Jimmy Carter's Triumph Over The Guinea Worm

Funeral services begin today for former President Jimmy Carter. He died Sunday, at 100-years-old. Carter brought attention to global health challenges, particularly "neglected" tropical diseases like Guinea worm. With reporter Jason Beaubien, we look at that decades-long effort and how science was central to Carter's drive for a better world. Questions or comments for us at Short Wave? Let us know by emailing [email protected] mailto:[email protected] — we'd love to hear from you! Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This message comes from NPR sponsor Viori with the Halo Essential Wide-Like Pant. Receive 20% off your first purchase at viori.com/NPR on any US orders over $75 and free returns. Exclusions apply. Visit the website for full terms and conditions. You're listening to Short Wave from NPR. Hey, Emily Kwong here. Former US President Jimmy Carter passed away Sunday at his home in Plains, Georgia. He was 100 years old. And during his lifetime, he did a lot for science and for treating one disease in particular. Here to talk about it with me is science reporter Jason Bobian. Hey, Jason.

• 0:39Speaker 01

  Hey, Emily.

• 0:40Speaker 00

  Hi. So how are you doing with the Carter news?

• 0:42Speaker 01

  Look, he had an amazing life, both in politics and out of politics. So I think it's great to be able to celebrate Carter. And he's probably going to be remembered more for the work that he did after he left the White House, rather than those chaotic four years that he spent in Washington in the late 1970s.

• 1:00Speaker 00

  Yeah. I mean, I wasn't alive, but it does appear that way from reading things.

• 1:05Speaker 01

  It was. It was a very chaotic time. And so I was thrilled when I got word you wanted to chat about two of my favorite subjects, Jimmy Carter and Guinea worms.

• 1:13Speaker 00

  Oh, yeah. We at Short Wave, we will seize any opportunity to discuss worms, so.

• 1:18Speaker 01

  Absolutely.

• 1:19Speaker 00

  No brainer.

• 1:19Speaker 01

  As you should.

• 1:22Speaker 01

  And you know, right here at the beginning, let's be clear.

• 1:24Speaker 00

  Yeah.

• 1:24Speaker 01

  Jimmy Carter, he did a lot of things in his post-presidential time. His legacy goes well beyond his battle with Guinea worms. You know, he became an advocate for Habitat for Humanity. He was out there actually swinging a hammer with them, building houses in the US and in other places. He was a major champion for human rights. He continued to work on peace in the Middle East. You know, he was working on elections. He helped negotiate some really sticky political stalemates in Central America. And for all of that work, he was recognized, not just in the US, but globally.

• 1:59Speaker 02

  The Nobel Committee in Norway has decided to award the Nobel Peace Prize for 2002 to Jimmy Carter for his decades of untiring effort to find peaceful solutions. To international conflicts, to advance democracy and human rights, and to promote economic and social development.

• 2:19Emily Kwong?

  Yeah, Jason, I remember when this happened. It was like, wow, this guy is like still out there, still doing things.

• 2:25Speaker 01

  Yeah, and that was in 2002.

• 2:28Emily Kwong?

  Yeah.

• 2:28Speaker 01

  And he had two more decades ahead of him. And one of the things that he worked on was trying to eradicate this really horrible disease called Guinea worm.

• 2:39Emily Kwong?

  We're going to talk about that today on the show and how science was central to former President Carter's drive for a better world. I'm Emily Kwong, you're listening to Shore Wave, the science podcast from NPR.

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• 4:01Emily Kwong?

  Okay, so Jason, former President Jimmy Carter was known for many things, including fighting disease around the world.

• 4:09Speaker 01

  Right.

• 4:09Emily Kwong?

  But how did he end up waging a war on Guinea worms?

• 4:12Speaker 01

  So, the World Health Organization has a list of so-called neglected tropical diseases. You know, these are diseases in need of more research, more treatment.

• 4:22Emily Kwong?

  Okay.

• 4:22Speaker 01

  He, however, had a former employee from the White House who got involved with working on clean water.

• 4:30Emily Kwong?

  Oh.

• 4:31Speaker 01

  And this guy came, gave this pitch to Carter, and Carter was like, this is doable.

• 4:36Emily Kwong?

  Yeah.

• 4:36Speaker 01

  You know, he was driven by this worldview of the need to ease suffering, to help the less fortunate. So, taking on neglected tropical diseases that were being overlooked and ignored, you know, this was right up his alley.

• 4:49Emily Kwong?

  And I think he's almost done that, right? Like, nearly managed to eradicate Guinea worm?

