The eradication of dracunculiasis, or Guinea worm disease, is an ongoing program. Dracunculiasis is an infection by the Guinea worm that causes severe pain and open wounds when guinea worms exit the body through the skin. In 1986, there were an estimated 3.5 million cases of Guinea worm in 20 endemic nations in Asia and Africa. The number of human cases has since been reduced by more than 99.999%, to the range of 10–15 per year in 2021–2025, with only six countries remaining to be certified free of transmission: Chad, South Sudan, Mali, Ethiopia, Angola, and Sudan. Cameroon has also had some cases in recent years, primarily due to its proximity to Chad, but was previously certified free of internal transmission.

The campaign has been spearheaded by the Carter Center and other members of the London Declaration on Neglected Tropical Diseases, with former U.S. president Jimmy Carter as part of its deworming programs, designed to eliminate neglected tropical diseases. Discussing his diagnosis of melanoma (which had metastasized to his brain), Carter said in 2015 that his last wish was to see the last Guinea worm dead before he was. Carter died in 2024 without quite seeing that wish fulfilled.

The World Health Organization (WHO) is the recognized international body that certifies whether a disease has been eliminated from a country or eradicated from the world. The WHO renewed its expressed intent to accelerate the eradication of dracunculiasis at its World Health Assembly in May 2025. The Carter Center issues frequent reports on the status of the Guinea worm eradication program, including country-by-country statistics.

As of 2024, the WHO goal for eradication in humans and animals is the year 2030. Previously, 1991, 2009, 2015, and 2020 were set as target years, but full eradication of dracunculiasis has proven to be much more difficult than originally thought, after the discovery of non-human animal hosts. Although the frequency of human cases has plateaued since the beginning of 2021, the frequency of cases in animals has continued to trend downward. Guinea worm is poised to be the second human disease to be eradicated, after smallpox. Eradication program

Formerly, humans were believed to be the only host for Guinea worms, and it was thought that once all human cases were eliminated, the disease cycle would be broken, resulting in its eradication. However, in the mid-2010s, it became clear that dracunculiasis had other animal hosts besides humans, greatly complicating eradication efforts, which now also had to be expanded to non-human hosts.

The eradication of Guinea worm disease has faced several challenges: Non-human host reservoir Inadequate security in some endemic countries Lack of political will from the leaders of some of the countries in which the disease is endemic The need for change in behavior in the absence of a magic bullet treatment like a vaccine or medication Inadequate funding at certain times

In January 2012 the WHO meeting at the Royal College of Physicians in London launched the most ambitious and largest coalition health project ever, known as London Declaration on Neglected Tropical Diseases which aims to end/control dracunculiasis by 2020, among other neglected tropical diseases. This project is supported by all major pharmaceutical companies, the Bill & Melinda Gates Foundation, the United States Agency for International Development, the United Kingdom Department for International Development, the Carter Center, and the World Bank, in cooperation with the governments of countries in which the disease is endemic.

By 2018, the disease was eliminated in 19 of 21 countries where it used to occur. By the end of the London Declaration programme, only 15 cases were recorded globally. Total eradication is projected by the Kigali Declaration on Neglected Tropical Diseases starting from 2022 to 2030.

Countries certified free

Endemic countries must report to the International Commission for the Certification of Dracunculiasis Eradication and document the absence of indigenous cases of Guinea worm disease for at least three consecutive years to be certified as Guinea worm-free by the World Health Organization.

The result of this certification scheme is that by 2007, Benin, Burkina Faso, Chad, Ivory Coast, Kenya, Mauritania, Togo, and Uganda were able to certify that they had stopped transmission, and Cameroon, Central African Republic, India, Pakistan, Senegal, and Yemen were WHO certified. Nigeria was certified as having ended transmission in 2013, followed by Ghana in 2015, and the Democratic Republic of Congo in 2022.

Endemic countries

Through the eradication campaign, the areas where dracunculiasis is found are shrinking. In the early 1980s, the disease was endemic in Pakistan, Yemen and 17 countries in Africa with a total of 3.5 million cases per year. In 1985, 3.5 million cases were still reported annually, but by 2008, the number had dropped to 5,000. This number further dropped to 1,058 in 2011. At the end of 2015, South Sudan, Mali, Ethiopia and Chad still had endemic transmissions. However, endemic transmission was discovered in Angola and Cameroon in 2018 and 2019 respectively. For many years the major focus was South Sudan (independent after 2011, formerly the southern region of Sudan), which reported 76% of all cases in 2013, but the last few cases are spread over several African countries.

Timeline of events 1980s

In 1984, the WHO asked the United States Centers for Disease Control and Prevention (CDC) to spearhead the effort to eradicate dracunculiasis, an effort that was further supported by the Carter Center, former U.S. President Jimmy Carter's not-for-profit organization. In 1986, Carter and the Carter Center began leading the global campaign, in conjunction with CDC, UNICEF, and WHO. At that time the disease was endemic in Pakistan, Yemen and 17 countries in Africa, which reported a total of 3.5 million cases per year.

