Fatalism and malaria elimination: A historical perspective from Palestine 100 years ago.

Fatalism is the acceptance of all things and events as inevitable. This sense of inevitability about malaria has obstructed malaria elimination from the outset and this article examines how this attitude was overcome in Palestine a century ago to enable the first start anywhere in the world of a successful malaria elimination campaign. The Balfour Declaration had been issued by the British Government in 1917 in support of a Jewish homeland in Palestine even though the British would have been aware Palestine was drenched in malaria and that Palestine was either uninhabitable in many areas or otherwise generally thinly populated. The only experience at that date of dealing with malaria control anywhere in the world had been demonstrated by General Gorgas at the Panama Canal together with his employment of thousands of men at vast expense, thus making it a method too costly to adopt for most countries. Notwithstanding this, Louis Brandeis, president of the American Zionists, had a strong commitment to grasp the moment provided by the Balfour Declaration, and to bring about a habitable Jewish homeland. Despite the pessimism and negativity of the rest of the Zionist establishment, which viewed malaria as a natural incident of Palestinian life, Brandeis prevailed upon Dr. Israel Kligler, a Zionist and also a brilliant public health scientist, to consider a fresh affordable method of controlling and eliminating malaria, and to thereby render Palestine habitable for Jewish settlement. Kligler's significant change in approach against the disease was to think not of malaria control and use of thousands of employed personnel, but to seek instead malaria elimination through involvement of the community through culturally-sensitive education. Only absence of fatalism made this possible.