Priority Questions

Defence Forces Medicinal Products

Seán Ó Fearghaíl


1. Deputy Seán Ó Fearghaíl asked the Minister for Defence his views regarding the concerns expressed regarding lariam; and if he will make a statement on the matter. [36050/13]

I apologise for my late arrival in the Chamber. Lariam is one of the most effective medications for protection against the type of malaria prevalent in sub-Saharan Africa. Malaria is a serious disease that kills approximately 1 million people per year in sub-Saharan Africa alone. It is a serious threat to any military force operating in the area. The anti-malaria regime in place in the Defence Forces, including the use of lariam, has worked. In the decade of deployment to sub-Saharan Africa by the Defence Forces, not a single member of the Defence Forces has died from malaria and there are only three documented cases of personnel getting malaria.

The Irish Medicines Board, IMB, is the statutory body that regulates medicines available in Ireland. I am advised the three anti-malarial medications licensed by the IMB, namely, lariam or mefloquine, malarone and doxycycline all can have significant side effects. The assertion that any one is automatically a more effective or safer alternative to the others is a grossly misleading oversimplification. 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 and so on.

I am further advised the Defence Forces are fully aware of the range of reported side effects attaching to all anti-malarial medications. Protocols are in place to control the risk of side effects in individuals. 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 six 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. The position is currently being reviewed by the Medical Corps of the Defence Forces.

The Minister had the various allegations surrounding the use of lariam investigated thoroughly and has obtained the advice of leading medical experts, who concur with the prescribing practices followed by the Defence Forces.

Additional information not given on the floor of the House

On 1 July 2013, the Irish Medicines Board and Roche Products (Ireland) issued a letter to all general practitioners, GPs, concerning lariam. The Director of the Defence Forces Medical Corps, DMC, has circulated the letter to all medical officers. The DMC is considering its content and whether it has policy implications. lariam remains licensed by the IMB and must remain in the formulary of medication prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions, particularly those in sub-Saharan Africa. This is necessary to ensure military personnel can have effective protection from the serious risks posed by this highly dangerous disease.

This may be the last opportunity Members will have to pay tribute to the outgoing Chief of Staff, Lieutenant General Seán McCann, on his three years at the helm, his outstanding work and on his career and lifetime commitment to the Defence Forces, as well as to welcome the appointment of Major General Conor O'Boyle. The former Minister for Defence, Tony Killeen, confirms this was an excellent choice. I also welcome the appointment of Mr. Maurice Quinn as Secretary General of the Department of Defence and wish Mr. Michael Howard well. I also wish to note to the Minister of State this is the second occasion out of four in which the Minister for Defence has not been present for Question Time. While accepting that any Minister can be called away, I note today, the defence questions were switched with the justice questions. Consequently, it appears as though the Minister is anxious to be present for questions on justice but not so anxious to be present for questions on defence and that, in effect, defence plays a lesser role for him, which I regret.

On the issue of lariam, I am conscious that Ministers drawn from my party gave precisely the same reply the Minister of State has just given and that the Minister, Deputy Shatter, has given in the past. However, the growing concern about lariam across the developed world is such that the Defence Forces must re-examine the issue. They must consider it and not simply give Members stock-in-trade answers, which is what they have been getting for several years. Instead, they must revisit this particular issue. Some pretty clear evidence exists that there is a direct link between the use of lariam as a treatment or as a preventative medicine for malaria and psychotic incidents and incidences of suicide.

I had intended to make these remarks at the conclusion of Question Time but I join Deputy Ó Fearghaíl in wishing Lieutenant General Seán McCann, his wife and his family a happy retirement, as well as welcoming the incoming Chief of Staff, Major General Conor O'Boyle. I also wish Mr. Michael Howard and his wife the very best in retirement and I wish the incoming Secretary General of the Department, Mr. Maurice Quinn, the best of luck.

The Deputy acknowledged that when his party was on this side of the House, previous Ministers also gave precisely the same answer. However, they were giving answers based on the best medical advice available to them at that time, and I am citing the very same medical advice that has been given to the Government at this point. This advice comes from the Irish Medicines Board and is that lariam is the best medication available to combat the form of malaria that obtains in sub-Saharan Africa. I note that everyone is a professional in his or her own field and the Government has received advice from such professionals, in that the best medical advice available to it is that lariam is the safest medication on hand.

