Other Questions
6Deputy Denis Naughten asked the Minister for Defence the scale of redeployment of Defence Forces personnel which will be required to facilitate the restructuring of the Defence Forces organisation to a two brigade structure; and if he will make a statement on the matter. [29851/12]
View answer8Deputy Denis Naughten asked the Minister for Defence his plans for the restructuring of the Defence Forces organisation, including plans to reduce the number of brigades; the implications that this will have for Custume Barracks, Athlone, County Westmeath; and if he will make a statement on the matter. [29850/12]
View answerI propose to take Questions Nos. 6 and 8 together.
As the Deputy is aware, arising from the Government's comprehensive review of expenditure, the strength ceiling of the Permanent Defence Force was reduced to 9,500 personnel. In response to this reduced strength ceiling, I initiated a major re-organisation of the Defence Forces, both permanent and reserve. This re-organisation will encompass a reduction in the number of Army brigades from the current three to two. A three brigade structure was no longer viable within a reduced strength ceiling of 9,500 personnel.
The priority is on maintaining the operational effectiveness of the Permanent Defence Force to the greatest extent possible within this reduced strength ceiling. This will be achieved through rationalising administrative and support functions and rebalancing force elements. As I have previously outlined, I requested the Chief of Staff and the Secretary General to bring forward proposals for my consideration. It had been my stated preference to await the submission of final proposals before making any announcements.
Unfortunately, I found it necessary to clarify the position with regard to Custume Barracks to dispel the ongoing campaign of misinformation and misleading speculation which suggested falsely that the removal of the brigade headquarters would result in some 600 personnel being withdrawn from the barracks. I have recently clarified that the two new brigades will have their headquarters located in Cork and Dublin. I have again confirmed that Custume Barracks will not be closed and that within an overall strength of 9,500, the reorganisation will see numbers serving in Custume Barracks remaining in the order of 1,000 personnel. This firmly rebuffs the misinformation regarding the impact of the withdrawal of the brigade headquarters from Custume Barracks.
Despite my reassurances that the numbers based in the barracks will not be reduced by any significant margin, it has been incorrectly stated, in this House and elsewhere, that this decision represents a loss of 400 jobs from Custume Barracks. This is without foundation and misleading. The strength ceiling of the PDF is 9,500 and it is impossible to lose jobs that simply are not there. There are not 1,400 personnel based in Athlone; no such number were based there during the life of the previous Government and Custume Barracks, as presently constituted, could not accommodate such numbers.
Given the scale of the re-organisation, there will be movement of functions and personnel within and between barracks. As with any reform or reorganisation, individuals may be concerned about the potential impact upon them. Any changes arising will be encompassed within the scope of the broader public service reform programme and Croke Park agreement.
The Secretary General of the Department of Defence and the Chief of Staff are continuing their work to finalise proposals on the re-organisation. I look forward to receiving and considering these final proposals. The Deputy will appreciate that I will not be in a position to answer further questions regarding the re-organisation until this process is complete. Nevertheless, I felt it important to clarify the position on brigade headquarters last week because the misinformation in the constituency is causing upset generally in Athlone and was unfair to members of the Defence Forces and their families.
I thank the Minister for his response. Can the Minister confirm approximately 200 staff currently based in Athlone will have to be redeployed to other barracks around the country because of the bizarre decision to downgrade Custume Barracks? On 31 January in a parliamentary reply to me, the Minister stated there were 937 personnel in Custume Barracks, both civilian and military, and it was projected that figure would increase by 278 when Mullingar and Cavan Barracks closed. The commitment is now that there will be an additional 63 personnel in Custume Barracks. The Minister has received the report from the Secretary General and the Chief of Staff. Did that report recommend the downgrading of Custume Barracks in Athlone and did it recommend that 1,000 personnel would be maintained in Athlone?
The interim report from the Chief of Staff and the Secretary General of the Department recommended the brigade headquarters would be based in Cork and Dublin. I was interested in the Deputy's figures. He asked if 200 members currently based in Athlone will be transferred along with their families. In the context of the reorganisation, no one will lose his job. There are no figures to indicate 200 members of the Defence Forces based in Athlone will be moved from there. The effect of the reorganisation will be that there will be approximately 1,000 members remaining in the barracks in Athlone. It is as simple as that.
From time to time, however, members of the Defence Forces are transferred from one barracks to another or they assume new duties or are promoted and as a consequence there is always movement within the Defence Forces. It would be quite extraordinary if the 1,000 who are there today, including 34 currently on international duty, were never to move out of Athlone. The position is that there will not be 500 or 600 members of the Defence Forces moved out of the barracks in Athlone. The exact modalities for implementing the reorganisation are a continuing part of the discussion between the Chief of Staff and my Secretary General involving those working under them. I look forward to receiving their final report and the position remains that the future of Custume Barracks is absolutely secure and the barracks will continue to play an important role in the western region.
