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Carter made eradicating Guinea worm a top mission of The Carter Center, the nonprofit he and his wife, Rosalynn Carter, founded after leaving the White House. The former president rallied public health experts, billionaire donors, African heads of state and thousands of volunteer villagers to work toward eliminating a human disease for only the second time in history.

69制片厂制作传媒淚t69制片厂制作传媒檇 be the most exciting and gratifying accomplishment of my life,69制片厂制作传媒� Carter told The Associated Press in 2016. Even after entering home hospice care in February 2023, .

Carter at age 100.

Thanks to the Carters' efforts, the worms that afflicted an estimated 3.5 million people in 20 African and Asian countries when the center launched its campaign in 1986 are on the brink of extinction. Only 14 human cases were reported across four African nations in 2023, according to The Carter Center.

The World Health Organization69制片厂制作传媒檚 target for eradication is 2030. Carter Center leaders hope to achieve it sooner.

That meant recently returning to Jarweng, in a remote area of South Sudan in northeastern Africa. The village of 500 people hadn69制片厂制作传媒檛 seen Guinea worm infections since 2014, until Nyingong Aguek and her two sons drank swampy water while traveling in 2022. A fourth person also got infected.

69制片厂制作传媒淗aving the worm pulled out is more painful than giving birth,69制片厂制作传媒� said Aguek, pointing to scars where four worms emerged from her left leg.

The center's staff and volunteers walked house-to-house distributing water filters and teaching people to inspect dogs, which can also carry the parasite.

69制片厂制作传媒淚f someone69制片厂制作传媒檚 hurt, The Carter Center will help,69制片厂制作传媒� said villager Mathew Manyiel, listening to a training session while checking his dog for symptoms.

An audacious plan

In the mid-1980s, global health agencies were otherwise occupied and heads of state largely overlooked the illness afflicting millions of their citizens. Carter was still defining the center's mission when public health experts who had served in his administration approached him with a plan to eliminate the disease.

Only a few years had passed since the WHO declared in 1979 that smallpox was the first human disease to be eradicated worldwide. Guinea worm, the experts told Carter, could become the second.

69制片厂制作传媒淧resident Carter, with a political background, was able to do far more in global health than we could do alone,69制片厂制作传媒� said Dr. William Foege, who led the U.S. Centers for Disease Control69制片厂制作传媒檚 smallpox eradication program and the CDC itself before becoming The Carter Center69制片厂制作传媒檚 first executive director.

Those who worked closely with Carter suspect Guinea worm69制片厂制作传媒檚 toll on poor African farmers resonated with the former president, who lived as a boy in a Georgia farmhouse without electricity or running water.

69制片厂制作传媒淣obody was doing anything about it, and it was such a spectacularly awful disease,69制片厂制作传媒� said Dr. Donald Hopkins, an architect of the campaign who led the center69制片厂制作传媒檚 health programs until 2015. 69制片厂制作传媒淗e could sympathize with all of these farmers being too crippled from Guinea worm disease to work.69制片厂制作传媒�

Eliminating other diseases

There69制片厂制作传媒檚 no vaccine that prevents Guinea worm infections or medicine that gets rid of the parasites. Treatment has changed little since ancient Greece. Emerging worms are gently wound around a stick as they69制片厂制作传媒檙e slowly pulled through the skin. Removing an entire worm without breaking it can take weeks.

So instead of scientific breakthroughs, this campaign has relied on persuading millions of people to change basic behaviors.

Workers from the center and host governments trained volunteers to teach neighbors to filter water through cloth screens, removing tiny fleas that carry the larvae. Villagers learned to watch for and report new cases 69制片厂制作传媒� often for rewards of $100 or more. Infected people and dogs had to be prevented from tainting water sources.

The goal was to break the worm69制片厂制作传媒檚 life cycle 69制片厂制作传媒� and therefore eliminate the parasite itself 69制片厂制作传媒� in each endemic community, eventually exterminating Guinea worm altogether.

The campaign became a model for confronting a broader range of neglected tropical diseases afflicting impoverished people with limited access to clean water, sanitation and health care. Expanding its public health mission, the center has supplied training, equipment and medicines that helped 22 countries eliminate at least one disease within their borders.

Mali became the latest in May 2023 when the WHO confirmed it had ended trachoma, a blinding eye infection. Haiti and the Dominican Republic are working to eliminate malaria and mosquito-borne lymphatic filariasis by 2030. Countries in Africa and the Americas are pursuing an end to river blindness by 2035.

