Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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40. To ask the Taoiseach and Minister for Defence if the medical service of the Defence Forces is continuing to prescribe the anti-malarial drug Lariam for members of the Defence Forces; and if he will make a statement on the matter. [23306/17]

Clare Daly (Dublin Fingal, Independent)
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74. To ask the Taoiseach and Minister for Defence further to Parliamentary Question No. 1459 of 2 May 2017, the current position regarding the prescribing of Lariam to the Defence Forces; the reason there is no plan at this time to withdraw Lariam from the range of anti-malarial medications available to the Defence Forces; and if he will make a statement on the matter. [23972/17]

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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My question is to ask the Taoiseach and Minister for Defence if the medical service of the Defence Forces is continuing to prescribe the anti-malarial drug Lariam for members of the Defence Forces, and if he could make a statement on the matter.

Paul Kehoe (Wexford, Fine Gael)
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I propose to take Questions Nos. 40 and 74 together.

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 Organization, it is a serious threat to any military force operating in the area. Anti-malarial medications, including Lariam, remain in the formulary of medications prescribed by the medical corps for Defence Forces personnel on appropriate overseas missions. This is to ensure that our military personnel can have effective protection from the very serious risk posed by malaria. Significant precautions are taken by the Irish Defence Forces and medical officers in assessing the medical suitability of members of the 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 service overseas and medical suitability. The objective is to ensure that our military personnel can have effective protection from the very serious risk posed by malaria. The health and welfare of the Defence Forces are a priority for me. The choice of medication for overseas deployment, including the use of Lariam, is a medical decision made by the medical officers in the Defence Forces, having regard to the specific circumstances of the mission and the individual member of the Irish Defence Forces. I am advised that the policy of the Defence Forces on the use of malaria chemoprophylaxis, including the use of Lariam, is in line with United Nations and World Health Organization guidelines.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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We have all known for some time that the use of the drug has caused, and still causes serious, problems for members of our Defence Forces. These are views that have been expressed by both current and retired members of the Defence Forces. Serious concerns have been raised for many years about the use of Lariam as an anti-malarial drug for members of the Defence Forces serving in Africa and in other areas where malaria is a problem. There have been serious indications that the drug can cause the risk of mental health problems. It is a huge issue. Last year, the British Ministry of Defence acknowledged that 1,000 ex-servicemen and women are suffering severe psychiatric and mental health problems as a result of being prescribed Lariam. Similarly, in 2013, an RTE investigation suggested there is a three to five times increased risk of suicide among Defence Forces personnel who have been prescribed the drug.

Clare Daly (Dublin Fingal, Independent)
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Despite the Minister of State's statements, he is not in line with anything. He is substantially out of step with best international practice in this regard by continuing to prescribe this dangerous and discontinued drug as the first line of defence in providing anti-malarial vaccinations and assistance. He is just teeing up the State for massive payouts and damages in the future. The case for removing Lariam is probably iron-clad at this stage. Other jurisdictions have moved in that direction, and the Minister of State is lagging behind. His response on 2 May seemed to indicate that because we have a stockpile of the drug, we might as well use it and let it run out. That is completely wrong for members of the Defence Forces. It is completely out of sync with the majority of Deputies in this House who have signed a motion to say that this drug should be discontinued.

I ask the Minister of State to rethink a step that is not in keeping with the thinking of this House and best international practice.

Paul Kehoe (Wexford, Fine Gael)
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As I stated in my original reply, I am advised by the Defence Forces' medical policy that the use of malaria chemoprophylaxis is in line with United Nations and World Health Organization guidelines. I have listened to the views of the Deputies on a number of occasions. However, I have been informed by management of the Defence Forces organisation that Lariam is the most appropriate medication for the missions in which we participate in Mali and sub-Saharan Africa. It is the medication that fights malaria, a serious disease that killed approximately 438,000 people in 2015. The advice I have received is the best possible from the Defence Forces. I am not a medical doctor, as I have stated in the House on numerous occasions. I do not have the medical knowledge to disregard the advice I have been given.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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Is it not extraordinary that the Defence Forces continue to use Lariam when the chairman of Roche, the company that manufactures it, has said its use against malaria is no longer necessary? Dr. Franz Humer is on record as saying science has advanced considerably since Lariam was introduced and that there are more effective anti-malarial drugs available with reduced side-effects. Surely the Defence Forces should be using such drugs. Lariam has been withdrawn from sale in Ireland. Its side-effects can be very severe and include anxiety, depression, paranoia and suicidal behaviour. Fifty serving and former members of the Defence Forces have lodged claims against the State, as Deputy Clare Daly mentioned. The Government is teeing itself up for further claims against the State. Legal proceedings have been served in 37 cases. Surely the game is up for Lariam.

Clare Daly (Dublin Fingal, Independent)
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The Minister of State's is now a lonely voice. I remind him of the hepatitis C scandals in the 1990s. In 1991 the Blood Transfusion Service Board was alerted to the fact that a batch of anti-D produced in 1977 might have been contaminated, but despite the alert, it continued to use it and the women were not given any information. The slip-ups were repeated and nothing was done. We are in danger of repeating that tragedy. It took a mother, Ms Brigid McCole, in taking a case against the State to rectify the matter. I remind the Minister of State that despite all of the digging of heels, the State ended up paying out €1 billion, including associated legal costs, in meeting 4,500 claims in the hepatitis C scandal. This is happening on his watch. Does he want to ruin the lives of Defence Forces' personnel and put them into a similar position to Ms McCole? Does he want to ruin his own reputation, just as the reputation of the present Minister with responsibility for NAMA, Deputy Michael Noonan, was impacted on by his treatment of Ms McCole? We must own up to our mistakes, discontinue the use of this failed drug and remove it now.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I will be very brief. There are other drugs available. Most other armies operating in sub-Saharan Africa use doxycycline or Malarone, in particular. Has the Minister of State ever asked the Health Products Regulatory Authority to peer review the use of Lariam by military services around the world, given that it is a number of years since it was first introduced? In recent times the vast majority of military forces operating in such areas have switched from the use of Lariam because of the effects it has on their troops.

Paul Kehoe (Wexford, Fine Gael)
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There are no plans to withdraw Lariam from the range of anti-malarial medications available to members of the Defence Forces. As I have indicated, it remains in the formulary of medications prescribed by the medical corps for Defence Forces personnel on appropriate overseas missions to ensure they have effective protection against the very serious risks posed by malaria. The use of and the information on the medication is kept under ongoing review.

Deputy Niamh Smyth spoke about Roche. My understanding is it pulled out of Ireland for commercial reasons and absolutely no other reason. It stated as much when it pulled out of Ireland in late 2015 or some time in 2016.

Deputy Clare Daly has stated that I said there was a large stock of Lariam in the Defence Forces and that that was the only reason we were using it. We are using it because it has been prescribed by the medical corps of the Defence Forces. That is the best available advice I have been given by the Defence Forces.

Clare Daly (Dublin Fingal, Independent)
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The Minister of State needs to get some new advice. This will be his legacy.

Paul Kehoe (Wexford, Fine Gael)
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The advice is that it is the best anti-malarial drug available for use by members of the Defence Forces.