Clare Daly (Dublin North, United Left)
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69. To ask the Minister for Defence if he will immediately order the cessation of the use of Lariam in the Irish Defence Forces, pending the publication of the findings of the working group into the drug, given the growing number of calls for this and given the paper published by Dr. Ashley Croft in The Pharmaceutical Journal on 12 November 2015 urging the discontinuance of the use of Lariam for the British military. [41376/15]

Clare Daly (Dublin North, United Left)
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This follows on from Deputy Crowe's question on Lariam. I am glad to hear the Minister has had some engagement since his last meeting with Mark O'Sullivan. Mark has been medically discharged since that meeting, and he is in the Gallery along with a number of his colleagues who have been negatively impacted by Lariam. This question is quite specific. The Minister has said he is interested in the best medical assessment. A recent report in The Pharmaceutical Journalby Dr. Ashley Croft was very clear about the danger of Lariam. We need to cease prescribing it immediately, in advance of the Minister publishing the outcome of the working group. Will the Minister stop prescribing it, because there are other alternatives which are just as effective in dealing with malaria? In the interim, when will we see the working group report and will it be published and discussed in the House? It is now a matter of absolute urgency.

Simon Coveney (Cork South Central, Fine Gael)
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I am aware of the paper recently published to which the Deputy refers and the ongoing debate relating to the use of Lariam. The health and welfare of the men and women of the Defence Forces is a priority, as I said earlier to Deputy Crowe. As I have already indicated to the House, the choice of medication for overseas deployment, including the use of Lariam, is a medical decision made by medical officers in the Defence Forces, having regard to the specific circumstances of the mission and the individual members of the Defence Forces. Significant precautions are taken by the Defence Forces' medical officers in assessing the medical suitability of members of the Irish Defence Forces to take any of the anti-malarial medications. It is the policy of the Irish Defence Forces that personnel are individually screened for fitness for services overseas and medical suitability, and a medical risk assessment for Lariam is carried out on an individual basis. The Irish Defence Forces policy on the use of anti-malarial medication is in line with the Health Products Regulatory Authority's current approved summary of product characteristics.

As I previously indicated to the House, my Department established a working group in January 2011 to examine the use of Lariam and other anti-malarial drugs in the Defence Forces. The group produced its report to a former Minister for Defence in 2013. I am advised that the group investigated the allegations surrounding the use of Lariam and obtained the advice of leading medical experts who concurred with the prescribing practices followed by the Defence Forces. Since production of its report, members of the working group have continued to monitor developments in the area of malaria.

My Department has recently reconvened the working group which is engaging once again with experts, both nationally and internationally, on the use of Lariam and other anti-malarial drugs in the Defence Forces. As I stated, I would like to get the report before the end of the year but I want to ensure it is as thorough as possible. My understanding is that I will probably get it in January.

Clare Daly (Dublin North, United Left)
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We have a real problem at this stage and there are people in the Gallery and beyond who believe that the attitude being adopted by the Irish Defence Forces is now akin almost to reckless endangerment. It is a fact that other drugs deal just as effectively with malaria as Lariam, which has 27 neurological side effects that leave permanent damage. Malaria is treatable if it is identified early. The other two drugs are just as effective and lead to substantially fewer side effects than Lariam, so why would they not be prescribed in the interim? The French never prescribed Lariam and the Americans have suspended its use. There are investigations in Australia. We know that across the water in Britain-----

Simon Coveney (Cork South Central, Fine Gael)
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The Americans have not suspended its use.

Clare Daly (Dublin North, United Left)
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Let me finish. Across the water in Britain, almost 2,000 British soldiers were given Lariam last year, with 14% treated for side effects. Since 2008, almost 1,000 people in Britain have been hospitalised in psychiatric facilities or treated in medical mental health facilities for side effects of Lariam. People want to know if its use will be ceased now and that treatment will come in the form of one of the other drugs. Publish the report promptly so we can get out of this nightmare for people.

