Lariam

Douglas Chapman Excerpts

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.

--- Later in debate ---

[Johnny Mercer (Plymouth, Moor View) (Con)]

I, too, want to thank the Defence Committee Clerks, who did a terrific job. We were presented with a wide range of evidence, some of which was reasonably scientific, and we certainly needed their help. I also pay tribute to our many witnesses, one of whom flew in from America to give us evidence.

The report has been an important one for the Committee. In the first 18 months following the 2015 general election we have produced three reports on the duty of care and how we look after people. It is an interesting time in politics, and there are diverse views on defence on either side of the party divide and in the SNP; that is great, but we have a duty to hold the Government to account. That is where Select Committees can come into their own, and we have had some success. The report speaks to the soft side of looking after people and why it is important.

Having served and so on, I know that the interesting side of the military is going on operations and all the things that come with that—shiny stuff, bombs and all the rest of it—but what we fail to get in this country is the importance to combat power of looking after people. I certainly would not hold the United States up as a bastion of getting everything right, but we have seen its forces go through a process so that they understand the whole force concept. They do not just talk about it doctrinally or write about it at staff college. They actually impose a whole force concept whereby looking after families, housing, accommodation, health, wellbeing and so on contributes to fighting power. The US has seen those rewards. We are slow to that game, but we are beginning to get there and we are making real strides, particularly under the current Minister.

In the challenging time we are going through with Brexit, which absolutely presents opportunities as well, it is important that we do not drop the ball on defence issues. As everyone will recognise, we have come out of a particularly tense time on operations. We must maintain our focus, as my right hon. Friend the Minister for the Armed Forces alluded to in the previous debate. People read and watch what happens in this place, and it means something to them, so I am pleased that we are having this debate.

Lariam can be quite a complex issue, but it comes down to one clear thing. There is a drug that is clearly very effective at fighting malaria, which is a killer—we should not lose sight of the fact that malaria still kills a lot of people worldwide—but any manufacturer will say that the drug should be used within the guidelines. Unfortunately, for one reason or another, we did not use it within those guidelines, and people were affected.

The matter can be viewed as being a bit niche. When I first brought it to the attention of the Ministry of Defence in August last year, I was treated as though it were a personal campaign of mine. I have never taken the stuff, so I have never experienced any of the effects at all, but the issue is not niche to those who have been affected. We are now doing so much better in this place when it comes to the problems caused by Lariam, as we are on other mental health matters. However, it is simply not good enough to understand it just because it happens to us, our family or someone close to us. We have to take these things seriously, and we must take responsibility.

[Douglas Chapman]

The hon. and gallant Gentleman has been identified as being closer to the issue than most. Do his former colleagues in the services believe that things have improved or changed? Is there any evidence of more support being given to our armed forces who have been subjected to the drug over many years, and are there signs of improvement in the support they get?

[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.