Other Questions

Defence Forces Medicinal Products

Seán Ó Fearghaíl


112. Deputy Seán Ó Fearghaíl asked the Minister for Defence if there has been any change in his Department's stance on the use of Lariam by members of the Defence Forces on certain overseas missions; and if he will make a statement on the matter. [21735/15]

The issue of the administration of Lariam to members of the Defence Forces travelling to countries where malaria is a problem has been raised in this House on a number of occasions. Deputy Pádraig Mac Lochlainn has raised it and I have raised it myself. I thought I got a certain sense from the Minister, when it was last raised, that he may have been slightly more open than his predecessor to looking at the impact of this drug. The stories I am hearing - I am hearing even more of them - are extremely alarming, to put it at its mildest, in terms of the impact of this drug on some people who use it.

I assure the Deputy that I have an open mind on this matter. The Deputy will be aware that malaria is a very serious disease which kills approximately 1 million people every year in sub-Saharan Africa alone. It is a grave threat to any military force operating in the area. 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. The anti-malaria regime in place in the Defence Forces, including the use of Lariam, is working.

The Health Products Regulatory Authority, HPRA, formerly the Irish Medicines Board, is the statutory authority with responsibility for the quality, safety and efficacy of medicines in Ireland. The Defence Forces policy on the use of anti-malarial medication is in line with current HPRA guidelines.

The Defence Forces are fully aware of the range of reported side effects attached to all anti-malarial medications. Significant precautions are taken by the Medical Corps in assessing the medical suitability of members of the Defence Forces to take any of the anti-malarial medications. As the Deputy will be aware, there are three anti-malarial drugs, all licensed by the HPRA, in use by the Defence Forces: Lariam, Malarone and doxycycline. It is the policy of the Defence Forces that personnel are individually screened for fitness and medical suitability for service overseas, including a medical risk assessment for Lariam.

Where malaria has been identified as a risk in a particular mission area, the choice of medication is dependent on a number of factors, including the type of malaria in the destination, its resistance to particular drugs, the profile of the traveller, and the duration of travel. The choice of medication 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.

I can assure the Deputy that there is no loyalty to Lariam in the Defence Forces and that there is an open mind towards the use of alternatives, which we do use in many cases. The overarching priority has to be the safety of our Defence Forces personnel abroad in ensuring that they do not get malaria. We treat them accordingly, in line with medical advice.

Additional information not given on the floor of the House

Former Ministers for Defence have had the various allegations surrounding the use of Lariam investigated thoroughly and obtained the advice of leading medical experts, who concur with the prescribing practices followed by the Defence Forces. Anti-malarial medications, including Lariam, must 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.

I am glad to hear the Minister unambiguously express an open mind. His predecessor did not express that same openness. There has been group-think within the Defence Forces, which has given rise to almost unquestioning support of the use of Lariam. How would the Minister respond to Dr. Franz Humer, the chairman of Roche, which manufactures Lariam? As far back as 2007, at the annual general meeting of the company, he stated that Lariam used to be the most important drug in the fight against malaria. In the meantime, however, science has advanced, and more effective anti-malarials with better side-effect profiles are now available. Why, then, does Lariam continue to be the predominant drug used by our Defence Forces? Are Malarone or doxycycline used at all for people who are being dispatched to locations such as sub-Saharan Africa?

My understanding is that they are. It would be ridiculous for a Minister to be responding to Dr. Humer, as his statement would require a medical response from a trained doctor or from the Health Products Regulatory Authority. My function as Minister for Defence is to take all of the advice I can and then make decisions. Any decision we make about Lariam is a medical decision, not a political or commercial one.

My understanding is that we are open to using the three drugs I have outlined, depending on where personnel are going and the types of malaria in those areas. Different drugs may be more effective in different settings. The only basis for a decision is medical, in order to ensure that when our Defence Forces personnel are abroad, they do not get malaria. We have a screening process to ensure that the side effects that can sometimes be associated with Lariam are not allowed to cause serious problems.

Will the Minister publish the names of the members of his expert advisory panel? It would be very useful for all of us to know which people have been advising him and the Department of Defence.

