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WHO report gives India high marks for fighting tobacco use

A new report by the World Health Organisation on the global use of tobacco shows India, Bangladesh and Bhutan on top of the list of South East Asian countries that have achieved a high level of tobacco control.

http://www.domain-b.com/organisation/who_collaborating_centre/20170721_tobacco.html

The prevalence of tobacco use in India has fallen from 34.1 per cent to 28.6 per cent over the last seven years, the report says, comparing data from two rounds of the Global Adult Tobacco Survey (GATS) in 2009-10 and 2016-17.

The WHO report titled Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies, was released in New York on Wednesday on the sidelines of the United Nations High-Level Political Forum on Sustainable Development. The report covers 194 countries, divided into The Americas, South East Asia, Europe, Eastern Mediterranean, Western Pacific, and Africa. There are 11 countries in the South East Asia group, including India.

Though the population worldwide protected by tobacco control measures has grown almost five-fold than ten years ago, the World Health Organisation (WHO) on Wednesday called on countries to do more to prioritise these life-saving policies.

In India, Mumbai, Kolkata, Delhi, Hyderabad, Bengaluru, Pune, Surat, Kanpur, Jaipur, Lucknow and Nagpur are among the top 100 cities across the world named for the strict implementation of policies to prevent tobacco use. The report lists the cities population-wise, using figures published in the UN Statistics Division’s Demographic Yearbook.

Globally, the WHO report said about 4.7 billion people, or 63 per cent of the world’s population, are covered today by at least one comprehensive tobacco control measure. Ten years ago, in 2007, the number was only one billion, or 15 per cent of the world’s population.

However, tobacco use has still become the leading single preventable cause of death worldwide, killing over seven million people each year.

Its economic costs are also enormous, totalling more than $1.4 trillion in healthcare and lost productivity, according to WHO.

Meanwhile, the tobacco industry continues to hamper government efforts to fully implement life- and cost-saving interventions, by, for example, exaggerating the economic importance of the tobacco industry, discrediting proven science, and using litigation to intimidate governments, the report says.

Poor countries ahead
More than half of the top national performers on tobacco control are low- and middle-income countries, showing that progress is possible regardless of economic situation. A tracking of MPOWER measures – introduced by WHO in 2007 to assist in the country-level implementation of measures to reduce the demand for tobacco – has revealed that the number of people protected by at least one best-practice measure has quadrupled to 4.7 billion – or almost two-thirds of the world’s population.

As many as 121 out of 194 countries have introduced at least one MPOWER measure at the highest level of achievement (not including monitoring or mass media campaigns, which are assessed separately).

Thirty-four countries with a total population of 2 billion have adopted large graphic pack warnings. Six countries (Afghanistan, Cambodia, El Salvador, Lao People’s Democratic Republic, Romania and Uganda) have adopted new laws making all indoor public places and workplaces smoke-free. Six countries (El Salvador, Estonia, India, Jamaica, Luxembourg and Senegal) have advanced to best-practice level with their tobacco use cessation services, the report says.

India and Nepal are regional and global leaders in implementing large, pictorial warning labels on tobacco packaging. With the increase in the size of pack warnings to 85 per cent of both front and back panels on all tobacco products, India now has the third largest pack warning label among all countries.

The findings of GATS-2 showed that graphic warning labels depicting throat cancer and oral cancer are a strong tool to discourage the youth from initiating tobacco, and have motivated 275 million current users to quit.

Dr Vinayak Prasad, Geneva-based head of the WHO Tobacco Free Initiative, told The Indian Express that among the many measures to control tobacco in India was the joint WHO-International Telecommunication Union initiative mCessation, launched in 2015 with the Ministries of Health and Family Welfare and Communication and Information Technology. ”The programme to encourage people to quit tobacco use registered more than two million users last year and the initial evaluation showed that more than 7% quit successfully after six months,” Dr Prasad said.

The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, was adopted by the World Health Assembly in 2003, and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history.

Tobacco companies interfere with health regulations, WHO reports

Tobacco industry is interfering with government attempts to regulate products and aggressively pursuing new markets in Africa, World Health Organization says

https://www.theguardian.com/world/2017/jul/19/tobacco-industry-government-policy-interference-regulations

Cigarette manufacturers are attempting to thwart government tobacco controls wherever possible, even as governments make progress regulating the products, a new World Health Organization report has found.

World health officials also warn that tobacco companies have moved their fight to the developing world, such as Africa, where smoking rates are predicted to rise by double digits in the coming decades.

“Tobacco industry interference in government policymaking represents a deadly barrier to advancing health and development in many countries,” said Douglas Bettcher, director of the WHO’s department for the prevention of noncommunicable diseases. “But by monitoring and blocking such activities, we can save lives and sow the seeds for a sustainable future for all.”

Tobacco-related diseases are the leading preventable cause of death worldwide. The products kill more than 7 million people each year – more than HIV and Aids, tuberculosis and malaria combined. The effects of the substance are also costly. Researchers believe that tobacco-related harm costs the world $1.4tn in healthcare costs and lost productivity.

A recent investigation by the Guardian found that tobacco companies, including British American Tobacco, threatened African countries with domestic and trade lawsuits if certain anti-smoking measures were put in place. BAT says it is not against all regulations but needs to take action from “time to time”.

A Reuters investigation found that BAT’s arch-rival, Philip Morris International, developed a vast lobbying campaign to delay and prevent tobacco controls. PMI says there is nothing improper about its executives engaging with government officials.

Wednesday’s WHO report, which was funded by Bloomberg Philanthropies, comes on the same day as a shareholder vote on a $49bn merger between BAT and Reynolds American Incorporated, a deal that would make BAT the largest listed tobacco company in the world.

“The epicentre of this epidemic has moved to the developing world,” said Dr Vera Luiza da Costa e Silva, head of WHO’s convention secretariat. “Low- and middle-income countries struggle to combat a tobacco industry seeking to pursue new markets, often through shameless interference with public health policymaking.”

Currently, the World Health Organization recommends countries put in place six regulations health officials see as critical to reducing smoking: systems to monitor smoking rates; laws to protect people from secondhand smoke; tools to help people quit; warnings about the dangers of tobacco use; enforcement of advertising bans, and increased taxes on tobacco products.

Six in 10 countries have implemented at least one of the six protections, officials said, four times the population that was protected in 2007.