The figures the Deputy mentioned were up to the end of February, when there were various changes as members resigned. The position as I described it was that there were just over 900 on 9 March 2011 based in the barracks. The numbers then changed as a consequence of retirements and transfers from Mullingar to Cavan and from Mullingar to Athlone and from Cavan to Athlone. The correct figure now is 1,050. It could be 1,052 because the world changes on a daily basis in the Defence Forces and the bottom line in all of this is that when the reorganisation is implemented, there will be in or around 1,000 individuals based in the barracks. There might be one day when there are 1,002 individuals and 999 the next day because there is always some level of movement between barracks, which is why I am constantly saying "in or about", but that does not mean "in or about" will be dramatically different from 1,000.
I regret people have been misinformed and there has been a campaign of misinformation and lobbying by some individuals on this matter. I must have regard to the interests of the country and the operational effectiveness of the Defence Forces.
I thank the Minister for his response to my questions. The Minister has answered them all, bar one: did the interim report recommend in or about 1,000 personnel to maintained in Custume Barracks, Athlone? Does the Minister agree, based on a back of the envelope calculation, that approximately 650 staff will be based in each of the five barracks in the Northern Brigade? If 1,000 personnel will be based in Custume Barracks, Athlone, one of the other four barracks within the brigade will lose out. That does not take into account the number required for brigade headquarters staffing. The figures do not add up and I ask the Minister to clarify them. He stated during the previous Question Time that he did not want to pre-empt a decision by the chief of staff and his Secretary General. He has done that by making the announcement for whatever reason. The people of Athlone are disappointed that the barracks is losing brigade status and that the 4th Western Brigade is being lost from the barracks and they want answers to these questions.
The figures I used are the same as those used by the Minister's backbench colleagues. One of them said he was tired of the Government using the midlands "as a kicking post". This is the first time in Athlone's history the barracks will be without a brigadier general. Seán MacEoin was the first brigadier general there.
Was a cost benefit analysis conducted? If so, will he publish same? He failed, despite repeated questioning earlier and on Midlands 103 last Friday morning - he gave me numerous mentions for which I thank him - to outline which units will remain and which will be transferred. He is unable to say which units will remain and, therefore, I do not know how he can guarantee the 1,000 jobs. Will he apologise to the people of Athlone because they did not consider this to be a good news story for the town? Will the meet the members of Athlone Town Council? The mayor, Councillor Alan Shaw, is a colleague of the Minister's and he has requested a meeting but has so far failed to get a reply.
The Minister's figures are all over the shop, as Deputy Naughten said. In reply to a parliamentary question, the Minister said the number based in the barracks is 937 and he expected that to increase by more than 270 to give a total of 1,215, but earlier he said the total number would be 1,050. I do not know whether he knows the figure.
The reason there are more Army personnel in Custume Barracks after a year of Fine Gael in government is it closed Columb Barracks, Mullingar.
The Deputy is a little confused. He cannot make up his mind about how many personnel he wants stationed in Athlone. I would have thought in the context of the town that the important issue is that approximately 1,000 personnel will be based in the barracks, which is 100 more than were there when we took office on 9 March 2011. Those members and their families contribute to the town's economy. I do not imagine that those engaged in business in the town are losing sleep about whether a brigadier general will be based in the barracks.
Businesses all over the country have sleepless nights because of the lack of support from the Government.
Allow the Minister to continue without interruption.
I did not interrupt the Deputy and perhaps he will do me the courtesy of not interrupting me. It is a great pity the Deputy ran a grossly misleading campaign. He first told people that 600 members would be transferred out of the barracks and, second, he laboured under the illusion that 1,400 personnel were based there. I presume he did not go to the barracks to count them because if he did, he has a serious problem with his arithmetic.
By all accounts, the Minister did not either.
The Deputy would not have had as many people at his public meeting if he announced it was a public meeting to ensure that forever more a brigadier general would be based in Athlone. I say that with the greatest respect for the current brigadier general but there is an inordinate concern as to where he should be posted. The important thing for the town is that the future of the barracks is secure and approximately 1,000 members of the Defence Forces will be based there.
Can the Minister answer the questions?
The misinformation that went around the area was such that I felt the need to clarify the position with regard to the location of brigade headquarters and to give assurances that there would be no substantial reduction in personnel, as was being stated.
In the context of the question Deputy Naughten asked, I will not second guess the ongoing work and I will not go around each barracks to announce how many individuals will be based in them. I am concerned to ensure that the process the chief of staff and those under him, together with my Secretary General and those assisting him in my Department, are engaged in continues and is completed; that changes to be announced are properly communicated to members of the Defence Forces in individual barracks; and that we engage with the Defence Forces representatives organisations. It was unfortunate that, because of the type of campaign run by Deputy Troy, we had to make the announcement we made but we felt it was important because the rumours going around and the campaign run by him, which was playing politics with the Defence Forces, were causing a great deal of concern unfairly to those members based in Athlone.
Says the man who gave an instruction not to invite Opposition Members to the Air Corps launch.
Will the Minister clarify that the chief of staff made the recommendation to station 1,000 personnel in Athlone?
