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The advantage of a vested interest in malaria elimination.

April 15, 2015 - 06:01 -- Anton Alexander

This article will focus on the improved likelihood of a successful outcome where malaria elimination is conducted by scientists who live in the affected area. The blog by Alvaro Pemartin of 22nd January 2015 entitled "Column: Public health concerns (too) far away from home. Who cares?" is both instructive and fascinating. He showed statistics that revealed the global burden of swine flu, avian flu and ebola is far lower than the losses caused by malaria. He demonstrated that the media seems to overlook this point. He suggested that one probable cause is the selfish concern of people in 'developed' countries with their own health, and indeed, most public health issues only get attention when there is a (remote) chance of transmission to western and northern countries. So perhaps sufficient constant attention is not given unless malaria elimination is conducted by scientists with some personal involvement?

This may be the case, and perhaps the benefit of personal involvement may be demonstrated by the illustration below at the end of this article. As is seen from the illustration, North America and Europe were declared free from malaria by 1970. The experts in the 1920s and 1930s dealing with malaria elimination tended very often to come from North America/Europe. They also probably lived there as well, and therefore had a vested interest in getting rid of the disease. But it is interesting to note that Israel was also declared free from malaria by 1970. 100 years ago, Palestine was either thinly populated or uninhabitable in many areas on account of severe malaria. Even the British Army collapsed from malaria in Palestine in 1918 at the end of WW1.

The architect of the malaria elimination which began in 1922 in Palestine over 90 years ago was Dr I Kligler who already had an impressive reputation as a public health scientist in the United States. He was a Jew and a Zionist who came from the US in 1920 to settle and remain in Palestine pursuant to his Zionist beliefs. He commented in 1925 that he had come in 1920 to Palestine “…. with a view to coming to grips with the malaria situation.” So what was common to malaria elimination both in North America/Europe and also in Palestine/Israel, when the rest of the world still struggled with the disease? Quite possibly, the disease was being tackled in both North America/Europe and Palestine by scientists fighting malaria on home soil. Kligler’s Zionism provided him with that vested interest in malaria elimination. He had come as a Jew to make his home in Palestine. Kligler taught that, for many years that were to come, the malaria elimination works would have had to be maintained (eg clearing overgrown canals or diverting springs and wadis), and that such maintenance would have had to be thorough, regular, continuous and systematic. Kligler educated and ensured the enthusiastic cooperation of both Jews and Arabs in the maintenance. Kligler managed this, notwithstanding the gulf that existed between the levels of education of the populations of Palestine and that of North America/Europe.

But, importantly, he was also on the spot to keep the question of maintenance alive. It can be assumed that such maintenance was more likely to be achieved where the malaria scientists were present, were at home, and could attend on a regular basis, rather than being outside scientists who visited countries only to give occasional advice. A word of caution. This blog does not deal with all aspects of the malaria elimination which made Dr Kligler’s approach so unique, but hopefully the illustration below demonstrates a significant point - an advantage was in all probability achieved by having a home-based scientist conducting and overseeing the necessary works and maintenance. Therefore the likelihood of successful malaria-elimination will probably be enhanced where the malaria scientists reside in the area or country in question.