If all goes well, if decades of education and international cooperation stand up for another year or so, mankind will accomplish something done just once before: the eradication of an infectious disease.

Smallpox was the first and only so far, wiped from the human population in the 1970s. Up next is a disease caused by a pesky and painful parasitic worm, a disease that as recently as the 1980s infected more than 3.5 million people a year.

Former President Jimmy Carter, a tireless statesman and world health advocate who recently disclosed his own battle with cancer, spoke of making health history last week when he touched on his hopes for the future in a news conference at The Carter Center in Atlanta.

"I'd like," said the 91-year-old Carter, "for the last guinea worm to die before I do."

An ancient scourge

A chart chronicles the life cycle of the Dracunculus medinensisA chart chronicles the life cycle of Dracunculus medinensis. (Image: Centers for Disease Control and Prevention/Wikimedia Commons)

The guinea worm and the disease that bears its name have been around for millennia. A calcified guinea worm reportedly was found in an Egyptian mummy. Some suggest a passage in the Old Testament that refers to "fiery serpents" is alluding to guinea worms. Some even say the Rod of Asclepius, a staff carried by the Greek god of healing and medicine that has become known as a symbol for modern health care, is based on treatment for guinea worm disease.

What it does in the human body — specifically how it gets in and how it gets out — are not for the faint of heart.

We now that the guinea worm enters the body when someone drinks water infected with the larvae of the worm. The worm mates in the body and matures, the female growing to maybe three feet long. When it's fully matured, it makes its way under the skin, causing painful lesions as it exits the body.

The accepted way to get it out is to slowly pull it from the sore, centimeter by centimeter, wrapping it around a small stick — like the snake on Asclepius' staff — or a small piece of gauze to maintain the tension. It can take weeks to get a three-foot worm out. The lesions can be become sore and infected. It burns. It's debilitating, sometimes for months.

"Imagine a worm one meter long coming out of your skin for, on average, 11 weeks. That in itself is a nightmare to me," Craig Withers of The Carter Center told The Atlantic earlier this year. "It’s sort of like 'Alien' in real life."

The plan to wipe it out

The fight to eradicate the guinea worm began in the 1980s, with programs led by The Carter Center — which carries the slogan "Waging Peace. Fighting Disease. Building Hope." — and the Atlanta-based Centers for Disease Control and Prevention. At that time, guinea worm disease affected some 3.5 million people in 21 countries in Africa and Asia.

Because there is no cure for the disease, the programs center on education and ways to get clean water; pouring it through cloth or mesh designed to keep the water-borne fleas that carry the larvae out, drinking through filtered straws, finding sources of clean underground water or using larvicides on the water.

The other part of combating the disease is making sure those with guinea worms don't go near the water. Many with Dracunculiasis — that's the Latin name for the disease — find relief soaking in water. But water prompts a guinea worm to release its eggs, beginning a new cycle.

The goal is simple: Let the disease run its course, but don't let the worms lay any more eggs.

The results have been astonishing.

The final steps

By 2006, 11,000 cases of guinea worm disease were recorded in only nine countries in Africa, mostly in Ghana and Sudan. By the beginning of 2012, that number had dropped under 1,000. Last year, 126 cases were recorded.

As of July, only 11 remain:

  • 7 in Chad
  • 2 in South Sudan
  • 1 in Ethiopia
  • 1 in Mali

"We know," Carter said last week, "where all of them are."

The Carter Center — which has partnered with the CDC, the World Health Organization, UNICEF and other national and local organizations — estimates that at least 80 million cases of the debilitating disease have been averted since the fight against the guinea worm began.

The fight's not over. In such far-flung populations, other cases still could pop up.

But the possibility of wiping out guinea worm disease once and for all — and soon — looks good. In fact, better now than ever.