Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697631832840.pdf (Australia)
Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence Force Key points:  The issuing of the drug Mefloquine as an anti-malarial to soldiers of 4RAR during the deployment to East Timor in 2001 was not voluntary;  My experience of Mefloquine during the phase of taking the drug is representative of many  soldiers; I have experienced persistent negative side effects commencing from the time of taking the drug, which is common in colleagues from that time.
Background: I deployed to East Timor with 4RAR in 2001, being part of the Battalion-wide trial of Mefloquine as an anti-malarial.

I originally joined the Army in the Ready Reserves in 1996.

I undertook a year full time at 8/9RAR before three years part time as I studied a Physiotherapy degree in Perth.
By 1999, I had a desire to deploy to East Timor as a personal challenge and an opportunity to serve Australia and our national interests while I was young and could easily re-join my Physiotherapy profession.

I missed out on the chance to deploy with 6RAR as they were only taking soldiers at the rank of Private – at this time I was a Lance Corporal in the Reserves so was excluded, although I would have gladly relinquished this rank for the opportunity to deploy.
Instead I took a three month trip as a Reservist to Sydney for the Olympics in 2000 and worked on delivery vehicle and venue searches.

Not glamourous work however it was satisfying in its own way.

While working in Sydney I met other soldiers posted to 4RAR, who were to deploy to East Timor in 2001 as an Infantry Battalion and with vacancies available I joined D Coy 4RAR in October 2000.
Pre-Deployment: The lead up training to that deployment was challenging and largely as expected except for the circumstances surrounding the trial of Mefloquine.

It was clearly portrayed to us as an experimental trial; notionally voluntary however it was overtly clear to the entire Unit that if one was to withdraw consent for the trial, then you would definitely miss out on the deployment.

This was reinforced several times in Platoon and Company level briefings.
I particularly recall the trial being raised in Platoon meetings in our demountable offices and our Platoon Sergeant saying that if anyone didn’t participate they would be ‘gone’ – meaning posted to another Battalion and missing the deployment.

Similarly I remember a much larger briefing in the Mess of at least Company size where someone raised the same question about participation and the answer was that while it was voluntary, it was also voluntary to not go to East Timor.
Whenever anyone questioned the trial we were told it was good research for the Defence Force and if we didn’t want to do it we’d be off the trip.

It was the same message passed down to Soldiers from every level of rank above me.

I don’t blame any of the men who made these statements – I am sure they were fed a consistent line from their commanders and they were under pressure to deliver that message.
Having just completed a degree in a para-medical field, I probably took more notice than other soldiers of the medical Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence ForceSubmission 77 briefings and the detail around the mechanics of the trial.

I was not opposed to being a participant in the trial given the information that was provided.
I agree it was probably valuable research for Defence; however I knew the definition of voluntary participation and nothing about this trial was voluntary.

I recall talking to a Medic after they had delivered a briefing on the drug and raising this fact – that the trial was not voluntary if participants were overtly told they would be disadvantaged by not participating.
The Medic agreed but said that was a decision made above his pay grade, he just needed to get soldiers to listen to the brief then sign the papers.

These were the trial participant disclosure documents and again being familiar with the structure of medical experiments and an individual with a penchant for detail I recall being bemused at the details.
The trail didn’t appear to be testing anything in a conventional or scientific way with some participants receiving the drug and others in a control group or receiving an existing anti-malarial.

There was no blind or double blind structure, no clear commentary about the evaluation methods or contingencies in case of widespread negative effects, just five or six hundred men being shipped off to another country and told to take a new experimental drug.
With the consistent messaging and the threat of being removed from the deployment there was no question of not participating.

We all wanted to deploy and I don’t recall one man refusing to participate, for fear of missing the trip.

Deployment: During the deployment it quickly became apparent that the weekly dose of Mefloquine was linked to obvious behavioural and psychological side effects.

