Relieving Human Suffering through Partnership and Perseverance

Remarks by Jimmy Carter

Meeting of the Coalition for Operational Research
on Neglected Tropical Diseases

Atlanta, Georgia

Good morning everybody. Good morning everybody! Just want to make sure you’re awake. I know that Pat didn’t put you to sleep. I’m going to repeat Pat’s speech a little bit and am going to use notes.

I was interested as they found out about the election the day before yesterday, I spoke to both the candidates. Yesterday early, I spoke to Mr. Trump, who is going to be our next president and who needs our support and our prayers, and I also spoke to Hillary Clinton later on in the day. I can share very intimately the way they both feel because I won the same election, as some of you may be old enough to remember, and later I lost the same election, so we have a lot in common.

Well, representing The Carter Center, I speak to a lot of different kinds of audiences, but my basic message I would say is always the same: we have a moral obligation to prevent suffering wherever we can. And this audience clearly recognizes that premise. I thank Bill and Melinda Gates for their invitation, also USAID, and I thank all of you for contributing, as we try to do at The Carter Center, to global health. When I was campaigning I always told a story to start with to put the audience at ease, but I don’t really do that anymore. But I told a story at one of my bible classes recently that I think is pertinent to this group. It’s about this young student who was participating in a freshman physics class. He took the examination that the professor gave and one of the questions was “How do you use a barometer to determine the height of a building?” And the wise young student, he was kind of a wise guy, wrote down, “There are so many answers to this questions, I don’t know how to respond.” So the professor called him in and said, “What do you mean by this? Are you just trying to aggravate me?” And he said, “No, I’m serious! There are a lot of answers to that question.” And the professor said, “I don’t know. What do you think the answers might be?” And he said, “First of all you could take the barometer and you could measure the atmospheric pressure at the base of the building, and you climb to the top, and you measure the atmospheric pressure, and you can determine the height by computation.” and the student said, “It’s the same principle that you use with modern-day altimeters.” The professor said, “That’s the answer I wanted! Why didn’t you say so?” He said, “Well, there are some other answers too.” The professor said, “I don’t know of any, you tell me.” He said, “Well you can take the barometer, and go down to the sidewalk and put it on the ground, and measure the height of the barometer, and measure the height of the shadow, the length of its shadow, measure the length of the shadow of the building, and you can determine the height of the building!” The professor didn’t say anything, and the student said, “Well, there’s another way, too. You can take a stopwatch and go to the top of the building, you can drop the barometer, see how long it takes to hit the ground, and you can determine the height of the building.” He said, “Oh there’s an easier way too. You can go to the top of the building, take a string, tie it to the barometer, lower it to the ground, and measure the length of the string.” By this time the professor was kind of aggravated and didn’t know what to say, but about that time the dean of the business school walked by, and the physics professor said, “Well if you could tell me a way to use it with business principles, I’ll give you an A on the course, on the exam.” So the student thought for a few minutes and said, “Well you could take the barometer, go to the building superintendent’s office and say ‘Look I’ll give you this nice barometer if you’ll tell me the height of the building.’”  

Well, as we say in the South, I am preaching to the choir this morning because you know all the things I’m going to say. But I’m going to cover them just as well to get your session started.

Like all of you, we have had to be persistent, and we’ve had to be innovative in finding new ways, new answers, to the questions that we face in trying to reach our goals in mental health, in physical health, and in global health. A major commitment of The Carter Center is to relieve and prevent suffering. It’s a mission that all of us will pursue, as you know, long into the future. We share one responsibility that I think we should remember. We have to inspire our children and grandchildren to take on challenges and risks that at first may seem to be overwhelming, or even impossible. They need to understand that the only failure is not trying. Sometimes we face potential failure, and we have to remember to try anyway to find a way to reach our goal. We can overcome many global problems and build a better world if we all work together as a community, and I’m sure that all of us in this room are working toward the same goals and cooperate whenever we can.

Reducing or wiping out diseases from entire regions or globally is not an easy task. But it is possible for a few diseases, and to determine those diseases is one of the tasks that we all face. I know I am speaking to those who are actually doing it.

