Tuesday, 27 September 2016
Defence Forces Medicinal Products
27. To ask the Taoiseach and Minister for Defence if his attention has been drawn to the fact that the former head of the British army (details supplied) has apologised to British troops who were given the controversial anti-malarial drug Lariam; his views on Irish troops continuing to be prescribed Lariam; and if he will apologise to serving and former members of the Defence Forces who were prescribed Lariam. [27135/16]
It is only very rarely that one hears me comment - it is usually in the negative - on British army officers, especially those who served in the North. However, given the comments last month of a former commander-in-chief of the British Army, Mr. Richard Dannatt, who apologised to British soldiers for being in charge when Lariam was prescribed for those operating in sub-Saharan Africa, will the Minister of State consider taking a similar stance, given that former Ministers for Defence, including Tony Killeen, Deputy Éamon Ó Cuív, Brian Cowen, Alan Shatter and Deputy Simon Coveney, as well as the Taoiseach, did not do so when I raised the matter with them?
I am aware of newspaper reports that a former senior UK military officer has apologised to British troops who were given the anti-malarial drug Lariam. The choice of malaria drugs in use by other armed forces is an internal matter for those forces. It would not be appropriate for me to comment on the policy and practices of other states in this regard or to engage in discussion on the merit of those policies and practices. The health and welfare of the men and women of the Defence Forces are high priorities for me and the Defence Forces. Malaria is a serious disease which killed approximately 438,000 people in 2015, with 90% of the deaths occurring in sub-Saharan Africa, as reported by the World Health Organisation.
The choice of medication for overseas deployment is a medical decision made by medical officers in the Defence Forces having regard to the specific circumstances of the mission and individual member involved. Lariam remains in the formulary of medications prescribed by the medical corps for Defence Forces personnel on appropriate overseas missions to ensure our military personnel can have effective protection against the very serious risks posed by malaria. It is notable that in the period of deployment to malarious areas not a single member of the Defence Forces has died from malaria. Significant precautions are taken by Defence Forces medical officers in assessing the medical suitability of members of the Defence Forces to take any anti-malarial medication. It is the policy of the Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability. There are no plans at this time to withdraw Lariam from the range of anti-malarial medications available to the Defence Forces. The use of and information on medications is kept under ongoing review.
In 2013 a working group investigated all of the various issues surrounding the use of Lariam and obtained advice from leading medical experts. These experts concurred with the practices followed by the Defence Forces in prescribing Lariam. This was outlined in the working group's report which remains legally privileged.
Nobody has died from malaria on operations, but how many have died by suicide because of the effects of Lariam? A study has been conducted of suicides in the Defence Forces.
I have a note taken from the medical records of one of the soldiers who operated overseas. It states the evidence presented in the report establishes a reasonable degree of medical certainty that the person's earlier symptoms of depression were the result of the person's initial intoxication by Lariam and that the person is now suffering from a range of chronic neurological and psychiatric symptoms, including seizure disorder, as well as persistent symptoms of disordered balance, dizziness, anxiety, paranoia, trouble in sleeping and cognitive dysfunction that, to a reasonable degree of medical certainty, were caused as a direct result of the neurotoxic effects of Lariam. The Minister of State cannot have soldiers operating while being prescribed Lariam in the way that has happened in the Defence Forces. Will he instruct the military authorities to re-examine this matter and concentrate on using more expensive drugs such as Malarone or dioxolane which are available in abundance but which seem to be issued to officers rather than non-commissioned officers?
While it is hoped the risk of developing an adverse reaction to a medication will diminish with time, there is no guarantee that this will happen.
One could certainly develop an adverse reaction to penicillin for no obvious reasons, having taken it for years. Where the medical officer forms the opinion that an individual has developed a sensitivity to Lariam while overseas, the individual will be advised to cease taking the medication and substitute it with another agent. The individual would be monitored to ensure that symptoms subside. Appropriate anti-systemic medication may be required in the interim and appropriate restrictions would be placed on duties. Ultimately, if serious enough, repatriation may be necessary if the medical officer felt that the individual was either not responding satisfactorily or that the symptoms are so severe as to require treatment not readily available in the mission area. An individual's file will indicate that the individual has developed sensitivity to Lariam so that it should not be prescribed again. If the individual's circumstances permit completion of the tour of duty, monitoring can be arranged on return to Ireland if required.
Choice of medication for overseas deployment, including the use of Lariam, is a medical decision made by the medical officer in the Defence Forces. I am satisfied, as Minister of State with responsibility for defence, that Lariam is the most suitable drug for overseas missions.