Carter made a personal visit to a Guinea-worm endemic village in 1988. He said, "Encountering those victims first-hand, particularly the teenagers and small children, propelled me and Rosalynn [Carter] to step up the Carter Center's efforts to eradicate Guinea worm disease."

1990s

In 1991, the World Health Assembly agreed that Guinea worm disease should be eradicated. At this time there were 400,000 cases reported each year. The Carter Center has continued to lead the eradication efforts, primarily through its Guinea Worm Eradication Program.

In the 1980s, Carter persuaded President Zia-ul-Haq of Pakistan to accept the proposal of the eradication program, and by 1993, Pakistan was free of the disease. Key to the effort was, according to Carter, the work of "village volunteers" who educated people about the need to filter drinking water.

2000s

Other countries followed the example of Pakistan, and by 2004, Guinea worm was eradicated in Asia.

In December 2008, The Carter Center announced new financial support totaling $55 million from the Bill & Melinda Gates Foundation and the United Kingdom Department for International Development. The funds will help address the higher cost of identifying and reporting the last cases of Guinea worm disease. Since the worm has a one-year incubation period, there is a very high cost of maintaining a broad and sensitive monitoring system and providing a rapid response when necessary.

One of the most significant challenges facing Guinea worm eradication during the 1990s was the Second Sudanese Civil War, which made Southern Sudan largely inaccessible to health workers due to violence. To address some of the humanitarian needs in Southern Sudan, Jimmy Carter negotiated a ceasefire—commonly called the "Guinea Worm ceasefire"—in 1995. The longest ceasefire in the Second Sudanese Civil War, as well as the longest humanitarian ceasefire in history, the Guinea worm ceasefire saw both warring parties agree to halt hostilities for nearly six months to allow public health officials to begin Guinea worm eradication programming, among other interventions.

Public health officials cite the formal end of the war in 2005 as a turning point in Guinea worm eradication because it allowed health care workers greater access to Southern Sudan's endemic areas. In 2006, there was an increase from 5,569 cases in 2005 to 15,539 cases, as a result of better reporting from areas that were no longer war-torn. The Southern Sudan Guinea Worm Eradication Program deployed over 28,000 village volunteers, supervisors and other health staff to work on the program full-time. The program slashed the number of cases reported in 2006 by 63% to 5,815 cases in 2007. By the time of South Sudan's 2011 independence, its northern neighbour Sudan reported no endemic cases of dracunculiasis.

Sporadic insecurity or widespread civil conflict could at any time ignite, thwarting eradication efforts. The remaining endemic communities in South Sudan are remote, poor and devoid of infrastructure, presenting significant hurdles for effective delivery of interventions against disease. Moreover, residents in these communities are nomadic, moving seasonally with cattle in pursuit of water and pasture, making it very difficult to know where and when transmission occurred. The peak transmission season coincides with the rainy season, hampering travel by public health workers.

Another remaining area in Africa remained challenging to ending Guinea worm: northern Mali, where Tuareg rebels made some affected areas unsafe for health workers. Four of Mali's regions (Kayes, Koulikoro, Ségou, and Sikasso) have eliminated dracunculiasis, while the disease is still endemic in the country's other four regions (Gao, Kidal, Mopti, and Timbuktu). Late detection of two outbreaks, due to inadequate surveillance resulted in a meager 36% containment rate in Mali in 2007. The years 2008 and 2009 were more successful, however, with containment rates of 85% and 73% respectively. The civil war prevented accurate information from being gathered in northern Mali in 2012.

In Ghana, after a decade of frustration and stagnation, in 2006 a decisive turnaround was achieved. Multiple changes can be attributed to the improved containment and lower incidence of dracunculiasis: better supervision and accountability, active oversight of infected people daily by paid staff, and an intensified public awareness campaign. After Jimmy Carter's visit to Ghana in August 2006, the government of Ghana declared Guinea worm disease to be a public health emergency. The overall rate of contained cases has increased in Ghana from 60% in 2005, to 75% in 2006, 84% in 2007, 85% in 2008, 93% in 2009, and 100% in 2010.

From June 2006 to March 2008, there were no cases reported in Ethiopia. No indigenous cases were reported in Chad in the 2000s; however, the country was known to have poor surveillance.

2010s

2011

In 2011, 1,060 human cases were reported—1,030 in South Sudan, 12 in Mali, 10 in Chad, and 8 in Ethiopia. The majority of cases in South Sudan were in Kapoeta East County, and Kapoeta North County. These adjacent counties are in the state of Eastern Equatoria. Of the 70 counties in South Sudan, 56 (80%) are considered free of dracunculiasis.