However, progress is lopsided. Some recommendations have been far more widely accepted than others. For example, 3.5 billion people in 78 countries are protected by graphic warnings on cigarette packs, but only 15% of the world’s population is protected by a comprehensive advertising ban, and high tobacco taxes, while very effective, are one of the least-implemented measures.

Even some wealthier nations have had trouble getting tobacco control measures in effect. In the United States, for example, there are no graphic warnings on cigarette packs because of industry lawsuits and regulatory delay, and tobacco taxes remain low.

Anti-tobacco lawmakers and campaigners in the US blame the slow progress on “pervasive” tobacco industry influence, which reaches all the way to top officials in the Trump White House.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness,” said Tedros Adhanom Ghebreyesus, the WHO director-general. “Governments around the world must waste no time”.

Bloomberg Philanthropies funds Vital Strategies, which part funds the Guardian’s Tobacco: a deadly business series, the content of which is editorially independent.

UN Reports More People Warned Against Tobacco Use

Despite measures protecting a majority of people from tobacco-related illness and death, the tobacco industry continues to hamper Government efforts to fully implement life and cost-saving interventions, the United Nations health agency reported.

http://www.womenofchina.cn/womenofchina/html1/features/health/1707/4690-1.htm

“One-third of countries have comprehensive systems to monitor tobacco use. While this is up from one-quarter of countries monitoring tobacco use at recommended levels in 2007, Governments still need to do more to prioritize or finance this area of work,” according to the UN World Health Organization’s WHO report on the global tobacco epidemic, which was launched today on side-lines of the UN High-level political forum on sustainable development in New York.

The report shows that some 4.7 billion people – more than 60 per cent of the population – are protected by at least one “best practice” tobacco control measure from the WHO’s Framework Convention on Tobacco Control (WHO FCTC). These measures include no smoking areas and bans on advertising tobacco products, for example.

In the foreword to the report, the head of WHO urged Governments to incorporate all the provisions of the WHO FCTC into their national tobacco control programmes and policies, and to fight against the illicit tobacco trade.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness, and save billions of dollars a year in avoidable health-care expenditures and productivity losses,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

The report, funded by Bloomberg Philanthropies, noted that systematic monitoring of tobacco industry interference in government policymaking protects public health by shedding light on tobacco industry tactics.

Such tactics include “exaggerating the economic importance of the tobacco industry, discrediting proven science and using litigation to intimidate governments.”

Douglas Bettcher, director of WHO’s Department for the Prevention of Noncommunicable Diseases (NCDs), said tobacco industry interference in government policy making represents “a deadly barrier to advancing health and development in many countries.

Controlling tobacco use is a key part of the 2030 Agenda for Sustainable Development. The Agenda includes targets to strengthen national implementation of the WHO FCTC and a one-third reduction in premature deaths from NCDs, including heart and lung diseases, cancer and diabetes, according to a press release launching the report.

“The progress that’s been made worldwide – and documented throughout this report – shows that it is possible for countries to turn the tide,” said Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and founder of Bloomberg Philanthropies.

Taxation: Most effective but still the least-used tobacco control measure

source: Infographic: Stop Smoking: It's Deadly and Bad for the Economy

source: Infographic: Stop Smoking: It’s Deadly and Bad for the Economy

A new report by the World Health Organization (WHO) shares some good news: Six in 10 people worldwide are now protected by at least one of the WHO Framework Convention on Tobacco Control (FCTC)-recommended demand reduction measures, including taxation. The report, launched on the sidelines of the UN high-level political forum on sustainable development, also makes clear that raising taxes to increase tobacco product prices is the most cost-effective means to reduce tobacco use and prevent initiation among the youth. But it is still one of the least used tobacco control measures.

https://blogs.worldbank.org/health/taxation-most-effective-still-least-used-tobacco-control-measure

The facts about this global public health scourge are undisputable:

  • Tobacco use is the leading single preventable cause of death worldwide, killing over 7 million people each year.
  • Cigarettes are addictive by design, and smoking cigarettes can damage every part of the body, causing different cancers from the head or neck to the lungs and cervix and other chronic conditions such as stroke and heart disease, which lead to early death.
  • The direct and indirect economic costs are also enormous, totaling more than US$1.4 trillion.
  • Controlling tobacco use is critical for the achievement of the health and social and economic targets in the 2030 Agenda for Sustainable Development.

But we know what needs to be done and governments are acting. Governments are implementing “MPOWER”, six tobacco control measures in line with the WHO Framework Convention on Tobacco Control (FCTC). MPOWER includes:

  • Monitoring tobacco use and prevention policies;
  • Protecting people from tobacco smoke;
  • Offering help to quit tobacco use;
  • Warning about the dangers of tobacco;
  • Enforcing bans on tobacco advertising, promotion and sponsorship; and
  • Raising tobacco taxes.

The WHO report indicates that 43% of the world’s population (3.2 billion people) are now covered by two or more MPOWER measures at the highest level, nearly seven times the number covered in 2007. Eight countries, including five low- and middle-income ones, have implemented four or more MPOWER measures at the highest level: Brazil, Islamic Republic of Iran, Ireland, Madagascar, Malta, Panama, Turkey, and the United Kingdom of Great Britain and Northern Ireland.

Some additional findings are noteworthy:

  • Monitoring: Several countries, such as Nepal, India, and the Philippines, that conducted WHO-backed initiatives to monitor tobacco use have used the information to adopt measures to protect people from tobacco use. For example, Philippines’ landmark Sin Tax Reform Law was passed in 2012 after its 2009 global adult tobacco survey showed high smoking rates among men (47.4%) and boys (12.9%). The implementation of this policy measure has contributed to declining tobacco use as evidenced by the country’s 2015 adult tobacco survey results.
  • Protect: Comprehensive smoke-free legislation is currently in place for almost 1.5 billion people in 55 countries. Dramatic progress has been witnessed in low- and middle-income countries, 35 of which have adopted these laws since 2007.
  • Offer: Appropriate cessation treatment is in place for 2.4 billion people in 26 countries.
  • Warn: More people are protected by strong graphic pack warnings than by any other MPOWER measure, covering almost 3.5 billion people in 78 countries – almost half (47%) the global population. And, 3.2 billion people live in a country that aired at least one comprehensive national anti-tobacco mass media campaign in the last two years.
  • Enforce: Bans on tobacco advertising, promotion, and sponsorship interfere with the tobacco industry’s ability to promote and sell its deadly products and reduce tobacco use. But only 15% of the world’s population is currently covered by a comprehensive ban.
  • Raise: Raising taxes to increase tobacco product prices is the most cost-effective measure to reduce tobacco use and encourage users to quit, but it is one of the least used tobacco control measures globally.

