Veterans Affairs Committee on May 6th, 2019

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Thank you, all, for your testimony here today.

Brigadier-General Downes, you mentioned the contraindications of prescribing mefloquine. If a serving member, prior to being deployed, checked off some of those boxes, might that have restricted him or her from the mission?

[BGen Andrew Downes]

I suppose it depends on when and where the mission was.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Let's say Somalia.

[BGen Andrew Downes]

Somalia: I was a student in those days and not working in the system at that time, so I don't know exactly what took place. From what I have read, screenings weren't done in that sense. There wasn't a check, a questionnaire that was filled out by serving members, but the expectation would have been that people would have had their medical file annotated or the pharmacy record on them would have been kept.

It's difficult at this point to look back at that, because pharmacy records are required to be kept for two years, so some of these records have been lost, not due to malice, but in the normal process of maintaining records.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

I have a question on that. If someone was getting a prescription filled at that time, and they were an active member, would they have been getting a prescription filled at a pharmacy or agency on base, or was it typically off base?

[BGen Andrew Downes]

Almost certainly it would be on base. I suppose it's possible that some were filled in a civilian pharmacy, but they would have typically been on base, either in a pharmacy or through a regimental unit medical station.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Okay. Thank you.

My next question is actually regarding the Korean conflict. My father did two tours of duty in Korea. In cases of malaria, or to reduce the risk of malaria, were those soldiers prescribed an anti-malarial drug?

[BGen Andrew Downes]

I certainly don't know about that. I don't know if anybody else does.

[Col Rakesh Jetly]

I'm not sure about then. In Africa, for sure; Cambodia, for sure; Korea, I can't be positive.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

To extend further my line of questioning, I'm just wondering about the other types of anti-malarial drugs that had been prescribed in previous conflicts and if there were comparable outcomes or questions regarding the prescriptions and the after-effects.

[BGen Andrew Downes]

Certainly anti-malarials have been provided for a fairly significant period of time, certainly predating mefloquine. We can't really speak to given missions at this point, but we do know that doxycycline had been used, and chloroquine was used in certain areas where the malaria is not resistant to chloroquine.

All of these medications have side effects. Some of the studies even suggest in terms of the side effect profile that although the particular symptoms are different, the actual numbers of side effects are similar between mefloquine and doxycycline, for example. In fact, the discontinuation rate of the two medications is about the same.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Thank you.

Although there do not appear to be active studies taking place in Canada, are Canadian officials working closely with our allies in Australia, the United States and even Germany where they have banned it?

[BGen Andrew Downes]

I'll ask Colonel Jetly to speak to that. He is quite engaged with the international community.

[Col Rakesh Jetly]

Essentially, the military is a subpopulation of the larger population. Countries are looking. Every opportunity we get to talk to our allies about what they are looking at.... The Australians have been looking. They just had a Senate hearing, and they have a few clinics in place where they are looking at people who have neuropsychological problems related to deployment, not specifically because of mefloquine, but if they have the reported problems. We are in communication, and we'll certainly share any information that we gather with them, and likewise. We're on that exchange.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Dr. Jetly, how is that research being funded? In the case of the Australians, is it the Australian government?

[Col Rakesh Jetly]

I think it's the Australian government—their VA, I believe.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

In other drugs that have been prescribed, anti-malarial drugs, do we know of any reactions to them?

Further, Mr. Downes, would there be a recommendation that the prescriptions that are filled on base be more closely tracked over time?

[BGen Andrew Downes]

Things have changed over time. I can tell you how things work right now with prescriptions provided on base. We have a system that, whether a prescription to a military member is obtained in a civilian pharmacy or on base, it is entered into the same system, as long as the individual uses his or her Blue Cross card when they go to a civilian pharmacy.

These things are all tracked through a single system, but we have not had that system throughout our history. We've only had it the last 10 or so years. Nothing is foolproof, but I do think we're in a much better position now than we were in the past to track these sorts of things.

We also have an electronic health record now, since the mid-2000s, which also allows us much better access to information. Previously, when we were using paper-based records, things would be entered there and sometimes papers would get misplaced, as can happen. Now, with things being entered directly into this electronic health record, it is a permanent record that clinicians have access to no matter where the patient is working.

[Karen Ludwig, Liberal, New Brunswick Southwest, NB]

Thank you.

[The Chair, Liberal, Neil Ellis]

Ms. Wagantall.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Chair.

Thank you, all, for being here.

I'm pleased with what has transpired since the first study this committee did on mental health, which brought forward a number of witnesses who have dealt with mefloquine and its impact on their lives. The surgeon general has put forward a report that resulted in mefloquine's becoming a drug of last resort instead of a priority drug. Health Canada has greatly changed the monograph in regard to this drug. I don't believe that just happened because who knows why. Clearly, around the globe, there's a lot of action on this drug and its impact on armed forces, especially with our allies, with the research that's being done.

I'm greatly disturbed, though, with the fact that we're looking and saying, “Now we're doing this.” You are doing a far better job of following the armed forces, determining whether or not it's safe for them to do this based on past history and whatnot. However, we have a significant cohort of individuals who took this drug not knowing what it was. They were forced to use it. They were not allowed to refuse it or they would lose their deployment. It's true that a lot of the testimony to this date has been anecdotal. A lot of times, I don't think you start a study to deal with an issue unless you have that anecdotal evidence first.

I will very quickly ask the question, and I just want a yes or no answer from each of you. In looking at this issue, have you read or do you give any weight to the studies this committee carries out? Have you read the testimony of those veterans who came to this committee? I just want a quick yes or no.

[Col Rakesh Jetly]

Yes.

[BGen Andrew Downes]

Yes.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you. I appreciate that.

We have an Order Paper question here, in which I asked how many Canadians had been given this drug over the course of their deployment. I was hoping the response would be from 1995 and onward. It's only from 2003 forward, which is unfortunate. That being said, you do take into account the reality that members move between ranks and may have served during those years in different locations, so the number of prescriptions, 15,844 prescriptions, would include all of that. Even if we went down to half, clearly our armed forces, Veterans Affairs, is aware of who has used mefloquine in our army. Is this correct? Yes or no?

[BGen Andrew Downes]

No, I don't think it is correct to say we know who took it.