Jimmy Carter's Trip to Mexico City

By Jimmy Carter

The primary purpose of this brief trip was to attend an Inter-American conference on onchocerciasis, a tropical disease that The Carter Center has been targeting for about 12 years. It is caused by the bite of small black flies, not much bigger than Georgia gnats, that breed only in rapidly flowing streams with high oxygen content. Occurring mostly in Africa, oncho also threatens about 540,000 people in six American nations: Mexico, Guatemala, Venezuela, Colombia, Ecuador, and Brazil.

An infected fly implants microfilariae (small thread-like worms) in the victim's body, causing intense itching, skin discoloration, and large nodules, where the adult worms breed and continue the infestation. The filariae eventually attack the eye, causing blindness. The common name for onchocerciasis, therefore, is river blindness. As centuries have passed, people have abandoned rich bottomland near rivers and moved to less fertile hillside areas to avoid contact with the insects. It is estimated that a small child is bitten more than 20,000 times each year, so everyone in an endemic village will harbor the disease.

For many years, river blindness could be prevented by only two methods: either to poison the stream to kill the fly larvae or to administer a strong medicine with serious side effects. Finally, about a dozen years ago, Merck Pharmaceutical Co. experimented with Mectizan, one of their veterinary medicines used to prevent heartworms in animals, and found that the same treatment was also effective against river blindness. One tablet per year would relieve the painful and embarrassing symptoms of the disease and prevent blindness.

Merck's CEO, Dr. Roy Vagelos, came to Atlanta and offered their tablets free of charge, provided we could work out a procedure whereby the medicine would not be wasted or sold in competition with their veterinary sales. Since we began our program in 1990, The Carter Center has helped to deliver 30 million treatments directly to individuals in endemic villages, and we are now maintaining an annual rate of seven million. In all areas, International Lions clubs are our strong partners because good eyesight is their primary commitment. About 370,000 of these treatments are in the Americas, in 1,969 endemic communities: Mexico with 670; Venezuela 609; Guatemala 554, and Brazil, Ecuador, and Colombia with the remaining 7 percent. Depending on effectiveness of treatment, results vary even within countries. For instance, there have been no new cases in Oaxaca since 1998, while the disease continues to spread in Chiapas, where political unrest has interfered with delivery of Mectizan.

We have been the lead agency among the endemic countries in this hemisphere, and there are several other organizations that share this responsibility with us in Africa, where we are treating about 6-1/2 million people in five countries. Our partners in the Americas are International Lions clubs, the Pan-American Health Organization, the InterAmerican Development Bank, CDC, and national health departments. Our primary goal is to reduce the ravages of the disease, but we now have hope that onchocerciasis might become the next disease to be totally eradicated (after smallpox, Guinea worm, and polio).

My role at the conference was to gain publicity for the elimination of onchocerciasis, to encourage and thank our workers, to increase political and financial support for the program, and to receive information and recommendations from the six countries. This will be helpful for a conference at The Carter Center in January that will be devoted exclusively to the question: Can onchocerciasis be eradicated?

We have been experimenting with the effect of an increased number of doses of Mectizan each year, and the results have been encouraging. If we can remove the microfilariae from the body, then a biting fly will not pick up the disease to carry to another person, thus ending "transmission." We are now convinced that this will occur in a geographical area if we can treat at least 85 percent of the people twice a year. Countries reported that they are giving these semiannual doses in Colombia to 98 percent of those at risk, 83 percent in Mexico, 75 percent in Guatemala, 64 percent in Brazil, 70 percent in Ecuador, and 30 percent in Venezuela in January-September 2001. In communities treated with our prescribed formula, we are now finding no evidence of the microfilariae in the bodies of children under five years of age, indicating an end to transmission even though adult worms are still present in people who harbor the disease.

This is an exciting project, with onchocerciasis being one of five tropical diseases with which we contend. The others are trachoma (#1 cause of preventable blindness), Guinea worm (dracunculiasis), schistosomiasis, and lymphatic filariasis (elephantiasis). We feel that good health is one of the basic human rights, especially if the preventable affliction is confined to people who are poor, isolated, forgotten, ignored, and often without hope. Just to know that someone cares about them can not only ease their physical pain but also remove an element of alienation and anger that can lead to hatred and violence.

Dr. Hardman and I visited President Vicente Fox on the way to the airport and gave him a report on our conference. He was quite interested and pledged to work with Mexico's Secretary of Health in the elimination of river blindness. I had not seen President Fox since we monitored the recent election in which he was elected for a six-year term. We were able to discuss human rights issues, his coming visit to Cuba, peacemaking in Colombia, control of corruption in Mexico, protection of Monarch butterfly habitat, the impact of Venezuela's President Chavez, the potential benefits and problems with Mexico's membership in the U.N. Security Council, and the improvement of Mexican immigrants' status in the United States.