What the World Bank Group is doing

As an institution, the Bank has long been committed to tobacco control as reflected in its unambiguous Operational Directive 4.76 of 1999 that mandates that the World Bank Group does not lend directly or provide credits, grants, or guarantees for tobacco production, processing, or marketing. The Bank’s policy advice and technical assistance support tobacco tax increases to protect the population from health risks and to mobilize additional domestic resources.

Over the past two decades, Bank teams have carried out substantial analytical work to build the global knowledge base on issues related to tobacco control.

In recent years, the Bank, in partnership with the Gates and Bloomberg Foundations, and in coordination with WHO, has supported countries in the design of tobacco tax policy reforms to raise prices, reduce consumption, and mobilize domestic resources in accordance with the 2015 Financing for Development Addis Ababa Action Agenda.

In addition to support provided to the reforms in Philippines in 2012, in Botswana in 2013, in Ghana in 2014, and in Peru in 2015, the Bank’s assistance to Armenia, Colombia, Moldova, and Ukraine contributed to the adoption of significant tobacco tax increases in 2016. The total population covered by these policy actions is about 250 million people.

Ongoing support is being provided in 2017 to an additional set of countries across regions, including Montenegro, where the government recently announced that tobacco taxes will be increased over the next 3 years in line with the European Union Tobacco Tax Directive’s target rates, and in Lesotho, as part of the 2017 budget presented by the new government to Parliament.

In moving the global tobacco control agenda forward, as the findings of the 2017 WHO report suggest, a dedicated focus by governments with support of the international community is required to raise tobacco taxes since it continues to be the least used tobacco control measure. This is of critical importance to make these deadly products unaffordable, reduce consumption among current smokers, and prevent smoking initiation among children and youth.

While health is the main objective, we also need to argue, on the basis of country evidence from across the world, that raising tobacco taxes can generate a significant fiscal benefit by helping to expand a country’s tax base and increase the budgetary capacity of governments to fund priority investments and programs that benefit the entire population.

Inside Philip Morris’ campaign to subvert the global anti-smoking treaty

The world’s largest publicly traded tobacco company is deploying its vast resources against international efforts to reduce smoking. Internal documents uncovered by Reuters reveal details of the secret operation.

http://www.reuters.com/investigates/special-report/pmi-who-fctc/

A group of cigarette company executives stood in the lobby of a drab convention center near New Delhi last November. They were waiting for credentials to enter the World Health Organization’s global tobacco treaty conference, one designed to curb smoking and combat the influence of the cigarette industry.

Treaty officials didn’t want them there. But still, among those lined up hoping to get in were executives from Japan Tobacco International and British American Tobacco Plc.

There was a big name missing from the group: Philip Morris International Inc. A Philip Morris representative later told Reuters its employees didn’t turn up because the company knew it wasn’t welcome.

In fact, executives from the largest publicly traded tobacco firm had flown in from around the world to New Delhi for the anti-tobacco meeting. Unknown to treaty organizers, they were staying at a hotel an hour from the convention center, working from an operations room there. Philip Morris International would soon be holding secret meetings with delegates from the government of Vietnam and other treaty members.

The object of these clandestine activities: the WHO’s Framework Convention on Tobacco Control, or FCTC, a treaty aimed at reducing smoking globally. Reuters has found that Philip Morris International is running a secretive campaign to block or weaken treaty provisions that save millions of lives by curbing tobacco use.

In an internal document, the company says it supported the enactment of the treaty. But Philip Morris has come to view it as a “regulatory runaway train” driven by “anti-tobacco extremists” – a description contained in the document, a 2014 PowerPoint presentation.

Confidential company documents and interviews with current and former Philip Morris employees reveal an offensive that stretches from the Americas to Africa to Asia, from hardscrabble tobacco fields to the halls of political power, in what may be one of the broadest corporate lobbying efforts in existence.

Details of those plans are laid bare in a cache of Philip Morris documents reviewed by Reuters, one of the largest tobacco industry leaks ever. Reuters is publishing a selection of those papers in a searchable repository, The Philip Morris Files.

Dating from 2009 to 2016, the thousands of pages include emails between executives, PowerPoint presentations, planning papers, policy toolkits, national lobbying plans and market analyses. Taken as a whole, they present a company that has focused its vast global resources on bringing to heel the world’s tobacco control treaty.

Philip Morris works to subvert the treaty on multiple levels. It targets the FCTC conferences where delegates gather to decide on anti-smoking guidelines. It also lobbies at the country level, where the makeup of FCTC delegations is determined and treaty decisions are turned into legislation.

Excerpts from the Philip Morris Files

Reuters uncovered thousands of pages of internal Philip Morris International documents. These excerpts show the company’s tactics for combating the Framework Convention on Tobacco Control, or FCTC, a treaty aimed at reducing smoking worldwide. (Some documents include highlighting by Reuters; some names have been redacted.)

01

A slide from a 2014 Philip Morris corporate affairs presentation about the FCTC, the global anti-smoking treaty. CoP5 and CoP6 refer to the biennial meetings of treaty nations in 2012 and 2014. “ENDS” refers to e-cigarettes.

Another slide from the 2014 PowerPoint presentation. “Paradigm shift” refers to an expected boom in what the company calls “reduced-risk products.”

Another slide from the 2014 PowerPoint presentation. “Paradigm shift” refers to an expected boom in what the company calls “reduced-risk products.”

A slide from the 2014 presentation shows Philip Morris plans for tracking anti-smoking groups, which the company calls anti-tobacco organizations, or ATOs.

A slide from the 2014 presentation shows Philip Morris plans for tracking anti-smoking groups, which the company calls anti-tobacco organizations, or ATOs.

The same 2014 document shows objectives for corporate affairs executives. “Roadblocks” refers to delays in implementing anti-smoking steps. “MoH” refers to ministries of health.

The same 2014 document shows objectives for corporate affairs executives. “Roadblocks” refers to delays in implementing anti-smoking steps. “MoH” refers to ministries of health.

Another slide from the 2014 document shows the characteristics that a Philip Morris corporate affairs (“CA”) person should possess.

Another slide from the 2014 document shows the characteristics that a Philip Morris corporate affairs (“CA”) person should possess.

