Response from Peace Corps on Mefloquine

There is much concern, as reported here on the risk/benefits of the use of mefloquine as a anti-malaria  medication for Peace Corps Volunteers.  It is important to raise awareness in the Peace Corps community about this issue. Here is the letter from Dr. Nevin Remington, a leading expert on this medication, to Peace Corps:  text to link to: http://www.remingtonnevin.com/rpcv20150305.pdf

RPCVs were urged to read  Dr. Nevin’s letter and review some of the information posted about the drug and then write to Peace Corps Director Carrie Hessler-Radelet urging Peace Corps to accept Dr. Nevin’s recommendations.  See: https://peacecorpsworldwide.org/malaria-mefloquine-and-peace-corps-what-price-protection-part-one/ and https://peacecorpsworldwide.org/malaria-mefloquine-and-peace-corps-what-price-protection-part-two/

In reviewing the following correspondence, it is important to note that Peace Corps is currently being sued by a RPCV over the use of mefloquine. See: John Coyne’s article on the law suit by Sara Thompson: https://peacecorpsworldwide.org/rpcv-sara-thompson/

I would presume that there are legal issues involved that might influence Peace Corps’ public response. I followed my own advice, however,  and did write to Director Hessler-Radelet.  I am not a lawyer or a medical professional.  But I strongly believe that our culture does not have good generational knowledge of our technology, particularly when it comes to medical procedures and medications.  Sometimes, over time, experience indicates that a new drug is so safe that it can be made available over the counter and no longer needs a prescription.  In the case of melfloquiene, however, experience has caused the FDA to move in the opposite direction and to issue increasingly stronger warnings about the side effects of this drug. I know that malaria is a very serious illness.  My father contracted that disease in World War II and had recurring bouts with it throughout his life.  However, there are now other drugs to combat chloroquine resistance malaria. Serving Volunteers must, because of the nature of the beast, live with many necessary risks.  In my opinion, whenever an unnecessary risk can be eliminated, it should be.

Here is that correspondence, including the reply from Peace Corps.

This is the reply:

Dear Ms. Roll:

Thank you for your recent email to the Director concerning mefloquine use. She has requested that I respond on her behalf. The health and safety of our Volunteers is our top priority and we are committed to malaria prevention throughout their service. We maintain a policy of informed decision-making by Volunteers regarding their choice of malaria suppression medications. The policy is designed to ensure that every Volunteer has an individual meeting with a Peace Corps Medical Officer when they enter service to discuss the risks and benefits of each medication before deciding which option is right for them.  The choice of which anti-malaria regimen to choose is entirely up to the Volunteer unless one is medically contraindicated. At this time, mefloquine remains only one of the anti-malarial medications available to Peace Corps Volunteers if they choose it.

Volunteers are monitored throughout their service for medication tolerance, and Volunteers can revisit their choice of medication at any time. While mefloquine continues to be an FDA-approved medication recommended for use to prevent malaria, Volunteers who wish to request a change in medication can do so simply by talking with their Peace Corps Medical Officer. This policy is in place at every Peace Corps post worldwide, and the Peace Corps is working hard to make sure each and every Volunteer is familiar with the options available to them.

I will ensure that your letter and concerns are shared with my colleagues in the Office of Health Service and our Post-Service Task Force which works to address issues of post-service medical care. Thank you again for your service and concern for the health and safety of our Volunteers.

Sincerely,

Paul Jung

Associate Director

Office of Health Services

My Letter:

On May 16, 2015, at 10:18 AM, JoanneRoll < joanneroll@aol.com> wrote:

Dear Director Hessler-Radelet,

Thank you very much for the work you are doing with Nancy Tongue and her team of “Health Justice for Volunteers.”  I now have a further request of you. Dr. Remmingto (Nevin) is encouraging  Peace Corps to stop using the anti-malaria Drug, mefloquine, once marketed as Lariam.  He argues the adverse and permanent side effects make it too dangerous for Peace Corps Volunteers to use.  I support his recommendations and urge you to do so, also.

I am a Returned Peace Corps Volunteer (RPCV) and did not take mefloquine nor do I have medical training.But I support those Volunteers who are advocating that  mefloquine be discontinued in order to protect  the safety of everyone serving.

Here are my reasons:

1) The FDA is only now beginning to look at how medication dosages should be reviewed and adjusted for females.  Ambien is an excellent example. Mefloquine has not undergone such a review, as yet. Approximately 67% of Peace Corps Volunteers are female. They may well be at even greater risk of adverse side effects than males, if the dosage for Females is not correct.

2) Peace Corps Volunteers serve for 27 months, a long time to be taking medication.

3) Peace Corps Volunteers may not be able to access medical services quickly because of the location of their assignment.

4) Peace Corps Volunteers are private citizens, not government employees. They terminate their service in their foreign host country. If they experience adverse side effects, months after taking Mefloquine and leaving Peace Corps service, they may have difficulty immediately securing private medical services for evaluation and treatment

Thank you very much.

Joanne Roll, RPCV Colombia 63-65

Director’s response:

On May 20, 2015, at 3:53 PM, “Hessler-Radelet, Carrie” < chessler@peacecorps.gov> wrote:

Hi Joanne:

Thanks so much for your email, and your passion for helping our Agency be the best it can be.I am not well qualified to answer questions about our malaria medications, so I have asked our Director of Health Services, Dr. Paul Jung, to respond to your inquiry.  He will reach out to you shortly. As you know, the health and safety of our Volunteers and RPCVs is our highest priority and we are so pleased with our engagement with the RPCV community on this subject.  We have gotten so many great ideas from all of you. Will I see you in Berkeley?

Warmest regards,

Carrie

Carrie Hessler-Radelet Director, Peace Corps

202.692.2100

Peace requires the simple but powerful recognition that what we have in common as human beings is more important and crucial than what divides us.” – Sargent Shriver