eradication of dracunculiasis eradication of dracunculiasis dracunculiasis, or guinea worm disease, is an infection by the guinea worm. in 1986, there were an estimated 3.5 million cases of guinea worm in 20 endemic nations in asia and africa. ghana alone reported 180,000 cases in 1989. the number of cases has since been reduced by more than 99.999% to 22 in 2015 in the five remaining endemic nations of africa: south sudan, chad, mali, ethiopia, and angola. logarithmic scale of reported human cases of guinea worm by year, 1989–2017. data from guinea worm eradication program. the world health organization (who) is the international body that certifies whether a disease has been eliminated from a country or eradicated from the world. the carter center, a nongovernmental, not-for-profit organization founded by former u.s. president jimmy carter, also reports the status of the guinea worm eradication program by country. as of 2019, the who goal for eradication in humans and animals is 2030 (previously targets have been set at 1991, 2009, 2015, and 2020). eradication program since humans are the principal host for guinea worm, and there is no evidence that dracunculus medinensis has ever been reintroduced to humans in any formerly endemic country as the result of non-human infections, the disease can be controlled by identifying all cases and modifying human behavior to prevent it from recurring. once all human cases are eliminated, the disease cycle will be broken, resulting in its eradication. the eradication of guinea worm disease has faced several challenges: inadequate security in some endemic countries lack of political will from the leaders of some of the countries in which the disease is endemic the need for change in behavior in the absence of a magic bullet treatment like a vaccine or medication inadequate funding at certain times in january 2012 the who meeting at the royal college of physicians in london launched the most ambitious and largest coalition health project ever, known as london declaration on neglected tropical diseases which aims to end/control dracunculiasis by 2020, among other neglected tropical disease. this project is supported by all major pharmaceutical companies, the bill & melinda gates foundation, the governments of the united states, united kingdom dfid and united arab emirates and the world bank. in august 2015, when discussing his diagnosis of melanoma metastasized to his brain, jimmy carter stated that he hopes the last guinea worm dies before he does. by 2018, the disease was eliminated in 19 of 21 countries where it used to occur. by then end of the london declaration programme, only 15 cases were recorded globally. total eradication is projected by the kigali declaration on neglected tropical diseases starting from 2022 to 2030. countries certified free endemic countries must report to the international commission for the certification of dracunculiasis eradication and document the absence of indigenous cases of guinea worm disease for at least three consecutive years to be certified as guinea worm-free by the world health organization. the results of this certification scheme been able to certify, by 2007, benin, burkina faso, chad, ivory coast, kenya, mauritania, togo, and uganda had stopped transmission, and cameroon, central african republic, india, pakistan, senegal, yemen were who certified. nigeria was certified as having ended transmission in 2013, followed by ghana in 2015, and the democratic republic of congo in 2022. endemic countries with the current eradication campaign the areas that dracunculiasis are found in are shrinking. in the early 1980s, the disease was endemic in pakistan, yemen and 17 countries in africa with a total of 3.5 million cases per year. in 1985, 3.5 million cases were still reported annually, but by 2008, the number had dropped to 5,000. this number further dropped to 1,058 in 2011. at the end of 2015, south sudan, mali, ethiopia and chad still had endemic transmissions. however, endemic transmission was discovered in angola and cameroon in 2018 and 2019 respectively. for many years the major focus was south sudan (independent after 2011, formerly the southern region of sudan), which reported 76% of all cases in 2013, but today the last few cases are spread over several african countries. datesouth sudanmaliethiopiachadangolacameroontotal 2011 1,028 12 8 10 0 0 1,058 2012 521 7 4 10 0 0 542 2013 113 11 7 14 0 0 148 2014 70 40 3 13 0 0 126 2015 5 5 3 9 0 0 22 2016 6 0 3 16 0 0 25 2017 0 0 15 15 0 0 30 2018 10 0 0 17 1 0 28 2019 4 0 0 48 1 1 54 2020 1 1 11 12 1 1 27 2021 4 2 1 8 0 0 15 2022 5 0 1 6 0 0 13 2023 (through february) 0 0 0 0 0 0 0 timeline of events 1980s in 1984, the who asked the united states centers for disease control and prevention (cdc) to spearhead the effort to eradicate dracunculiasis, an effort that was further supported by the carter center, former u.s. president jimmy carter's not-for-profit organization. in 1986, carter and the carter center began leading the global campaign, in conjunction with cdc, unicef, and who. at that time the disease was endemic in pakistan, yemen and 17 countries in africa, which reported a total of 3.5 million cases per year. carter made a personal visit to a guinea-worm endemic village in 1988. he said, "encountering those victims first-hand, particularly the teenagers and small children, propelled me and rosalynn to step up the carter center's efforts to eradicate guinea worm disease." 1990s in 1991, the world health assembly agreed that guinea worm disease should be eradicated. at this time there were 400,000 cases reported each year. the carter center has continued to lead the eradication efforts, primarily through its guinea worm eradication program. in the 1980s, carter persuaded president zia-ul-haq of pakistan to accept the proposal of the eradication program, and by 1993, pakistan was free of the disease. key to the effort was, according to carter, the work of "village volunteers" who educated people about the need to filter drinking water. 