Neglected tropical diseases

Dracunculiasis eradication: “on the threshold of a historic achievement”

26 February 2019 | New York | Geneva −− The World Health Organization (WHO) and The Carter Center (TCC) have called for renewed commitment, funding and support to address “last mile” challenges towards the eradication of dracunculiasis.

Since the beginning of 2019, Chad alone has detected more than 1700 dogs infected with Dracunculus medinensis (Guinea worm), and 32 of the 36 human cases reported globally.

During a joint event on the sidelines of the United Nations General Assembly in New York today, both organizations highlighted the need to accelerate work in concluding the three-decades-old eradication programme.

We continue to need your support, confidence and collaboration to finish the job," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We stand on the threshold of a historic achievement: eradicating the first parasitic infection and, possibly, the second human disease.

Dr Tedros said that getting rid of the disease will contribute to the general welfare and health of marginalized communities, including children and women, and should be part of the global community’s broader ambition to achieve universal health coverage.

Our successes are a testament to the fierce persistence of people on the front lines and our committed partners,” said Jason Carter, Chair of the Carter Center Board of Trustees, who represented President Jimmy Carter at the event. “We are grateful for every ally standing with us as we seek to eradicate the first parasitic disease in human history.”

The Carter Center announced a US$ 40 million fundraising campaign, including a US$ 20 million Carter Center Challenge Fund. The Challenge Fund will match, dollar for dollar, donations to the global dracunculiasis eradication programme, up to US$ 10 million per year in 2019 and 2020, for a total of US$ 20 million in matching funds. In response, Alwaleed Philanthropies – a global philanthropic foundation (Saudi Arabia) – will invest the first US$ 1 million in matching support.


Dr Tedros added that eradicating a disease means confronting several challenges as were faced by the smallpox eradication campaign, requiring perseverance, hope and courage.

He paid tribute to the former Chair of the International Commission for the Certification of Dracunculiasis Eradication (ICCDE), the late Dr Abdul Rahman Al-Awadi who in 1980, as President of the World Health Assembly alongside the then WHO Director-General Dr Halfdan Mahler, signed the document that certified the eradication of smallpox.

The Director-General also applauded the contribution of Dr Joel Breman (Vice Chair of ICCDE) and Dr Donald Hopkins (Special Advisor for Guinea Worm Eradication at The Carter Center) towards smallpox eradication and for their current role in the eradication of dracunculiasis.

Dr Tedros also recognized the significant financial assistance from various donors, particularly the United Kingdom’s Department for International Development and the Bill & Melinda Gates Foundation.

Current challenges

Finding and containing the last remaining cases, particularly in settings where there are security concerns and displaced populations, are the most difficult stages of the eradication process.

Detecting D. medinensis infection in dogs poses another challenge. WHO and its main partners – The Carter Center and the United States Centers for Disease Control and Prevention – are working together to assist health ministries in the remaining endemic countries to address this issue.

Canine infections with D. medinensis pose a challenge to the programme, particularly in Chad, Ethiopia and Mali. The phenomenon was noted in Chad in 2012. The results of operational research recommended by a scientific meeting convened by WHO in March 2016 indicate that transmission in dogs can be interrupted.


Since 1995, the ICCDE has met 13 times and, on its recommendation, WHO has certified 199 countries, territories and areas (belonging to 187 of the Organization’s 194 Member States) as free of dracunculiasis transmission.

WHO is the only organization mandated to certify countries as free of a disease.

Achieving eradication

WHO has been working closely with The Carter Center – alongside the United States Centers for Disease Control and Prevention, the United Nations Children’s Fund and many other partners – since 1986.

WHO advocates for eradication, provides technical guidance, coordinates eradication activities, enforces surveillance in dracunculiasis-free areas and monitors and reports on progress achieved.

The Carter Center for its part works with national Guinea-worm eradication programmes to implement field activities and provides financial and technical assistance to interrupt transmission of the disease.

The disease

Dracunculiasis is a crippling parasitic disease caused by D. medinensis, a long thread-like worm. It is transmitted when water contaminated with parasite-infected water fleas is consumed.

During the 1980s, dracunculiasis was endemic in 20 countries. Mali has reported zero human cases since 2016; the last case was reported in November 2015. Ethiopia reported its last human case in December 2017.

Surprisingly, in Angola (a country in which cases had never been reported), a first human case was detected in April 2018 followed by a second one earlier this year.

Ashok Moloo
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