Does the Minister recall the 2013 "Prime Time" investigations unit exposé which suggested there was a three to five times increased risk of suicide among Irish troops who were prescribed Lariam? I used Lariam myself on my first visit to Africa, to no obvious ill effect, it would appear. However, I have met people who have manifestly suffered as a result of using this drug.

I put it to the Minister that he, or someone who succeeds him, will end up standing up in this House and giving an account of why the Department of Defence continued to stand over the use of this drug long after there was proven international concern. Indeed, it is a concern which has been expressed by none other than the chairman of the company responsible for manufacturing the drug.

No one is suggesting there are not side effects but there are side effects to some of the other malaria drugs too. I have also used Lariam and I did not have any hallucinations or problems attached to it, I am glad to say, although maybe I was lucky.

It is important to say that the Defence Forces policy in regard to the use of antimalarial medication is in line with current HPRA guidelines. We follow those guidelines strictly and if we get a change in those guidelines, we will obviously respond to that. It is also worth repeating that not a single member of the Defence Forces who has been on peacekeeping missions in sub-Saharan Africa, and there have been many of them, has died from malaria. There has been a success here. Clearly, Lariam-----

Not if they died by suicide as a result of it.

Order, please. We are out of time.

If I was Deputy Ó Fearghaíl, I would be careful in what I say in regard to people taking their own lives. This is a serious issue and we take it seriously. I have an open mind with regard to changing our approach here but I would change that approach on the back of medical advice as opposed to political questions.

My concern on this issue, as with many other issues, is that the lawyers in the Department, or those advising the Department, will say that if the Minister changes tack at this stage, he admits liability in regard to cases that are before courts. The Minister repeatedly says that nobody has contracted malaria but, with respect, that is not the point. The point is that for people with pre-existing mental health issues, this drug allegedly exacerbates their conditions and has allegedly led to tragedy. As I said before to the Minister's predecessor, and possibility to the Minister himself, the United States army, which is obviously multiples the size of ours, stopped using this drug quite a long time ago. If it is a question of legal advice or that type of issue, I would ask that this would not be a barrier to doing what is right.

There is now an overwhelming body of evidence in this regard. I wonder is the Minister aware of the fact the British Ministry of Defence in April of this year released information under freedom of information which showed 1,000 ex-servicemen and women from the British army are suffering severe psychiatric and mental health problems or are suicidal as a result of being prescribed Lariam. An investigation is taking place there. How long are we going to have to wait until we catch up here?

As I said, I am not making decisions on the basis of legal advice. My only interest is medical advice. We screen people and make choices as to which antimalarial drug we prescribe on the basis of where people are going and how long they are going to be staying. That is a very different profile, by the way, to the US, which does not really have a peacekeeping role, as such, for its defence forces in the way that we do. On the continent of Africa, certainly, the US does not have a significant presence from a peacekeeping point of view.

I had a long conversation about this when I was in Mali over the St. Patrick's Day period, when I spoke to some German colleagues about their views on Lariam. It is not that we are not thinking about it; we are and I have an open mind on it. I do not want to make decisions because of statements people have made, unless there is a medical reason which shows that our personnel are safer using an alternative to Lariam, as opposed to using Lariam which has been very effective in certain circumstances. I will have no problem standing up here and changing my view on this on the basis of medical advice. That is the advice of which we will take note.

Naval Service Operations

Mick Wallace


113. Deputy Mick Wallace asked the Minister for Defence if the Irish Defence Forces plan to take any role in the European Union Naval Force Operation in the Mediterranean, which received the approval of the European Union Foreign Affairs Council on Defence on 18 May 2015; and if he will make a statement on the matter. [21375/15]

On 18 May, the EU Foreign Affairs Council on Defence agreed to establish what the Council refers to as an EU military operation to break the business of smugglers and traffickers of people in the Mediterranean. We know the LE Eithne has been dispatched to assist with the migrant crisis in the Mediterranean and has done some good work. Can the Minister confirm that this vessel or any other Irish vessel will not become involved in any EU military operation in the Mediterranean? Would the Government advocate that no one else in Europe become involved in a military capacity in this area, given the fiasco of 2011 when there was a so-called no-fly mission over Libya which resulted in the place being destroyed?

