Select Committee on Defence First Special Report


APPENDIX 20

Memorandum from the Ministry of Defence concerning medical preparedness for deployments to Sierra Leone (25 July 2000)

  In a letter of 27 June, we promised to let you have a note on the outcome of the three Services' Boards of Inquiry into medical preparedness for the deployment to Sierra Leone.

  I now attach a paper that summarises the findings of the three Boards.

BACKGROUND PAPER—SIERRA LEONE: SUMMARY OF FINDINGS OF SERVICE BOARDS OF INQUIRY INTO MEDICAL PREPAREDNESS

  1.  The three Service Boards of Inquiry (BOI) were tasked to investigate the apparent unpreparedness for deployment of OP PALLISER, in particular to determine the true extent of the problem, to examine the causes, to establish means of preventing a recurrence and, if necessary, to take appropriate disciplinary action. A summary is as follows:

True extent of the problem

  2.  The Army BOI found that some 200 personnel arrived in theatre without anti-malaria tablets due to last minute changes in the task organisation. This was quickly remedied by procuring a French anti-malaria drug locally, which was subsequently replaced by supplies of the preferred British drug, mefloquine.

  3.  As far as the number of malaria cases is concerned, the RN BOI stated that "The current level of malaria cases is well within the numbers that might be expected when operating in this area, based on the assessed effectiveness of prophylactic medication." The Surgeon General's Department (SGD) has confirmed that no anti-malaria drugs can provide guaranteed protection and it is likely that some personnel deployed to an area of high risk[9] will contract the disease. 4,500 personnel were deployed at the peak of the operation. Almost all of them came within malarial propagation range of the shore at some stage. The total number of personnel affected by malaria to date (19 July) is 82 (1.8% of the total force). Data is only currently available on 59 of these cases, but 58 of them were taking the malaria prophylaxis of choice. There was no requirement for any unit to be on anti-malarial prophylaxis before the operation but the order to commence the anti-malarial regime was given by MoD as soon as was reasonably practical, albeit not within the normal timescale. The Army BOI believes that the decision to deploy before the medication could become fully effective was a contributory factor to the number of malaria cases.

  4.  The BOI have reported different levels of immunisation in different ways. 594 RN personnel (19%) were out of date for one or more immunisation prior to deployment, of which only 38 personnel (1%) were out of date for more than two immunisations. Army figures, including Special Forces, show that 102 immunisations were out of date on deployment. This represents less than 2% of the 5,750 mandated immunisations required by the Spearhead Land Element (SLE). In the RAF, 15% of personnel who deployed were not fully immunised. The PJHQ Medical Cell has confirmed that, by 24 May, all personnel had been vaccinated in accordance with current policy. There is a national shortage of UK licensed Yellow Fever vaccine, but this did not have a significant impact. There are currently no reported cases of illness that can be attributed to overdue immunisation.

Causes

  5.  No single cause was identified, but there were a number of contributory factors.

  6.  All service personnel are required to be always in date for those immunisations which are set down in the Surgeon General's Policy Letters (SGPLs). Commanding Officers' responsibilities are laid down by the Surgeon General (SG) in Joint Service Publication (JSP) 311. They are also made clear in single Service instructions, for example Army General and Administrative Instructions, Volume 2, chapter 66, paragraph 66 121 states "Commanding Officers are responsible for ensuring that the immunisation states of their units are up-to-date at all times." Despite the clarity of their framework, and the fact that similar problems were noted after Operation GRANBY, it was apparent that the monitoring of immunisation status of personnel was being given insufficient command attention. It is clear that there is no standard procedure for the monitoring of immunisation status of personnel either across the Services or even within Services, and these procedures are unnecessarily complex.

  7.  The medical audit was made more difficult in some cases by breaking the formal Notice to Move (NTM) and by using personnel from both formed units and non-formed units. Some personnel without any formal NTM were deployed with only 24 hours notice. If NTM had been respected, there might have been time to catch up with the backlog of vaccinations. However, NTM sometimes needs to be broken for operational reasons and, having made a risk assessment, some commanders decided to deploy with unprepared personnel. There are also problems in that readiness is reported by ship/unit/aircraft and not by individuals. As far as the RAF is concerned, this meant that some individuals were not nominated until the aircraft were placed on standby. They were therefore unaware of their specific needs and requirements until the last moment.

  8.  Some individual responsibility is unclear. For example, in the RAF, Queen's Regulations lay responsibility on the individual to ensure that his vaccination state is current while at the same time stating that immunisation is voluntary. General awareness of malaria is also believed to be low.

Preventing recurrence

  9.  The Commanders in Chief deliver a capability to the Chief of Joint Operations and they must ensure that consideration is given to the appropriate immunisation states of all personnel that are likely to be deployed. Orders should be given to commence anti-malarial regimes at the earliest possible opportunity.

  10.  Readiness procedures need to be reviewed to ensure that all personnel likely to be deployed are at high readiness, accepting that this may not be possible for non-formed unit personnel. NTM should be reduced as early as possible and last minute changes to task organisations should be avoided if at all possible.

  11.  The SG's policy guidelines laid down in JSP 311 and various SGLPs are not prescriptive and allow the single Services scope to meet specific requirements. Single service guidelines should be reviewed to ensure coherence with the SG's policy guidance.

  12.  General awareness of malaria and tropical health risks is low and needs to be addressed, including the issue of environmental health preparedness. The SGD believe that their prophylaxis guidance in the event of short NTM could be amplified.

  13.  The question of a standard system of monitoring immunisation across the Services needs to be investigated. The current system also needs to be simplified. The SG has issued instructions for post-deployment health screening of all those deployed to Sierra Leone and the wider issue of a deployment health surveillance strategy is being pursued in ongoing work by the SG.[10]

  14.  Recurrence of malaria cases cannot be prevented, only minimised (see statistics in para 3). Health risks of overseas deployments should always be brought to the attention of senior Commanders and Ministers during the Defence Crisis Management Organisation decision-making process.




9   If SE Asia or S America are taken as a baseline, the risk of malaria in W Africa is 100 times higher. D/SG(Med Pol)370/9 dated 4 July 2000. Back

10   D/VCDS/5/2/4 dated 15 June 2000. Sierra Leone: Health Surveillance. Back


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 5 February 2001