When The Carter Center began leading the international campaign to eradicate Guinea worm disease in 1986, there were an estimated 3.5 million cases in at least 21 countries in Africa and Asia.

Today, thanks to the work of The Carter Center and its partners — including the countries themselves — the incidence has been reduced by more than 99.99% to 14 provisional* human cases in 2023. During the first three months of 2024, not a single case was detected worldwide.

Guinea worm disease, a parasitic infection caused by the nematode roundworm parasite Dracunculus medinensis, is contracted when people consume water from stagnant sources contaminated with Guinea worm larvae. Inside a human’s abdomen, Guinea worm larvae mate and female worms mature and grow. 

After about a year of incubation, the female Guinea worm, one meter long, creates an agonizingly painful lesion on the skin and slowly emerges from the body. To seek relief, sufferers may immerse their limbs in water sources, but this stimulates the emerging worm to release its larvae into the water and begin the cycle of infection all over again.

Guinea worm is a devastating disease that incapacitates people for long periods of time, making them unable to care for themselves, work, grow food for their families, or attend school. Traditional removal consists of winding the worm around a piece of gauze or small stick and manually extracting it, which often takes weeks. Secondary bacterial infections prolong the period of disability. There is no known curative medicine or vaccine to prevent Guinea worm disease — the same treatment for emerging worms has been used for thousands of years.

Since 1986, The Carter Center has worked closely with ministries of health and local communities, the U.S. Centers for Disease Control and Prevention, the World Health Organization, UNICEF, and many others to eliminate the disease.

The Guinea Worm Eradication Program uses community-based interventions to educate and change behavior, such as teaching people to filter all drinking water and preventing transmission by keeping anyone with an emerging worm from entering water sources.

A challenge has been the emergence of numerous Guinea worm infections in animals, first detected in 2012. Most were believed linked to dogs’ consumption of fish and fish entrails containing Guinea worm larvae. 

Volunteers trained by Chad’s Guinea Worm Eradication Program with the Carter Center’s help have encouraged people to bury fish discards, and cash rewards are being paid for reporting infected animals and for keeping them away from water sources. 

Researchers are actively seeking a remedy for canine infections, including the use of established veterinary deworming drugs. In 2023, Chad reported infections in 495 animals, Mali reported 47, Cameroon 97, Angola 85, Ethiopia one, and South Sudan one. 

Another challenge is insecurity. Parts of some affected countries are inaccessible because of internal conflict that makes these areas unsafe to enter or travel through. Guinea worm elimination cannot be confirmed until surveillance can be carried out in all areas.

The campaign has helped to establish village-based health delivery systems in thousands of communities that now have networks of health personnel and volunteers who provide health education and interventions to prevent other diseases. It has averted at least 80 million cases of this devastating disease among the world’s poorest and most neglected people.

The Carter Center leads the international Guinea worm disease eradication campaign, compiles and distributes case numbers, and provides technical and financial support to national programs to interrupt Guinea worm disease transmission and bring cases to zero. When transmission is interrupted, the Center provides continued assistance in developing or strengthening surveillance in Guinea worm-free areas and preparing nations for official certification.

The World Health Organization is responsible for certifying countries as Guinea worm-free, and is the only organization that can officially certify the eradication of a disease.

Cover image: A local volunteer in South Sudan uses a flip chart to educate villagers on Guinea worm disease prevention. 2008. The Carter Center/J. Albertson