Success Story from Sudan: Dr. Donald Hopkins’ Guinea Worm Disease Eradication Efforts

Donald Hopkins was born in 1941 in Miami, Florida in the USA. He obtained a Bachelor’s Degree from Morehouse College, a Master’s in Public Health from Harvard University, and a Doctor of Medicine from the University of Chicago.

In 1980, the Centers for Disease Control and Prevention (CDC) near Atlanta, Georgia in the USA began a global Guinea worm disease eradication program. In 1984 Dr. Hopkins was made Deputy Director of the CDC and the CDC was designated as the World Health Organization’s (WHO’s) Collaborating Center for Research, Training, and Eradication of Dracunculiasis, or what is more commonly known as Guinea worm disease. In 1987, Dr. Hopkins retired from the CDC and took a position with the Carter Center, a not-for-profit organization that was founded in 1982 by former U.S. President Jimmy Carter and his wife Rosalynn that works partnership with Emory University to advance human rights and alleviate human suffering.

Since 1986, the Carter Center has led international efforts to eradicate Guinea worm disease. It has worked closely with local communities, Ministries of Health, the CDC, WHO, UNICEF, and other organizations. For over 25 years, Dr. Hopkins has overseen the Carter Center’s work on the control and eradication of neglected tropical diseases, including the eradication of Guinea worm disease which is caused by the roundworm Dracunculus medenisis and contracted when people consume water contaminated with Guinea worm larvae.

Inside the human abdomen, Guinea worms slowly mature and can reach more than 1 meter (over 3 feet) in length before emerging through a skin lesion. Guinea worm disease is particularly devastating in that it incapacitates people for extended periods, making them unable to care for themselves, attend school, work, or grow food for their families.

When the Carter Center’s campaign against Guinea worm disease began in the mid-1980s, there were an estimated 3.5 million cases in 20 countries across Africa (which was home to 90% of Guinea worm disease cases) and Asia. Sudan was one of the more heavily infected countries. In Sudan, Dr. Hopkins worked closely with Dr. Nabil Aziz Mikhail, the Carter Center’s representative in Khartoum who was named Sudan’s national program coordinator for Guinea worm eradication in 1994.

Although it was originally believed that there were approximately 2,000 cases of Guinea worm disease in Sudan, Dr. Mikhail discovered there were approximately 118,500 cases in the country, with many in what is now South Sudan. Given the virtual impossibility of reaching some of the most heavily infected areas due to civil war, in 1995, Dr. Mikhail reached out to the Carter Center and invited President Carter and representatives from eight neighboring countries to a national conference on Guinea worm. The outcome of the conference was astounding. Within days what became known as the “Guinea worm cease fire” was announced, which enabled health workers to enter previously inaccessible regions for six months. By 2002, Sudan reported its last case of Guinea worm disease.

By 2011, three West African countries, Nigeria, Niger and Ghana had eradicated the disease. By 2012, there were only 542 cases of Guinea worm disease reported worldwide. By 2013, the number of cases globally had dropped to 148.

By 2014, the incidence of Guinea worm had been reduced by more than 99.99% worldwide to only 126 cases. Of these, the majority of cases (56%) were in one country, South Sudan, and only three other countries in the world reported any cases of Guinea worm disease in 2014: Chad, Ethiopia, and Mali.

Dr. Hopkins has received numerous awards for his disease control efforts. In 1983, his book, Princes and Peasants: Smallpox in History was nominated for the Pulitzer Prize. He has received the CDC’s Medal of Excellence, a Distinguished Service Medal from the U.S. Public Health Service and a MacArthur Fellowship, in 1995, for his leadership in controlling Guinea worm disease. In 1998, Dr. Hopkins was made a Knight of the National Order of Mali. He has served as a consultant to the WHO, an Assistant Professor of Tropical Public Health at Harvard’s School of Public Health, is a member of the Institute of Medicine, and was the director of the Smallpox Eradication and Measles Control Program in Sierra Leone. In 2013, he received an honorary doctoral degree from Harvard University.

Based on the literature on international development and personal success, why have Dr. Donald Hopkins and the Carter Center’s Guinea worm eradication initiatives been so successful?

Some key characteristics come to mind:

The Carter Center works in close PARTNERSHIP with national programs, the WHO, CDC, UNICEF, and many others. Dr. Hopkins recognized that wiping out Guinea worm disease would involve COMMUNITY-BASED EDUCATION and changes in local people’s behavior, such as filtering all drinking water and preventing transmission by keeping anyone with an emerging worm from entering water sources. The CDC and the Carter Center dedicated their Guinea worm disease efforts over the LONG TERM.

They were not satisfied with controlling the devastating disease but sought to ERADICATE it. Guinea worm disease is now anticipated to become the second human disease in history to be eradicated, after smallpox. It will be the first disease to be eradicated without the use of a vaccine or medicine and the first parasitic disease to be eradicated.

By Heidi G. Frontani

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