President Jimmy Carter had no idea what he was going to do next when he delivered his farewell address to the nation in January 1981. Defeated after a single term by Ronald Reagan, he simply told Americans that he would leave the White House and “take up once more the only title in our democracy superior to that of president — the title of citizen.”
Forty-four years later, there is little question among historians that Citizen Carter carved a new mold for life after the Oval Office and that his post-presidency was the most consequential in modern history. But his impact was felt more strongly overseas than at home — especially in the realm of public health.
One of Mr. Carter’s biggest and most lasting post-presidential accomplishments is also one of the most overlooked: the near total eradication of Guinea worm disease, a painful parasitic infection for which there is no treatment or vaccine. In 1986, it afflicted an estimated 3.5 million people, mostly in Africa and Asia. There were only seven reported cases through the first 10 months of 2024, according to the Carter Center, Mr. Carter’s human rights organization.
Mr. Carter first saw the devastating effects of the disease in 1988, in two villages near Accra, Ghana. “Once you’ve seen a small child with a two- or three-foot-long live Guinea worm protruding from her body, right through her skin, you never forget it,” he later wrote in The Washington Post.
Mr. Carter wrote books, 32 in all, and devoted his energies to advancing global health, democracy and human rights. He won the Nobel Peace Prize in 2002. He once said the world’s biggest problem was violence against women and girls, and he cited religious texts as a leading cause. He helped ensure free and fair elections in countries from Nicaragua to Nepal.
His personal diplomacy sometimes rankled. In 1994, with the assent of President Bill Clinton, he traveled to North Korea to avert a nuclear crisis, then irked the White House by announcing a deal with the North Korean leader, Kim Il-sung, live on CNN. He visited Cuba and met with Fidel Castro, drawing criticism that he was a “shill” for Mr. Castro’s dictatorship. He infuriated Israel and American Jews by likening Israel to an apartheid state.
Other former presidents have pursued post-presidential careers. John Quincy Adams, the nation’s sixth president, served in Congress after losing re-election in 1828. William Howard Taft, the 27th president, became the Supreme Court’s chief justice. Mr. Carter took a fresh path, said one of his biographers, Julian E. Zelizer, a historian at Princeton University.
“He just used that space you have as an ex-president — he’s not on the court, he’s not in Congress — and he figured out, over decades, how to use the stature to pursue ideas and policies that he thought were not getting enough attention,” Mr. Zelizer said. “No one looks at the post-presidency now as kind of a dead period where you don’t do anything.”
Yet the early days of Mr. Carter’s post-presidential life were a kind of dead period. He was depressed, said another of his biographers, Kai Bird, and had “no grand plan” beyond moving back to Plains, Ga., the tiny town where he had grown up and established himself as a peanut farmer before becoming the state’s governor.
He was 56 when he departed the White House, younger than many of his predecessors. He told a reporter that he figured then that he had about 25 years left. He threw himself into writing his memoir, Mr. Bird said.
“He was really expecting to be re-elected; he was always self-confident and optimistic about that,” Mr. Bird said. “So he was kind of shocked when he lost.”
A turning point came in October 1981, when President Anwar el-Sadat of Egypt was assassinated.
In perhaps the high point of his presidency, Mr. Carter had brokered a historic peace treaty between Mr. Sadat and the Israeli prime minister, Menachem Begin, in 1979. Mr. Carter had been close to Mr. Sadat. The murder shook him, said the historian Douglas Brinkley, who chronicled that period in his 1998 book, “The Unfinished Presidency.”
“He told me that if Sadat gave his life for peace in this broken world, then I have to dedicate my post-presidency to keeping peace alive,” Mr. Brinkley said.
According to Carter Center lore, Mr. Carter’s plan to carry out that mission came to him in the middle of the night. Ordinarily a sound sleeper, he woke up, startling his wife, Rosalynn Carter, who asked if he was ill. No, he said. He presented her with the idea of a center that would focus on conflict resolution.
Together, they founded the Carter Center in partnership with Emory University in 1982. It sits on the hillside in Atlanta where the Union general William Tecumseh Sherman watched the city burn during the Civil War, and by 2023 had more than 3,000 employees around the globe.
In Plains, Mr. Carter was a familiar figure, known around town as “Mr. Jimmy,” who frequently taught Sunday school at Maranatha Baptist Church. After services, he and Mrs. Carter would wait patiently as visitors lined up to shake their hands.
