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Durable malaria elimination and democracy (originally posted in 2015 in Forum Topics)

February 28, 2018 - 10:30 -- Anton Alexander

Can there be a link between Durable Malaria Elimination and Democracy?  Testing a hypothesis.

Democracy is a belief in freedom, a belief in equality between people, a belief that everyone should have an equal say in deciding our collective future.

Four years ago, with the Arab Spring, it was believed democracy was about to spread around the region. But there was no such spontaneous or mechanical outcome. Instead there was bloodshed and civil war.

So what went wrong?

Democracy is a difficult achievement and it is worth considering how much history elsewhere had to be worked through, how much pain was endured, before democracy was arrived at. There is nothing natural or automatic about democracy. Old ruling-elites, sectarian ideologies, tribal loyalties can disappear over time, but that can take generations to come about.

Generally, rule or control over tribal peoples is often decided by the leader(s) of a tribe or group, or by segments of that population. Democracy on the other hand is about voters who are individuals, who are independent, and are free to make up their own minds without consideration of ethnicity, religion or otherwise.

But what has all of this to do with malaria elimination?

Here is a curious observation.

Remember, real Democracy is about the individual, namely an independent voter who is free to make up his/her own mind. (But, importantly, emphasis remains on ‘the individual’.)

Consider the following illustration.











As is seen in the above illustration, Israel was the only country in the Middle East to have eliminated malaria by 1970.

It is also noted that Israel is a Middle Eastern country where a change of government has only ever come about through the ballot box, through the democratic process, rather than through revolution or street protests.

(No one party has ever won a majority in an Israeli general election. In the 2015 election, a total of 25 parties ran for election, representing views of all sections of Israeli Arab/Jewish society, attracting 985,408 votes for the largest party to 223 votes for the smallest, on a turnout of 72.34% of the registered voters. To put this turnout in perspective, compare it with recent turnouts in eg the UK general elections, where there was a turnout of 59.4% in the 2001 UK elections, 61.4% in the 2005 elections, and 65.1% in the 2010 elections. )

Is all of this just a coincidence? Could perhaps the Palestine/Israel malaria-elimination campaign not have had any effect on the Israel democratic process at all?

Or could such democracy in Israel have been a partial by-product of the malaria elimination in Palestine/Israel?  Is it perhaps that the population, after the malaria-elimination education, had become fertile ground for the principles of democracy?

100 years ago, Palestine was drenched in malaria, and was then either thinly populated or uninhabitable in many areas. It is often forgotten that the disease was so severe there, the British Army collapsed from malaria in 1918, but two weeks after the final battle in the Middle East in WW1, after the British had defeated the Turkish Army. See

The initiators of the malaria elimination campaign in Palestine in 1922 had felt the only way forward was by personal one-to-one contact with each inhabitant. Malaria-elimination in Palestine thereby involved each person. Each and every person in the rural districts would necessarily have received personal one-to-one attention/education, to ensure malaria-elimination was understood by everyone, thereby securing co-operation with the long-term maintenance of the anti-malaria works. The League of Nations, Malaria Commission, reported after inspecting the malaria elimination works in Palestine in 1925 that the original population in the rural districts was mainly composed of wandering Bedouin tribes, heavily infected with malaria. A British Royal Commission in 1937 had described the previous structure of Arab society in Palestine in 1920 as still quasi feudal. And so educating a person in Palestine at that time about malaria-elimination (on a personal one-to-one basis, at his own pace - and sometimes even repeatedly if aspects could not be understood at first) would probably have exposed that person for the first time to the idea that he counted, that he mattered and was needed, and that he had an identity independent of a group. The hope was he could eventually think on his own or act on instructions regarding the malaria-elimination works, or even perhaps decide whether or not further work was necessary, and without referring back to his group/tribe for instructions/decisions. He could begin to be an independent individual.

In 1922, Palestine became the first place where a successful national malaria-eradication campaign began. The co-operation of all the local inhabitants was essential, and which ensured thorough, continuous and systematic control including maintenance of anti-larval measures, and whereby the wadis and canals were gradually put in condition and kept so at very little cost. It was a unique campaign in that it immediately set out to educate each and every person (Arab, Jew, etc), each person being taught personally about malaria elimination, on a one-to-one basis, because it was necessary for each person to know (and to understand) what was required of him/her (and why), and to be vigilant and maintain the anti-malaria works. Only one-to-one education seemed to be effective.

The effectiveness of the education and the strength of the cooperation may be judged by the fact that, despite intimidation by a hostile politically-inspired segment of the Arab population, and despite physical attacks by these hostile elements on the actual workers engaged in anti-malaria work, the inhabitants of the land (both Arab and Jew) had come to understand the importance of the anti-malaria work, and continued to cooperate with the anti-malaria work.

An account of the one-to-one education of the individual which took place in Palestine 90 years ago may be seen at .

Generally, for all those areas around the world still blighted by malaria, for malaria-elimination to be considered successful, it has to be durable, and only significant and effective education of the population can achieve that. But can democracy also be a beneficiary?