ACVA Committee Report

Effects of Mefloquine Use among Canadian Veterans

Dissenting Report of the New Democratic Party (NDP)

 

The NDP strongly disagrees with the contents of this report. The committee heard from multiple expert witnesses about the need for screening of Canadian Armed Forces (CAF) veterans for long-term symptoms related to mefloquine exposure, the need for Veterans Affairs Canada (VAC) and the Department of National Defence (DND) to publicly acknowledge the effects their decisions have had on CAF veterans, and for the need for a public information campaign. These necessary measures were not adequately addressed in this report.

The NDP are not in agreement with the first recommendation of this report. The committee heard multiple references, some of which were included in this report, to the fact that the European Medicines Agency found enough evidence to indicate “a causal relationship between mefloquine and the occurrence of long lasting and even persistent neuropsychiatric side effects.”.¹ According to Dr. Jonathan Douglas, Australia and the U.K. have also identified the risk mefloquine poses in the development of neuropsychiatric disorders.²

To base Canada’s recognition of any long-term effects resulting from mefloquine exposure exclusively on the results of a single American study, when other studies are already available, is erroneous and wilfully ignorant.

The NDP disagrees with the second recommendation of this report for the same reasons stated above, but as the committee heard from multiple witnesses, a systematic screening program is vital for military personnel and veterans who, as a result of their service, may be experiencing long-term effects resulting from exposure to mefloquine.

Based on what the committee heard from witnesses, the screening process would not be complicated or expensive to implement. As stated by Dr. Elspeth Ritchie:

… we need to do a better job of screening veterans for exposure to mefloquine. That would be fairly simple. Have you ever taken the once-a-week anti-malaria pill? As a follow-up to that, have you ever experienced a variety of symptoms that include dizziness and nystagmus?³

Implementing systematic screening for veterans is worth both the resources and effort because it could give veterans a concrete diagnosis for symptoms that have either been undiagnosed or misdiagnosed. In addition, veterans having knowledge of the cause of these symptoms provides them with much needed peace-of-mind. Beyond that, the committee heard from Dr. Penelope Suter that management of some of the associated symptoms, particularly those related to vision and balance, is possible and veterans should be given access to this treatment as needed.⁴

Therefore, the NDP recommends:

That Veterans Affairs Canada, together with the Department of National Defence, task an independent research organization with implementing a systematic screening program for military personnel and veterans who may be experiencing the long-term effects of mefloquine.

The committee heard that CAF veterans who may be experiencing long-term symptoms related to mefloquine exposure are asking for three things: acknowledgement, outreach and research.⁵ Though acknowledgement may seem like a simplistic request, the impact would be profound.

Multiple expert witnesses testified about the reality of refusing to take a drug or wishing to discontinue the use of a drug following the onset of negative side-effects while in theatre. For many CAF members, doing so could have negatively impacted their careers; from being ridiculed by their peers and superiors to lost opportunities for promotions. For veterans to finally hear the government admit that their experiences are a result of a drug they were, in most cases, forced to take while deployed is a vital first step.

Therefore, the NDP recommends:

That Veterans Affairs Canada and the Department of National Defence publicly acknowledge that mefloquine was improperly prescribed and administered to Canadian Armed Forces members during various deployments and issue a formal apology to all those who have been affected.

The second request is that of outreach. This is being requested by CAF veterans as well as by the witnesses who appeared before the committee. Outreach must take different forms, as there are different audiences that require distinct information to address the issues around mefloquine. Healthcare professionals must be made aware of the issue and trained for the aforementioned screening; CAF veterans who may have been exposed to mefloquine have to know to seek that screening; and the general Canadian public needs to be informed so that they better understand the experiences and realities of service veterans.

Dr. Jonathan Douglas clearly showed the need for healthcare providers to have more information, especially those who work closely with the veteran community:

I have worked with veterans for about 15 years now, and as part of my work I have completed many psychological disability assessments. For most of these, the issues associated with quinism have simply not been on my radar. It’s not something there’s much awareness of in my field.⁶

Therefore, the NDP recommends:

That Veterans Affairs Canada create and disseminate a public awareness campaign on the suspected long-term effects of mefloquine toxicity with specific information campaigns for healthcare providers and veterans so that healthcare providers, veterans, and the Canadian public at large, have the necessary information to address this issue.

The final request is that of research. This report references the forthcoming study by the U.S. National Academies of Science, Engineering and Medicine on the effects of mefloquine exposure on American veterans. The committee also heard from several witnesses who have conducted research of their own and examined the research of others on the same topic. The NDP does not believe it is necessary to repeat this research in Canada, and instead would like to see a gap in the research filled.

Due to the only recent or complete lack of acknowledgement among governments around the world on the effects of mefloquine exposure, very little research has been conducted on the ways in which permanent symptoms resulting from mefloquine exposure can be managed or cured.

Dr. Jane Quinn recommended several treatments be made available to veterans following a diagnosis:

A 360-degree health review should be implemented to look holistically at the health and well-being of these veterans and their families, and appropriate support strategies should be applied, including access to occupational therapists, psychologists, psychiatrists or other health care professionals as appropriate.⁷

Access to treatment must be given priority, but as multiple witnesses mentioned, some veterans may not be receiving the appropriate treatment. Symptoms related to mefloquine exposure may closely mirror those of PTSD, and in some cases, veterans may be experiencing both these and other issues.

Therefore, the NDP recommends:

That Veterans Affairs Canada, in partnership with the Canadian Institutes of Health Research, establish and fund a study to determine the best possible treatments to manage and/or cure the long-term effects of mefloquine exposure.

Mefloquine was given to CAF members without their informed consent, and the horrifying effects during and following exposure have been dismissed by the DND and the Government of Canada for far too long. The NDP hopes that the recommendations made here will encourage CAF veterans speak out and demand the respect, treatment and closure that they have earned by serving this country.

¹ European Medicines Agency, Updated PRAC rapporteur assessment report on the signal of permanent neurologic (vestibular) disorders with mefloquine, EMA/63963/2014, p. 31.

² Dr. Jonathan Douglas, (Psychologist, Central Ontario Psychology, As and Individual), ACVA, 29 April 2019, 1600

³ Dr. Elspeth Ritchie, (As and Individual), ACVA, 1 May 2019, 1540

⁴ Dr. Penelope Suter, (Optometrist, As an Individual), Evidence, ACVA, 29 April 2019, 1540

⁵ Dr. Remington Nevin, (Executive Director, The Quinism Foundation), Evidence, ACVA, 1 May 2019, 1705

⁶ Dr. Jonathan Douglas, (Psychologist, Central Ontario Psychology, As and Individual), ACVA, 29 April 2019, 1545

⁷ Dr. Jane Quinn, (Associate Dean for Research, Faculty of Science, Charles Sturt University, As an Individual), ACVA, 13 May 2019, 1535