Q&A: President Jimmy Carter

Yesterday, in an event at the American Museum of Natural History in New York City, President Jimmy Carter and the Carter Center announced that there were just 126 cases of Guinea worm disease reported worldwide, a 15 percent decrease from the number of cases reported in 2013. Visitors to the museum will have the opportunity to learn about Guinea worm and other diseases—including polio, malaria, tuberculosis, and Ebola—in the new exhibition Countdown to Zero: Defeating Disease, created in partnership with the Carter Center. We chatted with President Carter about "neglected" diseases, the challenges of eradication, and how fashion has helped fight disease.

Why did you want one of the Carter Center’s main objectives to be fighting disease?
The Carter Center has a basic premise of addressing problems that nobody else wants to take on. If the United Nations or the World Health Organization or the U.S. government or the World Bank is handling a problem adequately, we don’t get involved in it. We just fill vacuums in the world. We found out back in the 1980s that no one wanted to address Guinea worm, because it existed in a bunch of scattered villages in the jungle and the desert that were inaccessible, where people couldn’t read and write in any language, and they didn’t have access to radio or anything. It was just a horrible disease, known from biblical times, that no one wanted to address. So we decided to take it on ourselves—maybe naively at that moment—but we got more and more deeply involved in it and learned more and more about it. And luckily, we live next door to the Centers for Disease Control, and there are a lot of experts there, on this and many other diseases, and they came over to the Carter Center to work full time for me. So those are the things that made it possible for us to do it.

How did you pick which diseases you wanted to target?
We target four other diseases that the World Health Organization calls "neglected tropical diseases." One of them is river blindness. This year, we’ll treat about 25 million people so they won’t go blind from this disease. That’s more people than live in the state of New York, as a matter of fact. Secondly, we treat trachoma, the number one cause of preventable blindness—second only to cataracts. And the Carter Center will be responsible for about one-third of the total eye surgeries that deal with trachoma. We also deal with a disease called schistosomiasis, which is caused by snails; it causes microorganisms in the body to take away all the nutrients, so little kids basically starve to death. Another one is lymphatic filariasis, or elephantiasis, when your sexual organs or arms and legs swell up to grotesque sizes—four to five times as large as their normal size. So these are the kinds of diseases we treat. Also malaria, which is carried by the mosquitoes that transmit lymphatic filariasis, so when we deal with malaria, we also deal with lymphatic filariasis at the same time.

Guinea worm eradication is now within sight. What are the challenges now in getting that number down to zero, and then keeping it there?
We started out with 3.5 million cases in 23,600 villages in 20 countries, and we’ve brought that number down, now, to 126 cases in the whole world. So we know every person in the world that has Guinea worm. So we have to monitor villages that didn’t show a case last year and make sure that those cases that we have identified don’t go in the water and spread the disease to future drinkers. So this is what we’re doing now, and I don’t think there’s a doubt that in the next two or three years we’ll find the last case.

What keeps this from being completely successful is that in two countries, Mali and South Sudan, there’s a war going on. So sometimes it’s hard to get to the villages in a timely fashion and to find the people who have Guinea worm.

The other problem is that sometimes there are nomads, who move from one place to another to work a seasonal crop. They spend their lifetime on horseback or camelback, just moving from one place to another. So they might drink water in one village and by the time the Guinea worm comes out of their body a year later, they’re 200 miles away in a different place.

So those are the kinds of problems we have. But we’ve faced those problems successfully for 35 years and I don’t have any doubt that we’ll be successful.

What kinds of strategies did you have to use to get people cured?
The worst problem that we had, at first, is that the people are in the most isolated and poverty-stricken communities on Earth. They didn’t speak any language that we knew—French or English or Portuguese or anything like that—they spoke native languages. They were almost entirely illiterate, and they had no access to radio or television. So the only way we could educate them about this disease is by going there personally to the villages or by drawing cartoons that the people could recognize. We would draw two women side by side. One would be filtering her water, and she would not have Guinea worm; the other woman would not filter her water and she would have Guinea worm. And sometimes they’d even print those cartoons up on dresses that they wore and shirts that they gave the men to wear.

So the first thing was just teaching people about the disease and what to do about it. We found out that if people just filtered every drink of water, it would take out the [copepods], and that would mean that there would be no more Guinea worm in that village ever—if everyone in the village was 100 percent following our advice.

What do you hope visitors to the exhibit at the museum take away from it?
About 5 million people every year go through the museum, and a lot of them go up and down that corridor. We hope that it will let them know, first of all, that these horrible diseases still exist, and secondly, that properly treated they can be, and are being, completely eliminated from the face of the Earth. Third, I would say that Americans and other visitors to the museum have some responsibility to help with this process. And there’s an interesting story to tell about just how you go about it and how success has already been reached and by the Carter Center and some other people who also work on this disease. Those are some of the things I hope people learn when they see this exhibit.