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Jerusalem declaration on malaria elimination in Africa

April 24, 2014 - 19:46 -- J20 Jerusalem Conf

Almost a century after Dr. Israel Kligler initiated a malaria elimination campaign in Mandate Palestine, the undersigned met in Jerusalem to honour his exemplary approach that consisted of an integrated attack on malaria that ultimately led to its disappearance. 
In many ways, the disease burden of malaria in Africa today resembles that of Palestine when Kligler first arrived. His success – a toolbox that included larval mosquito control, swamp drainage, quinine prophylaxis and treatment, community education - played a major role in making the Holy Land habitable and productive.

The value of this historical approach was seen again in the successes of Dr. Fred Soper of the Rockefeller Foundation. Between 1938-1940, Dr. Soper succeeded in the elimination of an imported but established African malaria mosquito population from its entire distribution over 54,000 km2 in Brazil. He achieved further success with the elimination of malaria from Egypt during WWII.

Today, children are needlessly dying of malaria in fourteen African nations that are smaller than the area cleared of African mosquitoes by Soper in Brazil. 

It is noteworthy that the success of these historical strategies, which consisted of the destruction of malaria mosquito breeding grounds, land reclamation, and housing improvement, occurred before the current strategies based on bednets, residual spraying, synthetic quinine derivatives and artemisinin-based therapies became mainstream.

Contemporary strategies are making inroads toward malaria elimination but are hampered mainly due to insecticide and drug resistance. It is absolutely imperative that we revive the historical strategies as an addition to existing integrated approaches. When augmented with exciting contemporary digital technologies that were absent in the Kligler and Soper days, we can save more lives by making malaria elimination cost-effective and realistic.

We cannot lose the gains of malaria control over the last decade. Worse, in the absence of dramatic successes in the fight against malaria in the near future, it is likely that donor fatigue will result in a situation comparable to that of forty years ago when malaria control and eradication was no longer of interest.

Therefore, we, the undersigned of this declaration, a unique gathering of concerned malaria specialists from around the world, urgently recommend that:

  1. Larval source management, i.e. the rigorous, systematic and uncompromised control of aquatic stages of malaria mosquitoes in breeding sites as well as the modification thereof, be added to current strategies. No country that eliminated malaria succeeded in doing so without larval source management.
  2. Elimination efforts be guided by detailed epidemiological monitoring of parasite prevalence in representative and comparable sentinel human populations as well as mosquito and climate data.
  3. The growing cadre of African specialists, now working in strengthened economies, lead in taking ownership of and responsibility for malaria elimination efforts tailored to their specific eco-epidemiological situations.
  4. Pilot elimination projects be undertaken in appropriate settings of Africa, several of which were identified by us, to demonstrate the advantages of classical integrated approaches. 

Signed this 12th Day of December 2013:

Dr. Safiou Abdou Razack, Gabon
Mr. Anton Alexander, UK
Capt. Serge Christiaans, The Netherlands
Dr. Major Dhillon, USA
Dr. Zalman Greenberg, Israel
Prof. Charles Greenblatt, Israel
Dr. R. L. Jacobson, Israel
Dr. William Jobin, USA
Dr. Bart Knols, The Netherlands
Dr. Sanford F. Kuvin, Israel and USA
Mr. Manuel Lluberas, USA
Dr. Silas Majambere, Tanzania/UK
Dr. Maureen Malowany, Israel
Dr. Wolfgang Richard Mukabana, Kenya
Mr. Steve Mulligan, USA
Prof. Yehuda Neumark, Israel
Dr. Olusola Oresanya, Nigeria
Dr. Laor Orshan, Israel
Mr. Leon Poddebsky, Australia
Dr. Clive Shiff, USA
Prof. (Emeritus) Dan Spira, Israel

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Comments

Submitted by Giampietro Corradin on

It is rather strange that you forgot to mention the malaria elimination in Italy.

Submitted by Anton Alexander (not verified) on

I would be interested to read what you feel in particular should have been mentioned about malaria elimination in Italy, as it is important to investigate the methods or attitudes towards malaria elimination all those years ago.

Submitted by Giampietro Corradin on

I suggest to read "The Conquest of Malaria: Italy, 1900-1962 (2006)" by Frank Swnoden

Submitted by Anton Alexander (not verified) on

I know of the book but I was interested to know what you feel in particular should have been mentioned about malaria elimination in Italy. Because Italy was respected and known at the time for its research into malaria elimination, it was because of the comments about Palestine by one of Italy's foremost malaria experts which convinced me that Kligler's work warranted attention. In 1925, after inspecting the anti-malaria work in Palestine with the Malaria Commission of the League of Nations, the Italian representative, Professor Ottolenghi,commented that Palestine could be rid of malaria, and that "the ideal method of drainage was of the kind carried out at Balfouria, (Palestine)" and congratulated them on the success of the antimalaria campaign there.
Indeed this was mentioned in literature at the Jerusalem conference/workshop to emphasise that Kligler's work was highly viewed, even by Italy. I don't know what was applied or changed in Italy after and as a result of the Palestine inspection.
But the December conference/workshop in Jerusalem was a practical review into how some of these 'old' methods and principles of malaria elimination could be applied in Africa today. It was not merely a historical jaunt and therefore it is important to read what you feel in particular should have been mentioned about malaria elimination in Italy, and that was perhaps missed or overlooked at the conference.

Submitted by Bill Jobin (not verified) on

Congratulations to all on getting the Jerusalem Declaration published on World Malaria Day. Now does anyone have suggestions on how we get the right people to read it, and understand it?
Bill

Submitted by Robert Bos on

It is critically important that the Declaration cofirms that source reduction must be ADDED to existing interventions. During the time I was the Executive Secretary of the joint WHO/FAO/UNEP Panel of Experts on Environmental Management for Vector Control (PEEM) I was repeatedly accused of wanting to exclusively promote EM at the expense or even the exclusion of other vector control methods. I perceived that as intentional attempts to discredit EM. Two obstacles remain: 1. environmental management lacks the support of a back-up by vested, commercial interests that chemical control has; 2. the addiction, going back to the eradication period, to universally applicable methods (i.e. IRS wherever there are indoor resting vectors) rather than designing more intelligent but also more challenging approaches based on evidence about vector biology and ecology and local disease epidemiology.

Robert Bos
10 Rte du Creux/du/Loup
1285 Sezegnin
Switzerland

William Jobin's picture
Submitted by William Jobin on

Thank you Robert for reminding us of your herculean effort in PEEM to promote a holistic approach to water-associated diseases such as malaria and snail fever.

I understand clearly your comment about the lack of commercial interest in anything but chemical or drug solutions. My only thought is that we might approach the African Development Bank and the World Bank when they are considering water resource development projects, and stress the value of including environmental management through community development programs in these projects, that will also reduce the vector-borne or water-associated diseases, such as malaria.

So -

to Bart Knols -

should we try to meet with the chief environmental engineer at African Development Bank, Dr. Mbarack Diop now in their office in Tunis, to see if we can get them to include such considerations in all their water projects. They have some huge hydroelectric dams under consideration, as well as plenty of irrigation and drainage projects.

Bill

William Jobin Director of Blue Nile Associates