Aengus Ó Snodaigh (Dublin South Central, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

acknowledges:— the serious side effects of the anti-malaria drug Mefloquine (Lariam) on some Irish Defence Forces personnel serving overseas in peacekeeping missions in the sub-Saharan region of the African continent;

— that these side effects have resulted in serious and prolonged psychotic and psychiatric behaviour and suicidal tendencies, including the possible death by suicide of some military personnel;

— the failure by the Department of Defence to implement a comprehensive screening programme to monitor the effects of Lariam on the estimated 4,500 plus Irish Defence Forces personnel who have received it since it was made drug of first resort for sub-Saharan Africa in 2000;

— that most of the world’s major military powers have, on the back of overwhelming evidence, completely banned Lariam or use it only as a drug of last resort for their soldiers;

— that the Irish Defence Forces are now one of the few in the world to administer Lariam as the only drug of first resort for its serving overseas soldiers in areas where there is a high risk of malaria;

— that RTÉ’s Investigations Unit engaged international medical experts whose analysis in their report in 2013 concluded that Irish Defence Forces personnel who had taken Lariam were three to five times more at risk from suicide; and

— the findings of a public inquiry by the British military, led by retired Lieutenant Colonel Dr. Ashley Croft and retired USA military Major Dr. Remington Nevin, two world experts into the effects of Lariam, who recommend that Lariam should be a drug of last resort and that the prescription of the drug should only be made under the most rigorous supervision; andcalls on the Government to:— instruct the military authorities to immediately cease administering Lariam to all Irish soldiers as the drug of first resort and to replace it with proven safer alternatives such as Doxycycline or Malarone, and Lariam should only ever be the drug of last resort where no suitable safer alternative is available; and

— instruct the Department of Defence, in conjunction with the Health Service Executive, the military authorities and in consultation with the representative bodies for serving and former soldiers, to draw up a plan of action to help alleviate and address the ongoing concerns regarding the anti-malaria drug Lariam issued to military personnel serving on overseas missions in sub-Saharan Africa in the past.

I acknowledge the presence of members of the Action Lariam for Irish Soldiers, Mefloquine Ireland and the Wives & Partners of the Defence Forces, WPDF, some of whom are in the Public Gallery and have come from various places throughout the country as well as from Dublin to listen to this debate, which is important for them and for those who have suffered the effects of Lariam. I commend them in particular on their sterling efforts to ban the use of Lariam as the anti-malarial drug of choice for military personnel serving overseas. I also thank them for their encouragement, their advice and assistance which greatly aided me in the course of my work on this important matter. I commend the opposition Deputies who have co-signed this motion. I know there are others supporting it who, thus far, have not signed.

7 o’clock

I commend the Opposition Deputies who co-signed this motion and others supporting it who have not signed it. I also acknowledge the importance my party has attached to this issue by giving me today's debate time.

To those at home watching this debate, and elsewhere, who are living with the effects of Lariam this is not only the issue of the day, it has been the issue of the day since they or a loved one first felt the full effects of a drug that was intended to protect not cripple. I hope I can do justice to the words and feelings that I have heard and felt since people first shared their personal stories with me.

For nearly a decade I have raised the dangerous and potentially fatal side effects associated with Lariam with successive Ministers for Defence. The value and respect rightly accorded to Irish military personnel is reflected globally. The courageous peacekeeping duties they have performed in some of the world's most dangerous conflict zones and their recent role in rescuing thousands of refugees in the Mediterranean have conferred upon them a reputation for bravery and professionalism that is unequalled. Unfortunately, the plaudits frequently lavished on the Defence Forces by Ministers on the floor of this House have not always been matched by their treatment of those men and women. Nowhere is this more starkly illustrated than in the inexplicable failure to replace the anti-malaria drug Lariam with a safer alternative.

For years, the plight of serving and retired personnel who have suffered the serious side effects of taking Lariam, which has been available since the early 1990s, has been ignored and dismissed. At a glance, this issue has been before at least eight Ministers or Ministers of State in the Department of Defence. There is a "hear no evil, see no evil, speak no evil" approach to the suffering of affected soldiers, whose plight has been ignored and whose scandalous treatment has been impossible to fathom. Indeed, I remember in April 2008 when the Minister of State, Deputy Kehoe's colleagues, former Deputies, Billy Timmins and Jimmy Deenihan, questioned the then Minister for Defence, Deputy O'Dea, about Lariam only to get virtually the same stock reply we have been given many times since, namely, "The drug in question is considered one of the most effective anti-malaria drugs ... The Military Authorities have assured me that they are fully aware of the drug's neuropyschiatric side effects." Deputy O'Dea's signature on this motion tonight shows that he is man enough to admit that the advice he was given nearly ten years ago was wrong. I hope the Minister of State and the military authorities today have the same humility.

The Ceann Comhairle, Deputies Clare Daly and O'Brien, an tSeanadóir Pádraig MacLochlainn and I have doggedly pursued this issue with the Minister of State and with previous Ministers since 2008, but without any hint of a change of policy. The purpose of this motion, when it is passed and I believe it will be, is to force the Minister of State to end his indefensible justification of the use of Lariam as an anti-malaria drug for soldiers.

In considering this issue, I want the Minister of State to try to imagine the life of a soldier who has volunteered to serve overseas, in the service of his or her country, and who succumbs to the effects of what is supposedly a life-protecting drug. The challenges for soldiers serving abroad, of performing their duties in a stressful and sometimes dangerous environment, are offset somewhat by the knowledge that, as peacekeepers, they are making a significant difference in a conflict zone and to the world. The pride that comes from fulfilling that challenging role wanes quickly when their lives are altered and no one seems to care. The change in their personalities happens slowly and is barely noticeable at first but it starts to be noticed by colleagues, family and friends. They become increasingly snappy and at times angry or depressed and experience occasional suicidal thoughts without any understanding of what is causing these uncharacteristic mood swings. They lose their appetite, become increasingly lethargic, demotivated and unable to concentrate. They find things to blame, maybe it is the weather, the long hours, arduous travel or the stress of serving in a country where they must remain constantly vigilant. When they return home, their loved ones are quick to comment on their change of mood, asking what happened during their tour of duty. Some blame it on post-traumatic stress disorder, PTSD, even if they did not directly experience the horrors of war.

