CHICAGO — In his home office, Dr. Donald R. Hopkins has statues of the Hindu smallpox goddess and the Yoruba smallpox god. And, floating coiled up in a glass jar, something that looks like a yardlong strand of capellini but is actually one of the last Guinea worms on earth.
Smallpox is gone, and Hopkins played an important role in its death. Guinea worm disease — formally known as dracunculiasis, or “affliction with little dragons” — is down to fewer than 600 cases worldwide, from 3.5 million in 1986, when Hopkins began leading the drive to eradicate it.
He took up the cause when he was at the Centers for Disease Control and Prevention, and now runs it as the vice president for health programs at the Carter Center, the group founded by former President Jimmy Carter to advance human rights and fight disease.
It has not been swift; several target dates for eradication have come and gone.
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Nonetheless, “I’m increasingly confident that it’s less and less likely that the disease will outlive me,” said Hopkins, who is 71.
Nearly all the remaining cases are in South Sudan, which is newly independent and largely at peace. A few are in northern Mali, which is too dangerous for eradicators to work in right now but is becoming safer since French troops ousted Islamist rebels. Ethiopia and Chad, the other two countries with cases, are not at war.
Choosing a life’s work that requires visiting remote villages around the world seems counterintuitive for someone who, by his own admission, is terrified of snakes, rats, bats, airplanes, heights and food poisoning.
Ernesto Ruiz-Tiben, Hopkins’ deputy and perhaps the only person who would still consider playing a practical joke on him, recalled sidling up behind his boss in a field of knee-high grass in Pakistan as he looked warily around for snakes.
“I made a ‘ssssssss’ sound,” Ruiz-Tiben said. “Don almost turned white.”
Hopkins grew up in Coconut Grove, a neighborhood in Miami. He was one of 10 children of Joseph Hopkins, a carpenter, and Iva Louise Major Hopkins, a seamstress who made her children say their multiplication tables beside her sewing machine and recited the inspirational poem “Don’t Quit” to them.
He knew he wanted to be a doctor, and was just 15 when he won a scholarship to Morehouse, the prestigious black men’s college in Atlanta.
While at Morehouse, he won a travel scholarship and spent a year in Vienna
He still remembers the moment he picked tropical medicine. On a winter-break trip to Egypt, he saw flies swarming on children’s faces, and later learned they transmitted trachoma, an eyelid infection that cause blindness.
In medical school at the University of Chicago, he was the only black student in his class. A tropical-disease professor rescued him from a boring summer job dissecting sheep hearts and nudged him into worm-disease research.
After graduation, he joined the Public Health Service, because he wanted to go to Africa, and to avoid being drafted for the Vietnam War.
In 1967, Dr. William H. Foege — a former CDC director and himself a legend of the war on smallpox, asked him to lead the smallpox effort in Sierra Leone, which then had the world’s highest case rate, and test a new strategy: Instead of trying to vaccinate the whole country, teams would race to new outbreaks, vaccinating around each in widening circles until it died out.
The strategy worked so well, Hopkins said, that Sierra Leone was smallpox-free in less than two years. It took a decade more to eradicate the disease globally, but that was “a big morale boost.”
After a stint fighting smallpox in India, he returned home, taught tropical medicine at Harvard and rose through the CDC ranks, ultimately retiring as acting director in 1987.
At the time, leading public-health experts had a lofty dream: Getting clean water to everyone on earth.
Hopkins suggested a more modest goal: Guinea worm, a plague of the rural poor, could be eliminated by simply filtering their existing water supplies.
The worms have been torturing humans since before history began. A calcified one has been found in an Egyptian mummy.
People become infected when they drink from ponds containing tiny freshwater crustaceans, known as copepods, that themselves have swallowed microscopic worm larvae. The larvae grow inside the body to about a yard long. They then migrate to the skin — usually in a foot, but sometimes a hand, a breast or even an eye socket. Then they exude a burning acid to create a blister, which they burst through. As soon as the victim dips the inflamed area in cooling water, the worm (described by Hopkins as “a giant uterus”) squirts out millions of larvae, starting the cycle anew.
Eradication relies not on a vaccine, but on simple filtering technologies and huge networks of local health workers.
Those workers do many tasks. They find cases, treat ponds with a copepod-killing pesticide and teach families how to filter their drinking water. Workers also help victims inch the worms out, keep the wounds sterile and assure they do not reinfect local water.
Hopkins excels at building those networks, finding local leaders to run them, and keeping health ministers focused even as the years pass.
President Carter is a fan
Carter backs him up, using his prestige as a former president, telephoning African presidents to urge them to keep the pressure on or even flying to Africa to tour villages where the worm persists. In 1995 he negotiated a four-month truce in the Sudanese civil war that became known as the Guinea worm cease-fire.
Now, with cases dropping steadily, Hopkins is optimistic. When programs are well run, he said, progress can be rapid; Ghana went from 501 cases to none in 18 months.
In a telephone interview, Carter was full of praise for Hopkins, saying, “We could not have gotten here without him,” and adding, “I have a promise from Don that he won’t retire until the last worm is gone.”
Hopkins had an answer: “If I even wanted to retire, exactly what would I say to President Carter? He’s 17 years older than me, and still going. He’s a tough man.”
Asked if he ever became discouraged as the fight dragged on, Hopkins recounted a conversation he had about 25 years ago, shortly after arriving in India to fight smallpox: “I met a guy who said, ‘You guys can come here with your West African experience, but I’m Indian and I know my country and we’re never going to get rid of smallpox here.’ ”
“But we did,” he added. “So I’m sort of immunized against skepticism.”