AFC0024

Written Submission by Lieutenant Colonel (retd) Andrew Marriott MBE PhD.

Introduction

I am grateful for the opportunity to assist the inquiry into the Armed Forces Covenant. I served for 35 years in the infantry, including deployments to Northern Ireland, the Balkans, Georgia, the Middle East and Sierra Leone. Home-based service included commanding the Infantry Battle School, and, in the MoD, developing the UK’s peace support doctrine, engaging Five Eyes and NATO Allies, former Soviet States, China, and India.

Subsequently, I gained a First-Class Honours degree and a Masters in archaeology (both with distinction) at York University. In 2018 I was awarded a doctorate by Newcastle University for studies into the material culture of conflict. My research has been published in academic journals and the national media.

Executive Summary

Following a Defence Committee inquiry in 2015/16, the MoD and other bodies committed themselves to a range of activities in support of personnel affected by their use of the anti-malarial drug Lariam. Regrettably, the expectations of many injured veterans were not met. This submission attempts to articulate those expectations and explores why a cohort of veterans and families were subsequently failed. This case study exemplifies how conflicts of interest and the protection of institutions can become a barrier to the Armed Forces Covenant. I suggest that only if the MoD is prepared to properly embrace the Covenant will other bodies be likely to follow. The Covenant may require a guardian who is fully independent of the government.

Background

In 2015 I submitted written evidence to the Defence Committee’s inquiry into the use of the anti-malarial prophylaxis Lariam (mefloquine), a drug implicated in multiple acts of violence, attempted and completed suicides, and homicides. I also gave oral testimony on 8 December 2015.[1]  Later, in 2022, I published my own research into Lariam in a book calling for the honourable and fair treatment of veterans and families profoundly damaged by the drug and yet abandoned by the MoD and other national institutions, including the NHS. That book achieved plaudits, here and abroad, most notably from experts in psychiatry and travel medicine.[2] [3] A previous Chair of the Defence Committee described it as “a passionate and persuasive indictment” of those charged with the care of service personnel and veterans.[4] I should declare that I took Lariam while serving and have been formally diagnosed with a long-term injury.

This present inquiry is timely, coinciding with an enduring failure of the Covenant and the principles upon which it is built. The Covenant is meant to establish a moral obligation to members of the Armed Forces, especially to those who suffer serious injury or death as a result of their service. This obligation extends to service families and the bereaved, some of whom may deserve what is described as special provision.[5]

Lariam Veterans’ Expectations

The legacy of the MoD’s use of Lariam offers an important case study into care and support for injured personnel and their next-of-kin. Clearly, those should be at the heart of the Covenant but serial failures continue to expose grave shortcomings, many emanating from the MoD itself.

The sterling work of the Defence Committee’s inquiry of 2015/16, which formally recorded a lamentable weakness in the MoD’s duty of care, had a number of outcomes, perhaps the most important being, because of its dangerous side-effect profile, a call for Lariam to be relegated to a drug of last resort. Shortly after, the drug manufacturer, Roche Pharmaceuticals, began the process of abandoning its product. The Defence Committee also pressed the MoD to establish a single point of contact for all current and former service personnel who had concerns about their experience of Lariam. This point of contact was to be publicised widely through the Chain of Command, veterans’ organisations, the MoD website and military and forces magazines and publications. Discussions were also to be held with the Department of Heath on possible ways of advising GPs of potential risks to veterans who may have been given Lariam.

Another major outcome was the extraction from the Minister for Defence Personnel (Mark Lancaster) and the Surgeon General, during oral evidence to the Committee, of a series of commitments to those adversely affected by Lariam.[6] These included making established processes available to veterans wishing to report concerns about the drug, and a personal assurance from the Minister that the MoD would engage positively with serving and retired personnel, encouraging them to get in touch.

Among the serious shortcomings in the MoD’s use of Lariam, the 2015/16 inquiry confirmed that the side-effect profile was poorly understood by military medical professionals up to, and including, the Surgeon General.[7] It was also established that because of poor record-keeping and the irregular manner in which the drug was issued, particularly during Op Herrick deployments to Afghanistan, many thousands of personnel had potentially been given the drug and in regions where its use was not necessary.[8] The MoD simply did not know the scale of the problem.[9]

These matters were subsequently raised at a meeting hosted by the NHS in Richmond House, Whitehall, in the summer of 2017. The meeting was co-chaired by the NHS Director of Armed Forces Commissioning and the MoD’s Chief of Defence People. Oddly, neither seemed aware of the causal link between the use of Lariam and the onset of serious neuropsychiatric harm. However, they did undertake to address the issue. They also made the important commitment to commission a study into personnel who deployed to Iraq and Afghanistan, and took Lariam, in order to monitor their mental and physical health and wellbeing outcomes.[10]

Thus, by 2017, those serving personnel and veterans badly affected by Lariam had expectations that their cases would be considered, not just in the light of promises made to Parliament and the public but also under the aegis of the Armed Forces Covenant. Those expectations were not met.

