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Thursday, 2nd of May 2013 Print

Readers of these updates may recall a generic discussion of disease eradication by

Dr. Donald R. Hopkins, accessible at http://www.childsurvival.net/?content=com_articles&artid=1643 .  Dr. Hopkins has also written extensively on dracunculiasis, notably athttp://www.ajtmh.org/content/73/4/669.full

Below, a portrait of the man and his work.

New York Times, 23 April 2013

Another Scourge in His Sights


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.

Donald R. Hopkins, vice president for health programs at the Carter Center, helped to eradicate smallpox and is trying to do the same to Guinea worm disease.

Smallpox is gone, and Dr. 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 Dr. 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.

Nonetheless, “I’m increasingly confident that it’s less and less likely that the disease will outlive me,” said Dr. 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, Dr. Hopkins’s 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,” Dr. Ruiz-Tiben said. “Don almost turned white.”

Told that story, Dr. William H. Foege — a former C.D.C. director and himself a legend of the war on smallpox — laughed aloud and said he remembered someone bringing a harmless garter snake to the C.D.C. offices to tease Dr. Hopkins with, and trying to say it was a gift from Dr. Foege.

That Dr. Hopkins keeps going back to villages teeming with snakes “proves how important a professional challenge is to Don,” Dr. Foege said. “He’s one of the most tenacious people you’ll ever find.”

Finding His Calling

Dr. Hopkins attributes that tenacity to his Bahamian parents and to Coconut Grove, the neighborhood in Miami where he grew up; it was founded by islanders who sailed over in the 1880s looking for jobs in the new resorts springing up. 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.

“I had tons of cousins, aunts and uncles within a three-block radius,” Dr. Hopkins said. “It was definitely ‘It takes a village to raise a child.’ We didn’t rebel or get in trouble. It just wasn’t allowed. We were very serious about our studies, because of the high expectations.”

He knew he wanted to be a doctor; he won a local science fair prize for a life-size clay model of the digestive system.

Just 15 when he won a scholarship to Morehouse, the prestigious black men’s college in Atlanta, he had to quit his paper route to go.

While at Morehouse, he won a travel scholarship and spent a year in Vienna, where he lived with a local family and came to love classical music while listening to operas for 12 cents in standing room. He saw only one other black person the whole year, he said. Adults were kind, he recalled, “but one little girl skipping along in the park took one look at me and screamed her head off.”

Back in Atlanta, race relations were harsher. One incident “burned in my memory,” he said, was being with classmates on a bus in a white neighborhood, and the driver flagging down a police officer to order them to the back. (The officer refused, he said, saying, “You know the law — I can’t.”)

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 causeblindness.

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. Foege 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, Dr. 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 C.D.C. ranks, ultimately retiring as acting director in 1987.

The Eradication Process

At the time, leading public health experts had a lofty dream: getting clean water to everyone on earth.

Dr. Hopkins suggested a more modest goal: Guinea worm, a plague of the rural poor, could be eliminated by simply filtering existing water.

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 escape being digested by either the crustacean or the human, and 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 Dr. 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.

Dr. Hopkins excels at building those networks, finding local leaders to run them, and keeping health ministers focused even as the years pass.

Mr. 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, Dr. 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, Mr. Carter was full of praise for Dr. 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.”

Dr. 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.”

His list of awards is long, and offbeat. He won a MacArthur “genius” grant in 1995 and is now on the MacArthur board. He was knighted by Mali. He was presented with a tassel-covered horse by a Niger chief (he stayed on just long enough for a photo and then quietly regifted it to the local Guinea-worm team).

In his office, he has two award plaques with pump handles on them — a reference to John Snow, the father of epidemiology, who traced a Londoncholera outbreak to one contaminated pump and halted it by removing the handle.

And he has nearly 30 pictures or carvings of woodpeckers, birds he has liked since he saw them in his grandmother’s oak tree; when his Carter Center subordinates do particularly good work, he inks the reports they have written with a rubber woodpecker stamp.

Asked if he ever became discouraged as the fight dragged on, Dr. 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.”

A version of this article appeared in print on April 23, 2013, on page D1 of the New York edition with the headline: Another Scourge in His Sights.