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ACVA Committee Report

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Supplementary report of the Conservative Party of Canada on Effects of Mefloquine Use Among Canadian Veterans

Mefloquine was licensed in Canada for public use in 1993 but its darker past began earlier in Somalia with a United Nations peace keeping mission known as Operation Deliverance. Significant quantities of Mefloquine were given to the Canadian Armed Forces (CAF) in exchange for conducting a clinical trial tracking the efficacy of the anti-malaria drug.  The clinical trial ultimately did not fit the operational parameters of the mission, so it was not completed but CAF members were still required to take the drug as refusal was not a career enhancing option.

While using Mefloquine during Operation Deliverance multiple atrocities occurred which were out of character for Canadian peace keepers.  The most public of these was the torture and killing of Shidane Abukar Arone.  These events became known as the Somalia Affair and they were investigated by the Commission of Inquiry into the Deployment of Canadian Forces to Somalia which produced a report titled: Dishonoured Legacy: The Lessons of the Somalia Affair.

In Chapter 41 the report reviews the limited scientific information that was then available about Mefloquine and it details many of the concerns raised about the drug’s effect on CAF members performance.  In its concluding observations the report states: “If Mefloquine did, in fact, cause or contribute to some of the misbehavior… CF personnel who were influenced by the drug might be partially or totally excused for their behavior.” [1]

This observation lingered for years as the inquiry was cut short before these and other hypotheses could be examined.

In 2017 the issue was taken up by House of Commons Standing Committee on Veterans Affairs in its study of Mental Health of Canadian Veterans: A Family Purpose.  In this study the Committee heard from individual veterans who detailed their experiences with Mefloquine and leading researchers in the field.  Most of the individual testimony was washed from the final report because it was considered anecdotal. Much of the expert testimony given at the committee was deemed unscientific and unproven by the government members of the committee and in their response to the tabled report, the Government ignored the subject of Mefloquine all together.

Through four more studies Conservative members continued to raise the issue of Mefloquine whenever appropriate for the witnesses before them.  This determination culminated in the committee agreeing to a motion by M.P. Wagantall to undertake a dedicated study of Mefloquine which would be titled: Effects of Mefloquine Use Among Canadian Veterans.  This study focused on the latest research in the field and the recent experiences of our allies.

There have been significant milestones concerning Mefloquine both in Canada and throughout the world over the past few years, including but not limited to the following:

  • March 2019 - Australia, announced a 2.1-million-dollar initiative which includes a comprehensive health assessment for veterans concerned about having taken anti-malaria drugs. The Australia Repatriation Medical Authority recommended that the benefit of the doubt be given to the link between Mefloquine and 14 medical conditions.
  • December 2016 - Germany took Mefloquine off the list of medications to be prescribed for their soldiers. The decision to do so was made after two separate reports were published: the 2013 USFDA's and European Medicines Agency Report.
  • August 2016 - In Great Britain MP's chided the Ministry of Defense for showing “lamentable weakness” in its duty to protect soldiers, sailors and airmen. They called for new and independent studies as military research provided to them did not reflect the public outcry they were hearing.[2]
  • In August 2016, Health Canada quietly stated that: “Psychiatric symptoms … on occasions … have been reported to continue long after Mefloquine has been stopped” and “In a small number of patients it has been reported that dizziness or vertigo and loss of balance may continue for months or years after discontinuation of Mefloquine, and in some cases vestibular damage may be permanent.”[3]
  • In 2013 - A boxed warning added to the United States drug label noted that Mefloquine may cause “neuropsychiatric adverse reactions that can persist after Mefloquine has been discontinued”. Prescribing guidance recommends to discontinue the medication at the onset of neuropsychiatric symptoms, due to a risk of “more serious psychiatric disturbances or neurologic adverse reactions” that could occur with continued use of the drug. The United States Drug label now cautions that psychiatric reactions “ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior can occur with Mefloquine use” and “have been reported to continue for months or years after Mefloquine has been stopped” and “have been reported to be permanent in some cases.”[4] 
  • In 2014 - Regulators at the European Medicines Agency recommended that substantially similar warnings to those of the United States be added throughout the European medicines regulatory network. The EMA concluded that there was sufficient evidence “supporting a causal relationship between Mefloquine and the occurrence of long lasting and even persistent neuropsychiatric effects” and speculated that these were due to “permanent brain damage.”[5]

Frustrated with government dithering veterans are taking their frustrations and claims to the public and to court.

  • December 2017 – Ireland settled a lawsuit with a veteran suing for damages he suffered to his health due to Lariam (another name for Mefloquine). This case was the first of 57 in the cue to sue for the same damages.
  • May 2019 – Eight Canadian veterans filed suit to for damages caused by Mefloquine after being ordered to take it without adequate warning about the possible side effects.
  • 2019 -2020 – Hundreds more Canadian veterans are expected to file lawsuits for damages caused by Mefloquine after being ordered to take it without adequate warnings regarding side effects.
  • Veterans hold an annual rally supporting research and protesting government inaction annually in September on the steps of the House of Commons.

A longstanding source of the frustration that is driving veterans to the courts for relief versus Veterans Affairs Canada (VAC) is the reluctance of VAC to recognize that their condition is caused by Mefloquine. 

