Tuesday, 17 December 2019
Ceisteanna - Questions (Resumed) - Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
Defence Forces Medicinal Products
53. To ask the Taoiseach and Minister for Defence the action he has taken further to the motion passed unopposed in Dáil Éireann on 28 June 2017 which instructed his Department, along with others, to draw up a plan of action to help alleviate and address ongoing concerns regarding the anti-malaria drug Lariam issued to military personnel serving on overseas missions in sub-Saharan Africa. [52726/19]
What action, if any, has the Minister of State taken on foot of the Dáil motion, passed unopposed on 28 June 2017, which instructed him to draw up a plan of action to help alleviate and address the problems of people who are affected by the anti-malaria drug Lariam, which is given to Defence Forces personnel acting overseas on behalf of this country, in particular in parts of Africa?
As I indicated to the Deputy in response to the Private Members' motion of 28 June 2017 regarding the anti-malarial drug Lariam, the use of anti-malarial drugs is a medical matter to be decided by medical professionals. In the Defence Forces, these are matters for highly qualified medical officers having regard to the specific circumstances of the mission and the individual member of the Defence Forces.
There are three anti-malarial drugs, namely Lariam, Malarone and Doxycycline, used by the Defence Forces. The selection by a medical officer of the most appropriate drug for use is a complex one and dependent on a number of factors. Significant precautions are taken by the medical officers in assessing the medical suitability of personnel to take any of the anti-malarial medications. It is the policy of the Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability for all missions and not just those to sub-Saharan Africa.
As the Deputy will be aware, the second report of the malaria chemoprophylaxis working group was completed in 2017. This report set out a number of recommendations relating to planning, training and education, information-sharing and for the establishment of a medical advisory group. An implementation group has been established and is progressing these recommendations.
The intent is that the medical advisory group will further inform internal and external expert medical advice to the Defence Forces on a range of medical matters, including malaria chemoprophylaxis. This will provide further supports in the ongoing evolution of Defence Forces medical policy. These actions will ultimately serve to enhance further the existing medical care provided to all members of the Defence Forces, including those posted overseas.
In addition to access to a wide range of primary care supports, a number of other supports are provided to members of the Defence Forces. For example the personnel support service makes confidential services, including critical incident stress management and psycho-social support available to all Defence Forces personnel through its network of barrack personnel support service officers and occupational social workers at formation, unit and barrack level.
In addition, my Department has arranged the provision of a confidential counselling, referral and support service on a wide range of personal and work-related issues for serving members of the Defence Forces.
Does the Minister of State believe he and the military authorities are acting undemocratically given that the Dáil, with the exception of the Fine Gael Party, passed a motion instructing him to take action to help alleviate and address the suffering of those who have had an adverse effect because Lariam was issued to them while overseas? A "yes" or "no" response will suffice.
The Minister of State referenced medical experts in his reply. On 30 September 1989 the World Health Organization warned that the new anti-malaria drug Mefloquine, which is Lariam, may cause severe mental disturbance and other psychiatric or neurological side effects and that airline pilots and others whose jobs involve fine co-ordination and spatial discrimination should not use Mefloquine to prevent malaria. It went on to say that there were reports of 300 of several thousand patients having experienced neurological and psychiatric side effects associated with the drug. That was stated by the WHO in 1989. I have been raising the issue in this House since 2010. The Minister of State has continued to allow the military authorities to use a drug which is no longer for sale in this State and has been withdrawn by many other military authorities throughout the world.
I have reminded the Deputy on numerous occasions that one of the reasons Lariam is no longer manufactured here is that Roche pulled out of Ireland for economic reasons. Medical policy in the Defence Forces is monitored constantly and reviewed when deemed appropriate. I understand the Deputy's point regarding the Private Members' motion but it would be irresponsible of me as Minister of State for Defence to go against the medical advice I am being given by the professionals within the Defence Forces. The director of the medical branch, DMB, advises the general staff on matters of medical policy in the Defence Forces. His instructions further provide policy guidelines on medical and ethical issues in the Defence Forces and to medical officers. Medical officers in the Defence Forces operate in accordance with the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners. We are working in line with the UN and the WHO.
If a branch of the State is causing hurt to citizens it is the duty of Deputy Kehoe, as Minister of State at the Department of Defence and a Member of Cabinet, to step in and protect them. This has been happening since I first raised this issue in 2010 and probably prior to that. The Minister of State said that it is his job to heed medical advice. The European Medicines Agency report of 2014 states that there is enough evidence from the presented drug safety reports and the submitted literature report and the US Food and Drug Administration, FDA, assessment report supporting a casual relationship between Mefloquine, which is Lariam, and the occurrence of long-lasting and persistent neuro-psychiatric side effects. This, too, is medical advice. I also quoted the WHO earlier. When will the Minister of State take action to prevent citizens within the Defence Forces being prescribed the poison known as Lariam which is causing them long-term damage, psychiatrically and neurologically? At this stage, the Minister of State has had sufficient warning. On his head be it if people continue to die, as they have, as a result of this drug.
As stated in my initial reply, medical policy in the Defence Forces is monitored constantly and reviewed when appropriate. I have been given the advice by military authorities, namely, the director of the medical corps, that this is the most appropriate drug when required. Prescription is dependent on the needs of the person and the mission in which he or she is participating. I hope that the Deputy understands that I am restrained in what I can say today as there are a number of litigation cases ongoing, two of which have been settled and another of which has been withdrawn by the plaintiff. It would be inappropriate for me not to accept the medical advice I have been given by the director of the medical corps.