Clare Daly (Dublin Fingal, Independent)
Link to this: Individually | In context | Oireachtas source

974. To ask the Taoiseach and Minister for Defence further to Parliamentary Questions No. 308 of 2 June 2016, 88 of 21 January 2016 and 1950 of 16 September 2016, his plans to update the Defence Forces' data management systems such that important data regarding Defence Forces prescribing practices and their outcomes and consequences are available for analysis. [26909/16]

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am informed by the military authorities that, historically, information in relation to specific medication prescribed to each individual is retained in the individual’s paper medical file. In July 2016 the Defence Forces introduced an electronic records system to enable details of all medical treatment given to individual members to be electronic ally recorded . The Deputy will appreciate that this database of medical information is only being populated from that date onwards and it will necessarily be some time before sufficient electronic information exists to allow meaningful statistical information to be obtained from the new system .

I am informed that there is a plan to record summarise past medical information contained on individuals’ paper medical files on the new system on a gradual basis and as circumstances allow.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

975. To ask the Taoiseach and Minister for Defence the number of officers or soldiers treated for the side effects of Lariam and the cost of same in the past ten years. [27336/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

977. To ask the Taoiseach and Minister for Defence the way in which it is determined whether Malarone or doxycycline, is issued to soldiers instead of the preferred drug Larium (mefloquine). [27338/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

980. To ask the Taoiseach and Minister for Defence if alternative anti-malaria drugs, such as Malarone or doxycycline, were prescribed as a matter of course instead of Lariam (mefloquine) to soldiers of all ranks or just some ranks who were scheduled to be deployed in sub-Saharan Africa; and the medical criteria which was used to decide not to prescribe Lariam in individual cases or in case of certain ranks. [27341/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

981. To ask the Taoiseach and Minister for Defence if cost was routinely or ever a factor when choices were being made by the Defence Forces medical staff when deciding which anti-malaria drug was to be prescribed for soldiers to be deployed in sub-Saharan Africa since 2005. [27342/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

982. To ask the Taoiseach and Minister for Defence if an explanation was ever given as to the reason the determination was reached that Lariam was to be the drug of choice for soldiers being deployed abroad in Sub-Saharan Africa; if the determination has been reviewed since; and the reason thereof, especially in view of other countries military authorities no longer prescribing Lariam due to concerns of its lasting side effects. [27343/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

983. To ask the Taoiseach and Minister for Defence the countries which the military authorise and still regard Lariam as the prescribing drug of choice to be issued to units of deploying soldiers. [27344/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

984. To ask the Taoiseach and Minister for Defence the number of persons who have died of malaria annually for the past ten years and the age profile of same [27345/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

985. To ask the Taoiseach and Minister for Defence if Lariam is prescribed to soldiers deploying to Afghanistan; if the strain of malaria there, the frequency of administering the tablets or the sensitivity of skin to the sun were factors when deciding which anti-malaria drug to issue to deploying soldiers heading to Afghanistan. [27346/16]

Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 975, 977 and 980 to 985, inclusive, together.

The health and welfare of the men and women of the Defence Forces is a priority for both myself and the Defence Forces. 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 the individual member of the Defence Forces. Cost of medication and or the rank of an individual are not considerations in prescribing anti-malarial medication.

Significant precautions are taken by the Defence Forces Medical Officers in assessing the medical suitability of members of our Defence Forces 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.

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. I am advised by the military authorities that they are not aware of any serving member of the Defence Forces dying from malaria in the past ten years.

I am advised that information in relation to side effects or illnesses contracted by Defence Forces Personnel including instances of malaria is maintained on each individual’s medical file. There is no way of providing the exact information sought by the Deputy without examining every medical record of each member who served overseas . With in the existing resources available, this is not feasible.

With regard to Afghanistan, Lariam was not the recommended first line chemoprophylactic agent for Irish Defence Force personnel when they were serving there. The Deputy may wish to note that Defence Forces personnel are no longer serving in Afghanistan. As I have indicated, 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 the individual member of the Irish Defence Forces. 