6Deputy Denis Naughten asked the Minister for Defence the scale of redeployment of Defence Forces personnel which will be required to facilitate the restructuring of the Defence Forces organisation to a two brigade structure; and if he will make a statement on the matter. [29851/12]
View answer8Deputy Denis Naughten asked the Minister for Defence his plans for the restructuring of the Defence Forces organisation, including plans to reduce the number of brigades; the implications that this will have for Custume Barracks, Athlone, County Westmeath; and if he will make a statement on the matter. [29850/12]
View answerI propose to take Questions Nos. 6 and 8 together.
As the Deputy is aware, arising from the Government's comprehensive review of expenditure, the strength ceiling of the Permanent Defence Force was reduced to 9,500 personnel. In response to this reduced strength ceiling, I initiated a major re-organisation of the Defence Forces, both permanent and reserve. This re-organisation will encompass a reduction in the number of Army brigades from the current three to two. A three brigade structure was no longer viable within a reduced strength ceiling of 9,500 personnel.
The priority is on maintaining the operational effectiveness of the Permanent Defence Force to the greatest extent possible within this reduced strength ceiling. This will be achieved through rationalising administrative and support functions and rebalancing force elements. As I have previously outlined, I requested the Chief of Staff and the Secretary General to bring forward proposals for my consideration. It had been my stated preference to await the submission of final proposals before making any announcements.
Unfortunately, I found it necessary to clarify the position with regard to Custume Barracks to dispel the ongoing campaign of misinformation and misleading speculation which suggested falsely that the removal of the brigade headquarters would result in some 600 personnel being withdrawn from the barracks. I have recently clarified that the two new brigades will have their headquarters located in Cork and Dublin. I have again confirmed that Custume Barracks will not be closed and that within an overall strength of 9,500, the reorganisation will see numbers serving in Custume Barracks remaining in the order of 1,000 personnel. This firmly rebuffs the misinformation regarding the impact of the withdrawal of the brigade headquarters from Custume Barracks.
Despite my reassurances that the numbers based in the barracks will not be reduced by any significant margin, it has been incorrectly stated, in this House and elsewhere, that this decision represents a loss of 400 jobs from Custume Barracks. This is without foundation and misleading. The strength ceiling of the PDF is 9,500 and it is impossible to lose jobs that simply are not there. There are not 1,400 personnel based in Athlone; no such number were based there during the life of the previous Government and Custume Barracks, as presently constituted, could not accommodate such numbers.
Given the scale of the re-organisation, there will be movement of functions and personnel within and between barracks. As with any reform or reorganisation, individuals may be concerned about the potential impact upon them. Any changes arising will be encompassed within the scope of the broader public service reform programme and Croke Park agreement.
The Secretary General of the Department of Defence and the Chief of Staff are continuing their work to finalise proposals on the re-organisation. I look forward to receiving and considering these final proposals. The Deputy will appreciate that I will not be in a position to answer further questions regarding the re-organisation until this process is complete. Nevertheless, I felt it important to clarify the position on brigade headquarters last week because the misinformation in the constituency is causing upset generally in Athlone and was unfair to members of the Defence Forces and their families.
I thank the Minister for his response. Can the Minister confirm approximately 200 staff currently based in Athlone will have to be redeployed to other barracks around the country because of the bizarre decision to downgrade Custume Barracks? On 31 January in a parliamentary reply to me, the Minister stated there were 937 personnel in Custume Barracks, both civilian and military, and it was projected that figure would increase by 278 when Mullingar and Cavan Barracks closed. The commitment is now that there will be an additional 63 personnel in Custume Barracks. The Minister has received the report from the Secretary General and the Chief of Staff. Did that report recommend the downgrading of Custume Barracks in Athlone and did it recommend that 1,000 personnel would be maintained in Athlone?
The interim report from the Chief of Staff and the Secretary General of the Department recommended the brigade headquarters would be based in Cork and Dublin. I was interested in the Deputy's figures. He asked if 200 members currently based in Athlone will be transferred along with their families. In the context of the reorganisation, no one will lose his job. There are no figures to indicate 200 members of the Defence Forces based in Athlone will be moved from there. The effect of the reorganisation will be that there will be approximately 1,000 members remaining in the barracks in Athlone. It is as simple as that.
From time to time, however, members of the Defence Forces are transferred from one barracks to another or they assume new duties or are promoted and as a consequence there is always movement within the Defence Forces. It would be quite extraordinary if the 1,000 who are there today, including 34 currently on international duty, were never to move out of Athlone. The position is that there will not be 500 or 600 members of the Defence Forces moved out of the barracks in Athlone. The exact modalities for implementing the reorganisation are a continuing part of the discussion between the Chief of Staff and my Secretary General involving those working under them. I look forward to receiving their final report and the position remains that the future of Custume Barracks is absolutely secure and the barracks will continue to play an important role in the western region.