What Went Wrong?

In this case, and especially because of the moral, legal and financial jeopardy to which the MoD was becoming exposed, it is now clear that the focus of ministers and senior officers was centred on the protection of governmental and individual reputations. We are now acutely aware that such behaviour is embedded in many state institutions. Here, the MoD becomes analogous to the Post Office, with Roche Pharmaceuticals equating to Fujitsu, and the drug to the Horizon software system.

It is, unfortunately, now clear that much of the evidence presented to the Defence Committee by the MoD in 2015/16 was flawed and should subsequently have been corrected. That did not happen and the MoD is now open to the highly-credible charge of having misled Parliament, and probably knowingly. Roche also presented wrong and misleading testimony, and it was subsequently established that both parties withheld vitally important evidence about Lariam’s side-effects[11] from both Parliament and the public.

This lack of fidelity has detrimentally affected thousands of veterans, denying them access to the truth about their injuries. Their condition does not sit comfortably in the wider veterans’ injury, mental health and welfare paradigms. The MoD has since manipulated research and care agendas, even denying the existence of long-term Lariam toxicity. The legal and moral consequences of acknowledging their faults have stimulated actions that should be an affront to honest government and certainly the Armed Forces Covenant. Prophetically, Baroness, then Jean, Corston said of Lariam in the House of Commons in 1997 “This matter has the makings of a government health scandal.”[12] That scandal has proved much deeper and wider than she could ever have imagined.

Over the past decade, veterans have attempted to engage with senior military commanders and ministers, most notably the Veterans’ Minister. Not one has embraced the problem. The lack of candour and accountability are suggestive of a guilty conscience, a view reinforced by multiple examples of serious ministerial conflicts of interest.[13] [14] This has, unfortunately, extended to the research arena and particularly into the study of mental illness among veterans. Much of this research is funded by the MoD and directed to researchers, including advisers to the MoD, compromised by their unwillingness to revise the discredited orthodoxy that Lariam was a safe drug.

Especially in the King’s Centre for Military Health Research, there has been little or no consideration of the damaging effect of drugs such as Lariam on mental health. As an academic, I would find this quite remarkable. Attention is, rightly, given to influences such as the operational environment, pre-existing conditions, alcohol and recreational drug use. Yet there remains this worrying investigative lacuna and, thus, it appears that none of the actions promised by the NHS and MoD in 2017 have been initiated. I would like to share the minutes of that meeting with the Committee but would rather you request a copy from the MoD or the NHS. They are an embarrassingly poor record of the meeting, littered with errors and seemingly compiled by someone quite unfamiliar with the topics being discussed. I remain astonished that they would be of an acceptable standard for a three-star officer. More importantly, they are indicative of contempt for those who dare to challenge systemic failures and institutional negligence.

Equally, the MoD Mefloquine/Lariam single point of contact, called for by the Defence Committee, falls far short of the requirement to address the failures in duty of care to support those adversely affected.[15] This single point of contact is no such thing and does not bring the veteran into contact with anyone in the MoD responsible for that duty of care. Rather, it simply deflects the veteran to other non-MoD resources, many of whom are quite unfamiliar with Lariam toxicity. It evades the intent of the Defence Committee and instead creates Kafkaesque circles for the veteran to navigate. Ultimately, they will give up or succumb to the desired MoD orthodoxy that they are suffering from PTSD. Both options can have disastrous consequences.

Another worrying failure, and one that the Ministry of Justice seems unwilling to address,[16] is the determination of coroners in England and Wales not to consider the highly plausible implication of Lariam in military and veteran suicides (most notably in Durham and North Wales), when it was drawn to their attention. This is in very stark contrast to the actions of the Milton Keynes coroner alerted to the probable contribution of another anti-malarial drug (doxycycline) in the suicide of a civilian Cambridge University student in 2019. In that case, an appropriate safety warning in the form of a Regulation 28 Report was raised.[17]

Lariam Soldiers’ Experiences

Among many egregious failures of the Covenant is that relating to the medical discharge of soldiers who, taking the advice of the Minister for Defence Personnel and the Surgeon General as expressed to Parliament in 2016, raised their concerns about the effect Lariam was having on them, and especially with regard to mental illness. If the promises made by the MoD to Parliament were passed down the military chain of command, in many instances they were ignored, either through negligence or as a matter of policy. There is now documentary evidence to confirm that medical discharges were being expedited, with the use of Lariam and consequent injury being ignored or suppressed.[18] At best, medical ethics were being ignored, with possible breaches of military and civil law.

Furthermore, there has been no attempt by the MoD to engage with any Lariam veterans in order to monitor their mental and physical health and wellbeing outcomes, far less address them. This is particularly disappointing for the cohort of veterans given Lariam during Op Telic (Iraq) and Op Herrick (Afghanistan) deployments in the light of the promise made in 2017.