A more detailed account of Philip Morris’ corporate affairs tactics from the same 2014 presentation.

A more detailed account of Philip Morris’ corporate affairs tactics from the same 2014 presentation.

A list of methods the company has devised for opposing the implementation of plain packaging, a measure advocated by the FCTC that bars the use of logos and distinctive coloring on cigarette packs.

A list of methods the company has devised for opposing the implementation of plain packaging, a measure advocated by the FCTC that bars the use of logos and distinctive coloring on cigarette packs.

This slide from the 2014 presentation shows some of the resources Philip Morris deployed at the FCTC treaty meeting in Moscow that year (CoP6), as the company looked ahead to the 2016 session in New Delhi (CoP7). ITGA = the International Tobacco Growers’ Association.

This slide from the 2014 presentation shows some of the resources Philip Morris deployed at the FCTC treaty meeting in Moscow that year (CoP6), as the company looked ahead to the 2016 session in New Delhi (CoP7). ITGA = the International Tobacco Growers’ Association.

Philip Morris pushes for more delegates to FCTC treaty meetings from government agencies that deal with economic and trade issues. This slide from the 2014 presentation shows the company’s plan to lobby for more delegates from outside of public health on India’s delegation at the treaty meeting last year.

Philip Morris pushes for more delegates to FCTC treaty meetings from government agencies that deal with economic and trade issues. This slide from the 2014 presentation shows the company’s plan to lobby for more delegates from outside of public health on India’s delegation at the treaty meeting last year.

Excerpt from an October 18, 2014, email from Chris Koddermann, who led the Philip Morris team at the treaty meeting in Moscow that year.

Excerpt from an October 18, 2014, email from Chris Koddermann, who led the Philip Morris team at the treaty meeting in Moscow that year.

An October 18, 2014, email from Nguyen Thanh Ky, a Philip Morris corporate affairs executive, about his meeting with the Vietnamese delegation to the 2014 Moscow treaty conference.

An October 18, 2014, email from Nguyen Thanh Ky, a Philip Morris corporate affairs executive, about his meeting with the Vietnamese delegation to the 2014 Moscow treaty conference.

Excerpt from an October 2014 email from Gustavo Bosio, then Philip Morris manager for international trade, a few days after the end of the Moscow meeting.

Excerpt from an October 2014 email from Gustavo Bosio, then Philip Morris manager for international trade, a few days after the end of the Moscow meeting.

Excerpt from a Philip Morris briefing paper on trade arguments, ahead of the treaty meeting in India last year. The company has long argued that the biennial Conference of the Parties (COP) should leave trade issues to the World Trade Organization (WTO).

Excerpt from a Philip Morris briefing paper on trade arguments, ahead of the treaty meeting in India last year. The company has long argued that the biennial Conference of the Parties (COP) should leave trade issues to the World Trade Organization (WTO).

Excerpt from a Philip Morris briefing paper on potential risks ahead of the treaty meeting last year, “COP7” in India. ENDS, or Electronic Nicotine Delivery Systems, refers to electronic cigarettes.

Excerpt from a Philip Morris briefing paper on potential risks ahead of the treaty meeting last year, “COP7” in India. ENDS, or Electronic Nicotine Delivery Systems, refers to electronic cigarettes.

Excerpt from a 2011 draft Philip Morris plan for responding to moves in Israel to pass new anti-smoking measures.

Excerpt from a 2011 draft Philip Morris plan for responding to moves in Israel to pass new anti-smoking measures.

 In this slide from a Japan corporate affairs presentation, some ministers in the Japanese cabinet are identified according to their positions on tobacco. The two ministers designated “Pro-tobacco” did not respond to questions from Reuters.

In this slide from a Japan corporate affairs presentation, some ministers in the Japanese cabinet are identified according to their positions on tobacco. The two ministers designated “Pro-tobacco” did not respond to questions from Reuters.

This slide, also from the Japan presentation, talks about Philip Morris Japan maintaining good relations with members of Japan’s FCTC delegation, and a Philip Morris executive meeting with members of the country’s FCTC delegation. (MOF = Ministry of Finance; MOFA = Ministry of Foreign Affairs; JT = Japan Tobacco.)

This slide, also from the Japan presentation, talks about Philip Morris Japan maintaining good relations with members of Japan’s FCTC delegation, and a Philip Morris executive meeting with members of the country’s FCTC delegation. (MOF = Ministry of Finance; MOFA = Ministry of Foreign Affairs; JT = Japan Tobacco.)

This slide, also from the Japan presentation, reveals the company’s plans for opposing moves in Australia to bar the use of logos or distinctive coloring on cigarette packs. The measure is known as plain packaging, or PP. The Tobacco Institute of Japan, or TIOJ, declined to comment.

This slide, also from the Japan presentation, reveals the company’s plans for opposing moves in Australia to bar the use of logos or distinctive coloring on cigarette packs. The measure is known as plain packaging, or PP. The Tobacco Institute of Japan, or TIOJ, declined to comment.

A slide from a Philip Morris training document.

A slide from a Philip Morris training document.

“Our everyday business”

Philip Morris International’s full response to Reuters findings:

“As a company in a highly regulated industry, speaking with governments is part of our everyday business. We publicly supported the creation of the framework convention on tobacco control, were involved in the consultation process prior to its establishment, but have not since been invited to contribute to any discussions on tobacco control measures. With our product knowledge, technical expertise and our vision to replace cigarettes with less harmful alternatives, we believe we have something to contribute and we look for a range of legitimate opportunities to express our views to decision-makers. The fact that Reuters has seen internal emails discussing our engagement with governments does not make those interactions inappropriate. We believe that the active participation of public health experts, policy-makers, scientists, and the industry is the best way to effectively address tobacco regulations in the genuine interest of today’s billion smokers. It is our hope that moving forward, all tobacco policy makers will invite open dialogue, and in the meantime we will continue to speak with governments about policies that can address the impact of smoking on health.”

– Tony Snyder, Vice President of Communications, Philip Morris International

The documents, combined with reporting in 14 countries from Brazil to Uganda to Vietnam, reveal that a goal of Philip Morris is to increase the number of delegates at the treaty conventions who are not from health ministries or involved in public health. That’s happening: A Reuters analysis of delegates to the FCTC’s biennial conference shows a rise since the first convention in 2006 in the number of officials from ministries like trade, finance and agriculture for whom tobacco revenues can be a higher priority than health concerns.

