Always referred to as the peanut farmer from Georgia, an outsider who made it to the White House, Jimmy Carter was even more of an unusual figure after he demitted office. He was possibly the most extraordinary ex-president America has ever had, undertaking several peace missions to end conflicts across the globe and launching public health campaigns in the poorest of countries.
One cannot remember any other former president and his wife trekking to the remote corners of Chad and Ethiopia to deliver medicines and hope to the sick and needy; or lobbying heads of government constantly to remind them that access to healthcare is a basic right they need to provide in the larger interest of social well-being.
The transformation of Carter from a typical American leader to an exceptional promoter of humanitarian initiatives, especially global health, was unexpected given his record in office. His one term as President was marked by a landmark foreign policy triumph and ended with the disaster of the Iranian hostage crisis, the reason why he failed to get re-elected.
Some would perhaps list his Camp David Accords of 1978, which led to the signing of a peace treaty between then Egyptian President Anwar Sadat and Israeli Prime Minister Menachem Begin — a treaty that the Arab world viewed as a sell-out to the Zionist state — as historic.
There was even more unhappiness over the United States boycott of the 1980 Olympics held in the Soviet Union because of its invasion of Afghanistan. The boycott was hugely unpopular in the US, too, and Carter admitted much later that it was “a bad decision”.
Once out of office, though, Carter trod a path in which few world leaders, much less ex-presidents of the US, have shown little interest. The Carter Centre he set up in Atlanta became a beacon of hope for those suffering from parasitic infections in Africa, in particular dracunculiasis, the hideous guinea worm disease. His legacy is a sterling example of what commitment can do to eradicate a disease for which there is no vaccine and no certified treatment.
How did Carter go about it? He brought William H Foege, who was the director of the US Centres for Disease Control and Prevention during his presidency, to head the Carter Centre, through which he hoped to work on conflict resolution and advance democracy. Foege, who helped in eradicating smallpox in the 1970s, was instrumental in drawing Carter into the field of global health.
He looked for neglected tropical diseases that are widely prevalent in a host of resource-poor countries and when he found these diseases, he went about fighting them in mission mode, devouring any material that he could find to help his crusade. These are diseases with no known treatments because pharma companies see no profit in developing drugs for such infections.
Carter left behind an impressive legacy and his success in eradicating the guinea worm is the reason why this column is writing a rare tribute to a political figure.
Guinea worm disease, according to the World Health Organization (who), is a parasitic infection caused by consuming contaminated drinking water from ponds that in the mid-1980s afflicted 3.5 million people every year in 21 African and Asian countries.
About a year after infecting a human host, the three-foot worm erupts from a blister on the skin and causing fever, burning pain and swelling. Guinea worm disease is considered zoonotic since dogs are carriers.
Thanks to Carter’s championship, the disease has been very nearly eradicated with just 14 “provisional” human cases in 2023. He even negotiated a “guinea worm ceasefire” in Sudan’s civil war in 1995, allowing urgently needed medical care and health education to be conducted in the country. That ceasefire lasted almost six months and enabled the campaign against guinea worm disease and river blindness (onchocerciasis) to continue during the next 10 years of the civil war.
India, too, had its burden of this debilitating disease but was able to control it early on. In 1996, it made history as the second nation to stop the transmission of dracunculiasis after Pakistan. In the mid-1980s who said that India had 44,818 cases of the disease in seven western states, the last known indigenous case being reported in July 1996 from Rajasthan. In 2000, who certified India as free of the disease and the country was honoured at a special ceremony at the Carter Centre.
Shaped by his first-hand experiences, the ex-president’s ideas on global health priorities crystallised into an abiding focus on neglected diseases and became his mission. He lobbied heads of government relentlessly across the world to fight neglected but preventable diseases, emphasising that “access to health care is a human right, especially among poor people afflicted with disease who are forgotten, ignored and often without hope”.
The Carter Centre’s work on the guinea worm has been in the spotlight and the ex-president also initiated programmes to fight other preventable diseases like trachoma, which is one of the world's leading causes of blindness and other parasitic infections such as schistosomiasis and lymphatic filariasis, commonly known as snail fever and elephantiasis.
His views on healthcare were influential and Melinda French Gates, who co-chairs the behemoth Gates Foundation, is reported to have consulted him on how to address health concerns in Africa and found his advice invaluable.
The New York Times reports that early on, French Gates had asked the ex-president what he had learned over time working on global health concerns. She is quoted as saying: “He said, Melinda, anything you do in global health, anything, you have to make sure you have the community bought in and they see it as their work — not as your work, as their work. That way they will own it and they will create lasting change,” she recalled him saying.
The Gates Foundation was at one point thinking of investing in the development of new drugs and vaccines, but Carter had a different idea. He urged that more money be spent on the neglected diseases that affect people today. French Gates said the advice led to a reordering of the Foundation’s priorities between funding for future vaccines and acting today to relieve some pain and suffering.
If that is, indeed, the case, the ex-president has left a deep imprint on global health priorities.