Likewise, his overseas work was infused with what Mr. Brinkley called his “onward Christian soldier modus operandi, that he is here in life to mend a troubled world.”
In 2002, Mr. Carter visited four African nations as AIDS was still ravaging the continent. Antiviral drugs were not yet widely available there; a whole generation was being wiped out.
In South Africa, he and Nelson Mandela, the country’s former president, cradled babies who were infected with H.I.V., or whose mothers were — part of their effort to destigmatize the disease. In Nigeria, he met commercial sex workers, who told him they needed condoms to keep themselves safe.
After seeing the women, Mr. Carter preached at the Catholic church attended by the Nigerian president, Olusegun Obasanjo. Dr. Helene D. Gayle, an AIDS expert who was with the Bill & Melinda Gates Foundation at the time, recalled the former president giving a blunt talk to the congregation, in terms that would resonate with a Christian audience.
“He spoke very plainly about sex with and without a condom, the importance of it, that as a Christian, one should be thinking about one’s responsibility to each other,” said Dr. Gayle, now the president of Spelman College. She added that Mr. Carter also urged men “to think about their behaviors,” while speaking from the pulpit in a “beautiful and candid way.”
Mr. Carter once called his post-presidency “a liberation from mandatory duties” — a kind of second term, albeit one that turned out to be 11 times as long as the first.
Freed from the need to court voters, Mr. Carter sought to finish some of the work he started when he was president, including his push for peace in the Middle East. His 2006 book, “Palestine: Peace Not Apartheid,” which prompted a backlash, was aimed at prodding the administration of President George W. Bush to take a more aggressive leadership role.
At home, he became known as a high-profile supporter of Habit for Humanity, the nonprofit group that seeks to build more affordable housing. In places as diverse as rural Georgia and Manhattan’s Lower East Side, Mr. Carter volunteered to do construction work well into his 90s.
Mr. Carter dipped gingerly back into politics in 2014, helping raise money for his grandson Jason Carter, a Democratic state senator in Georgia who was running for governor. During an interview in Plains that year, the elder Mr. Carter said he had vetted campaign strategists for his grandson and took a jab at the Republican incumbent, Nathan Deal, whose leadership he called “abominable.”
But he largely stayed off the campaign trail. In Georgia, he acknowledged in an interview with The New York Times, there were still many people who “look with great disfavor on my administration as governor and president.”
Mr. Carter’s early vision for the Carter Center was to solve conflicts around the world, but he quickly turned his attention to global health. He chose Dr. William Foege, who had helped lead the global effort to eradicate smallpox and ran the Centers for Disease Control and Prevention when Mr. Carter was president, to be the center’s first executive director. Together, they moved to tackle Guinea worm disease and, later, other neglected tropical diseases, including river blindness and schistosomiasis, also known as snail fever.
Guinea worm disease is a gruesome infection, passed through contaminated water, in which people unknowingly ingest tiny fleas harboring worm larvae, which grow into two-foot-long worms inside the body before escaping the infected person’s skin, causing excruciating pain. Without a treatment or vaccine, some experts thought it would be impossible to eradicate; doing so required behavioral changes, such as teaching villagers to filter their drinking water through cloth.
But Mr. Carter “was willing to take a gamble,” said Dr. Donald R. Hopkins, who led an eradication campaign at the C.D.C. and joined the Carter Center in 1987. “He understood instinctively that people are interested in improving their own lives.”
He was hands-on. He went to Nigeria and Ghana, Dr. Hopkins said, to see the effects of the disease up close. He traveled to Delaware to ask leaders of DuPont to donate a type of nylon fiber that could be woven into cloth filters, and to a West Virginia factory that did the weaving. He talked chemical company executives into donating a pesticide to kill the larvae.
In 2015, when he was 90, Mr. Carter visited the staff of CARE, an international humanitarian organization based in Atlanta. It was then run by Dr. Gayle; she remembered that about an hour into his talk, he indicated that he had somewhere else to go, not letting on that he was headed to see his doctor.
The next day, Mr. Carter held a news conference to disclose that cancer had been removed from his liver but had also been found in his brain. He spoke about his born-again Christian beliefs and said he was “perfectly at ease with whatever comes.” He said he would get his first radiation treatment that afternoon and would cut back on his Carter Center activities.
But something else was on his mind. “I would like to see Guinea worm completely eradicated before I die,” he told reporters. “I’d like for the last Guinea worm to die before I do.”
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