DVA and Mefloquine

A paper describing the current position of DVA regarding Mefloquine and Tafenoquine

Concerns have been raised about links between the antimalarial medications, mefloquine and tafenoquine, and adverse health effects.

What is malaria?

  •   Malaria is a deadly disease which in 2016 killed over 400,000 people worldwide, and affected more than 200 million people.
  •   The Australian Defence Force (ADF) has a duty of care to ensure its people deploying to malaria prone areas are protected.What is mefloquine?
  •   Mefloquine (also known by the trade name Lariam) is one of three anti-malarial medications approved by the Therapeutic Goods Administration for malaria prevention in our region. The ADF uses mefloquine as a third line agent and it is only used when members are unable to tolerate the alternatives.
  •   Mefloquine may not be suitable for individuals with particular medical conditions or those taking some other medications. In particular, mefloquine should not be taken for malaria prevention by people who have, or have had, a psychiatric condition, seizures, kidney disease or liver disease.
  •   For these reasons, Defence health policy requires ADF members be properly informed of the potential side-effects of mefloquine and the drug may only be prescribed by a qualified medical practitioner after the member has provided their informed consent.
  •   Mefloquine can cause psychiatric symptoms in some people, including disturbed sleep, anxiety, paranoia, depression, hallucinations and psychosis. Dizziness and loss of balance have also been reported as side effects from the use of mefloquine. For this reason, the medication is not used in ADF aircrew.
  •   Mefloquine is commonly used in the broader Australian community for the prevention of malaria in travellers. Mefloquine is also included on the World Health Organization List of Essential Medicines for both the prevention and treatment of malaria.Further information about malaria and anti-malarial medications is available on the ‘Malaria, mefloquine and the ADF’ website (www.defence.gov.au/Health/HealthPortal/Malaria/).How many people have been given mefloquine?
    •   The ADF’s use of mefloquine is conservative compared to the use of the medication in other militaries around the world and in the civilian population.
    •   The vast majority of ADF members have never been prescribed mefloquine.
    •   Records show that between July 2000 and January 2018, less than 2,000 ADF personnel wereprescribed mefloquine. Most of these prescriptions were as part of the ADF trials in East Timor from 2000-2002 (a total of 1,319 soldiers).

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 It is far more commonly prescribed across the general community, with an estimated 11,457 civilian prescriptions for mefloquine in 2016 alone.

Statistics are available on the ‘Malaria, mefloquine and the ADF’ website(www.defence.gov.au/Health/HealthPortal/Malaria/Anti-malarial_medications/Mefloquine/).

What is tafenoquine?

  •   Tafenoquine is a relatively new anti-malarial medication. Tafenoquine is not related to mefloquine and acts quite differently in the body.
  •   The main advantage of tafenoquine is that it is effective for both prevention and treatment of malaria.Further information about malaria and anti-malarial medications is available on the ‘Malaria, mefloquine and the ADF’ website (www.defence.gov.au/Health/HealthPortal/Malaria/).How many people have been given tafenoquine?

 To date, more than 4,000 people, both military and civilian, have taken tafenoquine in clinical studies around the world. Tafenoquine has successfully treated relapsing malaria (i.e. continued infections long after exposure) when combined with another medication called chloroquine.

What concerns have been raised?

  •   Concerns have been raised about the conduct of the ADF trials of mefloquine in East Timor. The Inspector General ADF (IGADF), an independent and impartial statutory authority, examined a number of allegations relating to this matter.
  •   The IGADF report found that the trials were conducted ethically and in compliance with National Health and Medical Research Council Guidelines for the conduct of human research. It also found that the trials were voluntary and participants were informed about possible side effects. This was consistent with relevant product and consumer medicine information available at the time.
  •   Concerns have also been raised that taking mefloquine causes chemically-acquired brain injury. Further information on the ADF mefloquine trials is available on the ‘Malaria, mefloquine and theADF’ website (www.defence.gov.au/Health/HealthPortal/Malaria/AMI_research/).Statements of PrinciplesWhat are Statements of Principles (SoPs)?
  •   Serving and ex-serving ADF members can claim compensation at any time for medical conditions they believe are related to their service.
  •   For DVA to accept liability for compensation there has to be causal link determined between the person’s service and their medical condition.
  •   Under the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004, the potential link between a medical condition and service is assessed using SoPs.
  •   Together, mefloquine and tafenoquine are included as a potential causal factor in SoPs for 16 conditions. Of these, mefloquine is covered by 15 SoPs and tafenoquine is covered by six SoPs.

