Cool water teems with life, much of it microscopic crustaceans; this is normal, and typically without consequences. But sometimes, resident water fleas host larvae of a rapacious, fiery serpent. When ingested, the water flea hosts dissolve in stomach acid, allowing the larval worms to move through the human body, where they mature and mate.
As the females of the next generation grow, they pack their own bodies with live young. During this period, the victim suffers no immediate symptoms. A year later, the 3-foot-long mother awakens deep in her host’s leg. She rises to the surface and induces a blister on her victim’s skin that is so fierce, and of such searing agony, that the afflicted seek relief in the coolness of water.
The Guinea worm can only reproduce at the expense of those it infects. Adult worms only infect humans, while the larvae only invade water fleas. It is also the only human parasite that must cause pain in order to successfully reproduce.
In addition to deeply wounding and torturing its victims for weeks on end, dracunculiasis is a disease of starvation. It leaves families in affected areas incapacitated and unable to reap the crops they have sown.
There is no vaccine for Guinea worm, and there are no drugs that can cure those who are infected. The pest once afflicted hundreds of millions of people from Gambia to India. But the worm is now gone from Guinea, and from almost everywhere else. At last count (2014), there were only 126 people infected, down from an estimated 3.5 million in 1986. Of the remaining cases, 70 are in South Sudan.
We know these numbers with precision because of a campaign that former President Jimmy Carter began leading in 1986 to destroy the worm. That community-driven process, coordinated by The Carter Center and executed by the South Sudan Ministry of Health, village volunteers, and trained technical advisors, is driving the parasite out of its last remaining human hosts. Each person known to be infected with the worm, along with every village in which outbreaks have occurred or are occurring, is tracked.
Intervention is multi-pronged: the infected are voluntarily quarantined, since patients with emergent worms must be kept away from water sources; containment-care facilities welcome not just the victims but their dependents, too; local education programs focus on water filtration.
Many years ago, when I was beginning a career in parasitology, I was told about the “parasitologists’ dilemma,” a spin on the Malthusian catastrophe. The premise was that, should parasitologists actually manage to eradicate infectious diseases caused by parasites, we’d be morally responsible for thrusting millions of people into the inevitable conflict and poverty that would result from population growth and increased pressures on a limited food supply.
But in every place where the Guinea worm has been eliminated, the very opposite is true. Just a couple of decades ago, Ghana and Mauritania had thousands of cases. Now, both countries are free not only of Guinea worm but, increasingly, of the shackles of extreme poverty: per capita G.D.P. has tripled, the number of people living on less than a dollar a day has been halved, and the birth rate has plummeted. This, obviously, is the result of many factors besides Guinea worms. But I can say this: so much for Malthus.
Most conservation efforts, like those for spotted owls and pandas, are proxies for threatened ecosystems, or seek to preserve “keystone species,” like sharks. Few focus on the despised and downtrodden species that crawl beneath our feet. As a leech expert, “save the maggots” has always been my rallying cry, but let no one mourn this extinction.
This essay is adapted from a story in the Winter 2015 issue of Rotunda, the Member magazine, and was originally published in The New Yorker’s Elements blog as “An Extinction to Celebrate.”