https://modmedia.blog.gov.uk/2015/08/20/use-of-anti-malarial-medication-in-the-military/

Use of anti-malarial medication in the military

Following a story on BBC Radio 4’s Today programme on the use of anti-malarials in the military, there has been further media coverage and calls for the use of the drug mefloquine to be suspended so a study into its side effects can be conducted.

Mefloquine (whose trade name is Lariam) is recommended as an effective anti-malarial by international health agencies, including the World Health Organisation. It is effective and is used by civilians and military personnel throughout the world. The life-threatening risks of malaria are extremely serious and mefloquine is one of a number of effective anti-malarials that we use. It is not our first choice of anti-malarial, but is used in some cases.

The Ministry of Defence needs to be able to use the most appropriate drug for the areas to where our people deploy to help ensure their resistance to this disease. The choice of prescribed treatment depends upon a number of factors including the region to which personnel are being deployed and the individual’s medical history. We use a range of prevention drugs in line with the guidance provided by the Advisory Committee on Malaria Prevention to ensure the treatment provided is going to be the most effective.

Mefloquine has been prescribed to a tiny percentage of MOD personnel – only 0.4% of those deployed to Afghanistan between April 2007 and December 2014 were prescribed the medication.

Further clarification on mefloquine and the MOD’s policy on prescribing the drug is below:

Mefloquine is a safe and effective anti-malarial drug

  • There are currently no countries where the drug has had its licence withdrawn on safety grounds.
  • There is no evidence that UK Service personnel are at an increased risk from adverse drug events related to mefloquine.

Mefloquine is recommended for use by national and international agencies

  • Mefloquine is licensed in the UK by the Medicines and Health Products Regulatory Agency, based on the expert guidance of Public Health England’s Advisory Committee for Malaria Prevention, which advises on malaria prevention for all travellers from the UK.
  • If compelling evidence is produced regarding the toxicity of mefloquine, then it is likely that the UK licence would be reviewed.
  • The World Health Organisation and other respected international health agencies continue to recommend mefloquine as a safe and effective means of malaria prevention.

The MOD uses a number of anti-malaria drugs

  • These include chloroquine; proguanil; chloroquine plus proguanil; mefloquine; doxycycline; and atovaquone plus proguanil. Mefloquine is not the drug of first choice.
  • The MOD’s choice of drug depends upon a number of factors including the region to which personnel are being deployed and any past history of side effects.
  • Anti-malaria drugs are prescribed in line with the Advisory Committee on Malaria Prevention’s guidance to ensure the treatment provided will be the most effective.
  • The MOD continues to keep under review its use of all anti-malaria drugs and follow the advice as provided by the Advisory Committee on Malaria Prevention.

Mefloquine is rarely prescribed

  • Out of a total of 131,000 UK Armed Forces personnel deployed on Operation HERRICK between Apr 2007 and Dec 2014, 536 (0.4%) individuals were prescribed mefloquine.
  • Between Apr 2007 and Dec 2014, a total of 16,473 UK Regular Armed Forces personnel were prescribed mefloquine.

The MOD ensures the drug is taken safely

  • Since 2013 mefloquine has only been prescribed after an individual risk assessment.
  • If a prescription of mefloquine is entered onto the MOD’s electronic medical records system, warnings are automatically generated to confirm that the prescriber is satisfied the individual is able to tolerate the drug. This ensures that no one with any previous psychiatric/mental health issue is prescribed it.
  • A medical officer, or suitably trained deputy, presents a brief to all personnel prior to anti-malaria drugs being supplied detailing the correct dosage, frequency and when to take their medication.
  • As with all prescriptions, the MOD follows the advice of drug manufacturers and drug advisory bodies.

Military personnel are at no greater risk from potential side effects

  • There is no evidence to suggest that members of the Armed Forces are significantly different to any other traveller taking mefloquine. The benefits and the risks are identical for both groups.
  • Of those prescribed mefloquine for Operation HERRICK, only 11 personnel experienced side effects that were subsequently reported and any care that was required as a result was delivered. Following consultation with their medical officer, eight of these required the drug to be withdrawn.

Mefloquine does not impact on the military’s operational capability

  • The MOD uses the most appropriate anti-malarial drug for the areas where our people deploy while ensuring it does not interfere with the individual’s primary role (i.e. military action).
  • At the moment, there is no suggestion that the use of mefloquine should be restricted in people who handle weapons.
  • For divers, the potential side effects of mefloquine can be confused with decompression or narcosis events. For this reason it is not prescribed.
  • The UK Civil Aviation Authority advises against the use of the drug by pilots although there is no evidence that it actually impairs function.

The US continues to prescribe mefloquine

  • The US Department of Defense prescribes mefloquine tor individuals who cannot take other anti-malarial drugs.
  • The drug is prescribed when appropriate to the US public and volunteers in the Peace Corps after appropriate education and counselling.

MOD policy has been recently reviewed

  • The policy was reviewed before Service personnel deployed to Sierra Leone on Operation GRITROCK.
  • The MOD continues to monitor and review the guidance of the Advisory Committee on Malaria Prevention, on which there has been a military representative since 1993. Should this guidance change, Armed Forces policy will be reviewed.