Philip Morris International says there is nothing improper about its executives engaging with government officials. “As a company in a highly regulated industry, speaking with governments is part of our everyday business,” Tony Snyder, vice president of communications, said in a statement in response to Reuters’ findings. “The fact that Reuters has seen internal emails discussing our engagement with governments does not make those interactions inappropriate.”

In a series of interviews in Europe and Asia, Philip Morris executive Andrew Cave said company employees are under strict instructions to obey both the company’s own conduct policies and local law in the countries where they operate. Cave, a director of corporate affairs, said that while Philip Morris disagrees with some aspects of the FCTC treaty and consults with delegates offsite during its conferences, ultimately the delegations “make their own decisions.”

“We’re respectful of the fact that this is their week and their event,” said Cave in an interview in New Delhi, as the parties to the treaty met last November. Asked in an earlier interview whether Philip Morris conducts a formal campaign targeting the treaty’s biennial conferences, Cave gave a flat “no.”

When the FCTC delegates gather, lives hang in the balance. Decisions taken at the conferences over the past decade, including a ban on smoking in public places, are saving millions of lives, according to researchers at Georgetown University Medical Center.

Between 2007 and 2014, more than 53 million people in 88 countries stopped smoking because those nations imposed stringent anti-smoking measures recommended by the WHO, according to their December 2016 study. Because of the treaty, an estimated 22 million smoking-related deaths will be averted, the researchers found.

According to the WHO, though, tobacco use remains the leading preventable cause of death – and by 2030 will be responsible for eight million deaths a year, up from six million now.

There was jubilation among anti-smoking advocates when the treaty was adopted in 2003. The treaty, which took effect in 2005, made it possible to push for measures that once seemed radical, such as smoke-free bars. About 90 percent of all nations eventually joined. A big holdout is the United States, which signed the treaty but has yet to ratify it.

Since the FCTC came into force, it has persuaded dozens of nations to boost taxes on tobacco products, pass laws banning smoking in public places and increase the size of health warnings on cigarette packs. Treaty members gather every two years to consider new provisions or strengthen old ones at a meeting called the Conference of the Parties, or COP, which first convened in 2006 in Geneva.

But an FCTC report shows that implementation of important sections of the treaty is stalling. There has been no further progress in the implementation of 7 out of 16 “substantive” treaty articles since 2014, according to a report by the FCTC Secretariat in June last year.

A key reason: “The tobacco industry continues to be the most important barrier in implementation of the Convention.”

Indeed, the tobacco industry has weathered the tighter regulation. There has been only a slight 1.9 percent decline in global cigarette sales since the treaty took effect in 2005, and more people smoked daily in 2015 than a decade earlier, studies show. The Thomson Reuters Global Tobacco Index, which tracks tobacco stocks, has risen more than 100 percent in the past decade, largely due to price increases.

“Some people think that with tobacco, you’ve won the battle,” said former Finnish Health Minister Pekka Puska, who chaired an FCTC committee last year. “No way,” he said. “The tobacco industry is more powerful than ever.”

With 600 corporate affairs executives, according to a November 2015 internal email, Philip Morris has one of the world’s biggest corporate lobbying arms. That army, and $7 billion-plus in annual net profit, gives Philip Morris the resources to overwhelm the FCTC.

The treaty is overseen by 19 staff at a Secretariat office hosted by the WHO in Geneva. The Secretariat spends on average less than $6 million a year. Even when buttressed by anti-smoking groups, the Secretariat is outgunned. Its budget for this year and last year for supporting the treaty clause on combating tobacco company influence is less than $460,000.

Vera Luiza da Costa e Silva, head of the FCTC treaty Secretariat, is the person tasked with preventing the industry from neutering the agreement.

In two interviews at her Geneva office, da Costa e Silva, a medical doctor who holds a PhD in public health and has a dyed pink streak in her hair, explained why the FCTC banned attendance by any member of the public at the 2014 biennial conference in Moscow. The ban came in response to efforts by tobacco executives to use public badges to get inside the venue, she said, adding that industry representatives then started borrowing badges from delegates they knew to gain entry.

“It’s a real war,” said da Costa e Silva.

tobacco

“Some people think that with tobacco, you’ve won the battle. No way… The tobacco industry is more powerful than ever.”

Former Finnish Health Minister Pekka Puska, who chaired an FCTC committee last year

But she had only a partial picture of the forces ranged against her. She wasn’t aware of the fact that Philip Morris had a large team operating throughout the convention in Moscow, or the details of its activities in New Delhi last November.

“This is so disgusting. These are the forces against which we have to work,” da Costa e Silva said in May after being told about the Philip Morris documents. “I think they want to implode the treaty.”

The idea of a global tobacco treaty had been discussed among health advocates since at least 1979, when a WHO committee suggested the possibility. Gro Harlem Brundtland, a former prime minister of Norway who became director-general of the WHO in 1998, made it happen.

She was aided by outrage over documents that surfaced as part of the landmark 1998 Master Settlement Agreement, in which the four largest U.S. tobacco companies agreed to pay more than $200 billion to 46 U.S. states. The internal communications showed that tobacco executives lied for years about their knowledge of the deadly nature of cigarettes.

A 1989 document revealed one company’s plan to fight threats to the industry. “WHO’s impact and influence is indisputable,” the document said. It went on to contemplate “countermeasures designed to contain/neutralize/re-orient the WHO.”

That company was Philip Morris.

In 2008, Altria Group Inc split up its Philip Morris business. Philip Morris USA, which remains a subsidiary of Altria, sells Marlboro and other brands in the United States. Philip Morris International was spun off, and handles business abroad. Since the split, Philip Morris International shares have more than doubled and Altria’s have more than tripled.

Philip Morris International’s operational headquarters are in Lausanne, Switzerland, down the street from a patch of Gallo-Roman ruins, in a sleek building with a cafeteria, gym and a patio facing Lake Geneva. From there, the company is working to hobble the treaty.

Internal company communications reveal the scope of Philip Morris’ operation during the 2014 FCTC treaty meeting in Moscow. The company set up a “Coordinating Room” that could seat 42 people, according to the 2014 PowerPoint presentation, titled “Corporate affairs approach and issues.”

Leading the operation was executive Chris Koddermann. Formerly a lawyer and lobbyist in Canada, Koddermann joined Philip Morris in 2010. He is now a director of regulatory affairs in Lausanne. The PowerPoint describes the ideal corporate affairs executive as someone who is able to “play the political game.” Koddermann previously worked for federal and provincial cabinet ministers in Canada, according to his LinkedIn profile.