I don’t need to explain to you why this is a worthy mission to pursue. You know the economic benefits and the scientific progress that can come from this work. And you understand that this work is also — and this is very important — a core act of kindness, a recognition of our common humanity. I’ve learned that people who are desperately poor—and  this is one of the most important things I’ve learned in the last 35 or 40 years--that these desperately people have the same hopes, the same work ethic, and the same dreams, as you and I. They are just as dedicated and just as intelligent. When they receive the right tools and training, they will implement the solutions themselves, become empowered, and be ready to address other challenges. They want to improve their own lives, and they just need some help.

Last week in Nigeria, The Carter Center celebrated the delivery of 500 million doses of donated medication in the last 28 years or so to combat lymphatic filariasis, schistosomiasis, trachoma, intestinal worms, and river blindness. We are just one of many organizations and agencies — most of which are represented in this room today — working with national and local ministries of health to do this important and challenging work. We all realize that much of what has been accomplished is due to the generosity of pharmaceutical companies. How many of you represent pharmaceutical companies? Raise your hand, don’t be hesitant. You’re heroes here, so you should be standing up and waving your hand like this, because you provide the free medicines that we can deliver that alleviate suffering. I want in particular to thank Merck, Pfizer, GSK, Eisai, E-Merck, and Johnson & Johnson for their contributions and their long-term commitment to the programs that we espouse.

The numbers that reflect our collective work are truly astounding.

In 2015 alone — now listen to some of these figures — 114 million people, 114 million, received treatment for onchocerciasis,

65 million for schistosomiasis;

500 million for trachoma;

556 million for lymphatic filariasis;

And nearly 568 million for intestinal worms.

To summarize, last year WHO reported that 979 million people received over 1.2 billion treatments for neglected tropical diseases.

Lymphatic filariasis, or LF as you may know, can cause elephantiasis, which Pat mentioned, in which a person’s arms and legs or genitals can become grotesquely swollen and the skin hardens on their arms and legs to resemble an elephant’s skin Our Carter Center program in Nigeria has been the first in that country — which is the second most endemic in the world — to eliminate LF transmission among about 8 million people in Nasarawa and Plateau States in Nigeria. This was done in a comprehensive way, using mass treatment, plus distribution of insecticide-treated bed nets.

Within the last year, lymphatic filariasis has been eliminated in Sri Lanka and the Maldives, and eight other countries are on the track to meet this goal.

The Carter Center and its partners have helped successful onchocerciasis elimination —as Pat mentioned also in Colombia, Ecuador, Mexico, and, just a few weeks ago, in Guatemala; the only place it still remains in the Americas is in a small tribe in the rainforest area on the border between Venezuela and Brazil. Of course, cooperation between those two countries shall be necessary to completely eliminate onchocerciasis in this hemisphere.

Trachoma is on a dramatic decline locally, with the number of people at risk of this blinding disease reduced by one-third in just the last five years, from about 325 million cases in 2011 to now just 200 million. We have information that Oman has eliminated trachoma as a public health problem, with six other countries soon to be achieving that status.

Ethiopia, the worst-affected country in the world with 75 million people at risk of trachoma, has made impressive gains. In 2012 for instance, the Carter Center program in Ethiopia’s Amhara Region was the only program at scale to provide assistance to about 22 million out of those 75 million people. And this year, our average in other hardest-hit regions are now moving to scale to provide close to  55 million people with lifesaving treatment for trachoma: Zithromax, which is an antibiotic as you know; surgery as required, a simple surgery on the eyelid; a focus on facial cleanliness, we encourage schoolteachers to monitor their kids and encourage them to wash their faces — for the first time in their lives, many of them; and also environmental improvements, primarily to get rid of the flies.

So you see, tremendous progress can be made if we persevere through difficult challenges.

In 1986, we participated in a global survey for Guinea worm disease, and which found about 3.5 million cases at that time in 21 countries in Asia and across Sub-Saharan Africa. Through the distribution of millions of filter cloths, the use of the larvicide ABATE, which kills their eggs in the water, and face-to-face public health education to teach people what causes Guinea worm and how they could prevent it, The Carter Center has helped to avert 80 million cases of this ancient disease.

