Editorial: “A vote against the guinea worm“

One less worm: this child in Southern Sudan is having a worm extracted – a scene that could soon be consigned to history (Image: J. Albertson/The Carter Center)

“There is huge excitement and euphoria here,” says Makoy Samuel Yibi, phoning from Juba in Southern Sudan. There, this week’s referendum vote looks set to divide Sudan into independent north and south countries, potentially ending decades of civil war. The result is largely a foregone conclusion: independence will be announced officially in February.

At the same time, as it does every February, Southern Sudan will report the year’s first cases of a painful and ancient disease: guinea worm. But this could be the last time. Besides creating a new country, this week’s vote could make guinea worm the second human disease – after smallpox – to be eradicated.


War and neglect have made Southern Sudan the worm’s last stronghold. “If the political situation remains stable, we can stop it in 2012,” says Makoy, director of the Southern Sudan ministry of health’s guinea worm eradication programme.

Painful parasite

People swallow guinea worm larvae in infested water. The worms grow for a year, then emerge through the skin, so painfully that the victim seeks relief by plunging it into cool water. The worm then ejects its eggs, continuing the cycle.

Without human infections, the worms die out. Clean drinking water has wiped them out across Asia and much of Africa over the past few decades, but they have held on where poor people drink from stagnant ponds. Since 1986 The Carter Center, a charity headed by former US president Jimmy Carter, has helped these people filter water and keep emerging worms out of ponds. Now only four countries still have the worm – and of these, Ghana, Ethiopia and Mali are practically rid of it. Of the 1785 cases found last year, 1690 were in Southern Sudan.

At least this is 38 per cent fewer than the number of cases in 2009, says Don Hopkins, head of the guinea worm programme at The Carter Center, and the area affected has halved. The best he hopes for this year, however, is a further halving of cases.

Cattle conflict

The problem is still conflict, but it isn’t between south and north, or even tribal, says Makoy. All 226 villages where people caught guinea worm last year suffered armed conflicts involving semi-nomadic herders over access to limited grazing and water. The disruption led both the campaign staff and those carrying the worms to flee, making it more difficult for staff to keep the worms away from water.

An independent Southern Sudan might finally end these conflicts, especially with foreign aid expected to flood in. More resources for the herders’ cattle, says Makoy, would remove the reasons for the fights that block anti-worm activities in the last infected villages: ironically, more water sources for cattle could be what defeats this water-borne disease.

But final victory over guinea worm is far from assured. Southern Sudan is in ruins, and it is not yet clear how north and south will share crucial oil revenues after independence. Furthermore, refugees who fled the south years ago are returning with inflated expectations. Makoy fears that the euphoria generated by independence may backfire. “People will expect things to get better overnight, but they won’t.”

If the government finds ways to channel the euphoria into action, though, he says “eradicating guinea worm will be the peace dividend we can give the world”.