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Sunday, 16 February, 2025
HomeObituaryJimmy Carter leaves global health legacy

Jimmy Carter leaves global health legacy

In his decades as a former US President, Jimmy Carter, who died on Sunday aged 100, and his wife, Rosalynn Carter, helped bring lifesaving treatments and sanitation to thousands of poor people worldwide.

His five decades of leadership in global health brought a hideous disease to the brink of elimination, helped deliver basic health and sanitation to millions of people, and set a new standard for how aid agencies should engage with the countries they assist.

It was quiet work and drew relatively little attention because it was focused on afflictions that plague the poorest people in the most marginalised places, but it had enormous impact, reports The New York Times.

“The work in global health may turn out to be some of the most important work he did,” said Dr William Foege, who helped lead the successful effort to eradicate smallpox in the 1970s and played a key role in drawing the former President into the field of global health after he left office.

Carter viewed his healthcare work through the prism of a larger effort for basic rights and as a tool for peace building.

“We believe access to healthcare is a human right, especially among poor people afflicted with disease who are forgotten, ignored and often without hope,” he wrote in 2001 after a trip to lobby Latin American leaders on neglected diseases. “Just to know that someone cares about them not only can ease their physical pain but also remove an element of alienation and anger that can lead to hatred and violence.”

He used his rare status as a former head of state to lobby Presidents and Prime Ministers on behalf of their poorest citizens. He and his wife trekked to remote corners of countries, including Chad and Ethiopia, to visit and comfort the sick. Then they travelled back to capital cities where in private meetings or, if those did not produce results, news conferences, they pressed for action on behalf of those same people.

Carter negotiated a ceasefire in Sudan’s decades-long civil war so that teams working to wipe out a parasite could reach civilians, and he brokered a major drug-donation programme that has been key to progress in eliminating river blindness, another scourge.

The Carter Centre, a non-profit that the couple founded in 1982, is admired in countries where it provides development assistance as an organisation whose beneficiaries set priorities and lead projects, an ethos that former staffers say originated with the Carters.

Foege, who had been the director of the US Centres for Disease Control and Prevention during the Carter presidency, was asked to run the Carter Centre, and when accepting the offer, told the former President there were so few people working in global health at that time that he could not imagine leaving the field.

“He became so interested in the field… You could not give him enough material to study. He became better at global health than almost any global-health person I know,” Foege recalls.

The Carters decided to focus on neglected tropical diseases, which draw little investment in research or treatment because they infect the poorest people in the poorest countries.

“He would often ask, as we were trying to brief him on a new area on which we were working, ‘Who else is working on it?’. He said, ‘If there are other people working on it, you don’t need me’.”

Eradication

The Carters learned about Guinea worm, an excruciating and disabling parasitic infection in which a metre-long worm slowly burrows out through the skin of the person it has infected, and for which there is no treatment other than painstakingly drawing out the worm over days or weeks.

With Foege and his team, the Carters set the goal of eliminating the disease.

Carter did not, as he often vowed to do, live long enough to see eradication. But in 1986 when they began the campaign, there were an estimated 3.5m cases in at least 21 countries. Last year, by early December, the Carter Centre reported a provisional total of just 11 cases.

The progress has been achieved without the help of a treatment or vaccine, which was essential to eliminating smallpox; it has instead been the result of the slow and laborious work of helping people gain access to clean water to avoid infection by the waterborne offspring of an adult worm.

In 1995, Carter personally helped negotiate a ceasefire in the civil war that had then been fought in the south of Sudan for more than a decade. The truce, which lasted nearly six months, allowed health workers to hunt for the worms and distribute water filters in areas that they had never been able to reach.

The agreement also helped start a long process of negotiation between the government and rebel leaders that eventually led to the independence of South Sudan.

Carter also brokered deals with big pharmaceutical companies. In the 1980s, Merck had begun a large-scale donation programme of a drug called Mectizan to treat onchocerciasis, or river blindness, another parasitic disease transmitted by small flies in Africa, Latin America and the Middle East.

“We said we would give it to people for as long as was needed, but we needed to get it to the villages,” said Dr Roy Vagelos, who began the programme in 1987 as the chief executive at Merck.

The Carter Centre agreed to incorporate the elimination of river blindness into its activities, delivering a Mectizan pill to everyone in infected areas – even the most isolated communities – once a year.

A few years later, Foege was at a meeting in Paris, where the World Health Organisation reported that Mectizan, combined with another drug, Albendazole, could treat lymphatic filariasis, a parasitic infection that can lead to elephantiasis.

He got a call from Carter to say he had met a pharmaceutical company executive the night before who was keen to be part of a drug-donation programme like the one Merck ran for Mectizan.

That company, SmithKline Beecham, it turned out, made Albendazole, and Carter co-ordinated an arrangement to send Mectizan and Albendazole to patients in Africa and Latin America, which has helped sharply reduce transmission of lymphatic filariasis in countries including Nigeria and Ethiopia.

In 2001, Bill Gates and Melinda French Gates consulted Carter when they were establishing priorities for the charity they had just set up with the world’s largest endowment. Gates said that the former President urged them to expand their work in global health.

Carter’s encouragement, Gates said, helped dispel scepticism he had about the public-health field, and arranged key introductions to African leaders. Gates also noticed that while the Carter Centre was working in many countries, it did not have its name displayed prominently on projects and instead, foregrounded the work of local leaders.

Carter said: “Anything you do in global health, you have to make sure you have the community bought in and they see it as their work – not as your work, but their work. That way they will own it and they will create lasting change.”

At one point, the Gates Foundation was considering work in the development of new drugs and vaccines, but Carter urged a different priority: “He said, If I were you, I would spend more money on the diseases that affect people today.”

That led to a balance in the foundation’s giving between funding for future vaccines and “relieving some pain and suffering today”, Gates said.

Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, first encountered Carter while serving as the Health Minister of Ethiopia. The Carter Centre was working on neglected diseases in Ethiopia, but Tedros’ priority was ending child malaria deaths, and he was short of 3m bed nets in a plan to distribute 20m.

He told the staff of the Carter Center, which did not do malaria work in Africa (because that effort was already comparatively well funded) that malaria, not the rarer diseases, was his chief concern.

When word got to Carter of the need for more nets, he quickly responded that the centre would source them.

“That showed me what kind of person he was: empowering and trusting. He doesn’t come in and say ‘I know better than you.’ He says, ‘You know your problems and you know the solution’. It comes from humility and humbleness. He doesn’t come to dictate, he comes to help you, with sincere help.”

Dr Yao Sodahlon today runs the Mectizan-donation programme for river blindness, which is administered by the Task Force for Global Health, an organisation founded by Foege. He survived a case of river blindness himself as a teenager in Togo, long before Mectizan. The drug used to treat him then was painful and toxic, with terrible side effects and low odds of success. But he regained his sight and became a doctor.

 

The New York Times article – Jimmy Carter’s Quiet but Monumental Work in Global Health (Restricted access)

 

See more from MedicalBrief archives:

 

Guinea worm disease eradication in sight

 

Poorer African nations rank high in disease-fighting league table, but SA languishes

 

Ethiopian trial finds trachoma not eliminated by mass antibiotic prophylaxis

 

 

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