Things are changing and new expertise is being brought to bear on these particular issues. I believe Deputy Mac Lochlainn may have referred to this when he raised the matter recently but the "Prime Time" programme found recently that there is a higher incidence of suicide in soldiers or Defence Forces personnel returning from overseas duty and that there can be a link drawn perhaps between the use of lariam and those events. One should consider what is happening in the United States, where highly reputable medical experts now are raising questions about the continued use of this drug.

We are all aware of how dangerous malaria is, but we are also conscious of the fact that other products can be used the side effects of which are less nefarious than the side effects of lariam appear to be. I say that as someone who took lariam some years ago.

The allegation of a link between lariam and suicide and suicidal ideation has been examined. Of 156 non-service related deaths among members of the Defence Forces in the period January 2000 to December 2009, 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 nine, 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%, and the death rate from self-inflicted injuries in the period from 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. To say suicide or suicidal ideation is due to lariam is not true. The Department and the Defence Forces have the medical evidence to support that statistic.

Overseas Missions

Pádraig MacLochlainn


2. Deputy Pádraig Mac Lochlainn asked the Minister for Defence if he will provide an update on the possible ending of the triple lock mechanism prior to Irish Defence Forces participating in overseas missions. [36427/13]

The statutory authority for the despatch of contingents of the Permanent Defence Force for service overseas as part of an international force is set out in section 2 of the Defence (Amendment) (No. 2) Act 1960, as amended by the Defence (Amendment) Act 2006. This provision is commonly referred to as the “triple lock”. However, personnel may be deployed for training, for humanitarian operations and for other such reasons, under the authority of the Government in accordance with the provisions of the Defence (Amendment) Act 2006, which formalised arrangements in this regard.

Ireland’s policy in regard to the triple lock was most recently underpinned by the adoption by the people of the Lisbon treaty in 2009. Ireland’s act of ratification of the Lisbon treaty was reinforced by the associated national declaration which states “that the participation of contingents of the Irish Defence Forces in overseas operations, including those carried out under the European common security and defence policy requires (a) the authorisation of the operation by the Security Council or the General Assembly of the United Nations, (b) the agreement of the Irish Government, and (c) the approval of Dáil Éireann, in accordance with Irish law”.

The White Paper on defence, which was published in 2000, has provided the policy framework for defence for the past 13 years. In the period since its publication, there have been significant changes in the defence and security environment and the defence policy framework has continued to evolve. In this context, the Government decided there is a requirement to prepare a new White Paper on defence. This will provide the policy framework for defence for the next decade. A Green Paper on defence was published last Tuesday. It will initiate a broad public consultative process which will provide for members of the public and interest groups to input their views as part of the process of developing the new White Paper on defence.

In this context, the Green Paper will engender discussion on all relevant matters, including the triple lock. The Green Paper states that the approval procedures that govern the despatch of contingents of the Permanent Defence Force on overseas peace support operations, commonly known as the “triple lock”, comprise three requirements, namely, the authorisation of the UN, the Government and the Dáil.

Additional information not given on the floor of the House

The legislative basis for the participation by the Permanent Defence Force in overseas peace support operations as part of an “International United Nations Force” was originally provided for by the Defence (Amendment) (No. 2) Act 1960. The legal provisions were updated in 1993 to permit participation in Chapter VII of the UN Charter - UN mandated operations mounted under this chapter are commonly known as “peace enforcement” operations or missions - and again in 2006 to take account of developments in peace support, including the UN’s increased reliance on regional organisations, such as the EU, the North Atlantic Treaty Organisation, NATO, and the African Union, AU. The requirements of the triple lock were formally set out in Ireland’s national declaration associated with the ratification of the Lisbon treaty.

The requirement for a UN resolution as part of the triple lock reflects the central importance of the UN in granting legitimacy to peace support and crisis management missions. At the same time, it also constitutes a self-imposed, legal constraint on the State’s sovereignty in making decisions about the use of its armed forces. This could prevent the State from participating in a peace support operation. In 2003, the EU-led peace support mission EUFOR Concordia in the Former Yugoslav Republic of Macedonia was welcomed in UN resolution 1371 in terms that did not conform to the requirements of the Defence Acts at that time. Accordingly, Ireland could not participate in the mission. The benefits of a formal legislative requirement for UN authorisation must be weighed against the possibility that this constraint may lead to an inability to act on occasions where there is a pressing moral or security imperative and overwhelming international support to do so, but where UN sanction is not forthcoming in circumstances where a veto is exercised by a permanent member of the Security Council acting in its own national interests.

