In the 1970s, a decade of peace opened up between civil wars in Sudan, allowing health workers to reach and immunize at-risk communities for smallpox. Without this window of peace, historians argue, smallpox might not have been conquered there.
Recent outbreaks of violence (Dec. 15, 2013) in the new country of South Sudan have led some to speculate whether eradication efforts will succeed for another primeval plague -- the Bible's "fiery serpent," known today as Guinea worm disease (dracunculiasis).
Guinea worm disease is so spectacularly terrifying it is believed to have inspired the symbol of medicine, the Staff of Asclepius. Spread by drinking contaminated water, the parasite grows inside a person for about a year, before exiting through burning blisters.
By then, the parasite has grown 3 feet long and must be slowly, painstakingly extracted -- inch by painful inch -- and coiled gingerly around a stick to avoid breaking the worm and crippling its victim; this same treatment was used in Ancient Greece. There is no immunity after previous infections, and a person can suffer with multiple worms at once.
We can prevent some cancers with a vaccine and cure the bubonic plague with antibiotics, but we have no vaccine or modern medical cure for Guinea worm disease.
The tactics for eradicating Guinea worm are mainly twofold: filter all contaminated drinking water through a simple, fine mesh cloth and prevent those infected with Guinea worm from entering water sources. We can also treat contaminated water with a mild larvicide, Abate. While these methods work, the process takes time and close collaboration with communities whose patience and commitment often are tested for years before significant progress is seen.
The year following the historic 2005 Comprehensive Peace Agreement, the southern states of Sudan, which would in 2011 become the new independent nation of South Sudan, were more accessible to health workers than ever before, and 20,579 cases of Guinea worm disease were reported. Compounding this burden, the conflict-ravaged south had less infrastructure: few miles of paved road in a country the size of France, no formal communication network, and virtually no access to basic health care. South Sudan also endured more Guinea worm disease than any of the other 21 original Guinea worm-endemic countries in Africa and Asia.
Yet this past year, the national program reported a 99-percent reduction in cases (113 cases in 2013, provisional) since 2006. In the history of the campaign, this is the greatest reduction of cases in just seven years and is a demonstration of what South Sudan can do with sustained peace when it puts its mind to it.
Every day the Ministry of Health, The Carter Center and our partners carefully follow the status of recent outbreaks of violence in South Sudan. We're all aware of what lies in the balance. We know the names, the faces, and the families of thousands of dedicated South Sudanese that we have worked among for nearly three decades. We know by the determination and civic spirit we've seen in the campaign to wipe out Guinea worm disease that the people of South Sudan have sacrificed greatly to achieve independence -- too much to slide into a prolonged conflict.
For all the work that the international community can do to fight Guinea worm disease, it is the people of the endemic villages themselves who have demonstrated the strongest commitment to eradicating this terrible disease, improving their lives, and hoping for a better and more peaceful future. This year, the world reported 148 cases (provisional), a historic low in the campaign.
Until political and ethnic hostilities broke out on Dec. 15, 2013, the South Sudan Guinea Worm Eradication Program had reported zero cases for that month. It reported zero cases in January and in November 2013. The current insecurity has not occurred in the country's most endemic area, peak transmission has not begun, and the network of thousands of local Guinea worm health workers remains largely in place despite the difficult situation. Based on work in 2013, the program expects less than 50 cases in 2014.
Permanent and sustained peace in South Sudan is critical for the people of South Sudan to go back to their important work building better lives for themselves, without the setback of prolonged conflict. With their help, one of their first achievements could be something from which we all can benefit -- Guinea worm disease will become the first parasitic disease eradicated, the first disease eradicated without a vaccine or medical treatment, and the second human disease eradicated after smallpox.
Smallpox eradication taught us the power of human ingenuity, but Guinea worm eradication may teach us the power of the human spirit to overcome even the most daunting of challenges.
Donald R. Hopkins, M.D., M.P.H., is vice president for The Carter Center's health programs and an expert on the eradication of diseases. The Carter Center spearheads the international campaign to eradicate Guinea worm disease. To learn more, please visit www.cartercenter.org/guineaworm.
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