Clare Daly (Dublin North, United Left)
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94. To ask the Minister for Defence to set out the process used for selecting anti-malaria drugs for use in the Defence Forces and the precise reason Lariam was selected despite the obvious faults in the drug with regard to the dangers of increased risk of suicide for users. [43330/14]

Simon Coveney (Cork South Central, Fine Gael)
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The Health Product Regulatory Authority (HPRA) formerly the Irish Medicines Board is the statutory authority with responsibility for the quality, safety and efficacy of medicines in Ireland. The Defence Forces Medical Corps is advised that the three anti-malarial medications licensed by the HPRA – Lariam (mefloquine), Malarone and Doxycycline – can all have significant side effects and protocols are in place to control the risk of side effects in individuals.

Each of the three drugs has been used by the Defence Forces, depending on individual circumstances including the type of malaria in the destination, the duration of travel, etc. Where malaria has been identified as a risk in a particular mission area, the choice of chemoprophylaxis is dependent on a number of factors including the type of malaria in the destination, resistance to particular drugs, the profile of the traveller (contra-indications, underlying health conditions, purpose of travel), the duration of travel and adherence issues. The choice of medication is a medical decision made by Medical Officers in the Defence Forces on the basis of best international practice having regard to the specific circumstances of the mission and the individual member of the Defence Forces.

I am advised that the Defence Forces follow policy in line with current HPRA guidelines, in prescribing Lariam. It is the policy of the Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability, i.e. a medical risk assessment for Lariam is carried out on an individual basis. This is intended to rule out personnel from overseas service with certain conditions, e.g. depression, anxiety, pregnancy, neurodegenerative disorders etc. which, as has been indicated by the Health Product Regulatory Authority, are more likely to precipitate serious adverse reactions to Lariam.

I am advised that the allegation of a link between Lariam and suicide / suicide ideation has been examined. Of 156 non-service related deaths among members of the Defence Forces in the period January 2000 to December 2010, 25 were apparently from self-inflicted injuries, although only one is recorded by a coroner as “suicide”. Of these 25 deaths, 16 had never been prescribed Lariam. Of the remaining 9, given the limited period of time during which Lariam remains in the bloodstream, according to our expert advice, it is extremely unlikely that Lariam could have been a contributory factor in practically all of these cases. There is no evidence in any of the coroners’ inquests linking any deaths to Lariam.

The death rate in the Defence Forces from self-inflicted injuries in the period 2000 to 2010, when Lariam was being prescribed, was 0.24%. The death rate from self-inflicted injuries in the period 1989 – to 1999, when Lariam was not being prescribed, was 0.32% which is higher than the death rate in the period when Lariam was being prescribed.

Former Ministers for Defence have had the various concerns surrounding the use of Lariam investigated thoroughly and obtained the advice of leading medical experts, who concur with the prescribing practices followed by the Defence Forces.