It is acknowledged that there is substantial public support for the triple lock mechanism and that, in practical terms, due to the size of our Defence Forces, the State only has a limited capacity to contribute to UN missions. In real terms Ireland has, in the context of its size, punched above its weight and made a valuable, disproportionate contribution and, save for the example of the Former Yugoslav Republic of Macedonia, has not been excluded from peacekeeping engagements by the triple lock. On balance, the advantages of retaining the mechanism can be seen as outweighing the disadvantages. Having said that, it is an issue worthy of discussion in advance of the adoption of a new White Paper.

Eight members of our Defence Forces were deployed to Mali without any debate in this House because the number was below the threshold of 12 troops. The Minister will know the concerns that were expressed about that, given the track record of the Malian Government, its army and the human rights issues there. Today, we had 60 minutes to discuss the deployment of 150 Irish troops to the Golan Heights and the very significant concerns about their safety, considering that the Austrian Government withdrew its troops from the same region due to safety concerns after the removal of sanctions on weapons being provided to Syrian rebels.

We should be involved in peacekeeping, in which we have a proud legacy. We are proud of our troops in Lebanon and elsewhere, but they must be in blue helmet operations. There must be more debate and discussion. In my supplementary question I will return to some suggestions I have about the triple lock.

As I said in my reply, the Green Paper was published last Tuesday and there is a paragraph in it on the triple lock in respect of overseas deployment. The Join Committee on Justice, Defence and Equality will discuss the Green Paper. I will talk to the Chairman of the committee, Deputy David Stanton, about ensuring the committee allocates time for a debate on it. Perhaps that can be done when the Dáil resumes early in September. It will provide an opportunity to all Members to have a say.

With regard to the motion we discussed this morning about sending a mission to the Golan Heights, when considering any mission, we consider the ability to protect the health and safety of our personnel going abroad. Of course, some form of danger faces every mission going abroad. We must be realistic about that. They are peacekeepers and they are going to dangerous situations, but the best advice available to us is from the Chief of Staff. He says the Irish Defence Forces will be willing and able to combat any situation out there and will be able to do the job the UN has tasked us with doing.

We would argue that the triple lock of the UN, the Government and the Dáil is really a double lock because the Government of the day obviously has a majority in the Dáil, as was the case today. It is really a UN and Government decision. The difficulty, as we have seen, is that not all UN Security Council resolutions are implemented consistently. It is certainly not consistent. The Government needs to add another lock. The Minister referred to the Joint Committee on Justice, Defence and Equality. We would argue that the committee is the fourth lock, or a quadruple lock. It could bring in experts on the region. We could do this quickly. We could convene in an emergency, even during the recess. The members could all come in, as that is their responsibility. We could invite experts on the war situation and relevant civil society groups and have a detailed, informed debate. They could make their presentations to the committee, the committee could formulate its opinion and submit it to the Government prior to these debates, which are basically people reading out statements about an issue as important as the safety of our troops. We will make this submission on the Green Paper when the opportunity arises over the recess. We would argue for strengthening the debate and discussion. We could do it as an emergency and get everyone together. However, we should make that happen before we carry out that deployment.

As I stated this morning, the Minister for Defence will consider a detailed threat assessment from the Defence Forces to ensure the security of personnel before any deployment takes place to UNDOF. He will reassess the situation on an ongoing basis.

I would welcome a submission from Sinn Féin or any party in advance of the White Paper. I accept what Deputy Mac Lochlainn said about the Government having a majority on this side of the House. I do not wish to be flippant, but that is democracy. Any decision the Government, the Department of Defence or the Dáil makes is not taken lightly. Everything was taken into consideration. The safety of our troops going to the Golan Heights was a paramount consideration. Our aim is to make sure they return home safely. However, there are dangers on every mission.

The members of the Defence Forces understand that they may be obliged to deploy in dangerous situations. All we can do is hope and pray that they return home safely.

The Deputy who tabled Question No. 3 is not present so we will proceed to Questions Nos. 4 and 5, which are being taken together.

Question No. 3 lapsed.

To clarify, will we each be given the same amount of time in which to pose supplementary questions?

As a result of the fact that two questions are being taken together, the time for each Deputy will be doubled. The Minister of State will have four minutes in which to make his reply and there will then be eight minutes for supplementary questions. Each intervention subsequent to the Minister of State's original contribution will be limited to one minute.

Green Paper on Defence

Seán Ó Fearghaíl


4. Deputy Seán Ó Fearghaíl asked the Minister for Defence when the Green Paper on defence will be published; and if he will make a statement on the matter. [36051/13]

Pádraig MacLochlainn


5. Deputy Pádraig Mac Lochlainn asked the Minister for Defence if he will provide an update on the long awaited Green Paper on defence; the timescale for the publication of the final White Paper on defence; and if he will make a statement on the matter. [36428/13]

I propose to take Questions Nos. 4 and 5 together.