A personal mission

Having a former U.S. president lead the charge brought big advantages to a nonprofit that relied on private donors to fund its initiatives.

Carter69制片厂制作传媒檚 fundraising enabled the center to pour $500 million into fighting Guinea worm. He persuaded manufacturers to donate larvicide as well as nylon cloth and specially made drinking straws to filter water. His visits to afflicted villages often attracted news coverage, raising awareness globally.

69制片厂制作传媒淗e went to so many of the localities where people were afflicted,69制片厂制作传媒� said Dr. William Brieger, a professor of international health at Johns Hopkins University who spent 25 years in Africa. 69制片厂制作传媒淭he kind of attention that was drawn to him for getting on the ground and highlighting the plight of individual people who were suffering, I think that made an important difference.69制片厂制作传媒�

Carter first saw the disease up close in 1988 while visiting a village in Ghana where nearly 350 people had worms poking through their skin. He approached a young woman who appeared to be cradling a baby in her arm.

69制片厂制作传媒淏ut there was no baby,69制片厂制作传媒� Carter wrote in his 2014 book 69制片厂制作传媒淎 Call to Action.69制片厂制作传媒� 69制片厂制作传媒淚nstead she was holding her right breast, which was almost a foot long and had a worm emerging from the nipple.69制片厂制作传媒�

Carter used his status to sway other leaders to play larger roles. Some heads of state got competitive, spurred by the center's charts and newsletters that showed which countries were making progress and which lagged behind.

Worms in a war zone

In 1995, Carter intervened when a civil war in southern Sudan made it too dangerous for workers to reach hundreds of hotspots. The ceasefire he negotiated enabled the center and others to distribute 200,000 water filters and discover more endemic villages.

Carter69制片厂制作传媒檚 efforts not only stopped transmissions in much of what became South Sudan, but also built trust across communities that resulted in a 69制片厂制作传媒渟ignificant peace dividend,69制片厂制作传媒� said Makoy Samuel Yibi, the young nation's Guinea worm eradication director.

Pakistan in 1993 became the first endemic country to eliminate human cases. India soon followed. By 1997, the disease was no longer found in Asia. By 2003, cases reported worldwide were down to 32,000 69制片厂制作传媒� a 99% decline in less than two decades.

Some setbacks frustrated Carter. Visiting a hospital packed with suffering children and adults amid a 2007 resurgence in Ghana, Carter suggested publicly that the disease should perhaps be renamed 69制片厂制作传媒淕hana worm.69制片厂制作传媒�

69制片厂制作传媒淕hana was deeply embarrassed,69制片厂制作传媒� Hopkins said.

Ghana ended transmission within three more years. Even more inspiring: Nigeria, which once had the most cases in the world, reached zero infections in 2009.

69制片厂制作传媒淭hat was a thunderclap,69制片厂制作传媒� Hopkins said. 69制片厂制作传媒淚t was important throughout Africa, throughout the global campaign.69制片厂制作传媒�

To the last worm

Even after being diagnosed with brain cancer, Carter remained focused: 69制片厂制作传媒淚69制片厂制作传媒檇 like the last Guinea worm to die before I do,69制片厂制作传媒� he told reporters in 2015.

Despite dwindling cases, total success has proven elusive.

Historic flooding and years of civil war have displaced millions of people who lack clean drinking water across central Africa. Of the 13 total cases reported in 2023, nine occurred in Chad, where infections in dogs have made the worms harder to eliminate.

69制片厂制作传媒淭hese are the most challenging places on planet Earth to operate in,69制片厂制作传媒� said Adam Weiss, who has directed the campaign since 2018. 69制片厂制作传媒淵ou need eyes and ears on the ground every single day.69制片厂制作传媒�

The campaign still relies on about 30,000 volunteers spread among roughly 9,000 villages. Staying vigilant can be difficult now that cases are so rare, Weiss said.

69制片厂制作传媒淚 would still like to think we will beat the timeline,69制片厂制作传媒� Weiss said of the 2030 eradication goal. 69制片厂制作传媒淭he Carter Center is committed to this, obviously, no matter what.69制片厂制作传媒�

This story has been updated to show there were 14 human Guinea worm cases reported across four African nations in 2023, according to The Carter Center.

69制片厂制作传媒�-

Bynum reported from Savannah, Georgia.