Lariam

Debate between Baroness Anderson of Stoke-on-Trent and Julian Lewis

Thursday 27th October 2016 Westminster Hall

[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.

Select Committee on Defence

Debate between Baroness Anderson of Stoke-on-Trent and Julian Lewis

Thursday 7th July 2016 Commons Chamber

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

I am grateful for this opportunity to lay before the House the Defence Committee’s new report entitled, “Russia: Implications for UK defence and security”, which has been produced on the eve of the Warsaw NATO summit and which highlights the need for that major event to focus on defence and deterrence, but also on dialogue.

I am extremely grateful to all the members of the Defence Committee for their contributions to the genesis of this report. We held four oral evidence sessions and received 18 pieces of written evidence. A delegation from the Committee, ably led by my hon. Friend the Member for North Wiltshire (Mr Gray), visited Moscow, where they attempted to engage with the Russian authorities. Because of the current state of relations, Russian Government authorities were reluctant to engage, but the delegation acquired much other useful information on that visit.

Russia’s annexation of Crimea and invasion of eastern Ukraine have undermined the post-cold war assumption of a stable Europe in which the military threat to NATO is low. The north Atlantic alliance must therefore restore its defences, review its deterrence and reopen its dialogue with the Russian authorities. The fact that NATO and the UK were taken by surprise by the interventions in Ukraine shows a failure to comprehend President Putin’s determination to maintain a sphere of influence beyond Russia’s own borders and to do so by force if necessary. His stance directly contradicts the rules-based international order that western democracies seek to promote.

Russia has become increasingly active not only in conventional warfare, but in unconventional methods, often deniable, which are designed to fall below the threshold that would trigger NATO’s article 5 guarantee—the undertaking to consider an armed attack against one NATO member state as an attack against them all. The creation of the very high readiness joint taskforce—VJTF—among NATO member states and the enhanced forward presence on NATO’s contested eastern flank are steps in the right direction, but our report warns that the VJTF was formed only recently and that its capacity to deploy the necessary forces within the required timeframe is as yet unproven.

The report’s recommendations include the following. First, the MOD should recognise the extent of Russian remilitarisation and respond to it robustly. Secondly, it should review the effectiveness of current deterrence policy against nuclear, conventional and hybrid or multidimensional warfare. Thirdly, NATO should determine whether the 1987 intermediate-range nuclear forces treaty is in need of repair or replacement in the light of allegations that Russia has breached its provisions. Fourthly, a timetable should be set out for the Trident Successor submarine debate and the decision in Parliament “without further delay”—indeed, that debate should be held before the summer recess. Fifthly, the renewal of EU-wide sanctions against Russia should be encouraged and possibly extended to a larger group among the Kremlin leadership. Sixthly, it should be accepted that

“it is perfectly possible to confront and constrain an adversary in a region where our interests clash, whilst cooperating with him, to some degree, in a region where they coincide.”

We regard the threat posed by Daesh, al-Qaeda and other international terrorists as a relevant example of the latter: the convergence, to a considerable extent, of NATO and Russian interests. I am glad to see the Under-Secretary of State for Defence, my hon. Friend the Member for Canterbury (Mr Brazier), assenting to that proposition.

The Committee believes that Russian cyber-attacks across Europe and territorial seizures in Georgia and Ukraine may not be isolated actions and may be symptomatic of a wider ambition to restore Moscow’s global influence. However, because Russia is a global power, there remain opportunities for co-operation if we can but grasp them. Yet with relations at what the Russian ambassador to London has described as an “all time low”, our report concludes that the UK must urgently boost its cadre of Russian specialists. We must restore and maintain a high level of expertise for the foreseeable future. Given the current climate, the defence attaché’s office in Moscow, for example, must be properly staffed by the end of the year.

Since the end of the cold war, Russia has not been a UK priority and our expertise in this field has withered on the vine. The UK needs a vastly strengthened body of experts who can help provide an effective response to the challenges Russia now poses. We cannot hope to understand Russia without a forthright dialogue, and in the current conditions of mistrust we run the risk of blundering into conflicts that may be preventable through better communication. The cold war was characterised not only by military confrontation, but by the then Soviet Union’s promotion of Marxism-Leninism, with its formidable appeal to impressionable minds inside the Kremlin’s targeted countries. No such totalitarian doctrine applies to present-day Russia, which, for all its nationalist and expansionist tendencies, is itself under threat from revolutionary Islamism, the brutal successor to the equally brutal Nazi and communist creeds which blighted so much of the 20th century. Therein lies the basis for potential co-operation, provided that our dialogue with Russia is from a position of strength, based on sound defences and credible deterrence.

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

May I say that it is a privilege to serve on the Defence Committee, which is so ably chaired by the right hon. Member for New Forest East (Dr Lewis)? I hope he will agree that one thing that is clear from our report is a lack of dialogue and understanding between our colleagues in Russia and ourselves, in terms of not only language, but shared history. Does he agree that, in the light of the upcoming NATO summit, we need to review that as part of our wider engagement with Russia, including how it perceives the threat from NATO, too?

[Dr Lewis]

Yes, indeed, and I thank the hon. Lady for that. She is a tremendously supportive member of the Committee; this is her first parliamentary term, but she has made a great start. I re-emphasise what I said about the importance of dialogue with Russia. The fact remains that different societies develop at different stages and go through different phases in their attitude to their relationships with the rest of the world. One mistake that the west clearly made after the downfall of communism was to evoke a degree of triumphalism at a time when magnanimity would have been more appropriate. Those in the west make a terrible mistake if they fail to recognise that Russia is and always has been a great power, and what we have to do is reach out the hand of friendship, while trying to discourage those aspects of the Russian tradition that seek to dominate lands beyond its own borders. Russia is a pretty large landmass and one would hope that the Russians could make a success of running their own country without feeling the need to impose their will on their neighbours.