Alan Shatter (Dublin South, Fine Gael) | Oireachtas source

Malaria is a serious disease which can cause serious complications and death. The World Health Organization, WHO, estimates that approximately 1 million people in sub-Saharan Africa alone die every year from it. It has long been recognised as a serious threat to any military force operating in a malarious area. In accordance with best international practice in prescribing Lariam and taking account of the contraindications, warnings and side effects, highlighted by the Irish Medicines Board, the Defence Forces screen all personnel for medical suitability. In the case of overseas missions to malarious areas, the medical screening involves a one-on-one assessment of the individual's suitability to be prescribed the selected anti-malarial agent in line with current Irish Medicines Board guidelines. This typically involves a review of the individual's previous experience, if any, with the medication, screening of the individual's medical history for conditions which have been identified as precipitating serious side effects in association with the medication. The screening system rules out personnel with certain serious conditions from overseas service, including depression, anxiety, neuro-degenerative disorders etc. which, as has been indicated by the Irish Medicines Board and other regulatory bodies worldwide, are more likely to precipitate serious adverse reactions to Lariam. In addition, blood tests are carried out to ensure the liver is healthy, as liver disease is an accepted contraindication to the use of Lariam.

It is the policy of the Defence Forces medical corps that personnel deemed suitable for use of Lariam should commence their medication three to four weeks in advance of their travel. This precaution allows a slow build-up of the medication in the blood stream, which permits assessment of the person concerned while still in Ireland of his or her individual reaction to the medication. Personnel are screened before and after deployment and all necessary actions are taken to ensure those with contraindications to Lariam use are not prescribed the medication.

In the context of what anti-malarial measures are to the forefront when preparing for missions, I have made reference to the use of Lariam and the importance of its use. In relation to the issue raised by the Deputy in the context of use by the US army, it is my understanding US forces ceased use of Lariam owing to concerns about inadvertent prescribing of the drug for soldiers who should not take it. In this regard, I am advised that the US authorities undertook mass administration of Lariam for soldiers serving in areas subject to malaria without individual screening of personnel of the nature undertaken by the Defence Forces. The US Centre for Disease Control, CDC, is one of the major operating components of the US Department of Health and Human Services. The CDC health information for international travel known as the "Yellow Book" is published every two years and a reference for those who advise international travellers about health risks. It advises that a risk assessment be carried out before deciding on the use of a malaria chemoprophylaxis agent. Chapter 3 of the Yellow Book recommends the use of malaria chemoprophylaxis, including Lariam. Chapter 8, under the heading "Special Considerations for US Military Deployments", states:

Individualizing advice and recommendations for large military deployments is rarely logistically possible or feasible. Recognizing this reality, in September 2009, the US military adopted a new policy on the use of malaria chemoprophylaxis in the US military.

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