Lariam

Baroness Anderson of Stoke-on-Trent Excerpts

Thursday 27th October 2016 Westminster Hall

[Johnny Mercer]

I absolutely agree that the single point of failure was that we had a drug that, like any drug—even paracetamol or Anadin—should be used within the guidelines set down by the manufacturer, but instead of people being given it carefully, in a medical fashion, with individual risk assessments as stipulated by Roche, Lariam was just handed out on parade. Clearly, that is not the way to do business. The hon. Lady is right. I am glad that we have identified that practice, and I believe that we have put a stop to it. That is a good thing to have come out of the report.

We now need to ensure that we look after those who come forward. There are conversations about compensation and things like that—I understand that that is the way of the world—but that is never the intent behind inquiries such as this. I am interested in looking after those who are going through the process. We must get those who come forward some sort of treatment. We must provide some point of contact that is not just known by me, other MPs and those within Main Building. Everybody should know where they can go to get help if they feel they have been affected, and we need to show them a clear pathway.

Ultimately, we need to pay people an interest and accept that something has gone wrong. There is a slight issue within the Department—I know that everybody, including the Minister, knows this—with accepting evidence of a problem. If I have seen that in my experience as a lowly Member of Parliament, I can only imagine what it is like for families who have an issue with the Ministry of Defence to come forward. I bring that point to people’s attention and ask that we never ignore evidence of problems. We all know what soldiers are like. They are fantastic people, although if they are not moaning, something is not right, but we need to be slightly smarter and understand what they are saying so that we can identify problems before they become as big a problem as Lariam.

[Ruth Smeeth (Stoke-on-Trent North) (Lab)]

I am loth to interrupt the hon. Gentleman when he is in such impressive flow, but I would suggest that the chain of command is a problem. Although soldiers may moan to one another—the hon. Gentleman will have more experience of that than I do—they are unlikely, at any point, to want to challenge. When soldiers are brave enough to say that there is a problem, that should be our priority and we should listen to them.

[Johnny Mercer]

The hon. Lady is right. That is a generic function of leadership, not one that is particular to this cause. Having that intimate relationship with our soldiers, or with those under our command, is something we work hard on at a junior level. At a senior level, it is desired. Whether the time is taken to do that is another matter. Across the military, we need to foster an environment where it is okay for a conversation to go both ways so that we can get on top of such problems.

I know that more Members want to speak, so I will finish soon. We need to change our view on having a softer side in the Ministry of Defence and understand how important it is to look after people. Whether we reconfigure what we do, or look into having a Minister for defence people or whatever as a No. 2 in the MOD, we need to bump that change up the priority list. I thank the Defence Committee and its Chair for letting us look into the issue. People talk about Parliament being so remote—that essentially, we just turn oxygen into carbon dioxide and no one really cares—but I hope that the people who have been affected by the issue see that Parliament does work for them and can take some comfort from that.

--- Later in debate ---

[Dr Julian Lewis (New Forest East) (Con)]

It is right that the first three speakers in this debate should be the hon. Member for Bridgend (Mrs Moon), who has campaigned on this subject for probably the longest time; my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer), who is an outstanding campaigner on behalf of anything to do with the welfare of veterans and current service personnel; and my hon. Friend the Member for Stafford (Jeremy Lefroy), whose unparalleled experience of malaria—experience of an unfortunately all too personal nature as well as professional experience—we have just listened to with great attention.

My hon. Friend the Member for Stafford asked whether the Committee had considered the question of mosquito nets impregnated with insecticide, and the answer is no. We were focused entirely on Lariam and our concern that it was being prescribed inappropriately. We said that the prescription of a drug known to have what were described as “neuro-psychiatric side effects” and to cause “vestibular disorders” without face-to-face interviews showed a lamentable weakness in the MOD’s duty of care towards service personnel. We are grateful that the Minister, who has an outstanding record of military service, made an apology to present and former service personnel when he appeared before the Committee on behalf of the MOD in relation to those who believe that they were prescribed this drug without the necessary individual risk assessments.

This is a slightly unusual case because, for once, nobody is pointing a finger of accusation at the drug manufacturer. Roche appears to have behaved responsibly in this matter from the outset. It always gave the clearest possible instructions that this particular drug, though it could be effective in some cases, could have dangerous side effects and therefore absolutely should not be prescribed without a face-to-face assessment of each individual first. It was good to receive a letter from the manufacturer, despite the Committee’s report being so critical of the drug itself and despite the adverse publicity that the drug inevitably received, stating:

“Your report has made a major contribution to highlighting the correct use of Lariam in the armed forces.”

That shows the strength of the arguments in the report and reinforces the importance of the MOD following Roche’s guidelines for use.

