Veterans Affairs Committee on May 13th, 2019

[The Chair, Liberal, Neil Ellis]

You have 40 seconds.

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

My last question is for Dr. Sellers as well. In terms of what you have learned internationally—one of you today talked about the Five Eyes: Australia, Canada, New Zealand, U.K. and the U.S.—are there any medical conferences or training specifically on this, discussing the topic of mefloquine and veterans?

[Dr. Edward Sellers]

Not to my knowledge, although I suspect Professor Quinn may have managed to stimulate this in Australia. She's quite a force.

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

Professor Quinn.

[Prof. Jane Quinn]

There have been no specific conferences or events outside of those organized in the veterans community.

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

Okay. Thank you.

[The Chair, Liberal, Neil Ellis]

Mr. Samson, you're next.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Thanks very much to both of you for your testimony today as we continue to dig deeper into understanding these effects and to prepare a report that will allow us to know more than we knew before. We may be able to make some recommendations that could make a big difference, so I thank you for that.

Doctor Quinn, I'd like you to comment on a report that came out in August, 2017. The Australian Repatriation Medical Authority, a science body responsible for making recommendations to the Department of Veterans' Affairs, specifically recommended to deny the benefit of the doubt in the link between mefloquine and this syndrome and its effect of brain injury.

Could you give your opinion on that, please?

[Prof. Jane Quinn]

Yes, I can.

I was asked to submit evidence to the Repatriation Medical Authority in order to assist them in the process of defining whether or not they would accept a statement of principles for acquired brain injury in relation to mefloquine, tafenoquine and primaquine specifically.

It was an interesting process in that I thought the remit of the investigation was flawed. It had looked across three drugs, one of which has a very discrete neuropsychiatric profile that's well documented; one that was at that time an experimental drug that had very limited evidence available about it outside of the development process for the pharmaceutical industry; and another that had not been systematically reviewed for some time in terms of its safety in terms of neuropsychiatric side effects.

It was an investigation that was very difficult to provide evidence to; therefore, the outcome, which was that the causality link was not determined, was probably quite predictable. However, what should be noted is that the Repatriation Medical Authority currently accepts 15 separate conditions associated with quinolines, or mefloquine specifically, in terms of poor health outcomes that can be claimed through the system in Australia.

If you put those 15 statements of principles together, you essentially get the syndrome we have described as mefloquine toxicity syndrome.

We were looking to confirm that the neurocognitive component could be identified as a separate condition, and unfortunately that was not upheld. I think the evidence for that is emerging and will need to be confirmed through specific, targeted case series. One of the issues around this area is that the desire to undertake those specific review case series has been extremely poor. The more recent evidence coming out of Australia in that sense will, I think, strongly assist us in the process of defining that statement of principles in the future.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

You said in your testimony that the Australian government had invested $2.1 million towards support. What was the basis of that determination, the conclusion that allowed that investment?

[Prof. Jane Quinn]

I think that has come from a number of places. The first was the very significant impact of the testimony those veterans who have been affected by the experimental drug tafenoquine, and also mefloquine here in Australia, put forward at the Senate inquiry, where it became clear and evident that their lives had been permanently impacted in a very negative way by being exposed to those two drugs.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Excuse me, sorry. What was the conclusion? I know there were all kinds of scenarios, but what was the clarity that determined the causality?

[Prof. Jane Quinn]

I think that final determination came in part from the study carried out by the University of Queensland for the Department of Defence, which showed there had been clear and tangible long-term negative health outcomes specifically related to taking mefloquine during the two deployments in Bougainville and East Timor.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Which ones would they have been? What would be the diagnosis, the symptoms, the exact ones—PTSD or?

[Prof. Jane Quinn]

No. They were particularly anxiety, and depression and neuropsychiatric symptoms. This again was based on a retrospective dataset, and thus was an opportunistic study. It was not targeted and defined. This is a piece of research that still needs to be carried out.

