Global Health Programs Draw on Lessons from Early 20th-Century Deworming Initiative in Southern United States
By Mark Rosenberg, President and CEO, The Task Force for Global Health
Mark Rosenberg, MD, MPP, President and Chief Executive Officer, The Task Force for Global Health
Outside of global health circles, there is limited awareness or understanding about neglected tropical diseases or NTDs. These diseases are typically associated with developing countries and don’t affect people in the United States. But some NTDs, specifically intestinal worms, have occurred much closer to home. In fact, an intestinal worm called hookworm was once a major public health concern in Georgia and across the South.
In 1910, 40 percent of the population in the southern U.S. was infected with hookworm, which can cause anemia and other disabling health effects. American philanthropist and business magnate John D. Rockefeller was troubled by the toll that hookworm was taking on the South, specifically on agricultural productivity and economic development in the region. In what would become one of the largest public health campaigns ever conducted, Rockefeller donated $1 million to create a commission focused on eradicating hookworm from the South.
An intestinal worm called hookworm was a common problem in the southern United States until the advent of widespread treatment programs. Here children line up for free treatment at a county dispensary in Alabama. Source: Rockefeller Foundation, “County Dispensary,” 100 Years: The Rockefeller Foundation, accessed July 28, 2015. Courtesy of Rockefeller Archive Center.
The commission launched a “co-operative movement of the medical profession, public health officials, boards of trade, churches, schools, the press, and other agencies for the cure and prevention of hookworm disease.” Following a public health approach that is still used today, commission health workers conducted health surveys, distributed medication, and educated people throughout the South about prevention and sanitation. They worked with county health departments where they existed and helped create county health departments where they didn’t exist. By the end of 1914, the program had successfully eliminated hookworm from the South and led to the creation of a public health network across the South.
The South’s experience with hookworm eradication has many parallels with global health programs that are working to control intestinal worm infections, particularly in developing countries where the disease is common due to warm soil, high humidity, and poor sanitation. Intestinal worms–called soil transmitted helminthiasis, or STH for short–are among the most common infections worldwide, affecting more than one billion people. Approximately 875 million children worldwide are at risk of intestinal worm infections, which can cause a cascade of health and developmental problems, including reduced absorption of nutrients and vitamins, anemia and stunted growth, and impaired cognitive development.
Children Without Worms partnered with Nicaragua’s government to support STH control activities. The country’s health workers distributed the mebendazole during the country’s annual health campaign. Source: Children Without Worms/Johnson & Johnson
Across the world, programs to fight intestinal worms are using many of the same collaborative, public health approaches employed by the Rockefeller-funded hookworm program in the South. Children Without Worms (CWW), a program at the Decatur-based Task Force for Global Health, is one of many groups leading the charge to stop intestinal worms.
CWW started in 2006 as a partnership between The Task Force and Johnson & Johnson. At first, the program was primarily responsible for making sure deworming medications donated by Johnson & Johnson reached children in STH-endemic countries. As more partners joined the fight against STH, CWW expanded work to a variety of fronts – through mapping and data collection, assisting with the distribution of medicine, and creating and presenting workshops and trainings focused on water, sanitation, and hygiene (referred to as WASH) in affected countries. In 2014, CWW started managing the STH Coalition, a multisectoral group of partners committed to creating a world where children are free from intestinal worms.
As the Rockefeller hookworm initiative realized all those years ago, fighting intestinal worm infections requires a multi-pronged approach. Members of the STH Coalition bring together expertise from a wide range of sectors, including public health, education, water, sanitation, hygiene, maternal health, nutrition, and global development. Partners have committed significant resources – including hundreds of millions of doses of deworming drugs, funds for research and program implementation, and the ability for members to collaborate across extensive organizational networks. They are working together to meet the World Health Organization’s target of treating at least 75 percent of children in STH-endemic countries by 2020. More importantly, they work to create a world in which children are healthy and able to reach their full potential.
There are many challenges when it comes to controlling intestinal worm infections. But, as the success of hookworm eradication in the South demonstrated, STH can be controlled. Members of the STH Coalition will continue their work together until control is achieved and children are free of this debilitating disease.