What conditions are covered?

Information paper: Mefloquine and tafenoquinepage3image2965995440

page3image2965998144 page3image2965998736Condition Anti-malarial Medication
page3image29660048481. Anxiety disorderpage3image2967624192Mefloquine
page3image29660096962. Bipolar disorderpage3image2966013392Mefloquine
page3image29676556483. Depressive disorderpage3image2967657440page3image2966665568Mefloquinepage3image2966648800
4. Heart blockMefloquine
page3image29665970405. Myasthenia gravispage3image2966547648Mefloquine
page3image29666462726. Peripheral neuropathypage3image2966552256page3image2966602640Mefloquinepage3image2966603296
7. SchizophreniaMefloquine
page3image29665581128. Suicide and attempted suicidepage3image2966560224Mefloquine
page3image29660162729. Trigeminal neuropathypage3image2966020704page3image2924314528Mefloquinepage3image2924320000
10. Epileptic seizureMefloquine and Tafenoquine
page3image296656707211. Acquiredcataractpage3image2966620528Mefloquine and Tafenoquine
page3image296602187212. Sensorineural hearing losspage3image2966026320page3image2966027072Mefloquine and Tafenoquinepage3image2966031072
13. TinnitusMefloquine and Tafenoquine
page3image296603896014. Psoriasispage3image2966042512Mefloquine and Tafenoquine
page3image296604686415. Methaemoglobinaemiapage3image2966051520page3image2966052208Tafenoquinepage3image2966055392
16. Toxic Retinopathypage3image2924324384Mefloquinepage3image2966568512

What did the Repatriation Medical Authority investigate?

  •   The RMA investigated whether SoPs may be determined in respect of ‘chemically-acquired brain injury caused by mefloquine, tafenoquine or primaquine.’
  •   Mefloquine, tafenoquine and primaquine belong to the chemical class of drugs known as quinolines.
  •   The RMA decided that there is insufficient sound medical scientific evidence that exposure to these pharmaceuticals causes acquired brain injury.
  •   For these reasons, the RMA decided that it does not propose to make SoPs in relation to chemically-acquired brain injury caused by mefloquine, tafenoquine and primaquine.
  •   The report can be accessed from the RMA website (www.rma.gov.au/sops/condition/chemically-acquired-brain-injury-caused-by-mefloquine- tafenoquine-or-primaquine).
  •   The Specialist Medical Review Council (SMRC) completed its review of the RMA investigation and it confirmed the RMA’s decision.
  •   Further information is available on the SMRC website (www.smrc.gov.au).This decision means that DVA will not be able to accept claims for this specific condition, or the same condition described differently. However, it is important to note that DVA claims staff will still investigate to determine whether another diagnosis may be appropriate and whether it is possible to accept the claim in accordance with that diagnosis.What is the Repatriation Medical Authority?
  •   The Repatriation Medical Authority (RMA) is an independent statutory authority which is entirely separate from the Department of Veterans’ Affairs (DVA).
  •   The RMA is responsible for determining Statements of Principles (SoPs) for any disease, injury or death that could be related to military service, based on sound medical-scientific evidence.Further information is available on the RMA website (www.rma.gov.au).

What is the Specialist Medical Review Council (SMRC)?

