Don Hopkins 2008 Guinea Worm Status

Interview Transcript
	   
Speech
Don Hopkins Audio File
Transcribed: February 5 | Duration 0:15:38




Welcome

By Stanley:
...briefly of two of the programs that sort of  learned  from  Smallpox  and
have gone on and are now doing tremendous things around the world. So  first
I'd like to introduce Don Hopkins. Don was in the  original  group  in  West
Africa. His work in Sierra Leone where he had enough resources  to  do  mass
vaccination in one, and surveillance and containment in  the  other,  showed
the surveillance and containment was far more effective, and  then  he  went
on to work in India. I guess you were in Calcutta, Don? Then over  the  last
few years he's been battling the serpent, so let's give a  hand  of  welcome
to Don Hopkins.


Speech: Don Hopkins

Good morning.

It's great to be here and a wonderful occasion, and especially for me to  be
able to share a bit of the story of the Great Worm. To do  so  would  really
require another symposium to do so fully. But I've only got nine slides  and
I want to run through them quickly. Stan asked me whether I might need  more
time and I said, "No." Fortunately the story of Guinea Worm Eradication,  or
at least part of it, is told very simply these days.  Thank  God.  Here  you
see this worm that grows up to two to  three  feet  long,  emerges  directly
through the skin on any part  of  the  body.  People  who  are  infected  by
drinking contaminated water containing immature forms of the  parasite,  the
parasite gets into the water when people with  worms  coming  out  of  their
body, go in to the water and the female  worms  spew  these  immature  forms
into the worm where they're taken up by water fleas and people  drink  water
containing those infected fleas; and a year  later  the  infection  emerges.
Someone has said, "This is  the  ultimate  in  an  emerging  and  infectious
disease."

I have nine slides, but this is really the one that tells the full story  or
much of it to date. This initiative began right here at CDC  or  right  here
at what used to be CDC, in a different part of the place, with an  estimated
three and a half million cases. We began here at CDC in  1980.  They  called
us in when President Carter took this up in 1986. But  in  1986  we  had  an
estimated three and a half million cases as you see, as of  last  year,  and
these are not provisional data; these are final data for 2007.  We're  down,
for the first time, to under 10,000 cases. Two years ago  when  I  presented
this; we're still at over  25,000  cases.  We've  gone  from  almost  24,000
villages in 1993 to just over 2,000 villages now, infected, and as you  see,
from 20 countries infected when  the  program  began,  now  to  five.  (Next
slide)

This shows on top there the less than 10,000 indigenous  cases  reported  in
2007 and you can see here the years in which the last  cases  occurred;  and
two years ago when I made this presentation to the  West  Africa  Group,  we
still had a number of other countries including these four which  had  their
last case in 2006 which was still then considered endemic. We are  now  down
as of the end of last year, to five countries: Sudan, Ghana, Mali,  Nigeria,
and Niger; and for a little bit of perspective, let me just note  that  when
in the early 1980s, Ghana and Nigeria were each reporting on  the  order  of
3,000 or 4,000 cases to the World Health Organization. When  Ghana  did  its
first case search in 1989, they found  just  under  180,000  cases,  they're
down last year to under 4,000 cases.  When  Nigeria  made  their  count  the
first time that year as well, Nigeria then counted over  653,000  cases,  so
you can imagine how far around this room that bar would go,  if  these  data
were for 1989 for Nigeria. On  the  bottom  here,  you  see  the  last  five
countries and we've listed Ethiopia here, even though Ethiopia recorded  its
last official case in 2006. Early this year, they became aware of  37  cases
that reportedly were imported from Southern Sudan where there's a  lot  more
Guinea Worm known, but we include Ethiopia here, again, to keep Ethiopia  on
its toes and not let them feel too comfortable. But here,  you  see  through
June of 2008, the number of cases reported so far  this  year  and  that  in
essence is where we are. Here, you see that presented in the form of  a  map
in yellow, the countries that have  already  broken  transmission  including
all three in Asia: India, Pakistan and Yemen. Then in  Africa:  Nigeria  and
Niger there in what appears pink to you; the countries that  reported  under
100 cases in 2007, and we think that both  of  them  may  well  have  broken
transmission already with Niger having reported its last  case  in  November
of last year, and Nigeria having had no cases in April, May  and  June  this
year.

Then you have Mali, Ghana and Sudan there in red, each having had more  than
100 cases last year. Here you see cumulatively the  global  campaign  as  of
the number of cases 2006, 2007, first seven months of 2008. Now the rest  of
the top three countries remaining, this  is  Sudan  which  has  reduced  its
cases so far this year compared to last year by 54%. The Civil  War,  having
ended officially at the beginning of 2005, we have a  very  energetic  group
of people there  and  things  are  proceeding  very  well,  except  for  the
political insecurity that still remains.

