Yesterday, the minister of health for the country of South Sudan announced that they had successfully put a stop to transmission of Guinea Worm Disease.

This means that they have achieved a 15-month period of no reported cases of Guinea Worm.  Since the Guinea Worm has a lifecycle of about twelve months, fifteen months with no cases means that the disease isn’t coming back unless it is reintroduced from the outside.

This is a massive accomplishment.

Guinea Worm Disease, also known as dracunculiasis, has been infecting people for as long as we have a historical record. It is mentioned in ancient Egyptian texts, and in the Hebrew Bible. It is rarely fatal, but it is excruciatingly painful and disabling. Its economic and social impact drags down economies and reduces educational attainment in the countries affected by the disease.

The parasite transmits when people drink water that contains Guinea Worm larvae, which are so small they’re invisible to the naked eye. The worm larvae then takes up residence inside the human body, growing larger and larger. Eventually, a three-foot-long worm starts to make its way out of the body through a sore in the skin – usually on a foot. This is excruciatingly painful to the patient. There is no cure or treatment for Guinea Worm once infection has taken place.

Modern medicine calls for slowly winding the worm around a stick to remove it from the body without causing infection, just as it was done in the time of the ancient Egyptians.

Image credit, Carter Center

In the mid-1980s, more than 20 countries were affected by Guinea Worm Disease. There were about 3.5 million cases worldwide. It was just one more grim fact of life in for poor people in poor countries, making cycles of poverty worse.

In 1986 The Carter Center began its Guinea Worm eradication campaign and cases around the world began to drop sharply — never before had a large international NGO crated a sustained campaign around this disease of the poor.

By 2016, there were just 25 reported cases of Guinea Worm in the world, limited to four countries – South Sudan, Mali, Chad, and Ethiopia. This is a reduction of more than 99%.

Now, in 2018, we’re down to three countries. South Sudan is expected to be formally certified Guinea Worm free by the World Health Organization in the next few months.

No Cure. Only Prevention

Eradicating Guinea Worm disease, one presentation at a time. Credit: Carter Center

There is no cure or treatment for Guinea Worm disease once infection has taken place. This means that the only way you can stop transmission is by convincing people to filter every drop of water they drink. In a context like South Sudan, with a literacy rate of 27% and an ongoing civil war, that means going door-to-door to educate people and convince them to do extra work to avoid being infected by invisible creatures.

If South Sudan can succeed in eliminating Guinea Worm, even in the face of violence, displacement, and severe poverty, then the other remaining countries certainly can.

One of the original architects of the eradication campaign, Dr. Donald R. Hopkins, put it this way, “South Sudan prevailed despite the most complex Guinea worm transmission among humans of any country, peak prevalence during a long rainy season, vast territory, and poor infrastructure, as well as ongoing postwar insecurity.”

That victory is the result of sustained hard work and commitment on the part of national level health authorities, global health donors, and health outreach workers.

If South Sudan can put a stop to Guinea Worm Disease, then the disease doesn’t stand a chance elsewhere

Ethiopia, Mali and Chad have better health infrastructure than South Sudan. South Sudan’s eradication of the disease is proof of what can be achieved through true commitment to a global health goal. The worms have no wild animal reservoir. If we stop it in humans and domestic animals, we eradicate the disease.

2017 saw just 30 cases of Guinea Worm Disease – 15 in Ethiopia and 15 in Chad. No human cases were reported in Mali, but there were Guinea Worm cases reported in dogs. Once Mali can eliminate canine cases, it will be next to interrupt the transmission cycle.

In 2015, President Jimmy Carter, founder of the Carter Center, announced that he had been diagnosed with cancer. He said he was responding well to treatment and he expected to out live the last case of Guinea Worm.

President Carter is now 95 and cancer free, and Guinea Worm Disease just lost the fight in South Sudan.

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