Guinea worm is now on the brink of eradication — as Pat also mentioned in his brief introduction. According to our provisional figures,  from January through October this year, there remained just 17 cases in the world.  We have 17 cases instead of three-and-a-half million.

We have a large coalition of partners, especially the national ministries of health, and literally hundreds of thousands — I’m not exaggerating — of trained health workers, chosen in their own communities just to monitor what goes on in their own villages.  They try to report the disease each time it occurs and also educate their neighbors on how to avoid the disease. We teach them, and then they teach their neighbors. The development of a simple water filter was a tipping point and a key factor in the elimination of this disease where we’ve been successful. The filter cloth uses a special nylon thread that was developed by DuPont, a chemical company, and Precision Fabrics, which I think is located in New Jersey, for the pioneer cloth that we use for the filter.  And more than six million square meters of this filter cloth has been donated by them to us to distribute to the people in the villages. Later, Vestergaard, which is a Danish company, worked with the Center to manufacture special personal filters in a little tube that you can hang around your neck. When we couldn’t get into areas that were endemic, we would send these neck filters in, and they would wear them. We used to encourage the leaders of those regions to wear the neck filter in order to set an example for their people. And when I went in, I always wore one. I can’t say I ever sucked water in and out of the filter. Well, Vestergaard is still our partner, and BASF still contributes ABATE for our use.

For two years, The Carter Center has had an exciting exhibit at the American Museum of Natural History in New York. It was originally scheduled for six months, but they have extended it now three times, so six months at a time, and I’m proud to announce that soon it’s going to moving to The Carter Center, right Mary Anne? And it’ll be here, when, the first part of January? Starting in January you can come to The Carter Center here in Atlanta, and see it, or in the meantime you can go to the American Museum of Natural History. Well, the name of that is “Countdown to Zero: Defeating Disease.” It highlights the scientific and social innovations that are at the heart of fighting eradicable diseases. In January, we are bringing the exhibit here.

Well, we work closely with our friends and neighbors in the Atlanta area. The CDC, obviously, the Task Force for Global Health, Emory School of Public Health, Morehouse School of Medicine, and also CARE, all of them located in the Atlanta area.  

There are other diseases that are potential candidates for eradication. The International Task Force for Disease Eradication is located at The Carter Center and is supported by the Gates Foundation. It evaluates the potential for controlling or eradicating other diseases. In addition to Guinea worm and lymphatic filariasis, which I have already mentioned, the task force has identified six other diseases that meet the criteria to be eradicable: polio, mumps, rubella, cysticercosis, measles, and yaws.

In the past, many scientists believed that transmission of river blindness in Africa could not be eliminated. Let me say that again: that onchocerciasis, or river blindness, could not be eliminated in Africa. But The Carter Center, together with the ministries of health in Sudan and Uganda, has demonstrated that moving from once-a-year treatment to more frequent treatments with ivermectin, which is given to us by MERCK, can eliminate the disease. Sudan and Uganda recently announced the elimination, total elimination, of river blindness transmission in key endemic areas and stocked over 1.8 million annual Mectizan treatments, where they had been, as you know, giving Mectizan each year to the people that were in danger of having river blindness; now 1.8 million that used to be given annually will not any longer have to be given.

The last global health effort I will mention this morning is our work to help eliminate lymphatic filariasis and malaria from the island of Hispaniola, which encompasses Haiti and the Dominican Republic.   I’ve been there myself and talked to the presidents and also the ministers of health and others, in both countries. Eliminating these two diseases in Hispaniola will eliminate both of these diseases completely from the Caribbean region. They have to be cooperative in the future and, as Pat pointed out, they are already working on this, and this may be one of the few things on which they can agree. They are not very friendly neighbors, but they are friendly when they want to do away with disease. Second, there must be community participation.