Simon Coveney (Cork South Central, Fine Gael)
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Of course we will publish recommendations as soon as we have them. The Deputy is making sweeping generalisations. The United States decided to stop using Lariam for troops sent to Afghanistan. We have troops in Afghanistan and we never gave them Lariam because it is not the appropriate drug for troops being sent to Afghanistan. It depends on the region, where personnel are going and for how long, and the strain of malaria. All this is part of the medical assessment. The reason most countries involved with peacekeeping continue to use Lariam is because there is no simple transfer to another drug. The suggestion that there are no complications or problems with the other available drugs for malaria is also not the way it is. If it were the case, we would transfer to another drug. Nobody is suggesting there are no problems with Lariam but we are trying to minimise those problems through effective screening, with Lariam only being used where it is the recommended drug to minimise the likelihood of having a problem with malaria. We do not always prescribe Lariam and it is only used for certain regions, where it is the best prescribed option to protect our troops. If the recommendation is to cease its use, we will do it straight away.

Clare Daly (Dublin North, United Left)
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We have a real problem with this. It is a fact that many Defence Forces personnel would refute strongly the Minister's assertion that there is individual screening. They have testified to the opposite, that they are not given appropriate warnings or assessed for mental health history and so forth. Even if they were, are the measures put in place to protect them, given that this could jeopardise their careers?

The Minister spoke earlier about weighing up risk assessments. In a parliamentary reply from 4 November, the Minister admitted that the Defence Forces have not carried out adequate risk assessments on this drug. He reinforced in the reply that Lariam is the first drug of choice in dealing with malaria for Irish personnel.

That is out of sync with other defence forces around the globe.

Simon Coveney (Cork South Central, Fine Gael)
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It depends on the region. The Deputy is trying to exaggerate for effect.

Clare Daly (Dublin North, United Left)
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The problem is that these risk assessments have not calculated how many deaths have occurred through suicide by those taking Lariam.

Simon Coveney (Cork South Central, Fine Gael)
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We have assessed that.

Clare Daly (Dublin North, United Left)
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Where is the publication? Where is the assessment of the permanent neurological damage done to former Defence Forces personnel in our State? Malaria is treatable; the side-effects from Lariam are not. It has destroyed the lives of people in the Gallery and their families, and it is not good enough to carry on regardless when the known side-effects for this drug were identified in 1995 and the information is getting stronger by the month. Why does the Minister keep doing it and exposing others?

Simon Coveney (Cork South Central, Fine Gael)
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I know the Deputy has genuine concerns about this issue, but so do I. Let us try not to make sweeping statements that are not true. We have looked at the incidence of suicide in the Defence Forces and among ex-Defence Forces personnel. We have looked at that in a lot of detail as regards trends over the last 20 years. We have tried to make comparisons between times when a lot of Lariam was being prescribed and times when not a lot of Lariam was being prescribed, such as now, because we do not currently have many troops in sub-Saharan Africa. The trends do not change hugely. It is tragic that people take their own lives for all sorts of very complex reasons. If there are links with the drugs they have been taking, then they need to be exposed, but there is no settled agreement on whether Lariam, for example, has permanent side-effects.

Clare Daly (Dublin North, United Left)
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There is.

Simon Coveney (Cork South Central, Fine Gael)
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No, there is not. I asked that very direct question of our Chief Medical Officer. Rather than jumping to conclusions and making political decisions to be popular, I am trying to make decisions on the basis of the best medical advice I can get, both nationally and internationally, just like in the UK-----

Michael Kitt (Galway East, Fianna Fail)
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Minister, I have to go on to the next question.

Simon Coveney (Cork South Central, Fine Gael)
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Despite the inquiries that are being made at the moment, the policy in the UK has not changed-----

Michael Kitt (Galway East, Fianna Fail)
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Thank you. I call Deputy Mick Wallace.

Simon Coveney (Cork South Central, Fine Gael)
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-----in terms of using Lariam to protect their troops, and is the Deputy suggesting-----

Michael Kitt (Galway East, Fianna Fail)
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We are going on to Other Questions now.

Simon Coveney (Cork South Central, Fine Gael)
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-----that they are not looking to protect their troops from Lariam in the UK?

Michael Kitt (Galway East, Fianna Fail)
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We are way over time. I call Deputy Mick Wallace. Members should please observe the clock.