Who will mourn the Guinea worm?

By Michael Igoe 30 October 2015

Former U.S. President Jimmy Carter tries to comfort 6-year-old Ruhama Issah at Savelugu (Ghana) Hospital as a Carter Center technical assistant dresses Issah's extremely painful Guinea worm wound. In May 2010, with Carter Center support, Ghana reported its last case of Guinea worm disease and announced it had stopped disease transmission a year later. Photo by: L. Gubb / The Carter Center

Former U.S. President Jimmy Carter revealed that cancer has spread to his brain in August. He also outlined a short list of accomplishments left to achieve in a life full of humanitarian service and leadership.

“I would like to see Guinea worm completely eradicated before I die,” Carter said. “I’d like for the last Guinea worm to die before I do.”

The founder of the Carter Center is well on his way to seeing it done with the help of public health workers and organizations around the world. They’ve sprayed ponds with insecticide, helped communities access water filters and isolated infected individuals to prevent the worm’s offspring from finding new watery nurseries. They’ve studied the worm to understand its weaknesses and learned how to attack them. The results are among the most dramatic in the history of public health.

Guinea worm disease afflicted an estimated 3.5 million people every year less than 30 years ago. Last year, that number was down to 126. So far in 2015 there have only been 15 cases, limited to a few African countries.

Ongoing conflict in some Guinea worm-endemic states — Mali and South Sudan in particular — could stall the eradication effort. Still, it is only a matter of time until the infectious worm is gone forever.

When the Carter Center succeeds, it will be a monumental triumph for global health. It will also signal the end of an animal species, an extinction brought about on purpose through human ingenuity.

Should anyone feel bad about that?

Jimmy Carter’s mortal enemy

The kind of harm the Guinea worm causes people over the course of its parasitic life span can only be described as cruel. It is painful, slow and debilitating, and exclusively targeted at the poor. People exposed to the worm are those born in places where fleas contaminate the only available fresh water, and where those fleas might harbor embryonic worms that reproduce and grow inside the human body until they die or seek to escape. It’s a nightmarish infection that has been remarked upon and suffered for centuries.

Now, Guinea worm disease — or dracunculiasis — is the first parasitic disease in history slated for eradication.

Of course, apart from the horrific harm it inflicts on humans, the worm’s lifecycle is also a highly adapted evolutionary miracle, and one that is entirely dependent on a parasitic relationship with its host. If you’re born a Guinea worm, the human body is your only viable habitat. So if humans are successful in evicting the guinea worm from our waterways and bodies, the animal, with nowhere else to live, will disappear forever.

“If we keep preventing guinea worms from getting into people, guinea worms will go extinct,” Carl Zimmer, science writer and columnist at the New York Times, told Devex.

In other words, they’re critically endangered due to human activity, like the hawksbill turtle or the Javan rhino, but with none of the public outcry.

This is not the first time human health and biodiversity have come into conflict. There’s a long list of animals causing harm to human beings. In sub-Saharan Africa an estimated 30,000 people die from snake bites every year, and another 8,000 suffer amputations. Malaria-transmitting mosquitos are killing over half a million people annually.

Given the opportunity, should health campaigns wipe them off the face of the earth? Or do harmful creatures, even the worst of them, deserve defending too?

‘This beautiful creature’

Several years ago, when the “Save the Guinea Worm Foundation” suddenly appeared in the early days of the blogosphere, it seemed the answer to that question might actually be, “yes, the worm should be protected.”

“As you read this, a cartel of powerful organizations is conspiring to exterminate a living endangered species from the planet. And almost no one is doing anything about it,” the ‘foundation’s’ website warns.

The Save the Guinea Worm Foundation delivers several calls to action, including: “Start a petition drive in your community to make Aug. 7 Save the Guinea Worm Day,” and, “Start a local Guinea Worm Club.”

Unfortunately for the worm, it was a joke, created “to satirize people who ignored or twisted facts and good science that conflicted with their worldview,” according to Adam Shannon, who authored the post more than a decade ago.

Shannon’s website raised more than a few eyebrows and even generated some heated backlash.

