For years, there has been great concern about the anti-malaria drug mefloquine or Lariam as it is known by its brand name. Troops in Canada, the U.S., Holland, Australia, and Ireland especially have reported terrible adverse effects when they have been issued the drug on deployments to countries where malaria is prevalent.
During the past 20 years, we have learned adverse effects of mefloquine (Lariam) are severe enough to warrant banning the anti-malaria drug as a preventative treatment for travellers or troops embarking into zones where malaria dominates. Because of a genetic predisposition to brain damage when taking this drug, it is impossible to assess who will suffer the worst of mefloquine’s adverse effects, including liver and thyroid damage leading to death.
Essentially, there is an invisible lethal predisposition for individuals who are treated with the anti-malarial medication mefloquine. No one knows if they will suffer adverse effects until they take it. Then it’s too late.
Some soldiers say they have not had sufficient warning about the drug when they take it, so the first thing to learn is what procedures DND follows. A former medic assigned to Afghanistan explains what immunization steps the DND follows for overseas deployments and admits mefloquine remains the military’s choice of antimalaria drug for those serving in Afghanistan:
“Everything is done with the best intentions. That is why for Afghanistan the primary drug of choice is still Mefloquine.
“Let me explain: there are many different strains of malaria, some drugs are more effective than others, and some don’t work any more. The World Health Organization (WHO) is the one that provides the initial medical intel for the various regions: what strain is prevalent and what works best. WHO sends out advisories. Before we go to an area, all that info is reviewed plus information for local sources and allies. Then a decision is made as to the best preventive medicine measures for the area: this drug, that needle, eat here, etc..
“So, once we get the recommendations, the rest is a question of risk. Medication side effects vs catching malaria. By the way, malaria is deadly disease. You will die from it if untreated, versus you could be messed up for life if treated. I think that is what a lot of people tend to forget.
“Anyway: the number one choice for Afghanistan is mefloquine: most effective and highest compliance rate (you take it once weekly. Number two: Malarone: moderately effective, must take primiquine afterward as terminal prophylaxis (hard on the body), and Malarone must be taken daily. Number 3: Doxy: least effective and lots of common side effects, also the other stuff primiquine and taken daily.
“The choice is now left with the soldier after being briefed by doctor and pharmacist, but yes, they will tend to recommend Mefloquine for the reasons stated above unless it is contra-indicated (known problems with it or psychiatric history). Hope this helps.”
As of 2006, this was the procedure for issuing malaria prophylaxis in the military:
1. Prior to a mission to an area, a threat assessment is done. Information is gathered from WHO, and from local health boards. The information is analyzed and a decision is made as to the type medications that are warranted (based on malaria type and mosquito type in that particular region). That information is then sent out to the deploying force (months in advance).
2. All the soldiers who are mobilizing for the mission have to go through a DAG (departure assistance group) where all sorts of things are checked and verified. From pay to training to medical stuff. So the medical stuff will include a complete physical, questionnaires, and mental health screening. All immunizations are checked.
3. The first thing that will happen to a soldier who has never deployed before is a blood test to test for G6PD (an enzyme.) Without it, if you took primaquine (terminal treatment for malaria) you would get very sick (anemia).
4. Next, soldiers are briefed about the malaria type and the recommended medications. (Mefloquine, Chloriquine, Malarone, Doxycycline). They are told of side effects, and interactions. They then individually see a pharmacist: who goes over this information again, forms (health questionnaires) are completed to determine the best suitable medications. They then receive an Rx for that medication. They would then typically start this medication as recommended before they even leave Canada. If there are any problems they are to attend the medical center to get things switched up.
5. Soldiers can refuse to take medications outright, but then they are DAG’ed RED and then it is up to the individual mission commander to accept the risk or not.
For my summary of the study on mefloquine go to the new page created for the Mefloquine Controversy. You will find a complete history of the drug here: http://bonnie-toews.blogspot.com/p/hidden-face-of-military-suicides-and.html