Reached on his cell phone in March, Koddermann said he wouldn’t be able to meet and that any questions should be directed to Philip Morris International.

At the end of the Moscow meeting, on Oct. 18, 2014, Koddermann sent an email congratulating a 33-person Philip Morris team on their success in diluting or blocking measures intended to strengthen tobacco controls and reduce cigarette sales. The gains he touted at the end of the week-long conference were the culmination of a two-year effort, his email said.

The documents shed light on one key objective in Philip Morris’ FCTC campaign: Keep tobacco within the ambit of international trade deals, so that the company has a way to mount legal campaigns against tobacco regulations.

In Moscow, one proposal initially called for carving out tobacco from trade pacts. International trade treaties often include provisions, such as the protection of trademarks, that Philip Morris has used to challenge anti-smoking measures. If tobacco were taken out of the treaties, as suggested by the proposal, Philip Morris could be deprived of many such legal arguments.

An early draft asked parties to support efforts to exclude tobacco from trade pacts and to prevent the industry from “abusing” trade and investment rules. In the end, the proposal was watered down. The final decision only reminded parties of “the possibility to take into account their public health objectives in their negotiation of trade and investment agreements.” There was no mention of excluding tobacco.

Koddermann, in his email to colleagues on the last day of the conference, declared victory, describing the change as “a tremendous outcome.” Overall, the company achieved its “trade related campaign objectives,” including “avoiding a declaration of health over trade” and “avoiding the recognition of the FCTC as an international standard,” he wrote.

The win was significant. A former Philip Morris employee said the company has routinely used trade treaties to challenge tobacco control laws. The aim, he said, was “to scare governments away from doing regulatory changes.” Even though the tobacco industry has lost a series of major legal battles, its suits have served to discourage the implementation of regulations that curb smoking. Those delays can yield years of unimpeded sales.

As the Philip Morris PowerPoint presentation from 2014 put it: “Roadblocks are as important as solutions.”

One roadblock was a campaign to stop the 2011 introduction of rules in Australia banning logos and distinctive coloring on cigarette packs. The company’s litigation and arbitration against the measure ultimately were dismissed – but not before five countries filed complaints against Australia on the same subject at the World Trade Organization. The global trade body has yet to announce a decision in the matter.

The attempt to undo Australia’s regulations has had a chilling effect elsewhere. It slowed the introduction of plain-packaging rules in New Zealand. Citing the risk that tobacco companies may “mount legal challenges,” the government announced in 2013 that it was postponing the move and waiting to “see what happens with Australia’s legal cases.” The legislation is now scheduled to go into effect next year.

In his Moscow conference email, Koddermann also expressed pleasure at the fate of a proposal on farmers. Initial language would have recommended that countries restrict support for tobacco growers. The proposal was “significantly watered down,” he wrote. “This is a very positive result.”

Gustavo Bosio, at the time a manager for international trade, chimed in a few days after the conference in an email: “These excellent results are a direct consequence of the remarkable efforts of all PMI regions and markets during the past two years and throughout the intense week in Moscow.”

Philip Morris isn’t alone in seeking to weaken the treaty. Ahead of the 2012 FCTC conference, in Seoul, four cigarette giants – Philip Morris, British American Tobacco (BAT), Japan Tobacco International and Imperial Brands Plc – formed an “informal industry Working Group” to oppose various proposals on tobacco taxation, according to an internal BAT document reviewed by Reuters.

The 45-page paper, whose existence hasn’t been previously reported, noted that the group would coordinate “to the extent that these issues do not raise any anti-competitive concerns.” The paper outlined a global campaign planned by BAT to counter the FCTC, which was “increasingly going beyond” its mandate. And it listed objectives, including a bid to block discussions around the introduction of a minimum 70 percent tax on tobacco.

BAT declined to answer questions about the industry working group. Both Imperial and Japan Tobacco International said they didn’t want to comment on a document from a competitor. Japan Tobacco International said its tax experts met with counterparts from other tobacco companies to discuss treaty guidelines on taxation ahead of the 2012 conference. Philip Morris did not comment on the document.

The Philip Morris emails and documents don’t explicitly detail how the company pulled off the victories in Moscow. But they provide insight into the importance it places on wooing delegates.

The FCTC traditionally makes decisions by consensus, and so influencing a single national delegation can have an outsized impact. The treaty has a key clause meant to keep the industry from unduly influencing delegations. Article 5.3, as it’s known, says nations should protect their public health policies from tobacco interests. Guidelines that accompany Article 5.3 recommend that countries interact with the industry only when “strictly necessary.”

But the article – a single sentence – contains a loophole Philip Morris has exploited. The sentence ends with the words “in accordance with national law,” opening the door to arguments by pro-tobacco forces that any lobbying that’s legal in a certain country is permissible when interacting with that country’s representatives. They also argue that a sentence in a related document, the guidelines for Article 5.3, allows for such interactions to take place as long as they are conducted transparently.

Philip Morris International: Facts & figures

• Has its roots in a small tobacconist shop in London in 1847.
• Now operates in more than 180 markets.
• Famous for its iconic Marlboro Man advertising.
• Has six of the world’s top 15 cigarette brands, including Marlboro, L&M and Chesterfield.
• Spun off from the Richmond, Va.-headquartered Altria Group in March 2008.
• Operational headquarters are in Switzerland.
• Produces over 800 billion cigarettes a year.
• Share price has more than doubled since the 2008 spin-off from Altria.

Sources: Philip Morris International website; Reuters reporting

Lobbying strategy

The Philip Morris International documents uncovered by Reuters include guidelines and country-specific lobbying plans aimed at hobbling the WHO’s global tobacco control treaty and national anti-smoking measures. Strategies include:
• Lobbying lawmakers, bureaucrats and other government officials
• Trying to move tobacco issues away from health departments
• Deploying third parties, including retail groups, to make its case and exert pressure on decision-makers
• Engaging the media on tobacco issues and generating public debate to influence decision-makers

The tabs below show the company’s strategy in action in three countries in recent years, according to internal company documents. The extent to which Philip Morris’ actions affected the outcome in each case is unclear.

