The Carter Center and its partners are now fighting the last 1 percent of Guinea worm disease (dracunculiasis). As of 2003, the total number of reported cases has been reduced by 99 percent since 3.5 million cases were estimated in 1986.

On Sept. 25, 2003, a collaborative action plan for making Guinea worm disease the next disease to be eradicated from Earth was issued from The Carter Center in Atlanta following a three-day meeting of more than 70 international dignitaries, experts, donors, and professionals. The recommendations target the three most endemic countries - Sudan, Ghana, and Nigeria - which account for 96 percent of the world's remaining Guinea worm cases. Former U.S. President Jimmy Carter, former Nigeria Head of State General Yakubu Gowon, and World Health Organization Director-General Jong-wook Lee led the final session, where the action plan was unveiled. As result of the meeting, Dr. Lee and UNICEF deputy director, Mr. Kul Guatam, later joined President Carter for a field visit to Ghana in early 2004.

The International Commission for the Certification of Dracunculiasis Eradication was established by WHO in 1995 and since has certified 168 countries and territories world wide as dracunculiasis free. Of the original 20 endemic countries in 1986, eight have interrupted Guinea worm disease transmission: Cameroon (1997), Chad (1998), India (1996), Kenya (1994), Pakistan (1993), Senegal (1997), Yemen (1997), and Central African Republic (2001). Remaining cases occur in Benin, Burkina Faso, Cote d'Ivoire, Ethiopia, Ghana, Mali, Mauritania, Niger, Nigeria, Sudan, Togo, and Uganda, with five of them reporting fewer than 100 cases each in 2003. The number of villages reporting one or more cases of the disease outside of Sudan dropped from more than 23,000 in 2002 to 2,022 in 2003.

Sudan reported 63 percent of all cases in 2003, while most of the other indigenous cases were reported in Ghana (8,285 cases), Nigeria (1,459 cases), and Mali (824 cases). Although the civil war in Sudan is now the most important barrier to completing the eradication of Guinea worm disease, Sudan has made significant strides toward elimination in recent years.

In Sudan, eradication effectively began under a six-month "Guinea worm cease-fire" negotiated by President Carter in 1995. Implementation of interventions has improved steadily since then, including the assembly and distribution of more than seven million pipe filters in 2001. In the 3,613 villages where the program intervened in 2002 and retained access in 2003, the number of indigenous cases reported was reduced by 51 percent, from 41,493 cases in 2002 to 20,299 cases in 2003.

Outside of Sudan, Ghana accounted for 70 percent of cases reported in 2003, with 739 Ghanaian villages reporting one or more cases of dracunculiasis. Of the reported cases, 95 percent were in only 15 of Ghana's 110 districts. With enhanced interventions in 2003, 70 percent of cases were contained within 24 hours of emergence by the Guinea worm. The primary remaining obstacle for the program in Ghana is the need to mobilize political will regarding the Guinea Worm Eradication Program among many health and political leaders - at all levels.

The Carter Center continues to work to counter the lack of urgency and increasing complacency of workers by escalating media coverage in Ghanaian and international media. U.N. Secretary-General Kofi Annan is among the latest African leaders to lend his voice as a spokesperson for the Guinea worm eradication campaign via radio and television. The international Guinea worm coalition is also gaining support from Ghana's frustrated West African neighbors. In 2003 Ghana exported more cases of Guinea worm disease than any other country, a total of 38 cases.

In February 2004, President Carter visited Ghana to encourage government officials to increase political will and financial support for the program. The delegation included the Director-General of WHO Dr. LEE Jong-wook and Deputy Executive Director of UNICEF Kul C. Gautam and was hosted by Ghana Minister of Health Dr. Kweku Afriyie.

By the end of 2003, the remaining endemic countries, excluding Sudan and Ghana, had reported 53 percent fewer cases of Guinea worm disease than during the same period in 2002. Nigeria in particular has shown remarkable progress, reducing the number of reported cases by 62 percent from 2002 to 2003. Benin and Cote d'Ivoire joined the ranks of those reporting fewer than 100 cases each at the end of 2003.

It is possible that Uganda will interrupt transmission this year, which means 2004 would be the first year that country reports zero indigenous cases for 12 consecutive months. Burkina Faso and possibly Niger are expected to report fewer than 100 cases for the first time in 2004.

For more information about the 2003 Guinea worm numbers, please refer to the Guinea worm wrap-up newsletter.

All numbers in this review were confirmed at the annual International Guinea Worm Eradication Program Review, Bamako, Mali, April 2004