Alan Shatter (Dublin South, Fine Gael)

I do not know on what basis the Deputy is alleging the Defence Forces have not acted properly in regard to this matter. It is important to look at the alternatives to Lariam. There are three other anti-malaria medications available, namely, Chloroquine, Malarone and Doxycycline. However, in the case of each of these products, there are specific reasons they are not suitable for use by the Defence Forces in sub-Saharan Africa and it is worthwhile setting out these reasons. Chloroquine is no longer in use because of the development of widespread resistance to it. Doxycycline must be taken in the absence of dairy products and it can also produce sun-sensitivity skin rashes in some individuals. This is particularly significant when used in sunny climates. For this reason, it is not recommended for first-line use by the Defence Forces in sub-Saharan Africa. Malarone is unsuitable for use as it is licensed for no more than 28 days continuous use in malarious areas by the Irish Medicines Board. In this context, this prophylactic agent is only suitable for use where the overseas deployment does not exceed 28 days.

These are among the reasons Lariam remains the anti-malaria chemoprophylactic agent of choice in areas where the predominant species of malaria is the virulent plasmodium falciparum. Lariam, therefore, is the agent of first choice on any sub-Saharan missions undertaken by the Defence Forces and that remains the position.

Doxycycline is the anti-malaria chemoprophylactic agent of choice in Afghanistan where the predominant species of malaria is the less virulent plasmodium vivax. Where Lariam is not required to be used, it is not used because it is not necessary to use it as a chemoprophylactic agent. In the context of sub-Saharan Africa, the alternatives do not offer our Defence Forces the protections to which they are entitled.

It is not practical to undertake a review of every file relating to every member of the Defence Forces who has taken Lariam since it was first utilised in the Defence Forces. The amount of resources and time it would take, in circumstances where there is not an indication that substantial numbers have been detrimentally affected by its use, cannot be justified. I have met some individuals who discussed with me their personal concerns as to the impact of Lariam on them. I am very conscious of these issues and their situation is not being ignored. As Minister, I must rely on the advice of the Irish Medicines Board but I will ensure what is necessary is undertaken in regard to any issue concerning the health of members of the Defence Forces.

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