In September 2011, Israel’s health ministry proposed new measures to regulate flavoring and advertising of tobacco products. In a draft company strategy document from October 2011, Philip Morris said the proposals included “a few excessive and disproportionate measures” such as restricting the use of fruit or chocolate flavorings in tobacco products, and broadly prohibiting advertising and marketing of tobacco. Elements of the campaign: 1: Leverage established relationships with different government ministries, mobilize retailers to advocate against “excessive” provisions, and lobby the health ministry. 2: Lobby the government through third parties such as an Israel-based supplier of licorice. 3: Use Philip Morris’ database of more than 60,000 adult smokers to reach consumers and create a public debate through the media “to influence MPs,” or members of parliament. OUTCOME: The bans on advertising and ingredients did not go through.

In September 2011, Israel’s health ministry proposed new measures to regulate flavoring and advertising of tobacco products. In a draft company strategy document from October 2011, Philip Morris said the proposals included “a few excessive and disproportionate measures” such as restricting the use of fruit or chocolate flavorings in tobacco products, and broadly prohibiting advertising and marketing of tobacco. Elements of the campaign:
1: Leverage established relationships with different government ministries, mobilize retailers to advocate against “excessive” provisions, and lobby the health ministry.
2: Lobby the government through third parties such as an Israel-based supplier of licorice.
3: Use Philip Morris’ database of more than 60,000 adult smokers to reach consumers and create a public debate through the media “to influence MPs,” or members of parliament.
OUTCOME: The bans on advertising and ingredients did not go through.

A 2010 Philip Morris document shows the company drawing up plans to lobby Sweden in an effort to influence the European Commission’s new tobacco regulations for member states, known as the Tobacco Products Directive (TPD). Elements of the campaign: 1: Engage the justice ministry to “put pressure” on the health ministry so that the Swedish representative on the European Commission committee opposes plain packaging and “excessive” health warning labels, and supports lifting the ban on snus, a smokeless tobacco product. 2: Build a “broad coalition” of “third-party stakeholders,” such as the Stockholm Chamber of Commerce, and get them to pressure the government. (The chamber told Reuters that it does not lobby on behalf of individual companies.) 3: Establish a retailer network and contact bloggers and journalists to voice concerns about issues, including plain packaging and point-of-sale display bans. OUTCOME: Plain packaging and point-of-sale display ban were not included in the directive, which came into force in May 2014.

A 2010 Philip Morris document shows the company drawing up plans to lobby Sweden in an effort to influence the European Commission’s new tobacco regulations for member states, known as the Tobacco Products Directive (TPD). Elements of the campaign:
1: Engage the justice ministry to “put pressure” on the health ministry so that the Swedish representative on the European Commission committee opposes plain packaging and “excessive” health warning labels, and supports lifting the ban on snus, a smokeless tobacco product.
2: Build a “broad coalition” of “third-party stakeholders,” such as the Stockholm Chamber of Commerce, and get them to pressure the government. (The chamber told Reuters that it does not lobby on behalf of individual companies.)
3: Establish a retailer network and contact bloggers and journalists to voice concerns about issues, including plain packaging and point-of-sale display bans.
OUTCOME: Plain packaging and point-of-sale display ban were not included in the directive, which came into force in May 2014.

In January 2013, Osaka Prefecture in Japan held a public consultation on a proposal to abolish existing smoking rooms, with a “roadmap towards total smoking prohibition in all public places,” according to a February 2014 Japan corporate affairs presentation. The Philip Morris document describes it as an “extreme proposal.” Elements of the campaign: 1: Ensure that “relevant stakeholders” oppose the move. Philip Morris field sales staff engaged retailers and others. 2: Engage local politicians and work with the industry in pushing back against the proposal. OUTCOME: The proposal was withdrawn.

In January 2013, Osaka Prefecture in Japan held a public consultation on a proposal to abolish existing smoking rooms, with a “roadmap towards total smoking prohibition in all public places,” according to a February 2014 Japan corporate affairs presentation. The Philip Morris document describes it as an “extreme proposal.” Elements of the campaign:
1: Ensure that “relevant stakeholders” oppose the move. Philip Morris field sales staff engaged retailers and others.
2: Engage local politicians and work with the industry in pushing back against the proposal.
OUTCOME: The proposal was withdrawn.

One of the company’s targets has been Vietnam.

The day the Moscow meeting ended, Koddermann received an email from his colleague Nguyen Thanh Ky, a leading corporate affairs executive for Vietnam. Ky said he had a “debrief lunch” with the Vietnamese delegation and had a good outcome to report: The delegation was in favor of “moderate and reasonable measures” to be implemented over a “practical timeline,” he wrote. He did not specify which measures they discussed.

The Vietnamese delegation spoke up often during the Moscow meeting. A review of notes compiled by tobacco-control groups accredited as observers showed Vietnam’s interjections frequently mirrored Philip Morris’ positions on tobacco-control regulations. Just like the tobacco giant, the Vietnamese said a higher tax on cigarettes would lead to more illicit sales. Like Philip Morris, they said the FCTC should stay out of trade disputes. And like Philip Morris, they opposed proposals to set uniform parameters for the legal liability of tobacco companies.

The FCTC guidelines on taxation did ultimately include a WHO recommendation for a minimum tax of 70 percent – something Philip Morris opposed. But the proposal to give the treaty more sway over trade disputes was weakened, and measures to strengthen the legal liability of cigarette companies were delayed.

Vietnam’s foreign ministry did not respond to questions from Reuters.

As soon as the conference ended, the documents show, Philip Morris turned to the next one: the 2016 meeting in India.

The 2014 PowerPoint presentation outlined the need to identify ways to gather intelligence during the Delhi conference. In a separate 2015 planning document, the company talks about the arrangement of farmer protests in the run-up to the meeting. Such protests did take place – including one in front of WHO offices in New Delhi. Reuters couldn’t determine whether Philip Morris was behind those demonstrations.

While other major tobacco companies also sent people to Delhi in November, Philip Morris was distinguished by its stealth. Executives from the company did not sign in with their tobacco industry colleagues at the FCTC convention center and stayed at a hotel about an hour’s drive away.

The anonymity and distance helped Philip Morris approach delegates covertly. On the second day of the conference, a white Toyota van pulled away from the front of the Hyatt Regency hotel – where Philip Morris had its operations room – and headed for the FCTC treaty venue. The van was carrying Ky, its corporate affairs executive from Vietnam.

