Clare Daly (Dublin Fingal, Independent)
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18. To ask the Taoiseach and Minister for Defence further to Parliamentary Question No. 683 of 18 October 2016, if he will address allegations that members of the Defence Forces not only did not receive a face to face consultation to assess their suitability to take Lariam but in some cases Lariam was also prescribed to persons who had a history of anxiety and depression recorded on their written medical files. [33809/16]

Clare Daly (Dublin Fingal, Independent)
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This again relates to the use of Lariam and the fact that it is widely known and was for decades that certain people should not be prescribed it. What is the response of the Minister of State to many members of the Defence Forces who state they did not have a face to face consultation to assess their ability to take Lariam? In this sense, what they are stating is the State did not protect their interests and failed in its duty of care to them.

Paul Kehoe (Wexford, Fine Gael)
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The Deputy is aware that there is ongoing litigation in respect of the use of Lariam in the Defence Forces, to which the Minister for Defence is the defendant. As I have previously outlined, the State Claims Agency is managing these claims on behalf of the Department. The Deputy will appreciate that I cannot discuss allegations about the screening or prescribing of Lariam, where matters are the subject of ongoing litigation.

However, the military authorities have assured me that significant precautions are taken by Defence Forces medical officers in assessing the medical suitability of members of our Defence Forces to take any anti-malarial medications. It is the policy of the Defence Forces that personnel are individually screened for medical fitness for overseas service and medical suitability to be prescribed the necessary malaria chemoprophylactic agent.

Malaria is a serious disease which killed approximately 438,000 people in 2015, with 90% of deaths occurring in sub-Saharan Africa, as reported by the World Health Organisation. There are three anti-malarial drugs in use in the Defence Forces, namely, Lariam, Malarone and Doxycycline. The United Nations recent medical support manual 2015, which is intended to serve as a standard reference document on medical support aspects of United Nations peacekeeping operations and political missions in the field, provides that anti-malarial medicines can be used to prevent malaria. It does not make any recommendations as to which malaria chemoprophylaxis should be used but rather references the WHO international travel and health handbook for the latest information on malaria chemoprophylaxis.

The WHO handbook provides for a range of anti-malarials which includes Lariam, Malarone and Doxycycline. The WHO handbook notes that there are specific contraindications and possible side effects for all anti-malarial drugs. I am advised that Defence Forces medical policy on the use of malaria chemoprophylaxis, including the use of Lariam, is in line with these United Nations and World Health Organisation guidelines.

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 in terms of contra-indications, underlying health conditions, purpose of travel, etc., the duration of travel, the mission operational profile and adherence issues.

Mefloquine, or Lariam, is one of the drugs listed for use by the WHO in its international travel and health handbook. Of the options available, Defence Forces medical policy has identified Lariam as the drug which in most circumstances, having regard to the nature and duration of operational deployments, minimises the risk to Irish personnel of contracting malaria in sub-Saharan Africa. As I have previously indicated, there are specific contra-indications to its use and personnel must be individually screened for suitability.

Defence Forces medical policy also provides for Malarone and Doxycycline to be used in sub-Saharan Africa, in specific circumstances. The potential usage of these alternative options is carefully considered having regard to the individual in question, the specific circumstances of the mission, the operational imperative for deployment of the individual, constraints associated with the drug and the overall risk profile. The risk to benefit ratio is a determining factor in recommendations from the director of medical branch permitting use of these medications.

The choice of medication for overseas deployments, for both officers and enlisted personnel, 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. The use of, and the information on, medications is kept under ongoing review by medical professionals within the Defence Forces.

I assure the Deputy that the health and welfare of the men and women of the Defence Forces remain a high priority for myself and the Defence Forces.

Clare Daly (Dublin Fingal, Independent)
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On the one hand the Minister of State says he cannot say anything as it is the subject of litigation but he then says there is nothing to see here and that we should move on. He is missing the point that sworn public testimony has been given, by one member of the Defence Forces after another, in which they categorically state that the guidelines issued with regard to the prescription of this type of medication were not followed. Defence Forces personnel did not receive face-to-face consultation and in many instances medical records, which were available to the Defence Forces and gave information of mental health issues, were not taken into account before the soldiers were prescribed Lariam.

The Minister of State repeated, verbatim, the standard line we got from his predecessor, Deputy Coveney, that everything was grand and there had been an assessment but what steps he has taken to verify that what he says is the case as against the sworn testimonies of others which state the complete opposite?

Paul Kehoe (Wexford, Fine Gael)
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As the Deputy is aware, a number of cases of litigation are taking place at the moment and I will not comment on individual cases or who had or did not have face-to-face consultations. The military authorities have assured me that significant precautions are taken by Defence Forces medical officers in assessing the medical suitability of members of the Defence Forces to take any anti-malaria medication. I understand that to be face-to-face consultation.

The first priority is the health and welfare of the men and women of the Defence Forces who are serving abroad. The death rate figures for malaria are startling - some 438,000 in 2015 alone in sub-Saharan Africa. That is not a risk I want to take. I depend on the advice given to me by the chief medical officer of the Irish Defence Forces.

Clare Daly (Dublin Fingal, Independent)
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Malaria can be effectively combatted by other prescription medication than Lariam, and most defence forces organisations around the world choose other drugs. I pose these questions against the background of Ireland remaining an exception in continuing to use Lariam.

The Minister of State should realise that the health effects suffered by the loyal members of our Defence Forces are real. They include acute depression, suicidal thoughts and many cases of suspected suicide and severe mental health problems as a result of taking this medication. Is the individualised medical risk assessment a policy paper? Does the Department actually have any evidence that it is taking place? Are records kept on file of the risk assessments? How does the Minister of State square what he says with the fact that people can give evidence that their prior medical history, which was known to the Defence Forces, was not accessed with a view to protecting them from Lariam when it clearly should have been?

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I accept that the Minister of State takes this issue seriously but the same institution that is reassuring him is the one that would be liable if found to be negligible, as other armies around the world are finding out with medical officers and chiefs of staff who gave directions on Lariam being held to be negligent. I ask the Minister of State to take it so seriously that he goes beyond the medical advice from the institution in question.

Brendan Ryan (Dublin Fingal, Labour)
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The Minister of State's reply is that he is relying on advice from the chief medical officer but I ask him to arrange a face-to-face meeting between the chief medical officer and spokespersons in this House, so that we can discuss the issues that regularly come up and will continue to come up.

Paul Kehoe (Wexford, Fine Gael)
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The choice of medication for overseas deployments for both officers and enlisted personnel is a medical decision taken by the medical officers. Deputy Ó Snodaigh spoke of the chief of staff giving me advice but the chief of staff also depends on advice from the chief medical officer, who has the qualifications to give it. Each individual is screened before they go to sub-Saharan Africa to ensure Lariam is suitable for them. If they do suffer side effects steps are taken. If they are abroad the medication can be changed and they are screened on an ongoing basis.