Given what we know now about mefloquine effects, the Liberals may have no option
Veterans Affairs Minister Kent Hehr must be starting to recognize the can of worms that landed on this desk this fall.
To be fair, this particular bucket of problems didn’t start with Hehr, or with his government. It dates back to 1992, when 900 Canadian Airborne soldiers were given an experimental anti-malarial drug called mefloquine (sold under the brand name Lariam) under a flawed clinical trial run by the Department of National Defence and Health Canada.
More than twenty years later, some of those soldiers say they are still suffering from neuropsychiatric side effects from the drug, including uncontrollable anger, anxiety, hyper-aggression, paranoia, hallucinations and suicidal thoughts. Recent research shows the drug can cause permanent brain damage.
The veterans want an outreach program, more research into better treatment and acknowledgment by the government that the drug was improperly prescribed to those soldiers serving in Somalia given that it had not been licensed for use in Canada (the conclusion of a 1999 auditor general’s report).
In November, this newly formed group of veterans got a major boost when they got themselves inside the door of the Commons Standing Committee on Veterans Affairs. The all party-committee turned out to be sympathetic to their requests.
The veterans told the committee they’re convinced the psychiatric side effects of the drug played a role in the incident that led to the Airborne being disbanded — the 1992 beating death of a local teen at the hands of two Canadian soldiers during the ill-fated Somali mission. They want that episode reviewed.
The MPs on the committee took surprisingly quick action, voting unanimously to ask Health Canada to do more research into the drug’s side effects and stating that the committee is concerned about “the historic and continuing use of mefloquine.”
While pointing the finger at Health Canada may appear to take the heat off Hehr, the committee may have found the better target. For years, Health Canada failed to acknowledge the long-term side effects of the drug — among them, brain damage — despite the fact that Canada’s allies, including the U.S. and Britain, have confirmed those findings and have taken steps to restrict the drug’s use.
In July 2013, the U.S Food and Drug Administration upgraded its warning on the drug to its toughest level after its own study concluded that some of the drug’s side effects could be permanent.
Shortly after, the U.S. military banned the use of the drug among special forces such as Green Berets, and downgraded it to a drug of last resort for the rest of the armed forces.
European drug regulators did their own study and came to the same conclusion two years ago — which is why the U.K. armed forces now also consider mefloquine a drug of last resort.
For the Liberal government — for any government — reopening the Somali affair to look at the murder of Somali teenager Shidane Arone would be problematic. But the pressure to do so may grow.Health Canada waited a long time — until August of this year, in fact — to approve a new label for mefloquine that would “add a more prominent warning on the labels to better emphasize its known risks,” as Health Canada put it. It did so quietly, by posting on its website the new wording on the drug label proposed by AA Pharma, the drug’s manufacturer in Canada.
“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,” says the company’s drug monograph updated Aug. 4. Health Canada also said in an email that it considered both the FDA warning and the European studies in approving this change to the drug warnings.
None of this seems to have changed the government’s policy on the drug’s actual use.
“The benefits of mefloquine outweigh its risks when it is used as directed. The drug is an important tool in preventing and treating malaria, and provides effective protection against a strain of malaria that is resistant to another drug that is often used to treat malaria, namely, chloroquine,” Health Canada added.
Oddly enough, Kent Hehr was unaware of that change in the warnings this summer. He sent a letter to the veterans saying that “a review of the scientific literature has shown there are no long term side effects.” That was a few days after Health Canada posted the new warnings.
Seems the military didn’t get the message either. The army Surgeon General, Brigadier General Hugh MacKay, told the Veterans Affairs committee last month that the long-term negative side effects have not been proven by science.
Now that Health Canada has acknowledged that permanent side effects are possible, will that be enough to prompt the military to make changes to its policy on mefloquine usage? That’s the question the veterans are asking. They want to see mefloquine classified as a drug of last resort, as other countries have done.
More than 16,000 Canadian soldiers took mefloquine between January 2001 and 2012, mostly in Afghanistan.
In recent years, use of the drug by Canadian soldiers has dropped significantly, to about five per cent of soldiers going to tropical countries. That’s still much higher than in the U.S. military, where use of the drug is down to one per cent.
In the 1990s, Reform (later Conservative) MP John Cummins of British Columbia was the lone voice prodding successive federal governments on the mefloquine issue. Despite his efforts, governments took no action.
This time around, Saskatchewan Conservative MP Kathy Wagantall is taking up the torch. She’s been asking pointed questions in the House of Commons and putting pressure on the Trudeau government.
Saskatchewan is also the home province of Clayton Matchee, one of two soldiers involved in the beating death of that Somali teen. Matchee attempted suicide after the incident and, due to brain damage he sustained, he never went to trial. There’s already a move afoot to have Matchee’s case revisited to determine whether mefloquine toxicity played a role.
For the Liberal government — for any government — reopening the Somali affair to look at the murder of Somali teenager Shidane Arone would be problematic. But the pressure to do so may grow.
Some of the veterans initially had some hope the new Liberal government would recognize their cause and take some meaningful action. These days, they aren’t so sure anymore. Some have joined a class action lawsuit against Health Canada. That kind of legal action spells trouble for any government.
Mr. Hehr has some work to do.
