I propose to take Questions Nos. 975, 977 and 980 to 985, inclusive, together.
The health and welfare of the men and women of the Defence Forces is a priority for both myself and the Defence Forces. The choice of medication for overseas deployment 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. Cost of medication and or the rank of an individual are not considerations in prescribing anti-malarial medication.
Significant precautions are taken by the Defence Forces Medical Officers in assessing the medical suitability of members of our Defence Forces to take any of the anti-malarial medications. It is the policy of the Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability.
Malaria is a serious disease which killed approximately 438,000 people in 2015, with 90% of deaths occurring in sub-Saharan Africa as reported by the World Health Organisation. I am advised by the military authorities that they are not aware of any serving member of the Defence Forces dying from malaria in the past ten years.
I am advised that information in relation to side effects or illnesses contracted by Defence Forces Personnel including instances of malaria is maintained on each individual’s medical file. There is no way of providing the exact information sought by the Deputy without examining every medical record of each member who served overseas. Within the existing resources available, this is not feasible.
With regard to Afghanistan, Lariam was not the recommended first line chemoprophylactic agent for Irish Defence Force personnel when they were serving there. The Deputy may wish to note that Defence Forces personnel are no longer serving in Afghanistan. As I have indicated, the choice of medication for overseas deployment 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 Irish Defence Forces.
Deployments to sub-Saharan Africa require the use of an anti-malaria regime. The Defence Forces, Director of the Medical Branch’s current advice, guidance and policy in relation to malaria chemoprophylaxis is that in the case of sub-Saharan Africa, Lariam is the agent of first choice. In special circumstances the other agents may be used. For example, if for operational reasons it was imperative that an individual deploy immediately without the normal ‘lead-in’ time which is required for Lariam, then one of the other alternative medications should be used. Equally, if an individual who had a specific skill set which was fundamental to mission success and either had previously demonstrated sensitivity to Lariam, or had a contraindication to its use in the first place, then that individual would receive derogation from the ‘normal’ policy and be placed on another medication. If during the course of deployment, an individual developed sensitivity to Lariam, he/she would desist from Lariam and be placed on an alternative. In all the examples above, the basic principle remains the same – it revolves around the balance struck between the requirements of the particular mission and patient safety.
As a result of its extended half-life in the blood, Lariam is taken on a weekly basis rather than on a daily basis. This has two direct and significant consequences. Firstly, a weekly medication facilitates compliance. Secondly, even if a dose is missed by 24 hours, there is still a residual quantity of the active ingredient in the blood which gives a certain degree of protection. If, however, one of the daily medications is missed by 24 hours, the patient is immediately susceptible to malaria. Prevention of disease for military personnel serving overseas is of the utmost importance. In addition, a peace keeping or peace enforcing military force has to prepare for all eventualities. The military activity of a force is dictated, not so much by a clock or calendar, but by the operational tempo at any given time. Such a reality creates difficulty in abiding by a daily dosing regimen. This is a fact of life which differentiates the civilian office worker or tourist from the deployed soldier. Thus the weekly medication provides some mitigation against the unforeseen and unpredictable aspect of overseas service. This is one of the reasons why Lariam remains the medication of choice in malaria chemoprophylaxis for Defence Forces personnel deployed to sub-Saharan Africa.
While there are other agents available, their use is associated with an increased risk of contracting malaria as indicated above. Therefore, subject to the special circumstances listed above, an individual who can take Lariam is selected in preference to one who cannot take Lariam because of the lesser risk to the individual and, by extension, to the mission. There are, however, circumstances when the demands of the mission justify this increased risk.
As I have already indicated, significant precautions are taken by Irish Defence Forces Medical Officers in assessing the medical suitability of members of our Defence Forces to take any of the anti-malarial medications. It is the policy of the Irish Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability.
The Deputy will be aware that a Working Group is currently reviewing developments arising in relation to the use of malaria chemoprophylaxis. This work has included further engagement with international experts and I anticipate that it will finalise its second Report shortly.
There are no plans at this time to withdraw Lariam from the range of anti-malarial medications available to the Defence Forces. The use of and the information on medications is kept under ongoing review. Anti-malarial medications, including Lariam, remain in the formulary of medications prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions, to ensure that our military personnel can have effective protection from the very serious risks posed by this highly dangerous disease.
