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How Jimmy Carter became a serpent slayer and global health pioneer

President Jimmy Carter speaks at World Affairs Council 60th Anniversary event

President Jimmy Carter speaks at World Affairs Council 60th Anniversary event

Former President Jimmy Carter is in Seattle, having spoken last night at the World Affairs Council’s 60th anniversary celebration and speaking today at the Bill & Melinda Gates Foundation about Guinea worm.

A Nigerian woman with Guinea Worm

Guinea worm is a human parasite that eats its way through the human body and emerges a year later, incapacitating people with the pain of completing its life cycle. It’s horrible.

I’ve seen people with Guinea worm in Africa. Over the years, I’ve also seen what Jimmy Carter and his team at the Carter Center have done to come close now to completely ridding the world of this horrific disease.

It’s a great story, and perhaps of much broader significance to global health than many might realize.

Earlier this week, the Gates Foundation, major pharmaceutical companies and others announced a major $$785 million push against “neglected tropical diseases.” This was celebrated by Bill Gates, World Health Organization chief Margaret Chan and others as a critical turning point in global health. The Carter Center got some of the loot, $40 million of it, to finish off Guinea worm.

But in one sense, this push against neglected diseases got a good first shove nearly 30 years ago by Jimmy Carter. One look at the Carter Center’s website shows they got to this point, of recognizing the need to fight neglected diseases, decades ago.

Diseases like river blindness, Guinea worm, parasitic (lymphatic) elephantiasis and schistosomiasis have been in Carter’s cross hairs since the mid-1980s.

Few would argue that it has been primarily the work of the Carter Center, carrying on the work of the CDC and others, that has brought the horrible parasitic disease Guinea worm so close to eradication today — from millions of cases in the 1980s down to a little more than a 1,000 last year. Poor, isolated communities in South Sudan, Mali, Ethiopia and Chad are home to remaining cases.

The parasitic disease, also known as dracunculiais — little dragons — is thought to have been what the Old Testament meant when it referred to “fiery serpents” afflicting people. The worm, which can grow to several feet long, eats its way through the infected person’s body over a year-long life cycle and causes great pain.

So how is it that Carter got on the neglected diseases bandwagon so many decades ahead of others?

This was due in large part to a local (Northwest) boy — a minister’s son-turned-adventurous-doctor — who got Carter started on the neglected disease warpath so many years ago, much as he did later for the richest couple in the world, who now sort of run the global health business.

Bill Foege

That man is Dr. Bill Foege, the guy who figured out how to beat smallpox and the man who helped the Gates family get the global health bug.

When my son and daughter-in-law asked me many years ago to help them start learning about global health, we turned to Bill Foege to be our teacher,” Bill Gates Sr. said last night at the WAC event featuring Carter.

Foege, a Lutheran minister’s son from Colville, Washington (Pacific Lutheran University grad and Univ. of Washington med school grad), first encountered Guinea worm when working as a medical

Donald Hopkins

missionary in Nigeria. He and his colleague Donald Hopkins worked hard to try to draw attention to this largely unknown affliction because they saw how debilitating it was to poor communities.

It didn’t usually kill directly, Hopkins and Foege found, but Guinea worm basically kept poor farming communities poor by regularly throwing them into seasonal terror and deadly incapacitation that led to deeper poverty, starvation and death from a general decline in health.

The smallpox campaign came and the two doctors were recruited to work on that. Guinea worm had to wait. It wasn’t until later that Foege, having served as head of the CDC during the Carter Administration, was able to work with Hopkins to revive interest in Guinea worm. In the mid-1980s, they enlisted philanthropist Jimmy Carter and the Carter Center in the battle.

As a result, as Bill Gates Sr. noted last night: “Since 1986, cases of Guinea worm have gone down from 3 and half million to fewer than 1,800 annually.”

I bring Foege into this tale — which was supposed to be about Carter, I know — mostly because he seems to always be there, often looming in the background despite his stature (he’s 6′ 7″), at key events or turning points in global health.

As a young physician, he re-designed the smallpox vaccination strategy to improve its impact. He was the one who got Carter going on neglected diseases and then, in the late 1990s as Bill Sr. says, helped craft the original global health strategy for the organization now largely running global health, the Gates Foundation.

Guinea worm may soon become only the second human disease, after smallpox, to be eradicated.

That will be because of the dedication of people like Jimmy Carter, with support from people like the Gates family, guided by people like Foege and Hopkins.

And so what if we get rid of this weird disease you may not have heard of? It’s hard to describe in a simple-minded blog like this, but these things tend to have multiplier, or domino effects.

Once Nigeria rid itself of Guinea worm, the thousands of health workers trained by the Carter Center were still out there. They have since turned their attention to reducing maternal mortality, malaria deaths and illness and are working across the board to improve health services.

Who would have thought you could get such bang for the buck just by going after one worm?


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.