Michael Fallon, the Secretary of State for Defence, has told the House of Commons Defence Committee that it will continue to administer the controversial anti malarial Lariam (mefloquine) to personnel.

ON 8 September the Committee wrote to Mr Fallon expressing its concern about the continued use of Lariam and asking six questions. The Committee has now published MR Fallon’s response, in which he states that the drug will continue to be used. He also says that the MoD complies with national guidelines on malaria prevention, and that “since 2004/5, Defence policy has required Mefloquine to be prescribed to Service personnel with the accompanying risk assessment.” A full copy of Mr Fallon’s response can be viewed (pdf).

As a lawyer representing serving and retired military personnel who were given the drug for deployments and have since suffered life-changing side effects, I find this response inadequate, and I am very disappointed. My clients will be unhappy that others are to be hurt as they have been. For more details of the legal position and the work we have been doing in connection with compensation claims for injury as a result of the side effects of Lariam, follow this link.

The accounts I hear from them and from others who have contacted me and the media appear to show that that for many years now the MoD has in fact failed to administer Lariam in accordance with the requirements of the medicines regulatory authorities.The Secretary of State should immediately forbid the use of Lariam in the forces and fully answer the questions he has been asked by the Committee about the extent to which the MoD has honoured its duty of care towards service personnel.

Individual assessments

Mr Fallon should give a full and frank response to the Committee’s query as to why individual risk assessments were not carried out before 2013 despite the manufacturer’s guidance that they were necessary. The reply he gave yesterday takes us no further forward. He says that since 2004/5 Defence policy has “required mefloquine to be prescribed, with the implied accompanying risk assessment”. This is a circular statement. Mr Fallon appears to be saying that, because the manufacturers said there should be assessments, the MoD must be assumed to have done them.

He refers to MoD guidance leaflets which in fact contain no reference to individual assessment. He must be asked to produce evidence that assessments were required by the chain of medical command, whether at joint service level or by the Army, Navy and RAF individually.

His response also leaves open the question of whether there was even a theoretical requirement for risk assessments before 2004, and why, in a press release date 20 August this year the MoD said that the requirement had been in force only since 2013.

Failure to give compulsory warnings

He has also glossed over the fact that it is common knowledge – and the manufacturers agree – that Lariam is associated with very serious neuropsychiatric effects including depression, hallucinations, nightmares, paranoid delusions, sleeplessness, psychosis, personality change and aggression. As a result, since 1996 the UK medicines regulatory authorities have imposed unusually strict safeguards. Any doctor who is thinking of prescribing the drug must:

  1. Make sure the patient is aware of the serious side effects associated with it, and
  2. Tell the patient that, if they experience any of those side effects, they must without fail seek medical advice before the next dose is due so they can be advised about an alternative.

In very many cases, however, service personnel have simply been handed the drug with their kit, and not given this advice. “Lariam dreams” are well known and apparently accepted quite casually by the chain of command and their colleagues. They have, therefore, not known that they should go straight to the medical centre and have continued to take the drug to the end of the course. At the least, this has caused months of ill health. At worst, some appear to have suffered permanent injury.

Inconsistency; is Lariam the first line drug?

The Minister states that Lariam “is not a first line drug”, yet an article published on 1 October 2015 in the Journal of Travel Medicine by Ministry of Defence employees, including one who is said to belong to the office of the Surgeon General, says the “Mefloquine is currently the default choice for anti-malarial prophylaxis for British military personnel on exercise in Kenya”.

There is a contradiction here between the Minister’s statement and that of the Surgeon General’s staff . If Mefloquine is the default choice in Kenya then it follows that it is also being used for preference in Sierra Leone and other locations where UK forces serve, where the main parasite encountered, Plasmodium falsiparum, is the same.

Duty of care

The Ministry of Defence has the same duty to care for its personnel as any other employer or healthcare provider and must therefore take reasonable steps to avoid foreseeable injury. By breaching Lariam guidelines it has instead put members of the armed services in harm’s way and laid itself open to compensation claims from those who have been hurt.