The figures the Deputy mentioned were up to the end of February, when there were various changes as members resigned. The position as I described it was that there were just over 900 on 9 March 2011 based in the barracks. The numbers then changed as a consequence of retirements and transfers from Mullingar to Cavan and from Mullingar to Athlone and from Cavan to Athlone. The correct figure now is 1,050. It could be 1,052 because the world changes on a daily basis in the Defence Forces and the bottom line in all of this is that when the reorganisation is implemented, there will be in or around 1,000 individuals based in the barracks. There might be one day when there are 1,002 individuals and 999 the next day because there is always some level of movement between barracks, which is why I am constantly saying "in or about", but that does not mean "in or about" will be dramatically different from 1,000.
I regret people have been misinformed and there has been a campaign of misinformation and lobbying by some individuals on this matter. I must have regard to the interests of the country and the operational effectiveness of the Defence Forces.
I thank the Minister for his response to my questions. The Minister has answered them all, bar one: did the interim report recommend in or about 1,000 personnel to maintained in Custume Barracks, Athlone? Does the Minister agree, based on a back of the envelope calculation, that approximately 650 staff will be based in each of the five barracks in the Northern Brigade? If 1,000 personnel will be based in Custume Barracks, Athlone, one of the other four barracks within the brigade will lose out. That does not take into account the number required for brigade headquarters staffing. The figures do not add up and I ask the Minister to clarify them. He stated during the previous Question Time that he did not want to pre-empt a decision by the chief of staff and his Secretary General. He has done that by making the announcement for whatever reason. The people of Athlone are disappointed that the barracks is losing brigade status and that the 4th Western Brigade is being lost from the barracks and they want answers to these questions.
The figures I used are the same as those used by the Minister's backbench colleagues. One of them said he was tired of the Government using the midlands "as a kicking post". This is the first time in Athlone's history the barracks will be without a brigadier general. Seán MacEoin was the first brigadier general there.
Was a cost benefit analysis conducted? If so, will he publish same? He failed, despite repeated questioning earlier and on Midlands 103 last Friday morning - he gave me numerous mentions for which I thank him - to outline which units will remain and which will be transferred. He is unable to say which units will remain and, therefore, I do not know how he can guarantee the 1,000 jobs. Will he apologise to the people of Athlone because they did not consider this to be a good news story for the town? Will the meet the members of Athlone Town Council? The mayor, Councillor Alan Shaw, is a colleague of the Minister's and he has requested a meeting but has so far failed to get a reply.
The Minister's figures are all over the shop, as Deputy Naughten said. In reply to a parliamentary question, the Minister said the number based in the barracks is 937 and he expected that to increase by more than 270 to give a total of 1,215, but earlier he said the total number would be 1,050. I do not know whether he knows the figure.
The reason there are more Army personnel in Custume Barracks after a year of Fine Gael in government is it closed Columb Barracks, Mullingar.
The Deputy is a little confused. He cannot make up his mind about how many personnel he wants stationed in Athlone. I would have thought in the context of the town that the important issue is that approximately 1,000 personnel will be based in the barracks, which is 100 more than were there when we took office on 9 March 2011. Those members and their families contribute to the town's economy. I do not imagine that those engaged in business in the town are losing sleep about whether a brigadier general will be based in the barracks.
Businesses all over the country have sleepless nights because of the lack of support from the Government.
Allow the Minister to continue without interruption.
I did not interrupt the Deputy and perhaps he will do me the courtesy of not interrupting me. It is a great pity the Deputy ran a grossly misleading campaign. He first told people that 600 members would be transferred out of the barracks and, second, he laboured under the illusion that 1,400 personnel were based there. I presume he did not go to the barracks to count them because if he did, he has a serious problem with his arithmetic.
By all accounts, the Minister did not either.
The Deputy would not have had as many people at his public meeting if he announced it was a public meeting to ensure that forever more a brigadier general would be based in Athlone. I say that with the greatest respect for the current brigadier general but there is an inordinate concern as to where he should be posted. The important thing for the town is that the future of the barracks is secure and approximately 1,000 members of the Defence Forces will be based there.
Can the Minister answer the questions?
The misinformation that went around the area was such that I felt the need to clarify the position with regard to the location of brigade headquarters and to give assurances that there would be no substantial reduction in personnel, as was being stated.
In the context of the question Deputy Naughten asked, I will not second guess the ongoing work and I will not go around each barracks to announce how many individuals will be based in them. I am concerned to ensure that the process the chief of staff and those under him, together with my Secretary General and those assisting him in my Department, are engaged in continues and is completed; that changes to be announced are properly communicated to members of the Defence Forces in individual barracks; and that we engage with the Defence Forces representatives organisations. It was unfortunate that, because of the type of campaign run by Deputy Troy, we had to make the announcement we made but we felt it was important because the rumours going around and the campaign run by him, which was playing politics with the Defence Forces, were causing a great deal of concern unfairly to those members based in Athlone.
Says the man who gave an instruction not to invite Opposition Members to the Air Corps launch.
Will the Minister clarify that the chief of staff made the recommendation to station 1,000 personnel in Athlone?
