Malaria, Mefloquine, and Peace Corps: What Price Protection? Part One

In a medically hostile environment, malaria is one of the fiercest enemies. Peace Corps has been fighting it for over fifty years; not only to help the people Volunteers serve, but to protect Volunteers, who are also targets of the disease. From 1961 to 1990, Volunteers in malaria areas, took chloroquine, brand name, Aralen, to protect against malaria. There was a increase in the incidence of  malaria among Volunteers in West Africa beginning in  the mid-80s due to the development of  Chloroquine-resistent malaria.

In 1989 thru 1992, Peace Corps Volunteers in West Africa participated in research studies for a  relatively new anti-malaria drug, mefloquine, (for a time, the drug was marketed under the brand name, Lariam). The drug was effective against the chloroquine-resistent form of malaria, but was not without its adverse side effects. It is these adverse side effects that is the focus, here, thanks to the efforts, of concerned RPCVs and their supporters.

RPCV Sara Thompson has filed suit charging that Peace Corps failed to adequately inform her of possible side effects of mefloquine. See: John Coyne : http://peacecorpsworldwide.org/rpcv-sara-thompson/

RPCV Nancy Tongue and members of her group Health Justice for ‪ Volunteers (http://www.healthjusticeforpeacecorpsvolunteers.org )are also involved with this effort; as is  Jeanne Lese,  Director at Mefloquine (Lariam) Action provides Information and outreach to Mefloquine survivors. Here is the link: http://www.lariaminfo.org/category/homepage/


“Dr. Remington Lee Nevin is a consulting physician epidemiologist board certified in Public Health and General Preventive Medicine by the American Board of Preventive Medicine.  Dr. Nevin specializes in the evaluation of adverse reactions to antimalarial medications, particularly the neurotoxic quinoline derivative mefloquine (previously marketed in the United States as Lariam®)” http://www.remingtonnevin.com/site/home.html Dr. Nevin supports the efforts of these RPCV advocates. Most importantly he has written to the Peace Corps Director, urging a change in policy regarding mefloquine. (To read the letter, here is the text to link to: http://www.remingtonnevin.com/rpcv20150305.pdf)

Thank you to all of these dedicated people who inform, educate, and advocate. They have provided the sources for this report.

These are  reports describing the research in which Peace Corps participated.

The Journal of American Medical Association (See text to link to: malaria-research-1991) reported on the initial research in which Peace Volunteers in Benin, Ghana, Liberia, Sierra Leone, and Togo participated.  This initial research was conducted from October 1989 through April of 1990.  The research was continued until April of 1992, and reported in LANCET. (The text to link to:

lobel-et-al-1993-long-term-malaria-prophylaxis-with-weekly-mefloquine)

The reports need to be read. They cannot be summarized by a layperson.  However, it is possible to state that Volunteers were required to take anti-malaria medication, but were given a choice and not required to take melflorine. The Volunteers did complete a questionnaire periodically on any adverse reactions to any of the anti-malaria medications.  From the Lancet Report:

“Malaria in Peace Corps volunteers

Use of mefloquine by volunteers increased from 37% in November, 1989 to 76% in january 1991, and 97% in May 1992.  Two years after the introduction of mefloquine the incidence had declined to a pre-epidemic level.”

In September 1995, Dr. Hans O. Lobel, MD. MPH, who was one of the researchers with the original studies and who was identified  as being with The Centers for Disease Control and Prevention, US Public Health Service, published “Adverse Health Events and Malaria Prophylaxis” in “HealthWise, a Newsletter for Peace Corps Medical Officers Worldwide.”, Read his review of the use mefloquine, here is the text to link to: 1996-lobel-adverse-health-events-and-malaria-prophylaxis

In 2004, the FDA issued a patient Medication Guide to be issued to everyone taking mefloquine, spelling out possible side effects. However, it was not until 2013, more than twenty years after Volunteers were initially involved with mefloquine research, that the FDA issued a Black Box warning:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm362887.htm

From the warning:

” ISSUE: FDA is advising the public about strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label. FDA has revised the patient Medication Guide dispensed with each prescription and wallet card to include this information and the possibility that the neurologic side effects may persist or become permanent. The neurologic side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations. Neurologic side effects can occur at any time during drug use, and can last for months to years after the drug is stopped or can be permanent.”

The Peace Corps incorporated this warning into its policy guidelines on providing anti-malaria medication to Trainees and Volunteers. The text to link to is: http://passport.peacecorps.gov/2013/08/09/staying-safe-preventing-malaria/

This then is the broad timeline of Peace Corps and mefloquine. But the timeline for the development and concern about mefloquine is much longer and the remaining concerns are addressed in: Peace Corps and Mefloquine: Protecting Volunteers from Malaria, But at What Price? Part 2

3 Comments

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  • So mefloquine did protect PCVs from getting malaria. Tell me an effective medication that does not have side effects? I assume Peace Corps is dispensing other protection now – fumigated nets? We almost eliminated malaria by eliminating mosquitoes in the 1950s. Then the concern about DDT. We dropped DDT and malaria came back with a vengence. Moral of the story, there is no easy way to overcome malaria that attacks and kills more people than any other infectious disease. And if you think nets will do the job I have a bridge in New York to sell you.

  • Leo,
    Peace Corps is still using mefloquine. Volunteers are supposed to meet with the PCMO and decide which anti-malaria medication is best for the him or her. There are questions here:
    1) Any medication has a risk/benefit ratio. With mefloquine, the benefits are lauded, but it took twenty years before the FDA fully publicized the very dangerous risks. This is very typical of our culture. But, just because the adverse effects are not fully recognized, does not mean that they don’t occur. Many suffered the side effects and are dismissed or don’t receive adequate treatment.

    2) DDT is very effective against malaria bearing mosquitoes. It probably helped us win WWII, but the long term consequences
    were not known at the time and after Rachel Carson’s “Silent Spring”, it was realized that the long term consequences could be universally disastrous in terms of the food chain. DDT has also been implicated in the breast cancer epidemic; as have many other “miracle” chemicals, such as estrogen.

    3) Please read Dr. Nevin’s letter. He outlines from a medical perspective, why the Peace Corps should reconsider using this anti-malaria drug.

    4) The incidence of malaria has been reduced and the various campaigns, including the nets, are seen as factors. Whether or not, there are unforeseen long term consequences to the insecticide used in the nets remains to be seen.

    There are no easy answers. Dona Emelinda’s caution has echoed through my life: Ponga se de attention! Pay Attention.

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