Brendan Ryan (Dublin Fingal, Labour)
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41. To ask the Taoiseach and Minister for Defence if he is examining the benefits of the drug doxycycline as a potential replacement for Lariam as an anti-malaria drug; and if he will make a statement on the matter. [33830/16]

Fiona O'Loughlin (Kildare South, Fianna Fail)
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46. To ask the Taoiseach and Minister for Defence his views on making Lariam the drug of last resort when prescribing anti-malarial medication for members of the Defence Forces; and if he will make a statement on the matter. [33849/16]

Brendan Ryan (Dublin Fingal, Labour)
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47. To ask the Taoiseach and Minister for Defence the medical basis, and any other basis, on which he chooses to continue the use of the anti-malaria drug Lariam for the Defence Forces; and if he will make a statement on the matter. [33827/16]

Paul Kehoe (Wexford, Fine Gael)
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I propose to take Questions Nos. 41, 46 and 47 together.

The health and welfare of the men and women of the Defence Forces is a high priority for both myself and the Defence Forces.

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.  It is a serious threat to any military force operating in the area.

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 (contra-indications, underlying health conditions, purpose of travel), the duration of travel and adherence issues.

The United Nations recent Medical Support Manual 2015, which is 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 chemoprophylaxis should be used but rather makes reference to the World Health Organisation (WHO) International Travel and Health Handbook for the latest information on malaria chemophylaxis.

The WHO Handbook provides for a range of anti-malarials which includes mefloquine (Lariam). The WHO Handbook notes that there are specific contraindications and possible side-effects for ALL anti-malarial drugs. I am advised that the Defence Forces Medical Policy on the use of malaria chemoprophylaxis (including the use of Lariam) is in line with the United Nations (UN) and World Health Organisation (WHO) guidelines.

The choice of medication for overseas deployment for both officers and enlisted personnel, including the use of Lariam, 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.  Significant precautions are taken by 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 medical fitness for service overseas and medical suitability to be prescribed the necessary malaria chemoprophylactic agent.

There are three anti-malarial drugs, in use in the Defence Forces, Lariam (Mefloquine); Malarone and Doxycycline.

In the case of Doxycycline and Malarone, I am advised there are specific reasons as to why they are not the drug of choice for use by the Defence Forces on typical deployments in sub-Saharan Africa.

Doxycycline has to be taken in the absence of dairy products for maximum efficacy. It can cause troublesome, mainly gastrointestinal side-effects, it can also produce sun-sensitivity skin rashes (akin to severe sun burn) in some individuals. This is particularly significant when used in very sunny climes.

Malarone:Up to September 2012, Malarone was only licensed for up to 28 days continuous use and was not an option as the usual duration of deployment for the Defence Forces is 6 months. The 28 day limit was removed in September 2012. However there is limited evidence as to the safety and effectiveness of Malarone usage for longer periods. On this basis the Defence Forces policy, to use Malarone up to the 27 day limit, remains unchanged. It should be noted that the majority of Defence Forces deployments to sub-Saharan Africa are for periods exceeding 28 days.

In the context of a military environment, the dosing regimen is also a considering factor. Lariam has the advantage of being taken weekly, minimising the dangers of a missed dose exposing the individual to contracting malaria. Doxycycline and Malarone have to be taken daily. Missing a daily dose can expose the individual to higher risk of contracting malaria. This is why Lariam is, in most circumstances, the drug of choice within the available options that minimises the risk of contracting malaria in sub-Saharan Africa where the predominant species of malaria is the virulent Plasmodium Falciparum. However, it should be noted that in Afghanistan, Doxycyline is the anti-malarial chemoprohphylactic agent of choice where the predominant species of malaria is the less virulent Plasmodium Vivax.

In this context and having regard to the constraints associated with the alternative drugs, this is why we do not deploy personnel in the first instance who have shown a sensitivity or contraindication to Lariam to sub-Saharan Africa.

However, if for operational reasons it was imperative that an individual deploy immediately without the normal “lead-in” time which is required for Lariam, or an individual who had previously demonstrated sensitivity to Lariam, or had a contraindication to its use, who had a specific skills set which was fundamental to mission success, then one of the other alternative medications would be used.  The risk to benefit ratio is a determining factor in recommendations from the Director of Medical Branch permitting use of these medications.

If during the course of deployment, an individual developed sensitivity to Lariam, he/she would be advised to cease taking the medication and substitute it with a “second line” chemprophylactic agent. The individual would continue to be monitored and ultimately if serious enough, repatriation could be necessary.

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.

There are no plans 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.

Paul Murphy (Dublin South West, Anti-Austerity Alliance)
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42. To ask the Taoiseach and Minister for Defence if he will report on discussions held with PDFORRA regarding the ongoing use of Larium; and if he will make a statement on the matter. [33819/16]

Paul Kehoe (Wexford, Fine Gael)
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At the request of PDFORRA, officials from my Department and the Director of the Defence Forces Medical Branch recently met with PDFORRA to outline the medical policy in relation to the use of malaria chemoprophylaxis in the Defence Forces.

I am advised, as were PDFORRA, that the Defence Forces Medical Policy on the use of malaria chemoprophylaxis (including the use of Lariam) is in line with the United Nations (UN) and World Health Organisation (WHO) guidelines.

The use of and the information on medications is kept under ongoing review. There are no plans to withdraw Lariam from the range of anti-malarial medications available to the Defence Forces.