Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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112. To ask the Minister for Defence if there has been any change in his Department's stance on the use of Lariam by members of the Defence Forces on certain overseas missions; and if he will make a statement on the matter. [21735/15]

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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The issue of the administration of Lariam to members of the Defence Forces travelling to countries where malaria is a problem has been raised in this House on a number of occasions. Deputy Pádraig Mac Lochlainn has raised it and I have raised it myself. I thought I had a certain sense from the Minister, when it was last raised, that he may have been slightly more open than his predecessor to looking at the impact of this drug. The stories I am hearing - I am hearing even more of them - are extremely alarming, to put it at its mildest, in terms of the impact of this drug on some people who use it.

Simon Coveney (Cork South Central, Fine Gael)
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I assure the Deputy that I have an open mind on this matter. The Deputy will be aware that malaria is a very serious disease which kills approximately 1 million people every year in sub-Saharan Africa alone. It is a grave threat to any military force operating in the 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, including the use of Lariam, is working.

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

The Defence Forces are fully aware of the range of reported side effects attached 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. As the Deputy will be aware, there are three anti-malarial drugs, all licensed by the HPRA, in use by 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.

Where malaria has been identified as a risk in a particular mission area, the choice of medication is dependent on a number of factors, including the type of malaria in the destination, its resistance to particular drugs, the profile of the traveller, and the duration of travel. 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.

I can assure the Deputy that there is no loyalty to Lariam in the Defence Forces and that there is an open mind towards the use of alternatives, which we do use in many cases. The overarching priority has to be the safety of our Defence Forces personnel abroad in ensuring that they do not get malaria. We treat them accordingly, in line with medical advice.

Additional information not given on the floor of the House

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 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.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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I am glad to hear the Minister unambiguously express an open mind. His predecessor did not express that same openness. There has been group-think within the Defence Forces, which has given rise to almost unquestioning support of the use of Lariam. How would the Minister respond to Dr. Franz Humer, the chairman of Roche, which manufactures Lariam? As far back as 2007, at the annual general meeting of the company, he stated that Lariam used to be the most important drug in the fight against malaria. In the meantime, however, science has advanced, and more effective anti-malarials with better side-effect profiles are now available. Why, then, does Lariam continue to be the predominant drug used by our Defence Forces? Are Malarone or doxycycline used at all for people who are being dispatched to locations such as sub-Saharan Africa?

Simon Coveney (Cork South Central, Fine Gael)
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My understanding is that they are. It would be ridiculous for a Minister to be responding to Dr. Humer, as his statement would require a medical response from a trained doctor or from the Health Products Regulatory Authority. My function as Minister for Defence is to take all of the advice I can and then make decisions. Any decision we make about Lariam is a medical decision, not a political or commercial one.

My understanding isthat we are open to using the three drugs I have outlined, depending on where personnel are going and the types of malaria in those areas. Different drugs may be more effective in different settings. The only basis for a decision is medical, in order to ensure that when our Defence Forces personnel are abroad, they do not get malaria. We have a screening process to ensure that the side effects that can sometimes be associated with Lariam are not allowed to cause serious problems.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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Will the Minister publish the names of the members of his expert advisory panel? It would be very useful for all of us to know which people have been advising him and the Department of Defence.

Does the Minister recall the 2013 "Prime Time" investigations unit exposé which suggested there was a three to five times increased risk of suicide among Irish troops who were prescribed Lariam? I used Lariam myself on my first visit to Africa, to no obvious ill effect, it would appear. However, I have met people who have manifestly suffered as a result of using this drug.

I put it to the Minister that he, or someone who succeeds him, will end up standing up in this House and giving an account of why the Department of Defence continued to stand over the use of this drug long after there was proven international concern. Indeed, it is a concern which has been expressed by none other than the chairman of the company responsible for manufacturing the drug.

Simon Coveney (Cork South Central, Fine Gael)
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No one is suggesting there are not side effects but there are side effects to some of the other malaria drugs too. I have also used Lariam and I did not have any hallucinations or problems attached to it, I am glad to say, although maybe I was lucky.

It is important to say that the Defence Forces policy in regard to the use of antimalarial medication is in line with current HPRA guidelines. We follow those guidelines strictly and if we get a change in those guidelines, we will obviously respond to that. It is also worth repeating that not a single member of the Defence Forces who has been on peacekeeping missions in sub-Saharan Africa, and there have been many of them, has died from malaria. There has been a success here. Clearly, Lariam-----

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
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Not if they died by suicide as a result of it.

Michael Kitt (Galway East, Fianna Fail)
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Order, please. We are out of time.

Simon Coveney (Cork South Central, Fine Gael)
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If I was Deputy Ó Fearghaíl, I would be careful in what I say in regard to people taking their own lives. This is a serious issue and we take it seriously. I have an open mind with regard to changing our approach here but I would change that approach on the back of medical advice as opposed to political questions.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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My concern on this issue, as with many other issues, is that the lawyers in the Department, or those advising the Department, will say that if the Minister changes tack at this stage, he admits liability in regard to cases that are before courts. The Minister repeatedly says that nobody has contracted malaria but, with respect, that is not the point. The point is that for people with pre-existing mental health issues, this drug allegedly exacerbates their conditions and has allegedly led to tragedy. As I said before to the Minister's predecessor, and possibility to the Minister himself, the United States army, which is obviously multiples the size of ours, stopped using this drug quite a long time ago. If it is a question of legal advice or that type of issue, I would ask that this would not be a barrier to doing what is right.

Clare Daly (Dublin North, United Left)
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There is now an overwhelming body of evidence in this regard. I wonder is the Minister aware of the fact the British Ministry of Defence in April of this year released information under freedom of information which showed 1,000 ex-servicemen and women from the British army are suffering severe psychiatric and mental health problems or are suicidal as a result of being prescribed Lariam. An investigation is taking place there. How long are we going to have to wait until we catch up here?

Simon Coveney (Cork South Central, Fine Gael)
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As I said, I am not making decisions on the basis of legal advice. My only interest is medical advice. We screen people and make choices as to which antimalarial drug we prescribe on the basis of where people are going and how long they are going to be staying. That is a very different profile, by the way, to the US, which does not really have a peacekeeping role, as such, for its defence forces in the way that we do. On the continent of Africa, certainly, the US does not have a significant presence from a peacekeeping point of view.

I had a long conversation about this when I was in Mali over the St. Patrick's Day period, when I spoke to some German colleagues about their views on Lariam. It is not that we are not thinking about it; we are and I have an open mind on it. I do not want to make decisions because of statements people have made, unless there is a medical reason which shows that our personnel are safer using an alternative to Lariam, as opposed to using Lariam which has been very effective in certain circumstances. I will have no problem standing up here and changing my view on this on the basis of medical advice. That is the advice of which we will take note.