9Deputy Aengus Ó Snodaigh asked the Minister for Defence the number of Defence Force personnel who were discharged after taking Lariam. [30057/12]
View answer15Deputy Jonathan O’Brien asked the Minister for Defence the number of Defence Force personnel who were administered Lariam but were deemed unsuitable. [30056/12]
View answer18Deputy Joe Higgins asked the Minister for Defence if he will explain the continued giving of anti-malaria drug, Lariam, to soldiers in the Defence Forces in view of the fact that the US army has discontinued its use and the numerous cases of neuropsychiatric side-effects including incidences of suicide. [29923/12]
View answer20Deputy Jonathan O’Brien asked the Minister for Defence the number of personnel in the Defence Forces who were administered Lariam and the years in which this took place. [30055/12]
View answer22Deputy Joe Higgins asked the Minister for Defence if he will commit to carrying out a study to compare the incidences of suicide amongst Irish soldiers who were prescribed Lariam as opposed to those soldiers that have not received Lariam. [29924/12]
View answer25Deputy Clare Daly asked the Minister for Defence if he will end the army policy of prescribing Lariam for malaria; and if he will conduct an inquiry into suicide and negative health side effects related to its use. [29849/12]
View answerI propose to take Questions Nos. 9, 15, 18, 20, 22 and 25 together.
Malaria is a serious disease which can cause severe complications and death. It is estimated by the World Health Organisation that approximately 1 million people die every year from the disease in sub-Saharan Africa alone. It has long been recognised as a serious threat to any military force operating in a malarious area.
Lariam is a malaria chemoprophylactic agent first authorised for use in 1989 by the Irish Medicines Board, IMB, which is the statutory regulatory body charged with regulating the use of medicines in Ireland to ensure their quality, safety and efficacy. Research has shown that it is one of the most effective medications for protection against the type of malaria prevalent in sub-Saharan Africa. While certain risks associated with the use of the drug were highlighted in FDA drug safety newsletters in 1996 and 2003, the IMB remains of the view that the benefit-risk profile for the product was acceptable. The IMB continues to review the safety of this and all medicines on an ongoing basis and updates the product information as appropriate. Lariam remains the medication of choice for the Defence Forces for missions to sub-Saharan Africa and continues to be certified by the IMB.
In accordance with best international practice in prescribing Lariam, and taking account of the contraindications, warnings and side effects highlighted by the IMB, the Defence Forces screen all personnel for medical suitability. The screening system rules out staff with certain conditions, including depression, anxiety and neurodegenerative disorders, from overseas services. These are the conditions which, as has been indicated by the IMB and other regulatory bodies worldwide, are more likely to precipitate serious adverse reactions to Lariam. In addition, personnel who are found suitable for Lariam are obliged to commence their medication three to four weeks in advance of their travel. This precaution allows a slow build-up of the medication in the bloodstream and also permits assessment by the person of his or her individual reaction to the medication while still in Ireland. Personnel are screened both before and after deployments and all necessary actions are taken to ensure that those with contraindications to Lariam use are not prescribed the medication.
It should be noted that the primary area of operations for United States forces is currently Afghanistan. Neither the United States army nor the Irish Defence Forces recommend Lariam as a first-line malaria chemoprophylaxis for Afghanistan. Another factor to consider is that while the United States military engaged in mass prescribing, the Defence Forces, in accordance with the prescribing instructions, consider each individual case.
I am advised by the military authorities that three members of the Defence Forces displayed a serious symptomatology which may have been caused or contributed to by Lariam, although there is nothing conclusive in this regard. I am also advised that all three personnel made a full recovery and their cases were reported to the IMB. I am further advised by the director of the Defence Forces medical corps that he is unaware of any suicide by a member of the Defence Forces linked to Lariam.
No personnel have been discharged because they were below Defence Forces medical standards as a result of taking Lariam. I am informed that the number of personnel deemed unsuitable for Lariam due to contraindications cannot be quantified without an examination of every medical file, which would be impractical. Likewise, the number of personnel to whom Lariam was administered cannot be accurately established without an examination of every file. I have asked the military authorities to provide an estimate of this number based on the number of personnel who served on certain missions.
It is difficult to believe, in this computer era, that the number of personnel deployed in the sub-Saharan region who were administered Lariam cannot be quantified. Given the concerns that have been expressed by serving soldiers and ex-soldiers in regard to this medicine, those data should be compiled without delay. Will the Minister give a commitment, in advance of any future deployment in sub-Saharan Africa, that a review of the drug and its administration in the Defence Forces will be undertaken? Its use as an anti-malaria drug has been discontinued in the armed forces of many countries on the basis of its severe side effects, which include suicide and suicidal tendencies. The Minister indicated that three Defence Forces personnel have been identified as suffering side effects after taking the drug but that it is very difficult to say conclusively whether any staff committed suicide as a reaction to Lariam. That would indeed be difficult to quantify if the question of whether Lariam had been administered was not considered by the medical officer who conducted the examination of personnel who died through suicide.