NHS services for those injured by Lariam are, regrettably, shaped by the institutional denial of long-term harm.  Critically, GPs remain quite unaware of Lariam toxicity. Nor does it seem to be recognised by the NHS Op COURAGE Veterans’ Mental Health and Wellbeing Service. Effectively, the default diagnosis for veterans with neuropsychiatric difficulties remains PTSD, an illness with which Lariam toxicity can be very easily confused. Lariam toxicity, however, is a distinct clinical condition, defined in the United States as chronic quinoline encephalopathy, or Quinism.[19] Across Europe and in the UK, the causal link between the drug and the onset of long-term and even persistent neuropsychiatric harm was confirmed by the European Medicines Agency in 2014.[20] Their report remains difficult to access in the UK and the Government has repeatedly refused to confirm when they first became aware of it and if they accept its conclusions.[21] I have only been able to secure a copy from a colleague in Europe who acquired it through a Freedom of Information request.

The Current Situation

There are now thousands of veterans and next-of-kin abandoned in what I would describe as a no-man’s-land of suffering. Here it is worth stressing how the Covenant is failing parents, spouses and partners who are now the carers for those wounded by an agent that the NHS does not understand and the wider system would prefer to ignore.

GPs who do attempt to use the single point of contact are likely to follow the MoD advice that veterans should be directed towards armed forces charities. That is likely to prove unfruitful as none, including the Royal British Legion, Combat Stress and Help for Heroes, appears to be prepared to consider the harm that Lariam is now known to cause. A search for ‘Lariam’ or ‘Mefloquine’ on their websites will produce no help. On behalf of damaged veterans, I have personally approached Combat Stress, the Royal British Legion and the Royal British Legion, Scotland. Not one is prepared to recognise Lariam toxicity and, like the MoD and the NHS, they promote the PTSD orthodoxy. It seems that internal political sensitivities and possible conflicts of interest are compromising the moral obligation due to those suffering from Lariam-induced chronic quinoline encephalopathy.

A similar culture seems to exist in the more formal support structures that should be available. Perhaps the Committee might like to explore why the subject has not been embraced by any of the UK’s Veterans’ Commissioners. I and others have tried but gained no traction. Rather, it seems that the matter was suppressed by the previous Minister for Veterans Affairs.

One recourse that remains active is through the civil courts. However, in one of the most shameful episodes of this scandal, the MoD has been resolute in its determination that the Lariam-injured should be denied fairness, dignity and respect. It has expended tens of millions of pounds defending its negligence in a cynical extension of the suffering of its victims, many of whom are on the verge of suicide. [22] [23] The MoD is now attempting to impose on physically and mentally exhausted veterans and their weary carers a “global settlement” in order to close the affair. Those accepting are, I believe, to be bound by non-disclosure agreements in settlements that are to be “full and final” and in which the MoD would acknowledge no blame or wrong-doing and nor would they even recognise the injury of Lariam toxicity. Were they to accept, the whole cohort would be silenced. Amounts being offered are derisory. Some darkly characterise the sums as barely sufficient to cover the cost of a funeral following a suicide triggered by this ploy. Others have said they would prefer a nominal settlement of £1 in return for a formal recognition of chronic quinoline encephalopathy, an apology, and an honest commitment to research and development of appropriate treatment and care. The latter point is what they really need. Litigants are even being told not to seek any external advice regarding the terms of the MoD settlement. They are being harassed and gas-lit in an affront to all that the Covenant should stand for.

A Criminal Footnote

The MoD is not the sole entity responsible for the plight of these veterans. Not bound by the principles of the Covenant, the manufacturer of Lariam, Roche, is heavily implicated in this scandal. I believe there is a prima facie case for the company to answer. Thus, last September, Roche (UK) was reported to thirteen police forces across Great Britain for marketing a drug that I believe they knew, or ought to have known, had a safety profile that put significant numbers of users at risk, causing serious and long-term injury to many, and even death through suicide. As far as I am aware, not one force has initiated an investigation or interviewed anyone affected by the drug. Two forces have stated that they would not be able to investigate, one passing the matter to the UK drug regulator, the MHRA, who have subsequently declined to act. Two others have declared that any investigation would be the responsibility of Hertfordshire Police, Roche (UK) being headquartered in Welwyn Garden City. Hertfordshire Police remains among those forces who have declined to respond. Another is North Yorkshire, my local force, who have ignored three formal approaches made by me in September, October and November 2024. Are they being directed to behave this way by the Home Office? It should not require a Covenant to have the police respond to a legitimate concern from a citizen. I would, of course, be very happy to provide the Committee with a copy of my detailed submission to those forces.

Conclusion

An Armed Forces Covenant is a worthy aspiration but as currently configured it is prone to failure, especially when it comes into conflict with institutional jeopardy. If it is to be embraced nationally, the concept must be underpinned by example, integrity and leadership from the MoD. Unfortunately, those qualities have been found lacking, and we can hardly expect national buy-in when the Covenant has been applied so casually by Defence ministers and senior commanders. It requires an effective guardian; such an individual or body should probably sit within a non-defence, and possibly non-governmental, institution.

20th January 2025