I do not think we are talking about a repeat of that. At the formal meeting of the Foreign Affairs Council with Ministers of Defence in Brussels on 18 May, a Council decision to establish a European Union military operation, EUNAVFOR Med, was adopted as part of a comprehensive approach to addressing the migration crisis in the south central Mediterranean. Operational planning for this naval operation is currently under way and it is anticipated that the launch of the operation may be on the agenda of the Foreign Affairs Council later this month.

It is intended that the mission’s mandate will be implemented in sequential phases. The first phase of the operation will support the detection and monitoring of migration networks through information gathering and patrolling in accordance with international law. The second phase involves the targeting, seizure and possible destruction of the vessels and assets of human traffickers. The third phase is an operational-disruption phase to try to stop people traffickers. The second and third phase shall commence in accordance with any applicable UN Security Council resolution and-or the consent of Libya.

Consideration of participation by the Irish Defence Forces in EUNAVFOR Med will only occur if there is a UN Security Council resolution and the applicable national statutory requirements are met. I understand that discussions on a draft Security Council resolution are ongoing and the Deputy will appreciate that any further comment would be premature at this point, pending the outcome of that process. In the meantime Ireland, through its deployment of the LE Eithne, will continue to assist the Italian authorities in the humanitarian search and rescue operation efforts to prevent further tragedy and loss of life at sea.

It is a bit worrying that the Minister has not answered either of my questions. Does he not think that we should play a neutral role and advocate for non-military action in the area? The idea that military action could in any way help things is ridiculous.

The EU was formed on the foundations built up after the Second World War and on the idea that inhumanity should not be tolerated. The idea that we would now use any type of measures to stop people coming to Europe is something I find hard to take, given the reasons that they want to come here. Sadly, we too have played a part. People want to come to Europe because we have gone to their countries and destroyed them. They are being driven out of their homes through economic policies, trade tariffs and military intervention.

More than 33 million people have been displaced because of war, yet we continue to allow Shannon Airport to be used by the US military machine, the biggest one on the planet, to cause devastation in many of the countries in question. Syria and Afghanistan are in the top three countries for internally displaced people. Can we take an active role and say that enough is enough and that the arms industry and the militarisation of the planet are madness, causing untold misery?

I do not accept the premise that every conflict in north Africa or every conflict that is contributing to mass migration in that part of the world has been caused by European or Western intervention, which seems to be the basis of Deputy Wallace's case.

I did not say that.

It was agreed at the Foreign Affairs Council meeting that the European Union would make an effort to disrupt human trafficking on a massive scale, where organised crime is essentially feeding on people's misery and vulnerability. We have an obligation to disrupt that while, at the same time, we have an obligation to assist people who are fleeing persecution.

At the moment, Ireland's commitment is a much more straightforward and simple one. It is about search and rescue and emergency responses. That is a relatively straightforward task in comparison with the other, which is much more complicated. We cannot simply do nothing and allow organised and well resourced human traffickers to continue to move large numbers of people, piling them like cattle onto boats that are not fit to get more than 30 km out to sea. This is an issue on which the European Union should not sit idly by, and anything we do should have a UN mandate and international approval.

We argued here a few months back about how mad it was to stop the Mare Nostrum operation. Did the Irish Government object to the stopping of Mare Nostrum? The argument against it was that it was encouraging migrants by rescuing them, but in actual fact, when we stopped saving them, they drowned. Up to 1,800 people have drowned already this year. It is great that Ireland has played a role in rescuing some of them. However, several root causes of the problem are not being addressed. We do not seem to want to talk about the reasons people are risking their lives in such numbers. Most of the solutions from the EU are short-term, geared towards stopping these people from coming here. The Europeans - including ourselves, given that we have facilitated the US war machine through Shannon Airport - have a responsibility for some of these people.

Also, I did not say they were all displaced because of war. The Minister misquoted me. However, many of them have been, and 33 million is a lot of people. We have a responsibility to do something about this.

Ireland has agreed to take 300 of the so-called good immigrants who are in camps waiting to be given a placement somewhere. However, up to 200,000 people have arrived in Europe. Are we prepared to take some of these people in? I believe we have a responsibility. They cannot just stay in camps in Italy and Greece forever. As a country, given that we have been so fond of going all over the planet ourselves, we have got to take a more humanitarian approach to these people. Will Ireland consider taking in some of the 200,000 immigrants who have arrived in Europe already?