Ghana, surprisingly for all of us, was an enormous headache for much  longer
that it should have been, but they have gotten now back on the straight  and
narrow and you can see  here,  Ghana  having  -  this  is  a  record  -  Jim
Zingerser is here, they beat[inaudible 0:7:22] even Niger some  years  back,
but Ghana has reported 85% fewer cases so far this year as compared to  last
year. This  is  not  a  calendar  year,  this  is  the  epidemiologic  year,
beginning in July and someone mentioned earlier the importance - I think  it
was you, Stan, in Bangladesh of social will and  involvement  of  the  media
and that  has  certainly  been  true  in  Ghana,  after  over  a  decade  of
stagnation in cases. Last year, 2007, Ghana had an  explosion  of  cases  in
the first of the year,  January  and  February,  up  in  the  North  of  the
country; a very neglected part  of  Ghana  from  even  Colonial  times.  The
epidemic happened to coincide just before March 6, 2007 when  Ghana  was  to
celebrate the 50th Anniversary of its Political Independence  from  Britain.
The month before that celebration in February, President Carter came and  we
used that occasion which unfortunately -  fortunately  for  us  -  coincided
with  that  terrible  outbreak  and  they  were  represented   on   Ghanaian
Television; there was just one reporter who was with  us  when  the  Chicago
Tribune said, this was  a  scene  from  hell;  of  lots  of  pre-school-aged
children crying. It was  just  awful,  but  all  of  that  was  on  Ghanaian
Television  and  there  were  reporters  already,  international  reporters,
beginning to come into the country for the 50th Anniversary  of  celebration
and that helped to generate the requisite political  will,  social  will  in
Ghana.

Mali is having a political problem with Tuaregs in the North, but  Mali  was
well on its way to getting rid  of  this  disease  when  year  before  last,
unbeknownst to anybody else. A Koranic student walked from an  endemic  area
several hundred kilometers up to the North near the border with  Algeria  in
the region of Kidal; and a year later we, and  those  people  there,  became
aware of this outbreak. The only good thing about it was that  these  people
in that area of the country were not used to having Guinea Worm disease  and
they were immediately hell-bent on getting rid of it, so we are having  very
good cooperation from that population. But we're still having some  problems
up in that area which we think we are getting on top of.  The  President  of
the country has promised to pay more attention to this now and he  has  been
a very strong supporter of this eradication effort. In fact,  now  President
Touré has been proselytizing for Guinea  Worm  Eradication  in  all  of  the
other endemic Francophone countries of Africa and now, to my great  sadness,
his own country Mali is going to be the last  Francophone  country  to  have
Guinea Worm disease.

This is my last slide showing that the countries in  green  that  have  been
certified already by WHO as  having  eradicated  -  eliminated  Guinea  Worm
disease. You see there that Cambodia in  Asia  is  the  only  other  country
outside of Africa, remained to be certified. One of the spillovers from  the
Smallpox Eradication Program to the Guinea Worm Eradication Program is  Joel
Breman whose on  the  International  Commission  for  the  Certification  of
Dracunculiasis Eradication. There have been many  other  spillovers  in  the
form  of  the  surveillance  containment,  we  call  it  "Case   Containment
Strategy" as supplied in the Guinea  Worm  Program;  the  use  of  data  and
indicators to motivate people and to make senior  people  uncomfortable.  In
Sierra Leone, we had a little newsletter run off by mimeograph  called,  The
Eradicator - We Now Have Guinea Worm Wrap Up, put out through  CDC.  Use  of
hand-drawn maps with dots from Sierra Leone to West  Bengal,  India,  in  my
experience; lots and lots of  local  heroes.  Some  of  whom,  you've  heard
about.  One  thing  unfortunately,  we  do  not  share  with  the   Smallpox
Eradication Program, was a two-week incubation period. Oh! What  I  wouldn't
give for a two-week incubation period of Guinea Worm disease.

Let me just ask all of the people in the audience who are  veterans  of  the
Smallpox Eradication Program who have also now worked  in  the  Guinea  Worm
Program to stand. Bill, thank you. That should have included you.

Just to end with one smallpox story; we're aiming to get rid of Guinea  Worm
disease by the end of next year. Sudan is going  to  be  the  final  battle.
We're getting very close, but we're not there yet. I didn't tell a  smallpox
story last night, but I just want to note that I spent three  months,  Ernie
and I, in West Bengal, India, in the fall of  1973  as  part  of  the  first
Autumn Campaign. I went there very full of enthusiasm and  enjoyed  it  much
more even than I expected to, but by  the  time  I'd  left  -  you  have  to
understand that as much as I loved India, I did not  like  Indian  food  and
the thing that saved me was that we found a Chinese restaurant  in  Calcutta
when we came back before I  left.  That,  plus  walking  into  the  villages
caused me to loose - and at that time when I went into  India  I  weighed  a
little less than I weigh now, but I lost 17 lbs. going  there,  and  I  also
came hell-bent on getting  a  replica  of  this  Shitala  Mata,  Goddess  of
Smallpox. I had a copy from the program in Lagos, the  last  big  reunion  I
attended in Lagos of the smallpox program, of the Smallpox Goddess  of  West
Africa; and I wanted to get one of India, and  the  whole  three  months  in
West Bengal, asking, asking, asking; I never found one.

Debriefed in Delhi and took a last quick trip down to Agra to  see  the  Taj
Mahal. Leaving the city in the vehicle going back  to  New  Delhi,  my  last
full day in India and I see - because I'm doing  constant  surveillance  for
my Smallpox Goddess - I saw in a little shop along the way this  thing;  and
I shouted, "Stop!" to the diver,  got  out  and  bought  -  these  were  two
marble, I think, small replicas of this goddess. I bought two  of  them  and
put them in my pocket because it's my last day there. Leaving  the  country,
I was overweight, so I put them in my trench coat pocket, I didn't have  any
room to plant them [inaudible15:01] and I actually  won  a  discussion  with
the airline people who  wanted  to  charge  me  overweight  baggage.  But  I
explained that I weighed 17 lbs less than when I came here; and  so,  I  got
rid of it. That is how Dave Sencer came to acquire a copy  of  the  smallpox
goddess which he donated - you see it in the Odyssey downstairs there.  They
were not presented to me, I bought them. Thank you.


[End of audio]