Through all of history, the world has managed to eradicate just one human disease — smallpox, in 1980. Today, thanks to the long-term dedication of numerous organizations, donors, corporations, governments, researchers, health-care workers, and volunteers on the ground, two more are on the verge of being wiped out: Guinea worm disease and polio. The challenges of eradicating diseases are enormous, but it can be done through smart strategies and a huge amount of work.
The fascinating multimedia exhibition Countdown to Zero: Defeating Disease, opening at the Jimmy Carter Presidential Library and Museum on Jan. 11, 2017, explores the factors that determine whether a disease can be eradicated and the scientific and social innovations that are making it possible.
Developed by the American Museum of Natural History in New York in collaboration with The Carter Center, the exhibition uses stunning photography, videography, and artifacts to highlight several global efforts to fight infections. Chief among these is the more-than-30-year campaign that has Guinea worm disease poised to become the next disease to disappear. The exhibition also highlights ongoing programs to eradicate polio and achieve local elimination of river blindness, lymphatic filariasis, and malaria, and the challenge of diseases that cannot be eradicated, including Zika.
“One of our duties, yours and mine, is to inspire our children and grandchildren to take on challenges and risks that at first may seem overwhelming or even impossible,” said former U.S. President Jimmy Carter, whose Carter Center has led the fight against Guinea worm disease since 1986. “They need to understand that the only failure is not to try. We can overcome many global challenges when we all work together as a global community. When nations and leaders and scientists and caring people focus on shared dreams, we can build a better world.”
The exhibition first appeared at the American Museum of Natural History in New York in 2015. It opened in London in 2016 and is scheduled to open in Dubai, United Arab Emirates, later this year.
“We are delighted that 'Countdown to Zero' will now be on view in Atlanta, where the Carter Center’s tireless work and unflinching vision are testament to the possibility that infectious diseases can be controlled or even eradicated in our time,” said Ellen V. Futter, president of the American Museum of Natural History. “The Museum’s own research in the ecology and genomics of infectious disease and our commitment to educating the public about critical science-based issues dovetails with the Carter Center’s work, and we are very pleased that our collaborative exhibition continues to reach new audiences and communities.”
“We are thrilled to collaborate with our colleagues at the American Museum of Natural History and The Carter Center to present this exhibition in Atlanta,” said Dr. Meredith Evans, director of the Jimmy Carter Presidential Library and Museum. “Public health has been one of the pillars of Jimmy and Rosalynn Carter’s post-White House contributions to the world, and we are delighted to give the public some insight into how these efforts work.”
The Jimmy Carter Presidential Library and Museum and The Carter Center are separate institutions that share a campus in Atlanta. The library-museum is owned by the federal government and operated by the National Archives and Records Administration. The Carter Center is a separate, not-for-profit organization that works to advance peace and health worldwide.
In 1959, the World Health Organization announced an audacious goal: the eradication of smallpox, one of history's deadliest diseases, estimated to have killed more than 300 million people since 1900 alone. Smallpox was a good candidate for eradication: It was easily diagnosed, there was an effective vaccine, and the variola viruses that caused it did not live in any other animal host. By 1977, international cooperation, technological innovations such as freeze-dried vaccine and the bifurcated needle, and a targeted public health strategy helped end the disease. WHO declared it eradicated three years later.
Eradicating smallpox prevented millions of deaths and, by removing the need to treat and prevent the disease, saved many countries tens of millions of dollars. It also demonstrated that disease eradication was possible. Today, the health care sector is still applying the lessons of the successful smallpox eradication effort.
"The most important tool is people: highly motivated local communities, deeply committed national health care workers, and international leaders like President Carter," said Mark Siddall, curator of Countdown to Zero and a curator in the American Museum of Natural History's Division of Invertebrate Zoology. "Whether there's a vaccine for smallpox, a drug for malaria, or a water filter to break the Guinea worm infection cycle, it has to get into the hands of people empowered both to deploy those assets and to gather massive quantities of data. You can't treat what you don't track."
Guinea worm disease, a debilitating condition caused by the parasite Dracunculus medinensis, has plagued humanity for thousands of years. When former U.S. President Jimmy Carter and The Carter Center began leading a coordinated program against Guinea worm disease in 1986, 3.5 million people in Africa and Asia were estimated to be infected. Relying on trained volunteers to help track every infection and to lead community-based intervention, this eradication effort has reduced the number of cases by 99.99 percent — and has put complete eradication within reach.
"The need to engage villages respectfully and fully in addressing their health problem is one of the most important lessons of the Guinea worm eradication campaign," said Donald Hopkins, Carter Center special advisor for Guinea worm eradication and co-curator for the exhibition.