2000s other countries followed the example of pakistan, and by 2004, guinea worm was eradicated in asia. in december 2008, the carter center announced new financial support totaling $55 million from the bill & melinda gates foundation and the united kingdom department for international development. the funds will help address the higher cost of identifying and reporting the last cases of guinea worm disease. since the worm has a one-year incubation period, there is a very high cost of maintaining a broad and sensitive monitoring system and providing a rapid response when necessary. one of the most significant challenges facing guinea worm eradication has been the civil war in southern sudan, which was largely inaccessible to health workers due to violence. to address some of the humanitarian needs in southern sudan, in 1995, the longest ceasefire in the history of the war, and the longest humanitarian cease-fire in history, was achieved through negotiations by jimmy carter. commonly called the "guinea worm cease-fire", both warring parties agreed to halt hostilities for nearly six months to allow public health officials to begin guinea worm eradication programming, among other interventions. public health officials cite the formal end of the war in 2005 as a turning point in guinea worm eradication because it has allowed health care workers greater access to southern sudan's endemic areas. in 2006, there was an increase from 5,569 cases in 2005 to 15,539 cases, as a result of better reporting from areas that were no longer war-torn. the southern sudan guinea worm eradication program has deployed over 28,000 village volunteers, supervisors and other health staff to work on the program full-time. the program was able to slash the number of cases reported in 2006 by 63% to 5,815 cases in 2007. since 2011, at the time that south sudan became an independent nation-state, its northern neighbour sudan had reported no endemic cases of dracunculiasis . sporadic insecurity or widespread civil conflict could at any time ignite, thwarting eradication efforts. the remaining endemic communities in south sudan are remote, poor and devoid of infrastructure, presenting significant hurdles for effective delivery of interventions against disease. moreover, residents in these communities are nomadic, moving seasonally with cattle in pursuit of water and pasture, making it very difficult to know where and when transmission occurred. the peak transmission season coincides with the rainy season, hampering travel by public health workers. another remaining area in africa remained challenging to ending guinea worm: northern mali, where tuareg rebels made some affected areas unsafe for health workers. four of mali's regions (kayes, koulikoro, ségou, and sikasso) have eliminated dracunculiasis, while the disease is still endemic in the country's other four regions (gao, kidal, mopti, and timbuktu). late detection of two outbreaks, due to inadequate surveillance resulted in a meager 36% containment rate in mali in 2007. the years 2008 and 2009 were more successful, however, with containment rates of 85% and 73% respectively. the civil war prevented accurate information from being gathered in northern mali in 2012. in ghana, after a decade of frustration and stagnation, in 2006 a decisive turnaround was achieved. multiple changes can be attributed to the improved containment and lower incidence of dracunculiasis: better supervision and accountability, active oversight of infected people daily by paid staff, and an intensified public awareness campaign. after jimmy carter's visit to ghana in august 2006, the government of ghana declared guinea worm disease to be a public health emergency. the overall rate of contained cases has increased in ghana from 60% in 2005, to 75% in 2006, 84% in 2007, 85% in 2008, 93% in 2009, and 100% in 2010. from june 2006 to march 2008, there were no cases reported in ethiopia. no indigenous cases were reported in chad in the 2000s; however, the country was known to have poor surveillance. 2011 in 2011, 1,060 human cases were reported—1,030 in south sudan, 12 in mali, 10 in chad, and 8 in ethiopia. the majority of cases in south sudan were in kapoeta east county, and kapoeta north county. these adjacent counties are in the state of eastern equatoria. of the 70 counties in south sudan, 56 (80%) are considered free of dracunculiasis. the cases reported in chad were part of an outbreak that was originally identified in 2010 as part of a pre-certification process. chad had not reported any cases between 2001 and 2009. two of the cases in ethiopia were imported from south sudan. ghana appears to have eradicated guinea worm. in august 2011, their public health officials reported that ghana was free of reported cases for over 14 months. while promising, given the incubation period, it will be some time before the who certifies ghana as free of this disease. after south sudan separated from northern sudan, northern sudan has been free of guinea worm disease since 2002 and it has been certified free of this disease by the who. burkina faso and togo were both certified free of dracunculiasis in 2011, as the last endemic cases were in november 2006 and december 2006, respectively. 2012 in 2012, 542 human cases were reported—521 in south sudan, 10 in chad, 7 in mali, and 4 in ethiopia. this represents a 49% reduction compared to 2011. the containment rate was 64%. however, since march 2012, mali's guinea worm eradication program workers have had limited access to northern mali due to the tuareg rebellion (2012), and were not able to investigate cases there. médecins du monde reported rumours of a further 5 unconfirmed cases in northern mali since march. 2013 in 2013, 148 human cases were reported—113 in south sudan, 14 in chad, 11 in mali and 7 in ethiopia, and 3 in sudan (imported from south sudan). this represents a 73% reduction over 2012. due to civil insecurity in south sudan, monitoring was suspended in parts of the country in december. containment was 66%. after a decade without any reported cases, it is clear that dracunculiasis has since reestablished itself in chad. there were concerns that surveillance vigilance has decreased, and renewed efforts were made to increase monitoring. this includes coordinating monitoring with its neighbours nigeria and cameroon. ivory coast, niger, and nigeria were all certified free of dracunculiasis in