The Irish Medicines Board determines the safety or otherwise of all medicines prescribed in this State. The board is appointed by the Minister for Health and its advisory committee on human medicines has a statutory role to provide advice in cases where it is proposed to refuse a licence for medicinal products on any grounds relating to safety, quality or efficacy. Following approval for use of a medicine, the IMB monitors the type and frequency of any reported side effects. As product usage increases, more information on the safety profile becomes available and further decisions and recommendations regarding its usage are made by the IMB and its international counterparts. The Defence Forces fully comply with IMB guidelines on the prescribing of medicines for members.
At present, no members of the Defence Forces are deployed in sub-Saharan Africa and there is no immediate plan for any such deployment. The fact remains that for certain types of malaria, Lariam is the treatment of choice. It is important that members of the Defence Forces who are deployed to areas where they are at risk of contracting the type of malaria for which Lariam is recommended as the appropriate treatment by the IMB, should have the drug available to them. The alternative, which I pointed out, is that in sub-Saharan Africa alone, there are 1 million deaths per annum arising from malaria, so this is not an issue of minor significance. I have no intention of sending nor wish to send members of the Defence Forces into harm's way in circumstances in which medicines are available to provide them with crucial protection. What was a failing in some defence forces elsewhere, including the United States defence forces, was that procedures were not in place whereby individual members of the defence forces were assessed as to the appropriateness of them being prescribed Lariam.
There are the contra-indications I mentioned. When a medical assessment is carried out and if there is an issue as to whether someone suffers from depression, may be taking medication for depression or has other difficulties which are contra-indications, it is very important that the member of the Defence Forces furnishes the medical doctor undertaking the assessment with the fullest information about his or her health. It is extremely dangerous should he or she not do so. That is the position.
I have no wish that anything would be done which would place at risk the health of members of the Defence Forces, nor could I stand over our posting members of the Defence Forces to an area of the world in which malaria is a serious risk without our relying on the best medical advice available to ensure they had whatever medical assistance was necessary.
One of the questions was about personnel who were administered Lariam but who were deemed unsuitable. There are people who might have depression and for whom the administration of Lariam might be deemed unsuitable. From my knowledge, few, if any, were deemed unsuitable for deployment based on the fact they would have to take Lariam and had some underlying ailment which might have reacted to it.
I have not only sought a review from this Minister but also raised the matter with the previous Minister for Defence. There are a number of cases of concern and that is why I raise the issue of Lariam. Given that we have the luxury of not having a deployment to sub-Saharan Africa in the near future, a review could take place on the use of Lariam and whether the alternatives would be more suitable. One of the alternatives needs to be administered more regularly and the belief is that is the reason it was rejected. Others said there was a cost implication.
I have asked the Minister and the previous Minister a range of questions about Lariam and to ensure the medical advice is not wrong. The Irish Medicines Board cannot act unless it has the information. The Defence Forces have not acted properly in regard to serving and former members of the Defence Forces who have raised a concern about Lariam. Can the Minister confirm that all such issues have been reported to the Irish Medicines Board by the Defence Forces?
I do not know on what basis the Deputy is alleging the Defence Forces have not acted properly in regard to this matter. It is important to look at the alternatives to Lariam. There are three other anti-malaria medications available, namely, Chloroquine, Malarone and Doxycycline. However, in the case of each of these products, there are specific reasons they are not suitable for use by the Defence Forces in sub-Saharan Africa and it is worthwhile setting out these reasons. Chloroquine is no longer in use because of the development of widespread resistance to it. Doxycycline must be taken in the absence of dairy products and it can also produce sun-sensitivity skin rashes in some individuals. This is particularly significant when used in sunny climates. For this reason, it is not recommended for first-line use by the Defence Forces in sub-Saharan Africa. Malarone is unsuitable for use as it is licensed for no more than 28 days continuous use in malarious areas by the Irish Medicines Board. In this context, this prophylactic agent is only suitable for use where the overseas deployment does not exceed 28 days.
These are among the reasons Lariam remains the anti-malaria chemoprophylactic agent of choice in areas where the predominant species of malaria is the virulentplasmodium falciparum. Lariam, therefore, is the agent of first choice on any sub-Saharan missions undertaken by the Defence Forces and that remains the position.
Doxycycline is the anti-malaria chemoprophylactic agent of choice in Afghanistan where the predominant species of malaria is the less virulentplasmodium vivax. Where Lariam is not required to be used, it is not used because it is not necessary to use it as a chemoprophylactic agent. In the context of sub-Saharan Africa, the alternatives do not offer our Defence Forces the protections to which they are entitled.
It is not practical to undertake a review of every file relating to every member of the Defence Forces who has taken Lariam since it was first utilised in the Defence Forces. The amount of resources and time it would take, in circumstances where there is not an indication that substantial numbers have been detrimentally affected by its use, cannot be justified. I have met some individuals who discussed with me their personal concerns as to the impact of Lariam on them. I am very conscious of these issues and their situation is not being ignored. As Minister, I must rely on the advice of the Irish Medicines Board but I will ensure what is necessary is undertaken in regard to any issue concerning the health of members of the Defence Forces.
