Lariam

Bob Stewart Excerpts

Thursday 27th October 2016 Westminster Hall

[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.

[Bob Stewart (Beckenham) (Con)]

I recall that evidence that came to us, as hearsay, from Lord Dannatt. It really shocks me that he was Chief of the General Staff and felt that way and did not take action. I think that the Committee felt that too.

[Mrs Moon]

We most certainly did; but that also shows the inertia in the Ministry of Defence. We heard from many personnel—either individually or as a Committee—at different ranks within the MOD. The matter was not something that was not known about, but it was not being tackled or recognised as a major problem for serving personnel.

Finally, and most tragically, we heard from many individuals who suffered severe long-term effects from taking Lariam. Long after leaving the military, they are still suffering such things as mental trauma, vivid dreams and suicide ideation. That is totally unacceptable. We sought to establish what support was on offer for them from the MOD as it became clear that arrangements were somewhat fragmented. We recommended the establishment of a single point of contact, which we felt was particularly important for veterans, some of whom have experienced mental health problems for years.

Having seen what happened in the previous debate, when the vice-chair of the Committee could not be called to speak owing to time restrictions, I shall now leave it to my colleagues to expand further on the report and evidence. We look forward to hearing from the Minister that further progress has been made.

--- Later in debate ---

[Johnny Mercer]

It would be hard for me to say, at the moment, whether there has been a shift. From the information I have been receiving, I understand that work has been done and it will take a little while to get the granular picture of that support. We have been given assurances that the report has changed things for people who are suffering.

We have to be mature and accept that, as an employer and a Government, we have asked young men and women to take medication to protect them from a disease in areas where we are asking them to operate, and we have not done so correctly. I welcome the fact that the report realises that. It is not in keeping with how we normally look after people. I know that, having served, I have come to this place on a bit of a mission, and that I get slightly carried away, as I did the other night, about how we look after people. However, one of the strengths of the military, including the Army, is that we do look after people. That pastoral care very much contributes to what we do, but the way in which we have looked after those who have taken this drug has been out of keeping with that.

[Bob Stewart]

I thank my very good friend for giving way. I am slightly concerned by the third condition for prescribing Lariam, whereby the danger of the drug is explained to the soldier, sailor, airman or airwoman, and then the decision is down to them. In my experience, a lot of soldiers will say, “For goodness’ sake, tell me whether I should take it or not. Why do you give me that decision?” That condition worries me, because I think that most soldiers will say, “You tell me what I should take. I am not the judge of that.”

[Johnny Mercer]

I thank my hon. Friend, loosely speaking, for raising that point. He gets to the crux of the problem. Essentially in the military, we go on medical advice. None of us are scientists or doctors. If we get into the real detail of the issue, it is on that point that we get to the nub of what has gone wrong.