In the absence of a vaccine or curative medicine, the campaign has focused on interrupting the parasitic worm's life cycle by filtering water to remove tiny crustaceans that carry infective Guinea worm larvae. Countdown to Zero will display a number of "pipe filters," which are worn by many people around their necks and used as straws to filter drinking water, as well as educational materials that raise awareness about the disease, including items like picture books for those who cannot read.
Polio has been around for millennia, but it was not until the late 1800s in Europe and the U.S. that the world witnessed the first great polio epidemics. By the late 1950s, mass vaccinations using injectable vaccines with dead poliovirus and oral vaccines with weakened live virus were underway across the U.S., Europe, Australia, and Canada. The global campaign to eradicate polio began in 1988.
Great progress has been made. In 2009, for instance, half of the world’s polio cases were in India. Just two years later — with the help of 2 million healthcare workers hired to reach remote and migrant populations — India saw its last case of the disease.
With sufficient funding, political will and people power, polio can be vanquished. Today, only Nigeria, Afghanistan, and Pakistan have never broken transmission of the disease. However, challenges remain. In those three countries, some religious fundamentalists have raised vocal — even violent — opposition to Western-backed vaccination efforts.
The end for polio is in sight, but failure or abandoning the effort now would lead to thousands of new cases.
About 120 million people worldwide are at risk for river blindness, which is transmitted by black flies that breed near fast-moving waterways. When they bite humans, these flies can pass along small thread-like parasites, which mate and send thousands of tiny larvae into the skin and eyes — causing extreme itching, skin rashes, and, in the worst cases, blindness.
The disease, also known as onchocerciasis, has been eliminated from four of the six countries afflicted in Latin America through twice-per-year community-based drug treatment with the medicine Mectizan® (ivermectin, donated by Merck). In Africa, where 99 percent of river blindness cases today occur, health officials have generally sought to control river blindness — to keep the number of blindness cases to a minimal level. But the success of semiannual mass drug administration in Latin America has raised hopes that the disease can be removed completely from some African countries as well. Still, challenges remain, including the African black flies' long flight range and higher efficiency at transmitting the disease, and co-infection in some areas with another parasite, Loa loa, that can cause serious complications after mass drug administration.
Lymphatic filariasis threatens almost 1 billion people around the world. Many of those infected by this parasitic worm suffer from severe, painful swelling of limbs or genitals, a condition known as elephantiasis. This debilitating disfigurement can be a source of shame and social isolation.
Health workers rely on mass drug administration (MDA) as the main tool to combat lymphatic filariasis. Combinations of medicines such as diethylcarbamazine (DEC), ivermectin and albendazole given annually prevent mosquitoes from becoming infected. MDA interventions have led to a remarkable decrease in transmission among at-risk populations.
Ivermectin, one of the drugs used to treat lymphatic filariasis, is also effective against the worms that cause river blindness. In Africa, where the same mosquito that transmits malaria also transmits LF, insecticide-treated bed nets have an additive impact on stopping LF transmission. Governments and health organizations are trying to work more efficiently and effectively by integrating lymphatic filariasis elimination with efforts to fight malaria and river blindness.
A child dies from malaria every minute, and despite ongoing research, existing treatments, and well-funded efforts to stop transmission, eradication remains a distant goal. Many drug treatments exist, but the parasites that cause the disease are constantly evolving resistance to the medications, and a highly effective vaccine is still far off. For now, bed nets treated with insecticide to create a physical barrier against mosquitoes that transmit the parasite to humans and timely treatment of those with fever, anemia and other symptoms of the disease remain the most effective tools.
In fact, thanks in large part to those two interventions, malaria cases have fallen by more than 35 percent worldwide since 2000. Improvements in diagnosis and treatment are also a big part of the success: New diagnostic tests can identify infection in a matter of minutes, and artemisinin-based combination drug therapies blend the effects of different medications to counter the emergence of more drug resistance.
Development of new interventions may lead to even greater success. Researchers are making progress on new vaccines, even better diagnostics, and improved insecticides. Scientists are also exploring other approaches, including genetically engineered mosquitoes that will no longer be able to transmit the parasite.
Countdown to Zero: Defeating Disease is curated by Mark Siddall, curator in the American Museum of Natural History's Division of Invertebrate Zoology, in collaboration with Dr. Donald Hopkins, Carter Center special advisor for Guinea worm eradication. The exhibition is on display at the Jimmy Carter Presidential Library and Museum from January 11-October 9, 2017.
The exhibition is designed and produced by the American Museum of Natural History's award-winning Exhibition Department under the direction of David Harvey, AMNH senior vice president for exhibition.
Countdown to Zero has been on display at the American Museum of Natural History in New York City since January 2015. A version of the exhibition was displayed in London in 2016, and another will open in the United Arab Emirates in 2017.
