Guinea Worm Initiative

The eradication of the final case of smallpox in 1977 generated considerable excitement in the public health world.  I asked Don Hopkins, a recent Harvard MPH graduate on my White House staff and Gerald Fill who coordinated my international health activities to review the possibility of finding some other disease that might be a candidate for eradication. I was hoping we could create a presidential initiative around a second disease to be eliminated. I had in mind that it might be perhaps polio, or measles or mumps. I also talked at length with Bill Foege, then CDC director, about the same topic. The consensus was that smallpox was somewhat unique and most other transmittable diseases did not, for a variety of reasons, lend themselves to easy eradication. The only good candidate that we came up with was guinea worm. To my disappointment I came to the conclusion that a disease that affected no US citizens, and was unknown to virtually all Americans, including many physicians, was not an adequate candidate for you to use up either your time or your presidential capital on. We were also at the time preparing for you a presidential statement outlining a new policy to promote global health ( the first by any president) that you released in March, 1978. It included such elements as increased vaccination, reduction in blindness and, notably, a new emphasis on water and sanitation. Although guinea worm was not mentioned specifically Don and I took comfort from the fact that this latter focus, if implemented, would impact guinea worm. During that same period I did testify before the Africa Sub-committee of the House Foreign Relations Committee on health issues during which I did specifically mention guinea worm.     

When I went to the UN to run the “The International Decade on Clean Water and Sanitation” and Don went to be deputy director at CDC he continued to have an interest in guinea worm. He prepared a nice little gold-covered brochure on how it might be eradicated. He brought it to me at the UN and asked if I could make the global eradication of guinea worm a sub-goal of the Water Decade. I enthusiastically agreed and formally included it even though I faced considerable criticism from some of my UN colleagues. The head of UNICEF said guinea worm affected adults so much more than children that he considered it a very low priority for them. The World Bank said the financial impact was too small for them to give it the priority I wanted. And WHO said they had been burned on their campaign to eradicate malaria and they did not want to talk about “eradication” in connection with any other disease-“reduce the incidence of” they thought was better phrasing. We did get the initiative launched and Don and I got our respective bureaucracies behind it despite their reservations.

I left the UN in 1981 and started an NGO, Global Water, that worked essentially to support the water decade goals including the guinea worm campaign. The first international meeting (really just a seminar with a dozen people) was held in Washington in 1982. One attendee was Dr Mueller from the Liverpool School of Public Health, then considered the world authority on the parasite.  Don was very eager to hold a meeting in Africa to bring together representatives of the endemic countries, but we did not have the money and most funding sources had no interest in this obscure disease. I finally persuaded David Hamburg at the Carnegie Corporation to write a check for $ 25,000 from his personal discretionary fund. It was more a personal favor than a belief that guinea worm could or would be eradicated. However, it allowed the meeting, held in Niamey, Niger, to go ahead. In many ways that meeting was a turning point in building real momentum behind the campaign.

Don and I, however, continued to have serious difficulties getting people to take the guinea worm initiative seriously. Government ministers in developing countries were mostly from urban backgrounds and had either had no personal experience with guinea worm or thought it a very low priority if it affected only the rural poor. Ministers of health in Yemen, Ethiopia and Saudi Arabia denied that they had or had ever had guinea worm in their countries. Even though we had evidence to the contrary. You are already familiar with the Pakistan situation. The other problem we faced was that our dealings were mostly with minsters of health who were low on the totem pole in their respective cabinet and had limited budgets. The news media had no interest.

This is not to say we did not make some progress. Working with some dedicated people in India we helped to get the final few cases dealt with there. Between 1980 and 1985 we made steady if slow progress. However, there were many frustrations. Of course the major change came with the conference on international health that the Carter Center sponsored in May, 1985. As the lunch speaker on water and the International Water Decade I was, as you recall, able to devote much of it to the guinea worm issue. Don and I subsequently talked about what an extraordinary difference it would make if we could convince you to take on the guinea worm campaign. We agreed that would raise it with you when you came to Wales the following month.  I did so while we were driving from Dylan Thomas’s grave to lunch in Newport. You did not make a commitment then but you did shortly afterwards.  

Peter Bourne