Let me point out some principles we have found in our Carter Center programs.  The first thing is that every step has to be collaborative; you have to have cooperation in order to be successful. We have to remember that this is made possible because local people have to be given the complete authority to make their own decisions. You can’t force anything on them. You can’t force our ideas on these local people, but just help them solve their own problems, because it’s their home, it’s their decision to be made, and their ownership of the success. If you don’t trust them and put the responsibility on their shoulders, there’s no way to be successful.  

Second, there has to be community participation. For example, in our Carter Center programs, overall strategy is set by the ministry of health. We always work with the ministers of health of those countries. Sometimes, we find the minister of health eager to cooperate and very knowledgeable. At times, we don’t find that the ministers of health have either one of those characteristics. But we work with them and through them; otherwise we can’t get cooperation out in the villages, or in the president’s office either. So, overall strategy is set by the ministry of health, and the actual work is carried out, as I said earlier, by a multitude of community-chosen village volunteers.

The third principle is that we must recognize the value of partnerships. And sometimes that’s not east to do for a proud organization that wants to get credit for all the progress made. We have to include governments at all levels, religious groups, civic organizations, international assistance agencies, donor corporations, which I’ve already mentioned, and nongovernmental organizations as well. So the cooperation is very important.

Finally — and I think this may be the most important thing to achieve success--we have to have a data-driven approach with measurable goals and also the ability to measure the progress that we make accurately, and not mislead ourselves, or the people that we are using to report. We have to monitor progress accurately and evaluate further innovations for reducing both the incidence of burden of disease, and also the transmission of infecting agents.   Use evidence-based practices to carefully monitor progress and evaluate whether interventions are reducing not only the burden of disease but also the transmission of the infecting agent. We evaluate locally what’s working, and what is not working, and then we share what we find with our national partners and our local partners to put into effect the corrective action that we have to take if things are not working well.

As I stated at the beginning, we must persevere, and often we must overcome great difficulties.

The last few cases of Guinea worm disease remain because they are in remote places. Sometimes people get overconfident when they get down near the end of an eradication program or elimination program, or they relegate the eradication or elimination of Guinea worm to a secondary position of importance in their country, or because there are areas of conflict, which is the case now in Mali and other countries, in South Sudan, or because of natural disasters. And sometimes, of course, we’ve found that projected deadlines for achieving our ultimate goal have to be extended. We’ve learned how to accommodate that with relative equanimity. But we accept risk as a condition of work and the cost of success.

There are other kinds of challenges as well. You may remember, or be aware, I spent, what was that, you’ll be talking about it later on today and tomorrow, that we found Guinea worm infection in dogs— literally hundreds of dogs — but we haven’t let that unforeseen development deter us in our commitment and with scientific help, which we are seeking and obtained, we are overcoming that problem as well.

We have had to overcome some other problems. I remember when I first began to work in Sudan, there had been a war going on between north and south Sudan for 16 years. And there was no way to get into the warzone. And so I went over and negotiated finally a cease-fire, which originally was okayed for just two months, and eventually this turned into more than six months, and they still call it the Guinea worm cease-fire. That was in 1995, and then after the cease-fire came, we could get in and take care of the Guinea worm.

In those moments when I do get frustrated, and I try to conceal my frustration as much as possible from my colleagues, I am cheered by the knowledge that there are mothers in Colombia and Ecuador and Mexico and Guatemala that never have to worry again about their families going blind from river blindness. I have to remember that there are women in Ethiopia who will never suffer from the ravages of blinding trachoma. There are millions of people in Plateau and Nasarawa States in Nigeria no longer exposed to lymphatic filariasis. And I have to remember that there will soon be no Guinea worm anywhere in the world.

I think of these realities and I am energized again.

Well, peace and health go hand in hand. Think about that a moment. That’s why I emphasized to the Nobel Committee 14 years ago — and why I maintain today — that the bond of our common humanity is stronger than the divisiveness of our fears and prejudices. God gives us the capacity for choice. We can choose to work together for peace. We can choose to alleviate suffering. We can make these changes and we must remember, that there are many ways to accomplish our goals, together.

Thank you.