Ireland's first White Paper on defence was published in 2000. In the intervening period there have been significant changes in the defence and security environment with the emergence of new and complex security challenges. In that context, the Government decided that there is a requirement to prepare a new White Paper on defence. In order to engender wider engagement in the development of a new White Paper on defence, my colleague, the Minister for Defence, initiated the preparation of a Green Paper on defence. Following Government approval, the Minister was very pleased to publish the Green Paper on Tuesday, 16 July 2013. The purpose of the Green Paper is to inform and encourage members of the public and other interested parties to consider and submit their views, which will be taken into consideration in the preparation of a new White Paper on defence. The Green Paper contains a comprehensive overview of our current defence policy framework and the changes that have taken place since the publication of the first White Paper on defence. It also includes an assessment of future challenges in the defence and security environment.

A broad range of issues must be examined in developing a new White Paper on defence. For example, we must consider the types of capabilities that should be maintained having regard to likely future operational requirements and available resources. We must reflect on our approach to collective security co-operation to ensure that it will continue to meet emerging requirements. This will be determined against the backdrop of our policy of military neutrality, our membership of the United Nations, our participation in the EU's Common Security and Defence Policy and our long tradition of international peacekeeping. In that context, the Green Paper sets out a number of focused policy questions to aid submissions.

The Green Paper does not aim to be prescriptive. It seeks to encourage active consideration of defence matters and to elicit views as to how we should address defence and security challenges in the coming years. Details on how members of the public and other interested parties can submit their views are set out in the Green Paper. The Minister is confident that this consultative process will better inform the development of the new White Paper on defence. It is anticipated that the latter will be submitted to Government for approval by mid-2014.

On a number of occasions I raised with the Minister for Defence the fact that carrying out a fundamental restructuring of the Defence Forces in advance of the publication of the Green Paper was something of a farce. In any event, the Green Paper has been published and it is welcome. We look forward to making contributions to the debate on it. The triple lock has quickly emerged as one of the key issues in the context of the Green Paper. This is because the Minister, Deputy Shatter, has clearly put it up for discussion. I do not believe the Minister was a Member of the House in 2004 when Fine Gael tabled a motion calling for the abolition of the triple lock. The Minister of State was probably here at that time and he probably voted in favour of the motion. Abolishing the triple lock was obviously an important part of Fine Gael policy because it was included in a policy document - Beyond Neutrality - which the party produced.

Perhaps the Minister of State might provide the answer to a riddle. On Wednesday, the Taoiseach came before the House in the aftermath of the publication of the Green Paper and indicated that there is no question whatsoever about the triple lock and that, in fact, it is as safe as houses. If that is the case, what is the value of the discussion process relating to the Green Paper? In the context of a document produced by the Minister for Defence, the Taoiseach, who is the Head of Government, has stated that the triple lock is not going to be dismantled. It appears that the decision has already been made - I am happy with it - before the discussion in which the Minister for Defence has decided we should engage has even begun. Will the Minister of State explain how this situation arose?

I was on the Fine Gael Front Bench when the motion to which the Deputy refers was debated. There would be no harm is engaging in a healthy debate on the triple lock. I welcome the fact that it is going to be discussed by all branches of the Defence Forces, the relevant committee, the political parties, etc. This issue has been raised not just by Fine Gael but also by other political parties over a long period. If we had not included reference to the triple lock in the Green Paper, Deputy Ó Fearghaíl would have said that we were hiding something. The best course of action, therefore, was to include it. I am of the view that it is worthy of discussion prior to the formulation of the new White Paper. I have no doubt that the Minister, Deputy Shatter, will set out his views - and those of the Government - on the triple lock at the relevant committee or perhaps in the Dail later in the year. I ask that the various spokespersons on defence read the Green Paper, which contains some very good material. The triple lock is one of the matters to which reference is made in the Green Paper and it will be up for debate.

As Deputy Ó Fearghaíl indicated, it is remarkable that a complete and radical restructuring of the Permanent Defence Force and the Reserve Defence Force has taken place and that we are now being presented with a Green Paper on the future of those very forces. Perhaps there might be an opportunity to revisit the restructuring and our submission on the Green Paper will certainly contemplate that matter.

