Jimmy Carter Worked to Eradicate the Vicious Guinea Worm Parasite, Slashing Cases by the Millions

About a year after Jimmy Carter left the White House, he founded the Carter Center in 1982, based on a “fundamental commitment to human rights and the alleviation of human suffering.” That mission launched him into a post-presidency that was singularly successful in its efforts to beat back the scourges of humanity, from civil war to disease.

One of Carter’s foremost achievements—“not for me, but for the people that have been afflicted,” as he told ABC News’ George Stephanopoulos in a 2015 interview—was the near-total eradication of Guinea worm, a vicious parasite passed on to humans by drinking stagnant, infected water in Africa and Asia.

“Once you’ve seen a small child with a two- or three-foot-long live Guinea worm protruding from her body, right through her skin, you never forget it,” Carter wrote in a 1990 op-ed for the Washington Post after visiting Ghana with his wife Rosalynn. He described walking through villages and witnessing hundreds of men, women and children in agony.

“Nobody was doing anything about it, and it was such a spectacularly awful disease,” Donald Hopkins, the Carter Center’s special advisor for Guinea worm eradication, tells Russ Bynum and Sam Mednick of the Associated Press.

In 2015, as he suffered from cancer, the former president quipped to reporters that he’d “like for the last Guinea worm to die before I do.” When Carter died on December 29, 2024, at 100 years old, he had come tantalizingly close to realizing that wish. Now, experts say the parasite’s eradication is on the horizon.

The Carter Center joined the fight against the neglected tropical disease in 1986, when Guinea worms tormented some 3.5 million people across 21 countries in Africa and Asia each year. By 2023, only 14 provisional human cases remained, according to the Center’s data.

The Centers for Disease Control and Prevention (CDC) notes that symptoms of Guinea worm disease, caused by consuming the parasite Dracunculus medinensis, might not manifest until a year after infection. But at that time, a pregnant female Guinea worm—which can measure up to three feet in length—begins to break through the human’s skin and emerge to expel her larvae into a body of water. The process is excruciating for the afflicted human, as the worm slowly pulses out, usually through the legs or feet.

“Having the worm pulled out is more painful than giving birth,” Nyingong Aguek, one of 500 residents of Jarweng, a village in South Sudan, tells the AP. She points to scars from four worms on her left leg.

Although the disease is not fatal, it can rip through entire villages via shared water sources in a process that NPR’s Jason Beaubien describes as an “evil little trick.” Just as the worm emerges, it burns and stings the skin, often encouraging the victim to seek relief by plunging their infected extremity into a body of water. Then, it releases the new larvae, which are consumed by tiny crustaceans and transferred to humans when they drink the water. The cycle begins again.

Carter’s deep sympathy for the victims of Guinea worm disease came in part from his background as a peanut farmer who grew up in a farmhouse with no electricity or running water. He understood how a parasite could curse an entire community “by crippling farmers for weeks during the planting or harvest seasons, by preventing children from going to school and by keeping mothers from caring for their infants and toddlers,” as he wrote in the Washington Post.

Humans cannot develop resistance to the worms, according to Scientific American’s Charles Schmidt, and the traditional process of removing them is painstaking: gently winding an emerging worm around a stick and pulling it slowly out, usually just an inch or two each day, in a process that can last for weeks. Pulling too fast or too hard might cause the worm to break off in the body, leading to secondary infections. When victims suffer from multiple worms—such as Abdullahi Rabiu, a Nigerian man who had a record-setting 84 in his body at one time—the excruciating recovery work compounds.

If Guinea worm disease were to be destroyed, it would become only the second human disease (after smallpox) to be eradicated by humans, the only parasitic disease to be eradicated and the only disease to be eradicated without a vaccine or medicine, according to the Carter Center.

“To think that you could eradicate a disease without any tools is really still just a crazy idea,” Julie Jacobson, a global health worker and doctor who helped secure funding for the Carter Center’s work, tells ABC News’ Mary Kekatos. “He did it with perseverance and working with people in the grassroots within communities.”

Since Guinea worm disease doesn’t have any vaccines or treatments, the Center, alongside global health agencies and governments of the countries where the disease dwelled, doesn’t fight the parasites with the sleek, precise instruments of modern epidemiology. Instead, it works to promote prevention and education.

The goal is to break the worm’s life cycle so it cannot continue infecting humans and reproducing in bodies of water. Workers from the Carter Center provide villages with cloth screens to filter larvae from their water. They construct barriers to isolate contaminated water sources and to keep the infected away from seeking relief in water. Villagers are encouraged to identify and report new cases, sometimes for cash rewards, according to the AP.

Although cases of Guinea worm disease recently hit an all-time low, eradication efforts are complicated by the presence of the parasites in stray dogs, according to NPR. Still, the World Health Organization aims to eliminate the disease by 2030, and officials at the Carter Center are confident that the scourge of Guinea worm disease will be over even sooner.

“I would still like to think we will beat the timeline,” Adam Weiss, the director of the Center’s eradication program, says of the 2030 goal to the AP. “The Carter Center is committed to this, obviously, no matter what.”

Carter himself asked for updates about his group's efforts, even after he went into hospice care. He was steadfast, caring and committed to his work alleviating human suffering until the very end.

“The last mile is the hardest,” Kashef Ijaz, the Carter Center’s vice president for health programs, tells Scientific American. “We have to stay committed and remain more focused than ever before.”

Eli Wizevich | | READ MORE

Eli Wizevich is a history correspondent for Smithsonian. He studied history at the University of Chicago and previously wrote for the El Paso Times.