  •   The SMRC is an independent statutory body responsible to the Australian Government Minister responsible for veterans’ affairs.
  •   On request from an eligible person or organisation, the SMRC can review decisions of the RMA.
  •   Further information is available on the SMRC website (www.smrc.gov.au).Information on the SMRC’s review process is available in the ‘SMRC Members Handbook’(www.smrc.gov.au/node/5).The Government is acting on the health concerns raisedWhat has been, or is being, done?The Government is acting on the health concerns raisedWhat has been, or is being, done?
  •   Response to Senate Inquiry Recommendations – The Government tabled its response to the Senate Inquiry into the use of quinolone anti-malarial drugs mefloquine and tafenoquine in the ADF on 15 March 2019. The Government has completed actions in response to eight of the fourteen recommendations, with actions ongoing for the other six recommendations.
  •   Mefloquine and Tafenoquine Consultation Forums – In late 2018, DVA hosted seven mefloquine and tafenoquine consultation forums across Australia for veterans concerned about having taken mefloquine or tafenoquine. A summary of the key themes of the forums was published on the DVA Website.
  •   Neurocognitive Health Program – Open Arms – Veterans and Families Counselling is implementing a Neurocognitive Health Program (NHP). The NHP will enable Open Arms to deliver an improved service response to veterans and family members, where the veteran has a presentation which may indicate symptoms of a neurocognitive disorder or concerns about neurocognitive decline. The primary focus of the program will be on assessment, prevention and early intervention, ongoing monitoring of cognitive function and pathways to effective treatment and support for veterans and their families and carers.
  •   DVA’s Improved Client Support Framework – DVA is dedicated to providing our clients with the right support at the right time to help meet their health and wellbeing needs. Every day we work hard to help resolve issues for clients, and provide a single point-of-contact to help them navigate DVA and external support arrangements. Our improved Client Support Framework provides a coordinated case management and triage service to quickly assess a client’s whole situation and create a streamlined pathway to individually tailored supports. This puts veterans at the centre of a coordinated case management approach, to ensure that they and their families are well-supported. DVA can also enact a client wellbeing and support program providing access to an exceptional needs team when additional specialist supports may be required.
  •   Fast-tracked claims investigations – DVA has fast-tracked investigations into claims relating to anti-malarial medications lodged since September 2016.
  •   Health assessment from a GP – DVA is implementing a new initiative for veterans who are concerned about having taken the anti-malarial medications (mefloquine or tafenoquine), to enable them to receive a health assessment from a GP. Veterans will be able to discuss their health concerns with a clinician who has an understanding of mefloquine or tafenoquine, the complex conditions with which some veterans may present, and the veteran experience. While

the initiative is being implemented, veterans can register their interest in attending an

appointment by calling DVA’s designated phone line -1800 MEFLOQUINE (1800 633 567).

  •   1800 MEFLOQUINE – DVA has a designated phone line for veterans who are concerned about having taken mefloquine and tafenoquine – 1800 MEFLOQUINE (1800 633 567). This support line can assist concerned veterans with enquires about the support available to them and theclaims process.
  •   Defence’s dedicated email address – Defence has established a dedicated email address(adf.malaria@defence.gov.au) and the ‘Malaria, mefloquine and the ADF’ information portal(www.defence.gov.au/Health/HealthPortal/Malaria/).
How to Obtain your ADF Medical Records

How to Obtain your ADF Medical Records

Former Members of the Australian Defence Force can obtain their medical records via requesting them from Defence Records in Canberra

Access to service records

How you access your service records will depend on the type and age of the records. Some records are held by agencies other than Defence such as the National Archives of Australia (NAA) and the Department of Veterans’ Affairs (DVA). See the table below for information on how to access records.

Air Force:

TypePeriod / ConflictCustodianHow to access
PersonalWW1 / WW2NAAwww.naa.gov.au
PersonalKorea / VietnamNAAwww.naa.gov.au
PersonalDischarged members that served from 1973Defence ArchivesRequest for records [PDF, 30 KB]
PersonalActive membersDefenceCurrent unit
    
HealthServed and discharged prior to 1952DVAwww.dva.gov.au
HealthDischarged members that served from 1952Defence ArchivesRequest for records [PDF,30 KB]
HealthActive membersDefenceCurrent health unit

Army:

TypePeriod / ConflictCustodianHow to access
PersonalWW1 / WW2NAAwww.naa.gov.au
PersonalDischarged members that served from 1947Defence ArchivesRequest for records [PDF, 30 KB]
PersonalActive membersDefenceCurrent unit
PersonalStandby Reserve members Email request to: standby.reserve@defence.gov.au
    