These included:   Vivid, disturbing dreams experienced over the two to three nights after the weekly dose.
These dreams in my case were extremely realistic and involved events of extreme violence.

Regular recurring dreams included images and events experienced during actual patrols but with violent outcomes involving death and personal involvement in killing “enemy”, often with bare hands or knives, ending with the dreamed sensation of being covered in blood.

These dreams have continued irregularly for me to this day and are extremely unpleasant.
A general feeling of antagonism towards colleagues which had never occurred before in the lead-up training prior to deployment.

It was frequent to hear of disagreements or actual physical fights between section members on a Thursday.

Our day for taking the drug was a Wednesday and this link was obvious, recognised and spoken about by junior leaders throughout D Coy.
I contend this was not an outcome of heightened stress from being on operations – some of the lead up training was more challenging than the actual tour and this behaviour was not repeated at any time during my subsequent five years in the Battalion.

Post-deployment: The post-deployment psych briefing was an event affected by the culture of the Unit and deserves exploration.
The absence of negative psychological reports by members of 4RAR post-deployment is probably used by defenders of the trial as evidence of the lack of negative effects experienced by subjects.

My experience, which was common, was that we were strongly advised by senior members of the Unit that to report anything negative about our experiences would affect our chances of continuing to serve in the Unit, and indeed in the Army generally and that we would never get another deployment.
I recall my psych debrief was conducted on the wharf at Dili, in clear earshot of Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence ForceSubmission 77 other members of the Platoon who were lined up waiting to talk to the Psych officer before going on to other tasks like cleaning weapons and equipment.
The environment was not confidential at all and we trusted the older soldiers who had deployed with the ADF previously – to East Timor and some to Rwanda – when they said that to admit to anything would mean no more trips with the Army for the rest of your career and we’d be kicked out of 4RAR.

Because of this, our records of the psych debriefs will be free of any negative effects of the deployment generally and in taking the drug Mefloquine in particular.
Even though subjects would have been reticent to report negative effects of the drug because of this cultural context, the fact that continued use of Mefloquine as a first defence against malaria has ceased indicates that its use is contraindicated in the majority of cases.

This mirrors decisions made in other countries for sound reasons.

It is time for Defence to admit that the trial did not bring any advantages and that the drug was, and is dangerous to participants’ heath.
On a personal note, I observed changes in my personality and worldview after participating in this trial.

I did not rejoin my previous profession after the deployment, instead going on to complete Commando selection and staying with the Unit for another five years.

After leaving the Army I worked in various high-threat environments for a number of years, things I never would have considered doing when I signed up for the original deployment.
I acknowledge that some of this personality change may be influenced by being around other members of the Unit and other experiences but I genuinely believe that some, or the trigger, is attributable to increased levels of aggression, lack of empathy and psychological instability first experienced during the Mefloquine trial.
I have experienced various negative mental health episodes over the course of my life since taking Mefloquine, including:     ongoing disturbing dreams that commenced during the trial; a change in personality to be more angry, intolerant, disconnected and negative; a period of depression requiring medication; and ongoing psychological issues for which I am currently receiving treatment via VVCS.
I know that this experience is not unique and that several colleagues from that time have also experienced negative mental health, including diagnoses of depression, bipolar disorder and anger management issues.

Suicide of colleagues has occurred and it is unknowable how much of the exposure to Mefloquine versus other experiences of war and the culture of warriors is to blame.
In conclusion I believe that Mefloquine had acute and chronic negative psychological side effects and that a large portion of the trial participants experienced and potentially continue to experience symptoms and further study of the longer term effects is warranted.
I further contend that support for the participants in this trial should be made available at no cost and in the form of whatever medical treatment is required for individuals (and families if required) and an acknowledgement that the trial was not voluntary and has had negative impacts on soldiers.

Thank you for accepting this submission.

Use of the Quinoline anti-malarial drugs Mefloquine and Tafenoquine in the Australian Defence ForceSubmission 77