It is not true that Ireland and other countries are not discussing the causes of these problems. They are, but the solutions are complex. Deputy Wallace does not want any intervention, yet he wants solutions to the causes of many of these problems, as in Afghanistan, where he does not want any Irish involvement in helping to build capacity.

Absolutely not.

We are in the business of doing multiple things at the same time - namely, trying to save people who are at risk of drowning when trying to cross the Mediterranean because they are in a desperate and vulnerable situation. That is, however, just an emergency response. The deeper issue is how the European Union can use its influence in a peaceful way, primarily to bring stability to countries that can look after their own populations rather than facilitating or causing the movements of large numbers of people looking for a better life.

We will not have the solution to this today or tomorrow, and this is the truth of it. In the meantime we need to ensure people do not drown, that they are treated with some dignity when they claim asylum and that there is a fair process to assess genuine asylum seekers. We also need to ensure Ireland, within reason, bears its fair share of the burden of accommodating some of these refugees. It will be up to the Government as a whole and, in particular the Minister, Deputy Fitzgerald, to decide the actual numbers involved.

Defence Forces Equipment

Bernard Durkan


114. Deputy Bernard J. Durkan asked the Minister for Defence the extent to which ongoing upgrading of military hardware continues, with particular reference to the need to ensure a regular modernisation of all Defence Forces equipment, including aircraft, sea-going vessels and computer systems, in line with best international practice; and if he will make a statement on the matter. [21329/15]

This question relates to the ongoing need for the upgrading, improvement and modernisation of all military hardware throughout the Army, Naval Service and Air Corps, paying particular reference to the fact some branches of the Defence Forces serve overseas where their authority is challenged. We acknowledge the tremendous work by the commander and crew of LE Eithne for their humanitarian work in recent weeks.

I thank Deputy Durkan for raising this issue. The acquisition of new equipment and equipment upgrades for the Defence Forces remains a focus for me as Minister for Defence and is a matter that is kept under constant review. The development of a new White Paper on defence is under way. The White Paper will provide the future policy framework for defence for the next decade. A key part of the development of the White Paper is the consideration of potential challenges arising in our future defence and security environment. Future capability requirements, including those in relation to overseas peace support missions, including the UN, are being considered in the drafting of the new White Paper. After this Question Time I will spend two hours with officials to finalise the first draft of the White Paper. This ongoing work on the White Paper will underpin recommendations regarding the future provision of military equipment to be deployed at home and overseas.

In many ways the type of equipment is changing all the time with regard to technology and potential threats. A threat such as cybersecurity was not even known to anybody 15 or 20 years ago, or perhaps ten years ago, whereas now it is a major part of the demands on any state to protect its citizens. For the present, decisions on new equipment, including aircraft, ships, information technology and computer systems and the upgrade of military equipment in operational use will continue to be made on a strictly prioritised basis within a restricted budget with a view to maintaining the capability of all roles assigned by Government to the Defence Forces.

I thank the Minister for the reply. Is the Minister satisfied the technology available and likely to become available is state-of-the-art and comparable to that available to all other defence forces alongside which Irish troops may serve overseas? Is there a programme of ongoing upgrading in this regard?

There has been. Even under the constraints of recent budgets we have seen a steady upgrading of equipment to ensure our peacekeepers abroad are safe. There has been a fleet replacement programme in the Irish Naval Service, which essentially will see three new ships in three years, namely, the LE Samuel Beckett, the LE James Joyce, which will arrive in the coming weeks, and a third ship, which will arrive next year, although probably not in time for this Government. The commitment has been made and the construction project is well under way. The third boat will be very similar to the LE James Joyce and the LE Samuel Beckett. We are investing and will continue to do so. Our deployment overseas in missions, such as UNDOF on the Golan Heights, is because of the training, skill sets, expertise, professionalism and equipment, such as armoured vehicles and Mowags, to which the Irish Defence Forces have access.

We are well trained and well equipped but we need to keep upgrading our equipment to ensure our troops remain safe and effective. It is my job to make sure that happens.

To what extent is the modernisation of aircraft and military hardware in the Air Corps continuing?