They live in denial and refuse to visit the Army doctor for fear of being put on sick leave with no duties which means reduced pay, no allowances and the all too real risk of being considered too weak to serve overseas again. They might have seen this happen to their comrades who were stigmatised, sidelined and ridiculed for seeking help, with some even being drummed out of the service for being too sick to serve. The physical and mental problems continue to worsen and they cannot shake their malaise but the cost of attending a private GP is daunting, so they suffer in silence. They hear the rumours about the high rates of suicide among military personnel - for example, the 12 men who took their own lives after returning from UN peacekeeping missions in Africa - and recall the rumours about Lariam, the anti-malaria drug they were forced to take without question or protest on pain of being told their services would no longer be required and think it might be responsible for their problems. Nobody ever explained to them the possible side effects. They find out that the Brits, the Yanks, the Canadians and most other militaries have banned or greatly restricted its use. They read about three Fort Bragg soldiers suspected of killing their wives after they exhibited unusual anger and incoherence upon returning from Afghanistan where they were prescribed Lariam. Similar, seemingly inexplicable, brutal killings by Canadian Special Forces in Somali in 1992 or massacres in Afghanistan in 2013 have a common theme, those responsible were soldiers who were prescribed Lariam.

Closer to home, an "RTE Investigates" report into the use of Lariam in 2013 found a "plausible link" between the drug and the high rate of suicides amongst soldiers. An examination of 28 suicides within the Defence Forces, found that 11 of those involved had taken Lariam and that four of them had taken their lives within a year of returning home from overseas duty. Two of the world's leading authorities on the medication are on record as saying that the results of RTE’s probe require urgent investigation. Dr. Remington Nevin, an epidemiologist and former US Army major, is unequivocal in his view that Lariam is responsible for symptoms of mental illness, including anxiety and depression, and a strongly increased risk of suicide brought on by severe psychosis. In spite of what has been uncovered, the Government and the Irish military authorities seem oblivious to the approach taken by other countries, including the United States, which, since 2009, issues Lariam for military personnel only in the most exceptional of circumstances. In Britain, an estimated 1,000 plus former military personnel have required psychiatric treatment as a result of the after effects of taking Lariam. That government was forced to act. In 2013, the British military authorities initiated a public inquiry that was damning in its conclusions about Lariam. In 2016, a report published by a House of Commons Defence Committee stated:

Lariam has a high risk profile and a minority of users experience severe side-effects. These side-effects are clearly highlighted by Roche, the manufacturer of Lariam. Our inquiry considered whether those risks outweigh the benefits of Lariam when other anti-malarial drugs, with a lower risk profile, are available to the MoD ... We also believe that if the MoD continues to prescribe Lariam, this must take place only after a face-to-face Individual Risk Assessment has been conducted.

There is overwhelming evidence of the dangers of Lariam, yet the testimonies of Irish Defence Forces personnel and the horror stories from other armed forces that highlight the drug's serious side effects have not, to date, been deemed serious enough to have it replaced.

When soldiers learn about Lariam's debilitating and dangerous side effects, it dawns on them that despite devoting a good part of their lives to the service of their country, they have been given poison which is likely to have compromised their mental well-being and physical health, possibly for the rest of their days. It quickly becomes obvious that the military authorities, the Department of Defence, the Irish Medicines Board and several Ministers for Defence have been fully aware of the major questions about this drug and have chosen to ignore the potential risks involved. It is simply not plausible for them to have been ignorant of the facts as the dangers associated with this drug are well documented and have been highlighted to them and their Ministers continuously by, to name but a few, the Action Lariam Group, Deputies and Senators who have continued to raise the issue, "RTE Prime Time" and various newspaper articles.

The obvious question for the Minister of State is why members of our military have been given Lariam when there are safer alternatives available and why has the Department persisted in issuing to soldiers a drug that could poison their minds and destroy their lives. Is the Minister of State afraid, in the face of such overwhelming evidence, to admit that he and the military authorities are fallible and have got things badly wrong in respect of Lariam? Thus far, the Minister of State has dismissed the evidence and testimonies of serving and retired soldiers on the basis of cost, saying it would be more expensive to replace Lariam with a safer alternative. That suggests the lives of the few soldiers who are affected are less important in the wider scheme of things, particularly if that means being able to make budgetary savings. I hope the Minister of State will contradict that. The only way to do it is to change the way we approach anti-malarial medicines for the Defence Forces very quickly. The Minister of State has that opportunity tonight. He must be brave enough to admit he is and has been wrong on this matter so that we can begin to finally address what has been inflicted on the men and women who were forced to take Lariam.

The Minister of State must not only pass the motion, he must immediately replace Lariam with a safer alternative drug. I ask him to provide an assurance that the health and well-being of Irish soldiers serving overseas will be a priority from now on and that they will longer be prescribed this drug. We must also begin to address the legacy of a drug which has left some men and women so debilitated that they cannot get out of bed in the morning and carry on their normal, day-to-day business while others are dead. The Minister of State has an opportunity to act in circumstances in which the motion has the backing of the majority of Deputies. The Minister of State can weigh in behind it and issue an instruction to the military authorities. Where other governments have learned of the horrors of this drug, they have taken the right and decent step of banning its use.

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