It is a great privilege to speak under your chairmanship, Mr Rosindell. I congratulate the Defence Committee, under the excellent chairmanship of my right hon. Friend Dr Lewis, and all previous speakers in this debate.
I declare an interest as chair of the all-party parliamentary group on malaria and neglected tropical diseases and as a trustee of the Liverpool School of Tropical Medicine. I have a large MOD base in my constituency, MOD Stafford, which has three signals regiments and the RAF’s tactical supply wing. Many members of those units spend quite a lot of time on deployment in countries where malaria is a problem.
Malaria, as my hon. Friend Johnny Mercer said, is a killer. It used to kill well over 1 million people a year, but thankfully that figure is now down to 438,000 a year, according to the World Health Organisation in 2015. I hope the figure is still falling, but it is an awful lot of people. I have had friends die from malaria, which is a serious disease.
It is absolutely right that the Ministry of Defence should take every precaution to protect its personnel from the depredations of malaria, but the question, of course, is how to do it. I had experience of Lariam when I lived in a tropical country. I took it when I was diagnosed with malaria—I took it not as a prophylactic but as a curative—and they were four of the worst days of my life, and not because of the malaria. Lariam produces extraordinary dreams that leave those who take it completely debilitated. The next time I had malaria—I have had malaria four times—I took a different drug, artemether, and the experience was quite different. Within 12 hours I was back on my feet, back at work and able to continue. The side effects were almost zero.
We are talking about Lariam as prophylaxis, but several alternatives are mentioned in the report. There is Malarone, which for many years was quite expensive, but it is a lot cheaper now that it is off patent—that is the one I use whenever I go to tropical countries. There is doxycycline, which is effective and cheap, and of course chloroquine and proguanil, which have been used for decades. Those two drugs have some side effects, particularly proguanil, which can cause mouth ulcers if taken over an extended period—proguanil is also an ingredient of Malarone.
On the curative side there is Lariam, but artemisinin-based combination therapies are also incredibly effective and are the recommended curative drugs for malaria across the world—I will talk about those in my conclusion.
The Committee’s recommendations for using Lariam are spot on. First, the MOD should find out whether service personnel are unable to tolerate alternatives. Secondly, individual risk assessments should be conducted and, thirdly, the patient should be aware of alternatives. I am delighted that the Committee has come up with those recommendations, which are all absolutely right, but they need to be put into effect. I am delighted to hear that the Ministry of Defence has taken the report seriously.
I finish by issuing a warning. We think that we have come a long way with both prophylactic and curative drugs against malaria, and that is indeed the case. All the research funding over the past decade and a half has partially resulted in halving the number of deaths, although a substantial part of that is also due to the use of mosquito nets. Has the Committee looked at how many service personnel are provided with insecticide-treated mosquito nets? A recent study by Oxford University found that almost two thirds of the reduction in deaths from malaria since 2000 is the result of insecticide-treated bed nets, not the improved drugs.
Be that as it may, it is vital that research into improved drugs continues because, unfortunately, we are beginning to see resistance to the artemisinin-based combination therapies—ACTs are the best drugs available at the moment—in south-east Asia, particularly on the Myanmar-Thai border. The worry is that resistance to all the previous effective antimalarials, first chloroquine and then sulfadoxine-pyrimethamine, started in that same area. The fact that resistance to ACTs is starting there gives us great cause for concern. The Department for International Development is putting a lot of effort into research on that subject, which I welcome, but it is important that we continue to focus research on antimalarials both as prophylaxis and as curative.
I am grateful for the opportunity to speak in this debate, and I thank my hon. and right hon. Friends on the Defence Committee for their excellent work, which I hope results in better treatment for our servicemen and women across the world.