Eradication – even guinea worm is not easy

The Carter Center has been one of the major players in the guinea worm eradication effort for the past two decades. Eradication is not an easy task, but some characteristics of the guinea worm help in its demise. The Carter Center explains that …

Humans are a Guinea worm’s only host, so spread of the disease can be controlled by identifying all cases and modifying human behavior to prevent it from recurring.  Once all human cases are eliminated, the disease will be eradicated. Today, cases of Guinea worm disease are down more than 99% since 1986, making it poised to be the next disease after smallpox to be eradicated.

borehole-well-sm.jpgThe nearly invisible crustacean that serves as the intermediary host stays put in ponds during the transmission season, so it is only human movement that is of concern.  Guinea worm was probably the first problem recognized as a neglected disease in part due to the fact that it infected neglected rural people. These people are not extremely mobil, and improved village water supplies can go a long way to eliminating the disease as well as improving the economic status of villagers.

Guinea worm was to be the test disease or indicator for the success of the United Nations Water Decade (the 1980s). While the annual number of cases world-wide has decreased from 3.5 million to less than 5,000, the disease has resisted eradication efforts for over 20 years. If a disease with a relatively simple life cycle and some obvious locally implementable solutions cannot be eradicated so easily, what of malaria?

Ernesto Ruiz-Tiben of the Carter Center notes that, “Hopefully Guinea worm will be the first parasitic disease ever eradicated. If and when that happens, we will have done it without a drug and without a vaccine to treat or prevent the disease. If we can do that, it will be one of the greatest achievements in public health.”  Even with nets and drugs and insecticides and hopefully, vaccines, there is long ways to go for malaria.

Finally though, if guinea worm is relatively simple to eradicate, why has it persisted for 13 years past its planned demise in 1995?  Some of the same problems facing malaria eradication plagued efforts against guinea worm, and these are in large part challenges of health systems resource management – for example, ensuring that funds for well construction were targeted at endemic villages, not politically expedient villages, planning to distribute simple cloth water filters before the transmission season, not during, enabling village health volunteers to report cases promptly and health workers to respond promptly to guarantee case containment.

Until there is support for improvements in health system functioning, any disease will be difficult to eradicate.

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