Deployments to Sub-Saharan Africa require the use of an anti-malaria regime. The Defence Forces, Director of the Medical Branch’s current advice, guidance and policy in relation to malaria chemoprophylaxis is that in the case of sub-Saharan Africa, Lariam is the agent of first choice. In special circumstances the other agents may be used. For example, if for operational reasons it was imperative that an individual deploy immediately without the normal ‘lead-in’ time which is required for Lariam, then one of the other alternative medications should be used. Equally, if an individual who had a specific skill set which was fundamental to mission success and either had previously demonstrated sensitivity to Lariam, or had a contraindication to its use in the first place, then that individual would receive derogation from the ‘normal’ policy and be placed on another medication. If during the course of deployment, an individual developed sensitivity to Lariam, he/she would desist from Lariam and be placed on an alternative. In all the examples above, the basic principle remain the same – it revolves around the balance struck between the requirements of the particular mission and patient safety.

As a result of its extended half-life in the blood, Lariam is taken on a weekly basis rather than on a daily basis. This has two direct and significant consequences. Firstly, a weekly medication facilitates compliance. Secondly, even if a dose is missed by 24 hours, there is still a residual quantity of the active ingredient in the blood which gives a certain degree of protection. If, however, one of the daily medications is missed by 24 hours, the patient is immediately susceptible to malaria. Prevention of disease for military personnel serving overseas is of the utmost importance. In addition, a peace keeping or peace enforcing military force has to prepare for all eventualities. The military activity of a force is dictated, not so much by a clock or calendar, but by the operational tempo at any given time. Such a reality creates difficulty in abiding by a daily dosing regimen. This is a fact of life which differentiates the civilian office worker or tourist from the deployed soldier. Thus the weekly medication provides some mitigation against the unforeseen and unpredictable aspect of overseas service. This is one of the reasons why Lariam remains the medication of choice in malaria chemoprophylaxis for Defence Forces personnel deployed to Sub Saharan Africa.

While there are other agents available, their use is associated with an increased risk of contracting malaria as indicated above. Therefore, subject to the special circumstances listed above, an individual who can take Lariam is selected in preference to one who cannot take Lariam because of the lesser risk to the individual and, by extension, to the mission. There are, however, circumstances when the demands of the mission justify this increased risk.

As I have already indicated, significant precautions are taken by Irish Defence Forces Medical Officers in assessing the medical suitability of members of our 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 Deputy will be aware that a Working Group is currently reviewing developments arising in relation to the use of malaria chemoprophylaxis. This work has included further engagement with international experts and I anticipate that it will finalise its second Report shortly.

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 the information on medications is kept under ongoing review. Anti-malarial medications, including Lariam, remain in the formulary of medications prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions, to ensure that our military personnel can have effective protection from the very serious risks posed by this highly dangerous disease.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

976. To ask the Taoiseach and Minister for Defence the number of Malarone and doxycycline tablets issued to both officers or soldiers by the Defence Forces since 2012. [27337/16]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

978. To ask the Taoiseach and Minister for Defence the number of tablets of Lariam (Mefloquine) issued to both officers or soldiers by the Defence Forces since 2012. [27339/16]

Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 976 and 978 together.

The health and welfare of the Defence Forces is a priority for both myself and the Defence Forces. As the Deputy is aware that there are three anti-malarial drugs in use by the Defence Forces, namely Lariam (mefloquine), Malarone and Doxycycline. The choice of medication for overseas deployment, 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 member of the Irish Defence Forces. Rank is not a consideration.

Significant precautions are taken by the Defence Forces Medical Officers in assessing the medical suitability of members of our Defence Forces 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.

I am advised by the military authorities that the following table reflects the number of Lariam (Mefloquine), Doxycycline and Malarone tablets issued to either officers or enlisted personnel in the Defence Forces since 2012.

Number of tablets issued to either officers or enlisted personnel in the Defence Forces since 2012:

*In addition, the Deputy should note that I have been advised that Doxycycline medication is used for a variety of ailments, and is not solely used as an anti malarial.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

979. To ask the Taoiseach and Minister for Defence if the Representative Association of Commissioned Officers, RACO, had complained on behalf of its members to military authorities regarding serious side effects of the anti-malaria mefloquine drug Lariam; if his Department was aware of the issues they raised as far back as 2005; and if RACO raised concerns with the military authorities or directly with previous Ministers and if so when [27340/16]

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am advised that at present there are no concerns or issues from the Representative Association of Commissioned Officers (RACO) to the Military Authorities with respect to the use of Lariam. I am also advised that back in 2005 the use of Lariam was discussed as part of a general briefing in the wider context of medical provisions for overseas deployments, specifically the Liberia theatre of deployment. Such enquiries and debriefs are routine in nature and are not considered to be complaints.