HealthServed and discharged prior to 1947DVAwww.dva.gov.au
HealthDischarged members that served from 1947Defence ArchivesRequest for records [PDF, 30 KB]
HealthActive membersDefenceCurrent health unit
HealthStandby Reserve members Email request to: standby.reserve@defence.gov.au

Navy:

TypePeriod / ConflictCustodianHow to access
PersonalWW1 / WW2NAAwww.naa.gov.au
PersonalDischarged members that served after WW2Defence ArchivesRequest for records [PDF, 30 KB]
PersonalActive membersDefenceCurrent unit
    
HealthServed and discharged prior to 1948DVAwww.dva.gov.au
HealthDischarged members that served from 1948Defence ArchivesRequest for records [PDF, 30 KB]
HealthActive membersDefenceCurrent health unit

Who can access service records?

Ex-ADF members can request access to their service records held by Defence Archives by completing the request for service records form.

Third parties requesting access to service records will require the member’s authority. For more information see the request for service records form.

Should you be seeking access to a deceased member’s service records, please be aware that the applicant will be required to provide proof of relationship such as marriage, birth and death certificates. For more information please see the request for service records form.

Which records are provided?

Defence Archives provides access to records electronically on CD or via email. The types of records provided may include:

  • Service Report
  • Full copy of personal documents
  • Full copy of health documents

Please note that in some cases you may only require access to particular documents in your records depending on the purpose of your request. By specifying the purpose for request on the request for service records form, you will be able to assist Defence Archives in determining which records you require. Please enter a reason for request in the reason and urgency of request field on the request for service records form.

Requests by Medical Units for Access to a Member’s Unit Medical Record (UMR)

Defence Health Centres (Medical Units) may request access to current members Medical Records held at Defence Archives under the following conditions: —

  • Where the UMR is in the custody of Defence Archives
  • Where the original UMR cannot be located at the member’s losing or gaining unit and an investigation has taken place in order to locate UMR

Where the UMR is in the custody of Defence Archives using Objective:

  • Medical Units must first search Objective to see if a UMR has been registered in Objective for that member and the ‘current location’ is shown as being in one of Defence Archives Repositories
  • Medical units are to request access to the UMR by using the ‘Request’ function in Objective

Where the UMR cannot be seen on Objective and known to be in the custody of Defence Archives

  • Medical Units must complete a PM384
  • Forward to Defence Archives via email

Where the UMR has been ‘lost’

  • Medical Units are to perform an investigation to ensure that the UMR cannot be located at either the members ‘losing’ or ‘gaining’ unit
  • If all attempts to locate the UMR have been exhausted Medical Units are to complete a PM384, requesting copies of the CMR, attach evidence that an investigation has taken place and
  • Forward to Defence Archives via email

Psychology Records

From 29 November 2013, Defence changed its policy in regards to filing of mental health documentation. All documentation raised for mental health assessments will be filed as medical records. Any mental health documentation completed prior to 29 November 2013 will be retained as psychology records.

If the information you are seeking is not on your psychology record, it is advised you obtain a copy of your medical record.

To request your psychology record, please complete the following form (ensuring it is signed by you — the Defence member or authorised representative) and send it to adf.records@defence.gov.au.

If you are seeking records from Defence Force Recruiting as part of an application to Defence please use the below form and send it to the Director Mental Health & Rehabilitation Programs and Evaluation.

Director Mental Health & Rehabilitation Programs and Evaluation
CP3-7-094
PO Box 7912
Department of Defence
CANBERRA BC ACT 2610
Telephone: 02 6266 3285
Email: dpsych@defence.gov.au

Compensation Records

If you are an ex-serving member seeking access to your Military Compensation file and it is post 1999, please contact the Department of Veteran’s Affairs.

If you are an ex-serving member seeking access to your Military Compensation file and it is pre 1999, please send request to the relevant Service area below.

