Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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78. To ask the Minister for Defence the medicines recommended for Irish troops travelling to Mali. [21284/13]

Alan Shatter (Dublin South, Fine Gael)
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Irish personnel being deployed to EUTM Mali are administered the anti-malarial medication mefloquine, also known as Lariam. Defence Forces personnel are also issued with individual first aid kits as well as insect repellent and sunblock. Irish personnel will also have access to the mission medical facilities and may be prescribed additional medications as appropriate.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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I am sure the Minister understands the context of this question, namely, the concern around the use of the anti-malarial drug, Lariam, and its side effects as outlined by many serving members, many of whom I understand are taking legal proceedings in this regard. The US army ceased using Lariam a number of years ago. Why do the Irish Defence Forces continue to use it? Are there no alternatives, given the concerns around the psychological side effects of Lariam? Also the Statute of Limitations provides for a figure of two years, yet it may take a number of years for symptoms to develop. I ask the Minister to address these concerns. This matter has been raised in the House by many Members, including, I am sure, the Minister when he was Opposition spokesperson on these matters.

Alan Shatter (Dublin South, Fine Gael)
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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.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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On a point of order, what time is allowed for the Minister's response?

Alan Shatter (Dublin South, Fine Gael)
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I am almost finished. The Defence Forces do not mass prescribe but rather follow all of the instructions issued by the Irish Medicines Board in order to fully screen personnel who may potentially have an adverse reaction to the medication.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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That was a very lengthy response.

Tom Hayes (Tipperary South, Fine Gael)
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The Deputy received a great deal of information.

Alan Shatter (Dublin South, Fine Gael)
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I like to be as comprehensive and informative as possible.

Tom Hayes (Tipperary South, Fine Gael)
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The time for this question has almost expired. I will allow a brief supplementary from Deputy Pádraig Mac Lochlainn.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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While personnel are screened for mental health and underlying issues, there are difficulties in detecting them. How can the Minister be sure the drug is being properly prescribed? As I stated, this medication has not been prescribed for serving members of the US defence dorces since 2009. Why do the Defence Forces continue using it? Are there alternatives that do not have the same side effects?

Alan Shatter (Dublin South, Fine Gael)
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As I explained to the Deputy, the Defence Forces continue to use it because, unlike the US military, they do not engage in mass prescribing without individualised assessment of Defence Forces personnel travelling abroad. Individualised assessment is important. It is also important that individuals being assessed engage truthfully with the medical assessor and that they, if in receipt of prescribed medicines or suffering from depression or showing other contraindications, disclose this to the medical assessor. This is an issue on which I have been constantly briefed since my appointment. I am aware of the background to the small number of cases being taken. I am also aware of the concerns expressed in this area. I am assured that individual assessments and proper oversight for a short number of weeks following commencement of the taking of the medication provide essential protections. In the context of the deployments in respect of which Lariam has been used, this is to ensure members of the Defence Forces are protected from contracting malaria, a disease that can have terminal consequences.