• 4:54Speaker 01

  Yeah, he, he has. And, you know, it wasn't just him. But you have to look back. It was the mid 1980s, Carter decides to start focusing on wiping out Guinea worm.

• 5:05Emily Kwong?

  Mm-hmm.

• 5:06Speaker 01

  At that point, the World Health Organization estimated that there were like 3.5 million cases of Guinea worm disease globally.

• 5:14Emily Kwong?

  Wow.

• 5:14Speaker 01

  Almost all of these were in really remote parts of Sub-Saharan Africa and Asia. Last year, the WHO says there were only 13, 1-3, cases of Guinea worm globally.

• 5:25Emily Kwong?

  Wow.

• 5:26Speaker 01

  Yeah, pretty impressive.

• 5:27Emily Kwong?

  And he was very successful in, in leading that. It seems like, I'm looking this up, there were only 13 cases of Guinea worm in 2023, and just three cases in the first half of last year. So, from three and a half million to basically a handful, that's amazing.

• 5:43Speaker 01

  It is amazing. Um, and, you know, I was talking to Paul Farmer about just how impressive this was.

• 5:49Emily Kwong?

  Yeah.

• 5:49Speaker 01

  And he gives much of the credit to Carter.

• 5:52Emily Kwong?

  Yeah, and you're talking, of course, about Paul Farmer, global health legend.

• 5:56Speaker 01

  That's right. Paul Farmer, you know, co-founder of Partners in Health, the subject of Tracy Kitter's incredible book, Mountains Beyond Mountains. Uh, Farmer, like Carter, was also a crusader his entire life, uh, for healthcare equity around the world. And I was talking to Farmer, obviously before Farmer died last year. But Farmer was saying that in the overall history of human medicine, there hasn't been a lot of progress in entirely eradicating specific diseases.

• 6:24Speaker 04

  All we've got behind us is smallpox. That's the only human disease that's ever been eradicated. And if Guinea worm is right behind, that's going to be thanks to Carter. I mean, there were millions of cases when he got involved in the, you know, after his presidency in the mid 80s. And now, you know, we're down to fewer than 100 last year.

• 6:43Speaker 01

  That was Farmer back in 2019.

• 6:45Emily Kwong?

  Yeah.

• 6:46Speaker 01

  So, you know, even from 2019, we've gone from a fewer than 100 down to just 13. It really is on the verge of being wiped out as we speak.

• 6:55Emily Kwong?

  Let's back up a step to focus on the Guinea worm itself and this disease it causes. What are these worms and how does their disease affect people?

• 7:06Speaker 01

  So I know we all like to respect all forms of life, but Guinea worms, they're really gross.

• 7:13Emily Kwong?

  You know what? Tell it like it is, Jason.

• 7:15Speaker 01

  I almost think of them as like evil. You know, that's my sort of my scientific assessment. These are evil worms.

• 7:21Emily Kwong?

  From our resident worm scientist, okay.

• 7:23Speaker 01

  That's right. I am a journalist with a degree in English, so I'm making that as a definitive statement.

• 7:28Emily Kwong?

  Strong word choice, chosen clearly for a reason. Why do you say that?

• 7:32Speaker 01

  Okay, so Guinea worms, they're parasites. They spread through contaminated drinking water. But they've come up with this little evolutionary trick. And their life cycle goes like this. The Guinea worm's larvae, they are born in stagnant pools of water. They live in there. They're tiny. You can't see them. People come along who don't have access to clean drinking water. They end up drinking the water with these larvae. Then inside the human, they reproduce. The male worms die off inside the people. The females migrate to the person's legs. And then over the course of a year, they cause these massive lesions. And it takes, you know, months before they start to emerge. And it's incredibly painful.

• 8:14Emily Kwong?

  Oh, man.

• 8:14Speaker 01

  These open wounds at times, if it's on someone's foot, they might not be able to walk. And here's their evil little trick.

• 8:21Emily Kwong?

  Okay.

• 8:21Speaker 01

  The worms cause this intense burning sensation under the skin right when they're about to release their eggs. And in an effort to extinguish that burning sensation, they plunge their leg into water, oftentimes a stream or a pond. And at that point, all the worms, all their little eggs go out into the water and the whole cycle starts over again, infecting more people.

• 8:46Emily Kwong?

  That is menacing. That is horrible.

• 8:49Speaker 01

  It is.

• 8:50Emily Kwong?

  And admittedly, the science person in me wants to say, very clever from an evolutionary point of view.

• 8:56Speaker 01

  Yeah. So the key, from an eradication point of view, is to break that reproductive cycle.

• 9:02Emily Kwong?

  Right. Also, is it only inside humans that you get that reproductive cycle?

