The Deputy is aware that there is ongoing litigation in respect of the use of Lariam in the Defence Forces, to which the Minister for Defence is the defendant. As I have previously outlined, the State Claims Agency is managing these claims on behalf of the Department. The Deputy will appreciate that I cannot discuss allegations about the screening or prescribing of Lariam, where matters are the subject of ongoing litigation.
However, the military authorities have assured me that significant precautions are taken by Defence Forces medical officers in assessing the medical suitability of members of our Defence Forces to take any anti-malarial medications. It is the policy of the Defence Forces that personnel are individually screened for medical fitness for overseas service and medical suitability to be prescribed the necessary malaria chemoprophylactic agent.
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 Organization. There are three anti-malarial drugs in use in the Defence Forces, namely, Lariam, Malarone and Doxycycline. The United Nations recent medical support manual 2015, which is intended 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 malaria chemoprophylaxis should be used but rather references the WHO international travel and health handbook for the latest information on malaria chemoprophylaxis.
The WHO handbook provides for a range of anti-malarials which includes Lariam, Malarone and Doxycycline. The WHO handbook notes that there are specific contraindications and possible side effects for all anti-malarial drugs. I am advised that Defence Forces medical policy on the use of malaria chemoprophylaxis, including the use of Lariam, is in line with these United Nations and World Health Organization guidelines.
Additional information not given on the floor of the House
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 in terms of contra-indications, underlying health conditions, purpose of travel, etc., the duration of travel, the mission operational profile and adherence issues.
Mefloquine, or Lariam, is one of the drugs listed for use by the WHO in its international travel and health handbook. Of the options available, Defence Forces medical policy has identified Lariam as the drug which in most circumstances, having regard to the nature and duration of operational deployments, minimises the risk to Irish personnel of contracting malaria in sub-Saharan Africa. As I have previously indicated, there are specific contra-indications to its use and personnel must be individually screened for suitability.
Defence Forces medical policy also provides for Malarone and Doxycycline to be used in sub-Saharan Africa, in specific circumstances. The potential usage of these alternative options is carefully considered having regard to the individual in question, the specific circumstances of the mission, the operational imperative for deployment of the individual, constraints associated with the drug and the overall risk profile. The risk-to-benefit ratio is a determining factor in recommendations from the director of medical branch permitting use of these medications.
The choice of medication for overseas deployments, 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 members of the Defence Forces. The use of, and the information on, medications is kept under ongoing review by medical professionals within the Defence Forces.
I assure the Deputy that the health and welfare of the men and women of the Defence Forces remain a high priority for myself and the Defence Forces.