There is no provision for the acquisition of new aircraft for the Air Corps in 2015. However, a significant level of investment in new equipment for the Air Corps has taken place in recent years. The investment programme included the delivery of training aircraft, the acquisition of two light utility EC135s, six utility AW139 helicopters and a mid-life upgrade of the two CASA maritime patrol aircraft.

As I mentioned, the role of the Air Corps is part of the White Paper deliberations and the question of proceeding with any replacement aircraft programme for the Air Corps will be considered in tandem with the White Paper, which we will hopefully see in the coming months.

Naval Service Operations

Clare Daly


115. Deputy Clare Daly asked the Minister for Defence the nature of the activities that the LEEithne will be engaged in as part of Operation Triton. [21356/15]

This is a continuation of the discussion we had earlier about the activities in the Mediterranean. The Minister has clarified that the LE Eithne is not involved in Operation Triton and is there on humanitarian grounds, but he also went into combat with a straw man by saying doing nothing was not an option when nobody was arguing for doing nothing. Operation Triton replaced the Mare Nostrum programme, which cost €9 million per month while Operation Triton costs €3 million. The EU has put up its borders and is making it more difficult for refugees. Should Ireland not be playing a more positive role? Being neutral is not the same as doing nothing.

I am glad we agree that being neutral is not the same as doing nothing and we are doing a lot. This is, however, the first time an Irish naval vessel has ever gone overseas on a mission such as this. When the LE Eithne has gone overseas previously, it has essentially been on diplomatic missions, as opposed to a humanitarian mission like this. It is a new departure for the Naval Service and it is doing a really good job under quite difficult circumstances.

Most people would recognise that it was a mistake to downgrade Mare Nostrum in terms of what was being spent and in terms of providing capacity to assist migrants coming across the Mediterranean Sea. That is why we are seeing a significant increase in activity on humanitarian grounds. That is my focus and it is that of the Defence Forces and the Naval Service. If that should change, it could only be on the back of a UN Security Council resolution and, should we be asked to be part of something broader, the application of the triple lock. Our role has been highly effective in the past ten days and will continue to be effective through the summer. I suspect we will maintain a presence from the point of view of search and rescue and humanitarian activities at least until the end of September.

Does the Minister agree with the words of President Michael D. Higgins that the failure at EU level has turned the Mediterranean into a graveyard? Given that the Minister said he did not agree with the downscaling of the Mare Nostrum operation, are we to take it that, at EU level, the Irish Government is arguing for search and rescue operations to be restored to that level rather than what has currently been embarked upon?

What is the Minister's attitude to the suspension of the Dublin Convention whereby people arriving in an EU country have to be processed for asylum in that country, which is causing major problems for Italy and Greece? Has he advanced the discussions about taking extra refugees? I do not know if the Minister saw the excellent letter by Ed Horgan, the famous peace activist in Limerick and former Irish officer, who made the point that on 11 April 2015 some 300 asylum seekers drowned in the Mediterranean. On the very same day the EU launched a spacecraft into space and recovered that piece of hardware from the ocean at a cost of €150 million. Is it not obscene that we would spend €150 million rescuing a piece of hardware and yet downgrade a rescue operation, putting the lives of hundreds of people at risk when we have been complicit in making them refugees in the first place?

The Minister said we had to look at it but that there was no immediate solution. We know that, but non-intervention would be a very good start. We could stop the flood of refugees by stopping the interference in their countries in the first place.

The Deputy has put a lot of questions and made a number of comments. I have dealt with most of them in previous questions. I said that most people would accept it was a mistake to reduce the resource level in terms of search and rescue and in terms of the assistance we give to migrants in the Mediterranean. The tragic drownings which happened in the past six weeks or so shocked many people. As a result, Ireland and other countries have dramatically increased resources which we are now applying to provide partial solutions to the problem, focusing at the moment on search and rescue and humanitarian assistance. That is a good thing. Rather than focusing on mistakes made in the past, we should focus on trying to solve the problems. Ireland wants to contribute to that effort and we are doing an excellent search and rescue job at the moment. We will contribute to the broader debate on how Europe, collectively, can help to address the reasons for mass migrations from Libya and north Africa.