Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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1. To ask the Minister for Defence his views regarding the concerns expressed regarding lariam; and if he will make a statement on the matter. [36050/13]

Paul Kehoe (Wexford, Fine Gael)
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I apologise for my late arrival in the Chamber. Lariam is one of the most effective medications for protection against the type of malaria prevalent in sub-Saharan Africa. Malaria is a serious disease that kills approximately 1 million people per year in sub-Saharan Africa alone. It is a serious threat to any military force operating in the area. The anti-malaria regime in place in the Defence Forces, including the use of lariam, has worked. In the decade of deployment to sub-Saharan Africa by the Defence Forces, not a single member of the Defence Forces has died from malaria and there are only three documented cases of personnel getting malaria.

The Irish Medicines Board, IMB, is the statutory body that regulates medicines available in Ireland. I am advised the three anti-malarial medications licensed by the IMB, namely, lariam or mefloquine, malarone and doxycycline all can have significant side effects. The assertion that any one is automatically a more effective or safer alternative to the others is a grossly misleading oversimplification. Each of the three drugs has been used by the Defence Forces, depending on individual circumstances including the type of malaria in the destination, the duration of travel and so on.

I am further advised the Defence Forces are fully aware of the range of reported side effects attaching to all anti-malarial medications. Protocols are in place to control the risk of side effects in individuals. Up to September 2012, malarone was only licensed for up to 28 days continuous use and was not an option, as the usual duration of deployment for the Defence Forces is six months. The 28-day limit was removed in September 2012. However, there is limited evidence as to the safety and effectiveness of malarone usage for longer periods. The position is currently being reviewed by the Medical Corps of the Defence Forces.

The Minister had the various allegations surrounding the use of lariam investigated thoroughly and has obtained the advice of leading medical experts, who concur with the prescribing practices followed by the Defence Forces.

Additional information not given on the floor of the House

On 1 July 2013, the Irish Medicines Board and Roche Products (Ireland) issued a letter to all general practitioners, GPs, concerning lariam. The Director of the Defence Forces Medical Corps, DMC, has circulated the letter to all medical officers. The DMC is considering its content and whether it has policy implications. lariam remains licensed by the IMB and must remain in the formulary of medication prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions, particularly those in sub-Saharan Africa. This is necessary to ensure military personnel can have effective protection from the serious risks posed by this highly dangerous disease.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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This may be the last opportunity Members will have to paid tribute to the outgoing Chief of Staff, Lieutenant General Seán McCann, on his three years at the helm, his outstanding work and on his career and lifetime commitment to the Defence Forces, as well as to welcome the appointment of Major General Conor O'Boyle. The former Minister for Defence, Tony Killeen, confirms this was an excellent choice. I also welcome the appointment of Mr. Maurice Quinn as Secretary General of the Department of Defence and wish Mr. Michael Howard well. I also wish to note to the Minister of State this is the second occasion out of four in which the Minister for Defence has not been present for Question Time. While accepting that any Minister can be called away, I note today, the defence questions were switched with the justice questions. Consequently, it appears as though the Minister is anxious to be present questions on justice but not so anxious to be present for questions on defence and that, in effect, defence plays a lesser role for him, which I regret.

On the issue of lariam, I am conscious that Ministers drawn from my party gave precisely the same reply the Minister of State has just given and that the Minister, Deputy Shatter, has given in the past. However, the growing concern about lariam across the developed world is such that the Defence Forces must re-examine the issue. They must consider it and not simply give Members stock-in-trade answers, which is what they have been getting for several years. Instead, they must revisit this particular issue. Some pretty clear evidence exists that there is a direct link between the use of lariam as a treatment or as a preventative medicine for malaria and psychotic incidents and incidences of suicide.

Paul Kehoe (Wexford, Fine Gael)
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I had intended to make these remarks at the conclusion of Question Time but I join Deputy Ó Fearghaíl in wishing Lieutenant General Seán McCann, his wife and his family a happy retirement, as well as welcoming the incoming Chief of Staff, Major General Conor O'Boyle. I also wish Mr. Michael Howard and his wife the very best in retirement and I wish the incoming Secretary General of the Department, Mr. Maurice Quinn, the best of luck.

The Deputy acknowledged that when his party was on this side of the House, previous Ministers also gave precisely the same answer. However, they were giving answers based on the best medical advice available to them at that time, and I am citing the very same medical advice that has been given to the Government at this point. This advice comes from the Irish Medicines Board and is that lariam is the best medication available to combat the form of malaria that obtains in sub-Saharan Africa. I note that everyone is a professional in his or her own field and the Government has received advice from such professionals, in that the best medical advice available to it is that lariam is the safest medication on hand.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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Things are changing and new expertise is being brought to bear on these particular issues. I believe Deputy Mac Lochlainn may have referred to this when he raised the matter recently but the "Prime Time" programme found recently that there is a higher incidence of suicide in soldiers or Defence Forces personnel returning from overseas duty and that there can be a link drawn perhaps between the use of lariam and those events. One should consider what is happening in the United States, where highly reputable medical experts now are raising questions about the continued use of this drug.

We are all aware of how dangerous malaria is, but we are also conscious of the fact that other products can be used the side effects of which are less nefarious than the side-effects of lariam appear to be. I say that as someone who took lariam some years ago.

Paul Kehoe (Wexford, Fine Gael)
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The allegation of a link between lariam and suicide and suicidal ideation has been examined. Of 156 non-service related deaths among members of the Defence Forces in the period January 2000 to December 2009, 25 were apparently from self-inflicted injuries, although only one is recorded by a coroner as suicide. Of these 25 deaths, 16 had never been prescribed lariam. Of the remaining nine, given the limited period of time during which lariam remains in the bloodstream, according to our expert advice, it is extremely unlikely that lariam could have been a contributory factor in practically all of these cases. There is no evidence in any of the coroners' inquests linking any deaths to lariam.

The death rate in the Defence Forces from self-inflicted injuries in the period 2000 to 2010, when lariam was being prescribed, was 0.24%, and the death rate from self-inflicted injuries in the period from 1989 to 1999, when lariam was not being prescribed, was 0.32%, which is higher than the death rate in the period when lariam was being prescribed. To say suicide or suicidal ideation is due to lariam is not true. The Department and the Defence Forces have the medical evidence to support that statistic.