The issue on which I wish to focus is neutrality. As Deputy Ó Fearghaíl correctly pointed out, some years ago the Minister of State's party produced an alarming document, Beyond Neutrality, which was launched by Gay Mitchell MEP, who was then a Member of these Houses. Some of the comments made by the Minister, Deputy Shatter, in respect of our neutrality - these were reported in NATO Review and the interview in which he made them is available online - are alarming. I wish to make it clear to the Minister of State that we are very proud of our policy of neutrality. It is a positive form of neutrality which does not involve sitting on the fence but which does allow us to play our role. On a per capita basis, this State is one of the best contributors of overseas aid. The influence this country has in proportion to its size is remarkable. We are proud of our peacekeepers who wear the blue helmets of the UN in regions across the globe. However, we do not want to be part of a growing NATO alliance. We do not need to be part of such an alliance. We can instead play to our strengths and intervene in human rights situation and act as advocates in the context of challenging regimes on their human rights records. We can also involve ourselves in the area of conflict resolution. The Government must clearly affirm our pride in our neutrality, particularly as it has been eroded somewhat as a result of what has happened at Shannon Airport in recent times and on foot of events surrounding the operation in Mali. Will the Minister of State outline his thoughts on that matter?

I should have replied to what Deputy Ó Fearghaíl said in respect of the Minister, Deputy Shatter, putting the cart before the horse. We were obliged to restructure the Defence Forces as a result of the state the country's finances were in when the Deputy's party left power.

The Minister of State should not be repeating that old hogwash.

We were faced with a situation whereby we could either not recruit personnel or else have plenty of barracks but with no one stationed in them. The Minister, Deputy Shatter, and the Government made the correct decision when they decided to deal with the issue of recruitment. It was the Deputy's party which suspended the recruitment of personnel for the Defence Forces. In line with a commitment it made, the Government has seen to it that new recruits were taken on at the end of last year and the beginning of this year in order to ensure that the number of personnel in the Defence Forces remains at 9,500. All going well, there will be a further recruitment process at the end of the year.

Deputy Mac Lochlainn referred to neutrality. Fine Gael produced what was more of a discussion document - as opposed to a policy document - on neutrality when it was in opposition. Neutrality, the triple lock and other issues must all be discussed and we cannot ignore them for long periods.

That area of neutrality and the Government's intention in that respect would be part of the Green Paper in preparation for the White Paper.

Is there anything else in the Green Paper that has been predetermined? What the Minister of State said is at variance with what the Taoiseach said, namely, that the triple lock was not for changing. The Minister included it for consideration and the Minister of State is telling us, contrary to what the Taoiseach said, that it is up for consideration and that submissions will be welcome on it. Are there any other issues in this Green Paper that have been predetermined by the Taoiseach, or by the Minister for Defence or are there any further insights the Minister of State can give us into the issue?

The final sentence of section 2.7 of the Green Paper, which deals with overseas deployment and the triple lock mechanism, states that this is an issue worthy of discussion in advance of the adoption of a new White Paper. That sets out clearly the Government's intentions regarding the triple lock. It is stated in this document that we want it to be debated and to get people's views on it. We will provide the opportunity for people to express their views on it. If the Government and the Department of Defence had published the Green Paper this week and omitted the area of the triple lock, the Deputy would be jumping up and down today asking why we did not include it. We are providing an opportunity for everybody to have their say once and for all. The preparation of the White Paper will be for the next decade for the Irish Defence Forces as they move forward. This is an area on which we must have a discussion. I am not disagreeing or agreeing with the Taoiseach in this respect but what I am saying is that the Deputy will have an opportunity to have a discussion, as will I and the Defence Forces, be it PDFORRA or whoever, on the area of the triple lock in preparation for the White Paper.

Will the Minister of State dissociate himself from the comments made by the Minister, Deputy Shatter, in that interview around the irrelevance of neutrality in Ireland? It is bad enough that our neutrality has been eroded, but can the Minister of State make it clear that the Government has no plans to remove neutrality and that he will send a clear message to that effect to the Secretary General of NATO who expressed his desire for Ireland to join, quite disrespectfully, when he was here some time ago?

I am not going to dissociate myself from any comments that the Minister, Deputy Shatter, made. As I said to Deputy Ó Fearghaíl, we have an opportunity to discuss the area of neutrality and many other issues will be addressed in the discussions around the Green Paper in preparation for the new White Paper. That will give everyone an opportunity to debate the issues and then we will find out what is the best policy as we move forward. I understand the Deputy has his views and we have our views. I have no doubt there are many other varying views inside and outside the House on these issues.