Mr. Chair, and members of the Standing Committee on Veterans Affairs, thank you for the opportunity to present specifically on the use of medications for the prevention of malaria within the Canadian Armed Forces.
Canadian Armed Forces personnel can deploy to areas of the world where malaria presents a significant threat to individual health and to mission success. Malaria is a significant infectious disease transmitted by a very determined mosquito vector that requires us to use multiple approaches to prevent disease.
The World Health Organization estimated that globally in 2015, there were 214 million cases of malaria and around 438,000 deaths attributed to this infection. In addition to personal protective measures, which are vulnerable to penetration and difficult to sustain in operational settings, it is critically important to provide the additional protection of malaria chemoprophylaxis, or medications. When used appropriately, chemoprophylactic medications can safely reduce the risk of malaria by more than 90%.
In developing our approach to malaria prevention and treatment in addition to our own assessment, we seek the advice and guidance of experts in this field, such as the Canadian Committee to Advise on Tropical Medicine and Travel. This committee has developed evidence-based clinical guidelines.
Those best medical practices address the very real threat that malaria presents, while taking into consideration the safety and effectiveness of the medications involved. This committee, along with similar authorities such as the United States Centers for Disease Control and Prevention, Public Health England and the World Health Organization, recommend several medications, including mefloquine, as suitable drugs for the prevention of malaria, depending on the regional susceptibility of the malaria and appropriate patient screening.
The Canadian Armed Forces, following the advice of the Canadian Committee to Advise on Tropical Medicine and Travel and other expert bodies, has included mefloquine as one of the suitable options available to patients to prevent malaria for several decades. Our other two main options at this time include doxycycline and a combination of atovaquone and proguanil, also known by trademark as Malarone. Each of these medications has its own advantages and disadvantages as well as potential side effects.
The selection of a potential anti-malaria medication for each mission involves an assessment by our Directorate of Force Health Protection to determine the risk of malarial infection and identify medication resistance in the region. Clinicians then work with the patients to discuss the risk of malarial infection along with a discussion of the advantages, disadvantages, and potential side effects and precautions of each of the medication options and a screening for potential contraindications before an informed choice is made by the patient as to the medication that fits their preferences and the situation.
The potential for medication side effects can impact the patient and their operational readiness, which is why it is so important that we appropriately educate and medically screen Canadian Armed Forces personnel. We want our people to make an informed and medically supported choice when selecting a drug to protect themselves against malaria.
In the Canadian Armed Forces, we have seen a decrease in the selection of mefloquine during the last decade. In the early 2000s, mefloquine was the most often used antimalarial. This started changing in the mid-2000s, and now mefloquine is our least often selected medication. It accounts for about 5% of our current antimalarial prescriptions, whereas atovaquone/proguanil, first licensed in 2002, now accounts for about 80%. The remainder of prescriptions are for doxycycline.
More than 17,000 Canadian Armed Forces personnel and tens of millions of people worldwide have received mefloquine since it was first licensed to prevent and treat malarial infection. We are aware of the potential short-term side effects of mefloquine; however, even given this extensive use of mefloquine, severe neuropsychiatric adverse effects have very rarely been associated with its use.
We are also aware of the assertions of some regarding their theories that mefloquine might cause long-standing neurological damage and mental health issues, which they themselves suggest requires more research to support. Our assessment of their assertions, at this time, is that they are not sufficiently supported through direct scientific evidence for us to remove mefloquine as an option for patients to protect themselves from malarial infection, particularly if they have used it safely in the past.
This assessment is consistent with the recommendations with respect to malaria chemoprophylaxis of the Canadian Committee to Advise on Tropical Medicine and Travel, the U.S. Centers for Disease Control and Prevention, Public Health England, and the World Health Organization.
As you are likely aware, mefloquine remains an option for malaria prevention for many militaries around the world. We do, however, remain vigilant and open to assessing any new evidence related to mefloquine and other antimalarial medications.
We also have confidence that our drug regulator and the Canadian Committee to Advise on Tropical Medicine and Travel will update their advice in a timely and appropriate way if or when new and credible scientific and medical evidence emerges.
We will, accordingly, update our approach to malaria prevention in a scientifically sound manner and with an emphasis on critical appraisal of the evidence.
Thank you for the opportunity to appear before the committee today.