Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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8. To ask the Minister for Defence his plans to continue the use of lariam as the anti-malarial drug of choice for future deployments in the affected region. [43269/14]

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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As the Minister will probably be aware, the issue of the use of lariam as an anti-malarial drug has caused profound concern for many years now. He will also probably know United States forces no longer use this drug. I want to probe whether there are alternatives and whether the Minister will stop the use of this drug in the Defence Forces.

Simon Coveney (Cork South Central, Fine Gael)
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The lariam debate is controversial and has been for many years. I remember taking lariam at one point when I went to travelling in Africa, and having the debate with my doctor on this issue, so it is not new.

The Deputy will be aware that malaria is a very serious disease which kills approximately 1 million people per year in sub-Saharan Africa alone. It is a grave threat to any military force operating in that area. 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. The anti-malaria regime in place in the Defence Forces includes the use of lariam, and I would contend it is working.

The Health Products Regulatory Authority, HPRA, formerly the Irish Medicines Board, is the statutory authority with responsibility for quality, safety and efficacy of medicines in Ireland. The Defence Forces policy in regard to the use of anti-malaria medication is in line with current HPRA guidelines.

The Defence Forces are fully aware of the range of reported side effects attaching to all anti-malarial medications. Significant precautions are taken by the Medical Corps in assessing the medical suitability of members of the Defence Forces to take any of the anti-malarial medications, all of which have some side effects. There are three anti-malarial drugs licensed by the HPRA in use in the Defence Forces, lariam, malarone and doxycycline.

It is the policy of the Defence Forces that personnel are individually screened for fitness and medical suitability for service overseas, including a medical risk assessment for lariam.

Additional information not given on the floor of the House.

Where malaria has been identified as a risk in a particular mission area, the choice of chemoprophylaxis medication is dependent on a number of factors, including the type of malaria in the destination, resistance to particular drugs, the profile of the traveller - contra-indications, underlying health conditions and purpose of travel - the duration of travel and adherence issues. The choice of medication is a medical decision made by medical officers in the Defence Forces, having regard to the specific circumstances of the mission and the individual member of the Defence Forces.

Former Ministers for Defence have had the various allegations surrounding the use of lariam investigated thoroughly and obtained the advice of leading medical experts, who concur with the prescribing practices followed by the Defence Forces. Anti-malarial medications, including the use of lariam, must remain in the formulary of medications prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions to ensure that our military personnel can have effective protection from the very serious risks posed by this highly dangerous disease.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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As the Minister knows, the statute of limitations provides for a period of two years but, often, the symptoms in regard to lariam present years afterwards. I am aware there are legal cases under way. My worry is that, rather than the State just acknowledging there is an issue, it will defend it to the last and continue to use lariam when there are other options available. It worries me that the United States armed forces have stopped the use of lariam. We know the array of advisers they have - multiples of what we have in Ireland - yet they have made that decision.

I am not a qualified scientist or pharmacist but it causes me concern that the reason we have not stopped the use of this drug is that we are going to defend legal cases and fight them all the way. My concern is that the outcome of this may be a damning indictment of this State.

Simon Coveney (Cork South Central, Fine Gael)
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I want to set the record straight on something I consider very important. We are not continuing the use of lariam because of legal cases that are being taken. We are continuing the use of lariam in the Defence Forces to ensure we have a responsible approach towards ensuring members of the Defence Forces do not contract malaria. We are acting on the advice of the Health Products Regulatory Authority, the former Irish Medicines Board, as most people will know it.

I am not a qualified doctor either but I took medical advice before I took lariam. Luckily, I did not have any side effects from it and I did not contract malaria either, and I have been to Africa many times. The Defence Forces are making decisions on the basis of the best medical advice that is available in Ireland and in terms of the best and most effective way of protecting our Defence Forces when they are operating in a country that has malaria. That is the only motivation here. If we get a change of recommendation from the Health Products Regulatory Authority, we will act on that, regardless of court cases. The only priority for me is protecting our Defence Forces and to ensure we do everything we can to protect them when they are in a difficult environment abroad. Malaria is a big part of that because we have a lot of troops in Africa.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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There is no challenge to the fact the Minister is fine after taking lariam or that we need to protect ourselves from the threat of malaria.

My point is that a number of former members of the Defence Forces believe their mental health problems are connected to side effects from taking lariam. The United States forces have stopped using lariam. Have our relevant authorities ever engaged with the relevant authorities in the United States to ask why they removed lariam and if there are grounds for us to do the same?

Simon Coveney (Cork South Central, Fine Gael)
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There are many people in this House who sometimes are not overly complimentary about the US military in terms of some of the decisions it makes but for me, that is not so much the issue. We have medical advice available to us in Ireland, which is of the highest standard, and we follow that advice. That is from where we take our lead. If there is growing international evidence to the contrary, we will look at it, whether it is in the US or in some other part of Europe or the world. I assure the Deputy that the only motivation here is the best interests of and the medical protection of our armed forces. If the Deputy has a concern about anything in this area, he should send it to me and we will look at it.

The only reason I mentioned I took lariam was that I was making the point that if one is not a doctor, is a policy-maker or has a different skills set and is making a medical decision, one takes one's lead on that decision from those who know what they are talking about and who understand medicine and the challenges of lariam and malaria which, as far as I am concerned and from an Irish perspective, is the Health Products Regulatory Authority. We will take our lead from that body unless there is reason to raise questions because of international evidence, which we will look at.