Lariam

Debate between Douglas Chapman and Madeleine Moon

Thursday 27th October 2016 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I beg to move,

That this House has considered the Fourth Report from the Defence Committee of Session 2015-16, An acceptable risk? The use of Lariam for military personnel, HC 567, and the Government response, HC 648.

Before I turn to the overview of the report and the conclusions of the Select Committee on Defence, I want to put on record our thanks to those who gave us the impetus to investigate the issue and contributed their knowledge and their time. I apologise if I leave anyone out. Our thanks go to Trixie Foster and the retired Colonel Andrew Marriott for their persistence in raising the issue and co-ordinating a detailed submission; to defence correspondents who took the matter up; and to Forces TV whose work brought in more evidence. I thank the Library for its research and our Clerks, who do a magnificent job, as well as the witnesses who appeared at our three evidence sessions, including from the drug’s manufacturer, Roche.

I would also like to put on record my personal thanks to the Committee for agreeing to pursue the issue for the sake of the approximately 25% to 35% of personnel who have taken Lariam who have been directly affected. The Committee was determined to ensure that the Ministry of Defence would examine the damage to lives and the failure of the duty of care, and to make the necessary recommendations to protect our armed forces personnel in the future.

Lariam is one of several antimalarial drugs that the MOD uses to protect military personnel against malaria. None of the alternatives is without its problems, but Lariam has been the subject of concern for a long time. The inquiry set out to establish a clear picture of the impact of its use in the UK armed forces. I think it is fair to say that the Committee was shocked and surprised by what we found. I will leave others to go into details, as it is my role to give an overview of our principal conclusions and recommendations.

From the evidence we received from individuals and the statistics that the MOD provided, we were shocked that Lariam is still being used so often despite the well-known problems. We were told by the drug’s manufacturer that the MOD accounts for one fifth of all its UK sales. At a minimum, 17,368 personnel were prescribed the drug between 2007 and 2015. There may well be more, but one of our findings was the haphazard nature of MOD medical record keeping. Note to the Minister: it was particularly unhelpful when the MOD published its first 10-page statistical bulletin on Lariam on the day we took evidence from the Minister.

The MOD receives advice from the Advisory Committee on Malarial Prevention alongside the advice from the manufacturer. Roche is clear in its guidance that every individual who is prescribed Lariam should undergo an assessment with a medical professional to identify any contra-indications that might make them more susceptible to side effects. We questioned whether the ACMP’s advice was appropriate. It was clear to us that the general advice that it offered was not tailored to the specific needs and circumstances of the military. It fell short and put military personnel at risk. We concluded that the MOD should work with the ACMP to develop specific guidelines, similar to the US so-called “Yellow Book”.

[Douglas Chapman (Dunfermline and West Fife) (SNP)]

Is the hon. Lady now confident that the MOD will be able to deliver on the duty of care and the commitment to proper prescribing of Lariam, especially when a large number of troops are leaving at the same time?

[Mrs Moon]

If I am perfectly honest, no. I think that the medical care that is offered continues to fall short, but I hope that the Committee will be able to address the issue again in future and ask for further updates. Of course, we have the opportunity to hear from the Minister today what further progress has been made.

Alongside our findings about the ACMP, we looked at whether Lariam was appropriate to where personnel were sent and the work that they do. The Minister and the Surgeon General told us that geographical location was a consideration in prescribing Lariam. By contrast, other witnesses made it clear that there is nowhere where Lariam should be the preferred drug, particularly given that there is increasing resistance to it and there are alternatives available. Geography aside, and linked to our earlier concerns about the ACMP advice, we sought to clarify whether Lariam, given the known side effects, was appropriate at all in a military setting. A military deployment is a world away from a tourist sightseeing or sitting by a pool. The physical and mental strain of being deployed in stressful situations does not need to be exacerbated by the severe side effects that Lariam can induce.

Dr Nevin gave evidence of an alarming potential negative impact on military performance and operations. There were cases of service personnel experiencing

“episodes of panic resulting in abnormal behaviour”

and incidents of servicemen becoming confused and being found “wandering aimlessly”. There were incidents of tension and anger, episodes of severe mental and physical exhaustion and nausea, lapses of concentration and episodes of short-term memory loss, ill temper, dangerous driving, confusion and suicide ideation. That is a grim picture of medically induced problems for military personnel on deployment.

We explored whether other nations gave Lariam to their armed forces. Our research uncovered a mixed picture, but a tendency towards either no longer using Lariam at all or using it only as a drug of last resort. That all added weight to our recommendation that greater clarity is needed in determining when to use Lariam, and that attention should be paid to whether it is appropriate for military personnel.

At the heart of our inquiry was the question whether the MOD was fulfilling its duty of care by following the clear guidance on prescribing Lariam. Did every individual undergo the Roche-required individual medical assessment prior to deployment? Was it realistic to think that the MOD could ensure that that happened, particularly for a large-scale, short-notice deployment? Alarmingly, there was evidence that individual assessments were not happening. Lariam was included in pre-deployment kit; it was handed out on parade; or the MOD relied on an assessment of medical records only for prescription. We felt that that was a fundamental failure in duty of care. We concluded that, aside from the need to consider the practicalities of arranging assessments, prescribing Lariam should only ever be a last resort bounded by strict conditions. Linked to that, we uncovered concerns about non-reporting of contra-indications; military personnel appeared unwilling to admit to conditions such as a previous history of depression, because of fear of a negative impact on their career. That underlines even further the need for individual assessments.

Several witnesses reported that personnel were so concerned by the reputation of Lariam that they discarded their medication and were potentially left with no antimalarial protection at all. That came even from the very top. I believe Lord Dannatt has announced that he refused to take Lariam and would throw it away. We were deeply disturbed by that and recommended that the MOD should monitor compliance rates.