Countdown to Zero was brought to Atlanta with the proud support of the Arthur M. Blank Family Foundation, the Trailsend Foundation, and the Turner Foundation.
The Jimmy Carter Presidential Library and Museum
The Jimmy Carter Presidential Library and Museum, located in Atlanta, Georgia, is part of the presidential library system administered by the National Archives and Records Administration, a federal government agency. The Museum of the Jimmy Carter Library includes photographs and historical memorabilia from the Carter presidency (1977-1981). An exact replica of the Oval Office and gifts received by the Carters are also featured. A 2009 renovation of the museum more thoroughly examines Carter’s highly productive post-presidential career, including his acceptance of the Nobel Prize for Peace in 2002.
The library is not a library in the usual sense but is a research facility. The archive is a repository of about 27 million pages of Jimmy Carter's White House material, and papers of administration associates, including documents, memoranda, correspondence, etc. There are also half a million photographs, and hundreds of hours of film, audio, and video tape.
The Carter Center (cartercenter.org)
A not-for-profit, nongovernmental organization, The Carter Center has helped to improve life for people in more than 80 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; and improving mental health care. The Carter Center, based in Atlanta, Georgia, was founded in 1982 by former U.S. President Jimmy Carter and former First Lady Rosalynn Carter, in partnership with Emory University.
Beginning with the Center's leadership of the international Guinea worm eradication campaign since 1986, the Center has pioneered neglected disease eradication and elimination by targeting river blindness, lymphatic filariasis, blinding trachoma, and malaria (the latter on the island of Hispaniola). The International Task Force for Disease Eradication is housed at The Carter Center and chaired by former Carter Center Vice President for Health Programs Dr. Donald Hopkins, now the Center’s special advisor for Guinea worm eradication.
The Center uses evidence-based practices to carefully evaluate whether its interventions are significantly reducing the burden of disease. In conjunction with ministries of health and other partner organizations, The Carter Center conducts rigorous annual peer reviews and evaluations of its five infectious disease health programs. Visit cartercenter.org for more information.
American Museum of Natural History (amnh.org)
The American Museum of Natural History, founded in 1869, is one of the world's preeminent scientific, educational, and cultural institutions. The Museum encompasses 45 permanent exhibition halls, including the Rose Center for Earth and Space and the Hayden Planetarium, as well as galleries for temporary exhibitions. It is home to the Theodore Roosevelt Memorial, New York State's official memorial to its 33rd governor and the nation's 26th president, and a tribute to Roosevelt's enduring legacy of conservation. The Museum's five active research divisions and three cross-disciplinary centers support approximately 200 scientists, whose work draws on a world-class permanent collection of more than 33 million specimens and artifacts, as well as specialized collections for frozen tissue and genomic and astrophysical data, and one of the largest natural history libraries in the world. Through its Richard Gilder Graduate School, it is the only American museum authorized to grant the Ph.D. degree. Visit amnh.org for more information.
The Jimmy Carter Library and Museum is open 9 a.m.-4:45 p.m. Monday through Saturday, and noon-4:45 p.m. Sunday. No tours may begin after 4:15 p.m. any day. The facility is closed on Thanksgiving Day, Christmas Day, and New Year’s Day.
Museum admission is $8 for adults, $6 for seniors (60+), military, and students with ID; free for children age 16 and under.
Throughout January 2017, the public will get the chance to see the Carter Center’s disease eradication work up close, through panel discussions, author talks, behind-the-scenes tours for teachers, and family discovery days.
In February, special educational events will introduce the next generation of citizens to the importance of public health work occurring right here in Atlanta and Georgia.
Future plans include tour opportunities for high school students studying health occupations, university programs developing public health professionals, civic organizations meeting in Atlanta, and visitors of all ages who want to dig deeper into the issues of disease prevention and treatment.
For additional information, the public may call 404-865-7100 or visit the Library and Museum's website at www.jimmycarterlibrary.gov.
Become a fan of the Museum on Facebook at https://www.facebook.com/CarterPresidentialLibrary; The Carter Center at https://www.facebook.com/CarterCenter. Follow @TheCarterCenter on Instagram or visit twitter.com/CarterCenter to follow on Twitter; use the hashtag #DefeatingDisease to track the exhibition and the Carter Center’s progress.
"Waging Peace. Fighting Disease. Building Hope." A not-for-profit, nongovernmental organization, The Carter Center has helped to improve life for people in over 80 countries by resolving conflicts; advancing democracy, human rights, and economic opportunity; preventing diseases; and improving mental health care. The Carter Center was founded in 1982 by former U.S. President Jimmy Carter and former First Lady Rosalynn Carter, in partnership with Emory University, to advance peace and health worldwide.