Lariam

Debate between Julian Lewis and Fabian Hamilton

Thursday 27th October 2016 Westminster Hall

[Fabian Hamilton (Leeds North East) (Lab)]

As always, it is a pleasure to serve under your chairmanship, Mr Rosindell. I thank Members for bearing with me; I know they will all get the chance to say their piece. I apologise to the Minister for having to leave. I have had to stand in at the last minute for my hon. Friend the Member for Caerphilly (Wayne David), who has been taken ill, and I need to catch a particular train to get back to my party meeting this evening.

Like my friend—I hope he does not mind my calling him that—the hon. Member for Stafford (Jeremy Lefroy), with whom I served on the International Development Committee for three years, I feel a personal connection to the subject of Lariam. Unlike him I have never had malaria, but had I contracted it I would no longer be standing here, because it is fatal to patients who have no spleen—mine was removed some 20 years ago. I really feel very concerned about malarial areas. The hon. Gentleman knows how difficult it is for people who do not have a spleen to go to them because of the risks involved. Even the prophylaxes that he mentioned are not 100% effective, so even places where there is a tiny risk of contracting malaria are too dangerous. The Foreign Office advises all its asplenic personnel not to visit those areas at all. His personal experience has informed us greatly about the effects of Lariam, and the fact that he has taken it himself and knows exactly what its side effects can be has brought the issue to life for many of us.

I also pay tribute to my hon. Friend the Member for Bridgend (Mrs Moon), because she has pursued and pursued this. I am so glad that the Chair of the Defence Committee, the right hon. Member for New Forest East (Dr Lewis), and the rest of the Committee agreed that the issue of Lariam was so important and wrote this splendid and well written report with all the evidence that they accumulated. I congratulate them and their staff on it.

I feel huge sympathy with the 25% to 35% of Army personnel who have been affected by taking Lariam. My hon. Friend the Member for Bridgend mentioned that geographical location was a consideration when prescribing Lariam, and the hon. Member for Stafford underlined that with his point about the resistance that is now growing in south-east Asia. My hon. Friend the Member for Bridgend also said something very important that is contained in the report: military deployment is very different from tourism. While it is unpleasant to suffer the side effects as a tourist, it is dangerous if not worse for military personnel who suffer them on military duties.

The biggest scandal of all that has been revealed in the contributions to this debate, many from former serving personnel such as the hon. Member for Plymouth, Moor View (Johnny Mercer), is that there seems to have been no duty of care from the Army. The right hon. Member for New Forest East said that just five minutes’ assessment may be sufficient to ensure that individual Army personnel have the right prescription and are not forced to take Lariam when it is wholly inappropriate for their needs.

[Dr Julian Lewis]

May I correct that? I did not say that five minutes was sufficient. I said that the MOD was saying that.

[Fabian Hamilton]

My apologies for that. I obviously did not write my notes correctly. I am sorry if I misquoted the right hon. Gentleman.

As we discussed in the previous debate, we have a duty to ensure that people who put their lives on the line for the defence of this country, like hon. Members in this Chamber who have done so, do so in the knowledge that those who ask them to do it and who send them to dangerous places are looking after their interests.

We know that Lariam is the brand name of mefloquine and that it is used to treat malaria. It is most commonly administered as a prophylaxis, but the history of side effects, the evidence we have received and the evidence in the Defence Committee’s report make it clear that it is not necessarily the most appropriate prophylactic medication. I am glad we have made it clear that we do not blame the manufacturer, Roche, for the misuse of its drug. It is clearly an issue for the Army itself and we want the Army to get it right. That is why the Committee’s report was written in the first place. I myself have taken chloroquine and proguanil; I suffered some side effects, but nothing like those that have been recorded for Lariam.

We know that many countries’ military forces have used Lariam in the past, but that it is becoming increasingly uncommon because of its side effects. Some 17,000 British military personnel were prescribed Lariam between April 2007 and March 2015, and the reports of those side effects meant that many of them have discarded their Lariam tablets instead of using them. That makes them far more susceptible to malaria, which is extremely dangerous—as the hon. Member for Stafford said, it has killed 438,000 people in the last 12 months.

The summary of the Defence Committee report says:

“The evidence we received highlighted some severe examples of the possible side-effects of Lariam in a military setting. While they may be in the minority, we do not believe that the risk and severity of these side-effects are acceptable for our military personnel on operations overseas.”

When the Minister responds to the debate—I apologise that I will not be present to hear him—will he care to tell us about the handing out of Lariam to military personnel in future in the light of the report and the evidence contained within it?

In preparing for this debate, I sought the advice of a specialist—he has asked not to be named—who works at the London School of Hygiene & Tropical Medicine. His view was quite interesting. He made the point that Lariam is a cheaper medication than some antimalarials, and that it is very effective. That could be one reason why the MOD is maintaining its support for Lariam in the face of media controversy, the Defence Committee report and, of course, resistance from many military personnel. The specialist said that it is a good drug. He even gave it to his spouse when they went to west Africa a few years ago. He reported that she had had the most vivid and crazy dreams. Like most drugs, it is not good for some people, but it is good for others.

One thing in favour of Lariam is that it is administered once a week. Many other antimalarials are administered once a day. For someone in a military setting who is in a conflict situation, or who has been deployed in a remote area, it being a once-a-week drug will have a huge benefit for those administering it and those having to take it. A once-a-week dosage also increases the chances of compliance and of people actually taking the medication when they need to take it.

The specialist I mentioned noted that the number of tests on the effects of Lariam on Army personnel were small and were not done in an adequately controlled situation. I do not know whether my hon. Friend the Member for Bridgend would agree with that, given the evidence taken by the Select Committee, but there needs to be far more testing. There needs to be a much greater database of evidence to prove conclusively that so many people will not tolerate Lariam and that it should perhaps be replaced by other drugs, depending on geolocation and the individual assessment of military personnel.