The hon. Member for Bridgend mentioned several of the people who gave evidence to the Committee. I would like to mention Mrs Ellen Duncan, who gave evidence on behalf of her husband, Major-General Alastair Duncan. Alastair Duncan was awarded the Distinguished Service Order while in command of the First Prince of Wales’s Own Regiment of Yorkshire, or 1 PWO. In May 1993, he took the battalion to Bosnia-Herzegovina under the UN mandate during the Balkans conflict. The Daily Telegraph described what he did in the following terms:

“The hostilities had escalated into a three-cornered fight between the Bosnian-Serbs, the Bosnian-Croats and the Muslims. In this dangerous environment, at great risk to himself, Duncan sought out the commanders of the belligerents in an attempt to broker a truce. In June, he was instrumental in the rescue of 200 Croats who had sought sanctuary from a violent attack in a monastery at Guca Gora. The citation for the award to Duncan of the DSO paid tribute to his courage, resolution and inspired leadership which, it stated, had saved many lives and had helped 1 PWO to win an outstanding reputation.”

He was subsequently awarded the CBE for his work in Sierra Leone.

Major-General Duncan suffered from post-traumatic stress as a result of all that he had seen and done, but his wife was absolutely convinced that taking Lariam destroyed his mental stability. He was sectioned many times. Our report was published on 24 May 2016, and I was truly saddened to read in The Daily Telegraph that he had died on 24 July 2016. He was a year younger than I am. It is a case of someone at the highest end of the Army whose life was wrecked by the inappropriate prescription of the drug.

I will touch briefly on a number of the Committee’s recommendations and the Government’s response. As we have heard, the Committee recommended

“a single point of contact for all current and former Service personnel who have concerns about their experience of Lariam”,

and the Government announced that that would be done. I would like an update on that, as I have heard suggestions that the advice people get when they ring the relevant number is very basic indeed, even on a par with “Go and visit your GP.” If that is all they are getting, we still have some way to go on that recommendation. We also said that people should be offered an alternative to Lariam if they are concerned about the risks, that this should be explained to them and that a box should be ticked to show that it has. I believe that that is now happening.

One part of the Government’s response was strange. They have alleged that they need to keep Lariam on the books because there are certain geographical areas where no other drug will work. The report disputed the Government’s assertion that geography was a valid factor. We therefore asked the Ministry of Defence to set out which geographical areas, if any, it believed to be resistant to each antimalarial drug it uses, and give us any accompanying evidence to support that view.

The Government’s response was:

“The MOD relies on authoritative external advice on the global distribution of antimalarial resistance.”

They provided us with a link to guidance from Public Health England. That guidance, which is 109 pages long, includes a table where areas of malaria risk are listed alongside the recommended antimalarial drug for that area. The table shows a dozen countries or areas for which only chloroquine is recommended, but by contrast, we could see no instances where Lariam was the only recommended antimalarial drug in any single area. [Interruption.] I am interested to see my hon. Friend the Member for Stafford assent.

The report questioned the feasibility of providing face-to-face individual risk assessments before prescribing Lariam in the event of a significant deployment, so we asked the MOD to set out how it would be able to do so, alongside an estimation of how much time it would take to conduct face-to-face individual risk assessments at both company and battalion level. I will not go into all the details of the MOD’s response, but I found one aspect worrying. The MOD acknowledged that if the operational imperative meant that the timing of a deployment did not allow for specific face-to-face interviews,

“an appropriately trained and regulated healthcare professional will review individual electronic health records and confirm that there are no contraindications to the recommended anti-malaria drug. It is estimated that this will take up to five minutes per individual, or approximately eight hours for a company, or approximately 50 hours for a battalion.”

Can the Minister explain—or, if not, write to us—exactly what that means? Is it predicated on the fact that people will have had a face-to-face individual assessment at an earlier stage in their career? In that case, there might be some argument for it, but if it is meant to be a substitute for individual face-to-face assessments, I am sure the Chamber will agree that that would be wholly unacceptable.

[Ruth Smeeth]

Is not one of the problems with Lariam that if someone has had a mental illness before, they may be more vulnerable? A lot of servicemen and women would feel uncomfortable admitting that, would be unlikely to have told anyone within their chain of command and may well not have sought guidance, so the idea that the medication could be used even with those measures is almost impossible.

[Dr Lewis]

That is probably the single strongest point that one could make in the course of this entire debate. Particularly in the macho military environment—I use that term in a non-sexist way—people are unlikely to disclose mental troubles in their past, meaning that either they may take a drug that is inappropriate for them or they may throw it away, rendering themselves vulnerable to contracting malaria.