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Topical Issues Debate
17th October 2013

REVISED TEXT - “The reason the report of the Working Group on Malaria Chemoprophylaxis is not being published.”

Deputy Seán Ó Fearghaíl, T.D.
Response by the Minister for Justice Equality and Defence, Mr. Alan Shatter, T.D.
CHECK AGAINST DELIVERY
Arising from assertions which had been circulating regarding the prescribing and side effects of Lariam, my Department established a working group in January 2011 to examine the use of Lariam and other anti malarial drugs in the Defence Forces. The Group comprises representatives of the Defence Forces Medical Corps, Defence Forces Personnel Policy Branch, Defence Forces Human Resources and Litigation Branch. The Group also includes representatives from the State Claims Agency and the Chief State Solicitors Office.

The purpose of this Group was to review issues arising in relation to the use of Lariam, particularly having regard to current and potential litigation; to review and confirm the Defence Forces approach in relation to the use of malaria chemoprophylaxis in the Defence Forces; and to ensure that the procedures in relation thereto continue to be appropriate and in accordance with best medical practice as promulgated by the relevant medical authorities. The work of the Group informs the Defence Organisation’s process of ongoing risk assessment and mitigation in the context of a proactive Risk Management Strategy.
The Group reported back to me in June this year. While the Report was produced in the context of current and potential litigation and is, therefore, legally privileged, I can confirm that the Group investigated all the various allegations surrounding the use of Lariam and obtained advice from leading medical experts. These experts concur with the practices followed by the Defence Forces in prescribing Lariam.

The State Claims Agency, on my behalf, is currently handling 24 cases taken by members and former members of the Defence Forces who allege personal injury as a result of their consumption of mefloquine (Lariam). High Court proceedings have been served in respect of 9 of these cases.
Malaria is a serious disease that can cause serious complications and death. It is estimated by the World Health Organisation that approximately 1 million people die every year from malaria in sub-Saharan Africa alone. It has also long been recognized as being a serious threat to any military force operating in a malarious 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.
Research has shown that Lariam is one of the most effective medications for protection against the type of malaria prevalent in sub-Saharan Africa. It is authorised for use by the Irish Medicines Board (IMB), which is the statutory regulatory body charged with the regulation of the quality, safety and efficacy of medicines available in Ireland. I am advised that the decisions of the IMB are taken in consultation with European and other International bodies and that the IMB remain of the view that the benefit/risk profile for the product remains acceptable.

The choice of chemoprophylactic medication depends on a number of factors including the type of malaria in the destination, resistance to particular drugs, the profile of the traveller (contra-indications, underlying health conditions, purpose of travel), the duration of travel and adherence issues. This choice must always remain a medical decision to be made by Medical Officers in the Defence Forces on the basis of best medical practice having regard to the specific circumstances of the mission and the individual member of the Defence Forces. It is not a matter for Ministerial direction.

The Defence Forces are fully aware of the range of reported side effects attaching to all anti-malarial medications and significant precautions are taken by the Medical Corps in assessing the medical suitability of members of the Defence Forces to take Lariam or any of the other anti-malarial medications.
Lariam must remain in the formulary of medications prescribed by the Medical Corps for Defence Forces personnel on appropriate overseas missions, particularly those in sub-Saharan Africa, to ensure that our military personnel can have effective protection from the very serious risks posed by this highly dangerous disease.


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