6Comparisons with the use of Lariam by other States
87.Our inquiry also covered the use of Lariam in comparison with other nations’ Armed Forces. In written evidence, the MoD provided the following table setting out the use of Lariam by NATO allies and others127:
|
Country |
Use of Lariam |
|
Denmark |
Mefloquine offered but Malarone and doxycycline preferred. |
|
Germany |
Mefloquine offered but Malarone and doxycycline preferred. |
|
Netherlands |
Mefloquine offered but Malarone preferred. |
|
France |
Mefloquine offered but doxycycline preferred. |
|
Czech Rep |
Mefloquine offered. (Supplies are imported as an exception). |
|
Slovakia |
Mefloquine offered. |
|
Sweden |
Mefloquine offered. No general restrictions on its use. |
|
Belgium |
Mefloquine offered but Malarone and doxycycline preferred. |
88.While this provides a headline account of the use of Lariam, our witnesses painted a picture of UK policy becoming increasingly divergent from its allies. Dr Nevin argued that the MoD was “increasingly isolated among Western militaries in its continued preferential use of Lariam” and that that “many of our Western allies have all but abandoned the use of the drug”.128
89.In a recent interview in the Independent, Dr Croft, claimed that Defence Ministries in Germany, the Netherlands, Denmark and Canada had either banned the use of Lariam completely, or restricted its use to a drug of last resort. In the article he highlighted the fact that:
The French military, although with a large presence in the tropics, has deliberately and sensibly never used the drug, for malaria prophylaxis.129
90.In supplementary evidence, Dr Nevin stated that, while the US and Australian militaries continued to prescribe Lariam to military personnel, it was now only used as a drug of last resort, employed “exclusively by those rare service members who cannot tolerate these two safer and equally effective alternatives”.130
91.Dr Nevin also highlighted the fact that the US placed restrictions on the use of Lariam in 2009131 and that in 2013 the US Army Special Operations Command had become the first U.S. military command to prohibit the drug outright.132 He declared that it was of “some note” that the US military had declared Lariam a drug of last resort and that the US Army Special Operations Command had taken the “very wise step of banning it altogether”.133 He concluded by telling us that the reason for the decision was based on “the totality of evidence” presented to the US military”.134
92.However, the MoD did not believe that these changes could be considered as “sufficient evidence” to justify a change to its policy.135 Brigadier Hodgetts accepted that US Special Forces had now stopped using Lariam, but argued that the change was for administrative rather than clinical reasons.136 In addition, he highlighted what he described as another “confounding factor” in that all US service personnel were issued with an antibiotic—moxifloxacin—which “directly interacted with Mefloquine, and could cause abnormal heart rhythms”.137
93.In written evidence, Dr Nevin disputed the reasons given by the MoD for the U.S. Army Special Operations Command (USASOC) decision to discontinue its use of Lariam. He said the decision was made “primarily on clinical grounds” and was specifically intended to “decrease the risk of negative drug-related side-effects”. Furthermore, Dr Nevin argued that the policy was informed by “a clinical statement in a publication of the US Centers for Disease Control and Prevention (CDC) that the symptoms caused by [Lariam] may confound the diagnosis of post-traumatic stress disorder and traumatic brain injury, and by the addition of the boxed warning to the approved U.S. drug label advising that side-effects from the drug could be “permanent” or last “years after [Lariam] use”.138
94.In respect of France, Surgeon Vice Admiral Walker told us initially that while the French Armed Forces did not use Lariam “routinely” it did have the drug within its “armamentarium”.139 He went on to say that this was also the case in Canada and the Republic of Ireland.140 However, he was unable to provide any details on whether France had actually used Lariam.141
95.In similar vein, Dr Nevin argued that the Australian Defence Force had long “de-prioritised” the use of Lariam on the clinical basis of its known adverse neurological effects and had declared it a “third-line” drug.142 He acknowledged that both the US and Australian Armed Forces continued to prescribe Lariam but highlighted the fact that it was retained only as ‘drug of last resort’, for use “exclusively by those rare service members who cannot tolerate these two safer and equally effective alternatives”.143
96.The Ministry of Defence asserts that its use of Lariam is not out of step with that of our allies. To support this, it has provided evidence on which of our allies offers Lariam as an anti-malarial drug. However, a number of our witnesses told us that our allies take a far more restrictive approach to the use of the drug. We recommend that the MoD updates its information on the use of Lariam by our allies to include the extent to which Lariam is used and under what circumstances it is prescribed.
127 Ministry of Defence (LAR0013)
129 ‘Lariam: Hundreds of British soldiers suffering from mental illness after being given anti-malarial drug’ The Independent, 15 April 2015
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19 May 2016