from the airport in the early 1990s, Carter showed him a graphic illustrating how far his country was behind others in wiping out Guinea worm, Hopkins said. Touré went on to mobilize support for Guinea worm eradication in Mali and other African countries.

In 1995, Carter negotiated a cease-fire in the civil war in Sudan that allowed the Guinea worm program to expand to war-torn, disease-ridden areas. The halt in fighting also allowed health workers to bring in other interventions, including treatments for river blindness and measles vaccination.

Carter and his namesake nonprofit are household names in South Sudan, said Makoy Logora, director of the country's Guinea worm eradication program. "There are children named after him," he said, including his youngest son, Jimmy. Cattle too, he said.

While there are challenges to ridding the world of the final cases of Guinea worm, including infections in animals, he said workers are making effective use of new tools and strategies. Villages once beset by the disease are now free of it and their economies productive.

"It will be eradicated, I am very confident," he said.

Write to Betsy McKay at betsy.mckay@wsj.com

(END) Dow Jones Newswires

December 30, 2024 05:00 ET (10:00 GMT)

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