Navy – NavyMLO@defence.gov.au

Army – AHQ.FOICoord@defence.gov.au

Air Force – RAAFFOI@defence.gov.au

ADF training records and civilian recognition

If you are seeking access to your ADF training records or seeking civil accreditation of your courses that you undertook while serving, please contact the relevant Service below:

Navy Registered Training Organisation (RTO)

Navy RTO Section Training Centre
CP4-7-008
Department of Defence
PO Box 7913
CANBERRA BC ACT 2610
Email: navy.rto@defence.gov.au
Phone: (02) 6266 2500
Fax: (02) 6266 2388

Army Registered Training Organisation (RTO)

As of 01 May 2017, all Army RTO enquiries are to be forwarded to the DCAM Customer Service Network.
Phone: 1800DEFENCE (1800 333 362)
Email: yourcustomer.service@defence.gov.au

Air Force Registered Training Organisation (RTO)

RTO Manager Air Force
Headquarters Air Command DTS
Glenbrook Great Western Highway
GLENBROOK NSW 2773
Email: raaf.accreditation@defence.gov.au
Phone: (02) 4737 7833
Fax: (02) 4377 7140

Amendments and annotations to service records

If you wish to make an amendment to your personnel records that contain incorrect, out of date or misleading information you may do so by either of the following:

Privacy Act 1988

Australian Privacy Principle (APP) 13 – correction of personal information provides that an APP entity must take reasonable steps to correct personal information it holds, to ensure it is accurate, up-to-date, complete, relevant and not misleading, having regard to the purposes for which it is held.

The requirement to take reasonable steps applies in two circumstances

  • Where an APP entity is satisfied, independently of any request, that personal information it holds is incorrect; or
  • Where an individual requests an APP entity to correct their personal information.

Further information on APP 13 is available from: OAIC Website.

Please forward your request for amendments to defence.privacy@defence.gov.au

Freedom of Information Act 1982

You may apply, under the FOI Act, for amendment or annotation of a record of your personal information that you consider to be incomplete, incorrect, out of date or misleading.

However, several conditions must be met to make a valid request for amendment or annotation which is outlined in the document provided below.

DVA Mefloquine Tafenoquine Health Checks

Veterans Health Centre has partnered with BUPA and DVA to provide health assessments for Veterans who are concerned about their exposure to Anti-Malarial medications Mefloquine and Tafenoquine used in Timor-Leste in the early 2000s.

The Department of Veterans’ Affairs (DVA) has engaged Bupa Australia to deliver a national program of health assessments for veterans who are concerned about having taken the anti-malarial medications MEFLOQUINE (trade name Lariam®) or TAFENOQUINE (trade names Kozenis® and Kodatef®). 

The program is open to any Veteran who has concerns about the potential health effects of having taken these anti-malarial medications and offers a single comprehensive health assessment conducted by a General Practitioner who has been appropriately trained. 

The whole-of-person comprehensive health assessment will help identify MEFLOQUINE or TAFENOQUINE- reported symptoms.  At the conclusion of the assessment, the participating Veteran will receive a customised Health Assessment Action Plan that will provide a basis for further investigation and/or treatment if and as required.  Ongoing management and coordination of further investigations and treatment will be undertaken by the participating Veteran’s usual or regular General Practitioner if desired. 

To access the program, interested Veterans will contact DVA’s 1800 MEFLOQUINE (1800 633 567) inquiry line, the DVA personnel attending to the call will complete the Expression of Interest form and forward it to Bupa for follow up. Alternatively, Veterans may contact Bupa directly via the 1800 612 798vline. 

Following a Senate inquiry into the use of MEFLOQUINE and TAFENOQUINE in the Australian Defence Force, DVA has engaged Bupa Australia to deliver a national program of single whole-of-person comprehensive health assessments for veterans who are concerned about having taken the anti-malarial medications MEFLOQUINE (trade name Lariam®) or TAFENOQUINE (trade names Kozenis® and Kodatef®).   

Information about the inquiry, and relevant clinical information can be accessed using this link to the Department of Veterans’ Affairs:  https://www.dva.gov.au/health-and-wellbeing/health-services-and-conditions/mefloquine-and-tafenoquine-information