But I think that with the weight of that evidence, together with the evidence presented at the Senate inquiry, plus events that are occurring internationally around acceptance and acknowledgement of the impacts of mefloquine on veterans' mental health, and settled cases of litigation, I think there was probably a cumulative effect that suggested to the government this was a necessary process. As well, there were those individuals who are working inside the Department of Veterans' Affairs and Open Arms who were strongly supportive of this group of veterans and, more broadly, those veterans affected by brain injury of many different causes.

[The Chair, Liberal, Neil Ellis]

Mr. McColeman.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Am I done? Six minutes?

[The Chair, Liberal, Neil Ellis]

That was six minutes and 20 seconds.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Thank you to the witnesses for being here today to give your perspectives on this.

I want to put things in context for you. You may or may not know this, but I think it's worth getting on the record that we had the top medical people of the Canadian military here—this would be our Department of National Defence, or DND—and Brigadier Downes, the surgeon general of our DND. He said that he had done extensive research and had read just about everything there was about mefloquine and its effects on military people—this is the top medical officer in our national defence department—but could not agree with anything you would have said today.

In other words, his view was there is not enough evidence and not enough study, just as my colleague across the table, from a medical background, was trying to draw the connection between a study and the fact that it did not show any evidence of the correlation that both of you clearly outlined to us today. Not surprisingly, either, the other witnesses we have had at this committee have all drawn the same connection that you have—except for our military brass, the people making the decisions within our military circles. This was the drug of first choice right up to Afghanistan, in particular the one that stands out in Canadian history in terms of some of the effects and psychological and mental health issues that happened in Somalia and the atrocities that happened through military hands.

One of our more respected generals, I believe, who's now a senator, is Roméo Dallaire. He has said unequivocally that we should not be giving this to people in the military. He forcefully said it, publicly, and yet we are here at committee asking questions of our military leaders who don't find any credibility in what you're saying. They obviously haven't read Professor Quinn's references to what's happened in Australia.

Obviously, you have had study. Interestingly enough, there was never a reference to the fact that Australia had taken action on this and had developed policy within government to compensate and help these individuals who are struggling so much.

I put that in context because it's simply a matter of screening, of asking those who served whether they took this drug. That would be up to and including Afghanistan and including the ones who are still taking it in our military.

So I'm outraged; you might be able to see that across the video screens. I'm outraged by the fact that this government has not taken action on it—or other governments previously, if we had this information. It seems to me that the database is there. That was another question brought up: How do we know who took it? Well, we know who served. We have all their records. We ask them, “Did you take it?” That's all. Then we acknowledge the fact that there is a correlation. Australia has dealt with it, the United States is dealing with it and banning it, and yet we somehow stubbornly within our military want to continue to allow our military people to take it. If we did nothing more than just stop it from being offered, we'd be doing a service to our military people and to future veterans. We're here talking about veterans, the ones who took it and the ones who have claimed the correlation of these symptoms and these problems with their health issues, and we have a defence and a government trying to say that it doesn't exist.

When I give you that context, my question is, what do you think the next steps for Canada should be on this issue of those veterans who consumed this toxic drug and those who are continuing to consume it? Could I have your general thoughts, each of you?

Why don't you go first, Professor Quinn? Then perhaps Dr. Sellers could weigh in as well.

[The Chair, Liberal, Neil Ellis]

We're short on time, so could you be to the point, please?

[Prof. Jane Quinn]

Yes, I think it's very clear that mefloquine is fundamentally unsuitable for use in military populations, for many reasons. The immediate discontinuation of oral use of mefloquine across the board should be your first step, acknowledgement of those who have taken the drug and been affected by it should be the second, and implementation of a clear treatment and screening program should be the third.

[Phil McColeman, Conservative, Brantford—Brant, ON]

Thank you.

[The Chair, Liberal, Neil Ellis]

Dr. Sellers, do you want to add to that quickly?

[Dr. Edward Sellers]

I know that you've characterized this as being a uniquely military problem, but it's actually not uniquely a military problem. This is a problem with a drug that has toxicity, and it has been observed in many populations.

Whatever you decide to do, I would urge that it be a process that involves independent medical assessment and management and clinical pharmacology input, because that's the way we would manage any public health issue with a drug that was causing toxicity of this type.

[The Chair, Liberal, Neil Ellis]

Mr. Chen.