9Deputy Aengus Ó Snodaigh asked the Minister for Defence the number of Defence Force personnel who were discharged after taking Lariam. [30057/12]
View answer15Deputy Jonathan O’Brien asked the Minister for Defence the number of Defence Force personnel who were administered Lariam but were deemed unsuitable. [30056/12]
View answer18Deputy Joe Higgins asked the Minister for Defence if he will explain the continued giving of anti-malaria drug, Lariam, to soldiers in the Defence Forces in view of the fact that the US army has discontinued its use and the numerous cases of neuropsychiatric side-effects including incidences of suicide. [29923/12]
View answer20Deputy Jonathan O’Brien asked the Minister for Defence the number of personnel in the Defence Forces who were administered Lariam and the years in which this took place. [30055/12]
View answer22Deputy Joe Higgins asked the Minister for Defence if he will commit to carrying out a study to compare the incidences of suicide amongst Irish soldiers who were prescribed Lariam as opposed to those soldiers that have not received Lariam. [29924/12]
View answer25Deputy Clare Daly asked the Minister for Defence if he will end the army policy of prescribing Lariam for malaria; and if he will conduct an inquiry into suicide and negative health side effects related to its use. [29849/12]
View answerI propose to take Questions Nos. 9, 15, 18, 20, 22 and 25 together.
Malaria is a serious disease which can cause severe complications and death. It is estimated by the World Health Organisation that approximately 1 million people die every year from the disease in sub-Saharan Africa alone. It has long been recognised as a serious threat to any military force operating in a malarious area.
Lariam is a malaria chemoprophylactic agent first authorised for use in 1989 by the Irish Medicines Board, IMB, which is the statutory regulatory body charged with regulating the use of medicines in Ireland to ensure their quality, safety and efficacy. Research has shown that it is one of the most effective medications for protection against the type of malaria prevalent in sub-Saharan Africa. While certain risks associated with the use of the drug were highlighted in FDA drug safety newsletters in 1996 and 2003, the IMB remains of the view that the benefit-risk profile for the product was acceptable. The IMB continues to review the safety of this and all medicines on an ongoing basis and updates the product information as appropriate. Lariam remains the medication of choice for the Defence Forces for missions to sub-Saharan Africa and continues to be certified by the IMB.
In accordance with best international practice in prescribing Lariam, and taking account of the contraindications, warnings and side effects highlighted by the IMB, the Defence Forces screen all personnel for medical suitability. The screening system rules out staff with certain conditions, including depression, anxiety and neurodegenerative disorders, from overseas services. These are the conditions which, as has been indicated by the IMB and other regulatory bodies worldwide, are more likely to precipitate serious adverse reactions to Lariam. In addition, personnel who are found suitable for Lariam are obliged to commence their medication three to four weeks in advance of their travel. This precaution allows a slow build-up of the medication in the bloodstream and also permits assessment by the person of his or her individual reaction to the medication while still in Ireland. Personnel are screened both before and after deployments and all necessary actions are taken to ensure that those with contraindications to Lariam use are not prescribed the medication.
It should be noted that the primary area of operations for United States forces is currently Afghanistan. Neither the United States army nor the Irish Defence Forces recommend Lariam as a first-line malaria chemoprophylaxis for Afghanistan. Another factor to consider is that while the United States military engaged in mass prescribing, the Defence Forces, in accordance with the prescribing instructions, consider each individual case.
I am advised by the military authorities that three members of the Defence Forces displayed a serious symptomatology which may have been caused or contributed to by Lariam, although there is nothing conclusive in this regard. I am also advised that all three personnel made a full recovery and their cases were reported to the IMB. I am further advised by the director of the Defence Forces medical corps that he is unaware of any suicide by a member of the Defence Forces linked to Lariam.
No personnel have been discharged because they were below Defence Forces medical standards as a result of taking Lariam. I am informed that the number of personnel deemed unsuitable for Lariam due to contraindications cannot be quantified without an examination of every medical file, which would be impractical. Likewise, the number of personnel to whom Lariam was administered cannot be accurately established without an examination of every file. I have asked the military authorities to provide an estimate of this number based on the number of personnel who served on certain missions.
It is difficult to believe, in this computer era, that the number of personnel deployed in the sub-Saharan region who were administered Lariam cannot be quantified. Given the concerns that have been expressed by serving soldiers and ex-soldiers in regard to this medicine, those data should be compiled without delay. Will the Minister give a commitment, in advance of any future deployment in sub-Saharan Africa, that a review of the drug and its administration in the Defence Forces will be undertaken? Its use as an anti-malaria drug has been discontinued in the armed forces of many countries on the basis of its severe side effects, which include suicide and suicidal tendencies. The Minister indicated that three Defence Forces personnel have been identified as suffering side effects after taking the drug but that it is very difficult to say conclusively whether any staff committed suicide as a reaction to Lariam. That would indeed be difficult to quantify if the question of whether Lariam had been administered was not considered by the medical officer who conducted the examination of personnel who died through suicide.