“I didn't expect anyone to take it seriously, and was surprised by some of the irate mail I received from people who didn't perceive the satire … People were much less savvy consumers of online content in the earlier days of the Web,” he told Devex by email.

His ruse made it all the way to the halls of the world’s disease-fighting centers, according to Shannon, where officials apparently worried about the negative publicity it could bring.

“At one point, some officials from the [World Health Organization] (I believe) were apparently concerned that [the Save the Guinea Worm Foundation] might represent a PR threat. A friend who worked with them forwarded me the email thread, before he let them know the truth,” Shannon said.

He almost pulled the site, but decided not to after a teacher contacted him and told him she used his post to teach her students about the dangerous world of online misinformation, and how to separate fact from fiction.

Devex asked Shannon, who lived near areas afflicted with the disease as a Peace Corps volunteer in the mid-90s, about his real views on guinea worm eradication, and whether he thinks the soon-to-be extinct animal deserves any genuine protection.

“The question of whether or not it's ‘right’ to eradicate a species for human benefit is, I suppose, a legitimate one in the abstract, but the context of human suffering produced by the Guinea worm makes this question moot in my mind,” he said.

Shannon’s “foundation” spawned some imitators, including a Change.org petition directed to the U.S. House of Representatives, U.S. Senate and the president of the United States. The petition describes the Guinea worm as a “misunderstood and magnificent creature” threatened by pesticides and increased use of water filtration in developing areas.

“Please stop the pointless destruction of this beautiful creature,” it concludes.

When you’re not an ‘umbrella species’

Carl Zimmer has come closer than anyone to publicly standing up for the last members of a dying race of Guinea worms, but he still thinks we probably need to kill them all.

Zimmer sees the loss of the Guinea worm as a loss of potential knowledge about it, its biology and genetic composition. The worm does some interesting things, which Zimmer referenced in his National Geographic blog post about them. It’s possible that guinea worms are capable of producing morphine to dull their hosts’ pain sensors, for example. But as Zimmer pointed out, we don’t — and probably won’t ever — know for sure.

“I certainly think that it’s important to reduce the burden of disease whenever we can, we just have to bear in mind that sometimes that has consequences,” he said. “Sometimes, we have choices.”

But in this case, Zimmer conceded, we really don’t.

To prevent excruciating human suffering and to keep the guinea worms alive would require some kind of synthetic habitat — an artificial human body that would deliver just the right biochemical signals to prompt the worms to behave properly. To Zimmer’s knowledge, nobody’s tried to do that, and it wouldn’t be easy.

“Parasites like Guinea worm are very tightly tuned to their hosts,” Zimmer said. “If they’re not getting the right cues, they’re going to get very confused.”

In the end, the Guinea worm’s single-minded focus on human hosts is likely to be its undoing. It also diminishes the animal’s ecological significance. Where other parasites play important roles in food webs, as sources of biomass fertilizer and possibly as agents of ecosystem stability, a world without Guinea worms does not appear to be much worse off.

The World Wildlife Fund takes a similar view when it selects species for conservation initiatives, focusing on “umbrella” species and “conserving the habitat needs that include a wide range of other species and biodiversity,” Colby Loucks, senior director of WWF’s Wildlife Conservation Program, told Devex in an email.

But some parasites are ecologically significant, and as it turns out, humans are likely driving many more of them to extinction. Deforestation and other habitat-degrading activities are killing both parasites and their hosts. Most of those losses probably go unacknowledged.

“Conservation biology has paid very little attention traditionally to parasites,” Zimmer said. “Parasites are not charismatic megafauna, to say the least. It’s a lot easier to sell people on saving habitat with pandas than with all the root nemotodes that live on the bamboo that are going to survive too.”

“But they do matter.”

With their few remaining days on earth, maybe the Guinea worms will leave us with this parting thought.

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the author

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Michael Igoe@AlterIgoe

Michael Igoe is a senior correspondent for Devex. Based in Washington, D.C., he covers U.S. foreign aid and emerging trends in international development and humanitarian policy. Michael draws on his experience as both a journalist and international development practitioner in Central Asia to develop stories from an insider's perspective.


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