National Defence Committee on Feb. 23rd, 2017

[BGen Hugh MacKay]

To my knowledge, there are no medications that don't have any potential side effects. If you look at all three of the choices that we have for anti-malarials right now, you see that there is a long list of potential adverse effects from each of them. All of them have gone through the Health Canada licensure process and have met the Health Canada regulatory requirements for marketing within the country with respect to safety and effectiveness.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you. I understand that mefloquine was convenient to take because it was a once-a-week pill as opposed to a pill that had to be taken every day. Has cost ever been a factor in mefloquine being the drug that the CF chooses or that they recommend the soldiers take?

[BGen Hugh MacKay]

The cost is—

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

It's considerably cheaper, right? My understanding is it's considerably cheaper than some of the alternatives. I don't know if that's....

[BGen Hugh MacKay]

Malarone is the most expensive medication of the three choices. I can't remember.... Mefloquine may be a little bit more expensive than doxycycline on a per-person basis, but cost has never been a factor in our recommendation.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thank you.

Do I still have some time?

[The Chair, Liberal, Stephen Fuhr]

You have about 30 seconds for a question and response.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Who can go to an OTS clinic? Is it uniformed soldiers, is it veterans, is it both?

[BGen Hugh MacKay]

You're speaking of our operational trauma stress support clinics. We have an MOU with Veterans Affairs that it is there for Canadian Forces members, but we can take veterans into our—

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Do you? If someone is suffering from PTSD 10 years after leaving the forces, do they have the ability to go to the OTS?

[BGen Hugh MacKay]

They do, yes. We have had patients that come in.... We have benefited more from the MOU in that when we had a problem with psychiatry in Shilo, we were able to use the operational stress injury clinic that Veterans Affairs has in Winnipeg to get good care for our military members. It's a reciprocal agreement that we have with Veterans Affairs.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

I look forward to March and your report on mefloquine.

Thank you very much. Thank you, Mr. Chair, for the extra few seconds.

[The Chair, Liberal, Stephen Fuhr]

It was a pleasure.

Mr. Bezan is next.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Thank you, Mr. Chair.

We just witnessed the end of sunny ways.

[Some hon. members]

Oh, oh!

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

General, Colonel, thanks for joining us today.

I want to follow up on Mr. Fisher's question about mefloquine. We're about to send troops to Africa on a UN mission. Are they going to be given anti-malarial drugs? How do we determine which anti-malarial drug we will give them?

[BGen Hugh MacKay]

Every time we go on a deployment into a region, we will look at whether or not malaria is a threat. We don't know where we're going yet, so when that is determined, we'll do an evaluation. If malaria is a risk to our members, then we will recommend anti-malarial medications. At the present time, we are using the current recommendations, but as I said, I'm studying a report right now to look at what my policy recommendation is going to be.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

In the past when we have had to deal with malaria, was mefloquine at any point in time given on the basis that it was easier to administer, since it's only once a week versus a daily dosage with other medications? Would the chain of command ever order that mefloquine be the chosen drug? Could it happen that the troops actually weren't given a choice?

[BGen Hugh MacKay]

To my knowledge, there has never been an order as to which medication needs to be taken for anti-malarials.

I'm sorry; the first part of your question was...?

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

It was whether the chain of command made the decision and if it was easier to administer.

[BGen Hugh MacKay]

We have, in the past, looked at mefloquine as having a benefit in that it is a once-a-week medication, and what we knew of its side effect profile compared favourably—before malarone was available—to the doxycycline, which has problems with sun sensitivity and people getting significant sunburns if they take it. When you looked at the side effect profiles known at the time, and the convenience....

There's an added protective factor because it's once a week. If you miss a pill of doxycycline one day and you are exposed to malaria, you can get malaria. If you miss your mefloquine pill and take it the next day, the likelihood of your getting malaria if you were bitten by a malaria-infected mosquito the day you forgot your pill is far lower, because the mefloquine is still in your system to protect you. That once-a-week protection factor was part of the consideration in recommending mefloquine.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

I want to switch gears a bit and go back to the mental health side of this.

The road to mental readiness program is very well used, and the Canadian Armed Forces are a leader in it. Are we still actively doing road to mental readiness with all our troops, including those who are going to sea or in the air force?

You also talked about the continuation and the continuum of other programs. Is that a follow-on to the road to mental readiness program? How often do we reach out to the men and women in uniform to ensure that they're always doing the self-assessments, assessing their colleagues, and monitoring mental health in their brigade?

[BGen Hugh MacKay]

Colonel Downes may be better placed to answer the question of how often people are getting exposed to the road to mental readiness training right now.

[Col Andrew Downes]

Certainly, I'm happy to answer that.

Road to mental readiness is really a suite of about 36 different programs, I think. The first module, as General MacKay already mentioned, is given during basic training. There are other modules that are given at different stages in an individual's career as they move up in rank. There is a module for people when they're going on deployment, there's a module when people come back from deployment, and we've also recently started focusing on certain occupations. For instance, we've developed a road to mental readiness program for search and rescue technicians, for military police. We've incorporated very particular aspect stressors and so on that are unique to those particular groups.

Road to mental readiness training is something we've tried to infuse throughout somebody's career. We're continuing to extend the reach of it, and also the breadth of it in terms of getting people exposed to it as often as possible.

[James Bezan, Conservative, Selkirk—Interlake—Eastman, MB]

Okay.