The Irish Medicines Board determines the safety or otherwise of all medicines prescribed in this State. The board is appointed by the Minister for Health and its advisory committee on human medicines has a statutory role to provide advice in cases where it is proposed to refuse a licence for medicinal products on any grounds relating to safety, quality or efficacy. Following approval for use of a medicine, the IMB monitors the type and frequency of any reported side effects. As product usage increases, more information on the safety profile becomes available and further decisions and recommendations regarding its usage are made by the IMB and its international counterparts. The Defence Forces fully comply with IMB guidelines on the prescribing of medicines for members.
At present, no members of the Defence Forces are deployed in sub-Saharan Africa and there is no immediate plan for any such deployment. The fact remains that for certain types of malaria, Lariam is the treatment of choice. It is important that members of the Defence Forces who are deployed to areas where they are at risk of contracting the type of malaria for which Lariam is recommended as the appropriate treatment by the IMB, should have the drug available to them. The alternative, which I pointed out, is that in sub-Saharan Africa alone, there are 1 million deaths per annum arising from malaria, so this is not an issue of minor significance. I have no intention of sending nor wish to send members of the Defence Forces into harm's way in circumstances in which medicines are available to provide them with crucial protection. What was a failing in some defence forces elsewhere, including the United States defence forces, was that procedures were not in place whereby individual members of the defence forces were assessed as to the appropriateness of them being prescribed Lariam.
There are the contra-indications I mentioned. When a medical assessment is carried out and if there is an issue as to whether someone suffers from depression, may be taking medication for depression or has other difficulties which are contra-indications, it is very important that the member of the Defence Forces furnishes the medical doctor undertaking the assessment with the fullest information about his or her health. It is extremely dangerous should he or she not do so. That is the position.
I have no wish that anything would be done which would place at risk the health of members of the Defence Forces, nor could I stand over our posting members of the Defence Forces to an area of the world in which malaria is a serious risk without our relying on the best medical advice available to ensure they had whatever medical assistance was necessary.
One of the questions was about personnel who were administered Lariam but who were deemed unsuitable. There are people who might have depression and for whom the administration of Lariam might be deemed unsuitable. From my knowledge, few, if any, were deemed unsuitable for deployment based on the fact they would have to take Lariam and had some underlying ailment which might have reacted to it.
I have not only sought a review from this Minister but also raised the matter with the previous Minister for Defence. There are a number of cases of concern and that is why I raise the issue of Lariam. Given that we have the luxury of not having a deployment to sub-Saharan Africa in the near future, a review could take place on the use of Lariam and whether the alternatives would be more suitable. One of the alternatives needs to be administered more regularly and the belief is that is the reason it was rejected. Others said there was a cost implication.
I have asked the Minister and the previous Minister a range of questions about Lariam and to ensure the medical advice is not wrong. The Irish Medicines Board cannot act unless it has the information. The Defence Forces have not acted properly in regard to serving and former members of the Defence Forces who have raised a concern about Lariam. Can the Minister confirm that all such issues have been reported to the Irish Medicines Board by the Defence Forces?
I do not know on what basis the Deputy is alleging the Defence Forces have not acted properly in regard to this matter. It is important to look at the alternatives to Lariam. There are three other anti-malaria medications available, namely, Chloroquine, Malarone and Doxycycline. However, in the case of each of these products, there are specific reasons they are not suitable for use by the Defence Forces in sub-Saharan Africa and it is worthwhile setting out these reasons. Chloroquine is no longer in use because of the development of widespread resistance to it. Doxycycline must be taken in the absence of dairy products and it can also produce sun-sensitivity skin rashes in some individuals. This is particularly significant when used in sunny climates. For this reason, it is not recommended for first-line use by the Defence Forces in sub-Saharan Africa. Malarone is unsuitable for use as it is licensed for no more than 28 days continuous use in malarious areas by the Irish Medicines Board. In this context, this prophylactic agent is only suitable for use where the overseas deployment does not exceed 28 days.
These are among the reasons Lariam remains the anti-malaria chemoprophylactic agent of choice in areas where the predominant species of malaria is the virulentplasmodium falciparum. Lariam, therefore, is the agent of first choice on any sub-Saharan missions undertaken by the Defence Forces and that remains the position.
Doxycycline is the anti-malaria chemoprophylactic agent of choice in Afghanistan where the predominant species of malaria is the less virulentplasmodium vivax. Where Lariam is not required to be used, it is not used because it is not necessary to use it as a chemoprophylactic agent. In the context of sub-Saharan Africa, the alternatives do not offer our Defence Forces the protections to which they are entitled.
It is not practical to undertake a review of every file relating to every member of the Defence Forces who has taken Lariam since it was first utilised in the Defence Forces. The amount of resources and time it would take, in circumstances where there is not an indication that substantial numbers have been detrimentally affected by its use, cannot be justified. I have met some individuals who discussed with me their personal concerns as to the impact of Lariam on them. I am very conscious of these issues and their situation is not being ignored. As Minister, I must rely on the advice of the Irish Medicines Board but I will ensure what is necessary is undertaken in regard to any issue concerning the health of members of the Defence Forces.