In answering a question related to receiving a disability award for Quinism or Mefloquine toxicity Dr. Cyd Courchesne replied: “At Veterans Affairs the message has been consistent: Any service member who has developed any illness or injury as a result of their service can apply. That includes if they believe that Mefloquine is a cause of their illness or injury.

We don't compensate for cause, however. We compensate for a diagnosed medical condition. It is possible that some veterans have applied for a disability award for PTSD, but we don't track what the cause of their PTSD is. If you serve and you have a diagnosis of PTSD, you get your disability award and treatment and benefits that go along with that.”[6]

This is a colossal false equivalence.  Unlike PTSD events veterans are prescribed Mefloquine with its known side effects and injest it into their bodies for an extended period of time.  Although very real to the veteran, the side effects from taking Mefloquine are not a diagnosed medical condition as committee member Dr. Doug Eyolfson noted, there are currently no published criteria for Quinism or Mefloquine toxcicity.[7]

This is the ultimate example of a catch 22.  The government is saying we gave you pills that made you sick but since we don’t have a definition of the disease we gave you we can’t help you!

Professor Jane Quinn (Associate Dean for Research, Faculty of Science, Charles Sturt University) and Dr. Jonathan Douglas (Psychologist, Central Ontario Psychology) highlighted how not recognizing the cause of the condition is problematic and potentially damaging to our veterans.

“Mefloquine causes permanent neurological and neuropsychiatric changes in a significant minority of those who take it. Many of these veterans have been told they have treatment-resistant post-traumatic stress disorder, without it being acknowledged that their symptoms were actually caused by an ongoing neurological brain injury…

Recognition that Mefloquine causes long-term brain injury and other systemic medical conditions is a first and necessary step to getting effective and appropriate treatment, and ongoing medical support for those impacted ...

The disease cannot be identified by name in a diagnostic manual under a discrete code in either DSM-5 or ICD-10, but this is not the same as the condition not existing.”[8]

“Acceptance that Mefloquine causes long-term harm is critical to resolving the health issues for those affected, and I believe that this evidence is not in doubt.”[9]

“One of the significant issues that veterans have faced is the fact that the role of the drug in their ongoing medical conditions has not been formally acknowledged and has therefore not been allowed to be taken into account in their treatment”[10]

The reluctance of VAC to recognize Quinism or Mefloquine toxicity creates Sanctuary Trauma: “the idea is that the level of injustice somebody experiences subsequent to an injury predicts very strongly the duration of that disability. It predicts that, independent of the severity of the physical injury that occurs. It applies to both psychological and physical illnesses.

I have absolutely no doubt that it's a very common reaction really in anyone who's up against that system that says, “Prove to me you're sick.” That person's going to experience that at some point. Some people are going to be embittered by that experience and, as a result of that, their injuries are going to get worse.”[11]

The time has come to recognize Quinism or Mefloquine toxicity and provide veterans suffering from it the care they need.  The Royal Canadian Legion has recognized the significant problems cause by Quinism or Mefloquine toxicity and they have taken action on behalf of veterans by funding a study at the University of Saskatchewan and donating $25,000 to the Quinism foundation to fund additional research.

The Conservative Party of Canada stands with our veterans and the Royal Canadian Legion in their call concerning Mefloquine; “for more research into its use and long-term consequences, in particular as it pertains to veterans who received this drug when deployed. We want affected individuals to receive proper diagnosis, care and tailored support.”[12]

CPC Recommendations:

  1. That the Government of Canada notify all veterans who were administered Mefloquine about the potential side effects of the drug.
  2. The government conduct an independent inquiry to study the effects of the anti-malarial drug mefloquine on members of the Canadian Armed Forces.

[1] Dishououred Legacy: The Lessons of the Somalia Affair (Page 1396)

[2] UK Telegraph August 31, 2016

[3] Mefloquine [product monograph] Vaughan (ON): AA Pharma; 2016. Aug 4

[4] U.S. Mefloquine product insert, June 2013.

[5] Pharmacovigilance Risk Assessment Committee. EMA/63963. London (UK): European Medicines Agency; 2014. Updated PRAC rapporteur assessment report on the signal of permanent neurological (vestibular) disorders with Mefloquine.

[6] Dr. Cyd Courchesne (Director General, Health Professionals Division, Chief Medical Officer, Department of Veterans Affairs):  ACVA, 6 May 2019, 1620.

[7] Dr. Doug Eyolfson (committee member) ACVA, 12 May 2019, 1555.

[8] Prof. Jane Quinn, (Associate Dean for Research, Faculty of Science, Charles Sturt University) ACVA, 13 May 2019, 1530.

[9] Prof. Jane Quinn, (Associate Dean for Research, Faculty of Science, Charles Sturt University) ACVA, 13 May 2019, 1535.

[10] Prof. Jane Quinn, (Associate Dean for Research, Faculty of Science, Charles Sturt University) ACVA, 13 May 2019, 1550.

[11] Dr. Jonathan Douglas, (Psychologist, Central Ontario Psychology) ACVA, 29 April 2019, 1645.

[12] Royal Canadian Legion advocacy agenda 2019 - Mefloquine (Lariam) toxicity.