Other Committee members may correct me, but I have a feeling that we never quite got to the bottom of why the MOD is so fixated on that particular drug. What I am about to say is sheer speculation, but it could have something to do with the relative cost of different types of drug, or with concern about compensation claims. If the drug were given up completely, it might be easier to bring claims on that basis: “You don’t prescribe this drug at all now, so therefore you were wrong ever to have prescribed it.”
We sought to give the MOD a bit of wriggle room, for want of a better term, by saying that all we wanted it to do was designate Lariam as a drug of last resort. I do not see why it should not do that. It is obviously a drug of last resort, because the MOD accepts the fact that it should now be issued only under the most strictly defined conditions. What is that if not making it a drug of last resort? So why does the MOD not say so?
Similarly, there has been reluctance to acknowledge the experience of other countries. The MOD asserted that Lariam was
“to be equally suitable (with an individual clinical assessment) as each of the other drugs”.
However, Dr Remington Nevin—one of the two doctors to whom we owe a great deal of gratitude for their consistent campaigning on this issue and for the evidence they brought to the Committee—described that as a “misinterpretation of CDC’s position”. The section entitled “Special Considerations for US Military Deployments” in chapter 8 of the CDC’s publication “Yellow Book” states:
“The military should be considered a special population with demographics, destinations, and needs that may differ from those of civilian travelers.”
In respect of the use of Lariam in other states’ armed forces, Dr Nevin argued that
“many of our Western allies have all but abandoned the use of the drug”,
and that the US and Australian military use it only for
“those rare service members who cannot tolerate…two safer and equally effective alternatives”.
That is why we made the point that Lariam should really be used only for such people, because we are not convinced that there is any geographical area where some other drug could not be used.
Dr Nevin also referred to the US Army Special Operations Command having taken the
“very wise step of banning it altogether”.
He said that the decision by the US military was made
“primarily on clinical grounds” and was intended to
“decrease the risk of negative drug-related side-effects”.
The MOD’s response commits merely to updating the information held on the use by our allies of Lariam and other antimalarial drugs, including the extent to which Lariam is used and the circumstances in which it is supplied. It still does not appear to accept that its policy on Lariam is increasingly out of step with that of our allies.
We have made considerable progress by focusing on the terrible situation in which a drug designed for very specific issuing to very specific people after a very specific interview was doled out en masse as a routine prophylactic to our service personnel who were about to go to malaria-infested areas. That really was a scandal, and it would be another scandal if it ever happened again.