• 9:07Speaker 01

  So this is one of the tragedies of this epic battle against guinea worm. You know, for decades, it was believed that humans were the only reservoir, basically the only hosts.

• 9:21Emily Kwong?

  Yeah.

• 9:21Speaker 01

  For this, this worm. And that the parasite needed that year-long period inside the human body to grow and reproduce. Unfortunately, as the numbers of cases dropped dramatically, researchers found that the worms were also turning up in some stray dogs and chads and fish, some other animals. So unfortunately, that complicates the eradication efforts because there's no longer just this one single place where you need to look. That said, the number of guinea worms that have been found in animals is quite small.

• 9:51Emily Kwong?

  Jason, you mentioned that one of the ways to get to the bottom of this whole disease is by improving access to drinking water. Was that the main strategy of Carter and others in trying to eradicate this disease?

• 10:03Speaker 01

  Yeah. Clean drinking water is key. And, you know, obviously, there are a lot of other great benefits to making sure people have access to clean drinking water.

• 10:10Emily Kwong?

  Yeah.

• 10:10Speaker 01

  And if you can break that reproductive cycle of, of the worm living in stagnant water and reproducing and then spreading back into the water supply, yeah, you can defeat the parasite. But getting people better water supplies, you know, particularly in remote parts of some of the poorest countries in the world, it doesn't happen overnight. So education was a big part of the campaign against guinea worm. Just letting people know what this cycle is, letting people know that they have the worms to not plunge their leg into a, a pool where people might later be drinking.

• 10:41Emily Kwong?

  Yeah.

• 10:42Speaker 01

  You know, they were also tracking where these parasites are turning up. They were testing water. Um, you know, because obviously if health officials know where the cases are occurring, then they can focus more efforts and resources in those areas. And at one point, a number of places in Africa were offering rewards of a hundred dollars for any worms that anyone could turn in. This was at a time when things had gotten fairly low in terms of the numbers of cases that were occurring. And Kenya was even offering 100,000 Kenyan shillings. But I should point out that that was when they had pretty much wiped out the disease entirely.

• 11:16Emily Kwong?

  Okay, so what was Jimmy Carter's role in all of this? Because he wasn't out there handing a hundred dollar bill bounties for each Guinea worm, right? Like, why is it that Paul Farmer and others are accrediting Carter with nearly eradicating this parasite?

• 11:30Speaker 01

  You know, the thing about Carter is that he did get out there to many of these places where Guinea worm continued to be a problem. But you're absolutely right. You know, this war against this worm was not hand-to-hand combat between Carter and the worms. But what he did was he, he looked at this health problem and he said, this neglected tropical disease is fixable. We can solve this. And he made it a priority to keep global resources focused on it. And Carter would be the first to tell you that he didn't do this alone at all. You know, there's thousands of healthcare workers out there in the field.

• 12:04Emily Kwong?

  Yeah.

• 12:05Speaker 01

  You know, it really drove Guinea worm to the brink of extinction.

• 12:08Emily Kwong?

  Yeah.

• 12:08Speaker 01

  And, and Paul Farmer points out that Carter's role was staying on top of it and keeping the focus for years and decades on this fight. And, you know, as Farmer said, convincing people.

• 12:21Speaker 04

  When you take on a problem like this, like Guinea worm or onchocerciasis, you have to sweet talk the ministry officials, the political figures, the nurses, the doctors, the community activists, the farmers, the people who are, you know, most at risk. Carter's had to sweet talk all those people. And, you know, that's something that's been very inspiring to many of us.

• 12:43Speaker 01

  You know, and as I said, Guinea worm eradication was just one of many things that Carter worked on in his post-presidential life. But this project was incredibly important to him. And I should note that when he was diagnosed with cancer in 2015, he was still single-mindedly focused on eradicating Guinea worm. I would like to see Guinea worm completely eradicated before, before I die. For the last guinea worm to die before I do. I'd like the last guinea worm to die before I do. I mean, it's just a great line.

• 13:15Emily Kwong?

  Yeah.

• 13:16Speaker 01

  And he didn't completely kill off the last guinea worm, but Carter did come incredibly close.

• 13:23Emily Kwong?

  Jason Moby, NPR correspondent, thank you for telling us about the public health legacy of Jimmy Carter.

• 13:29Speaker 01

  You're absolutely welcome. Thank you.

• 13:32Emily Kwong?

  This episode was produced by Burleigh McCoy. It was edited by our managing producer, Rebecca Ramirez, and fact checked by Anil Oza. The audio engineer was Patrick Murray. I'm Emily Kwong. Thanks for listening to Short Wave from NPR.

• 13:59Speaker 00

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