OFFSITE MEETING: During the treaty conference on the outskirts of New Delhi last year, a Philip Morris representative met privately with a member of the Vietnamese delegation, Nguyen Vinh Quoc. In the first picture (left to right), Quoc can be seen emerging from a session at the treaty conference on Nov. 8. In the second picture, a van that left a Delhi hotel carrying a Philip Morris representative heads for the convention center. In the third picture, Quoc can be seen exiting the convention center moments before climbing into the van. REUTERS/Duff Wilson; Tom Lasseter

OFFSITE MEETING: During the treaty conference on the outskirts of New Delhi last year, a Philip Morris representative met privately with a member of the Vietnamese delegation, Nguyen Vinh Quoc. In the first picture (left to right), Quoc can be seen emerging from a session at the treaty conference on Nov. 8. In the second picture, a van that left a Delhi hotel carrying a Philip Morris representative heads for the convention center. In the third picture, Quoc can be seen exiting the convention center moments before climbing into the van. REUTERS/Duff Wilson; Tom Lasseter

Ky’s driver talked his way past police at the barricade outside the conference center, where FCTC-issued credentials were checked, explaining that he was driving “VIPs,” the driver later told Reuters.

A few minutes later, a man in a dark suit walked out of the conference center, passed the van and stopped at a street corner. The van did a U-turn, and a Reuters reporter saw the man in the suit quickly climb in. He was a senior member of Vietnam’s delegation to the FCTC conference: Nguyen Vinh Quoc, a Vietnamese government official.

The driver, Kishore Kumar, said in an interview that he dropped the two men off at a local hotel. Kumar said that on several other occasions that week, he took Ky to pick up people from the Hotel Formule1, a budget lodging where Vietnam’s delegation was staying during the conference.

Ky and Quoc did not respond to requests for comment.

Asked by Reuters about the interaction between Ky and the Vietnam representatives, Philip Morris executive Andrew Cave thumped on the table in a bar at the hotel where company representatives were staying. Reuters should focus, he said, on efforts by the industry to develop so-called reduced-risk products – those that deliver nicotine without the burning of tobacco and which the company says reduce harm.

When pressed about the meetings with Vietnam, Cave thumped the table again: “I’m angry that you’re focusing on that, rather than the real issues that matter to real people.”

In a subsequent email, Cave said: “Representatives from Philip Morris International met with delegates from Vietnam” during the Delhi conference “to discuss policy issues and this complied fully with PMI’s internal procedures and the laws and regulations of Vietnam.”

Delegates, Cave said in separate interviews, are reluctant to meet openly with Philip Morris because they are afraid of being “named and shamed” by anti-smoking groups.

Some delegates questioned the extent to which Philip Morris shaped the decisions made at the Moscow conference, saying attendees genuinely disagreed on certain issues. Nuntavarn Vichit-Vadakan, a Thai delegate, oversaw many discussions as the chair of an FCTC committee at the Moscow conference. She said delegates differed over the regulation of e-cigarettes, for instance, and any lobbying the company carried out would not have determined the outcome.

The Philip Morris documents leave questions unanswered. In some cases, the documents show the company hatching plans to change an anti-smoking regulation or to monitor activists, but don’t always make clear to what extent or how the plans were executed, if at all. The 2014 PowerPoint presentation called for “achieving scrutiny” of tobacco control advocates and said a “global project team” had been established for this purpose. It did not list what means would be used.

In some instances, Philip Morris’ lobbying plainly failed. In July 2015, the Ugandan parliament passed sweeping new anti-tobacco laws inspired by the treaty. All that was needed was President Yoweri Museveni’s signature, and the small African nation would become a leader on the continent in implementing a strict interpretation of the FCTC.

Philip Morris sent an executive, a younger white man, to tell the septuagenarian president, who long ago had helped topple dictator Idi Amin, why the tobacco act was a bad idea. Sheila Ndyanabangi, Uganda’s lead health official for tobacco issues who was present at the meeting, described the executive’s approach as lecturing the statesman.

“He said, ‘Ugandan tobacco will be too expensive’ and ‘it will not be competitive,’” Ndyanabangi said. Her account was confirmed by a senior Ugandan government official who was also present.

Museveni stared for a moment at the Philip Morris executive and a representative from a major tobacco buyer who’d come with him. The president then declared: “Slavery ended a long time ago.” There was a long silence in the room, recalled Ndyanabangi. Museveni said Uganda didn’t need tobacco, and the meeting was over. The president signed the bill that September.

Museveni’s office did not respond to requests for comment.

Over time, however, the industry’s lobbying has slowed the treaty’s progress. At the biennial conferences, the discussions have changed. In Moscow, for instance, there was a strong focus on trade and taxes. “You could see from the floor that interventions were very, very, very much focusing on the trade aspects, many times even putting trade over health,” the FCTC’s da Costa e Silva said in an interview last year.

The composition of FCTC delegations sent by governments has changed to include more members who aren’t involved in health policy. That’s in line with what Philip Morris and other tobacco companies want: Philip Morris, as well as British American Tobacco, has sought to move the balance of the membership away from public health officials and toward ministries like finance and trade. Such agencies, said the former Philip Morris executive, benefit from tobacco tax revenues and attach less weight to health concerns.

“The health department would just want tobacco to be banned, while for the finance ministry it’s more like how can we leverage or get as much money as we can,” he said.

The object of Philip Morris’ efforts, according to the 2014 PowerPoint on corporate affairs, is to “move tobacco issues away” from health ministries and demonstrate there are broader public interests at play – that “it’s not about tobacco.”

Cave, the Philip Morris corporate affairs executive, confirmed the company tries to persuade governments to change the composition of delegations. Health officials, he said, aren’t equipped to handle the intricacies of issues such as taxation.

“You’re looking at illicit trade, you’re looking at tax regimes, you’re looking at international law,” he said. “Now each of these areas, it’s logical, if you want to really tackle the trade and tobacco smuggling, illicit trade, who would you go to? You wouldn’t go to the health ministry.”

TOBACCO FARMERS: A worker tends to a tobacco crop in the farming community of Beatrice, Zimbabwe. At the treaty meeting in Moscow in 2014, a proposal calling for countries to limit support for tobacco growers was weakened. “This is a very positive result,” wrote Chris Koddermann, a Philip Morris executive, in an email. REUTERS/Philimon Bulawayo

TOBACCO FARMERS: A worker tends to a tobacco crop in the farming community of Beatrice, Zimbabwe. At the treaty meeting in Moscow in 2014, a proposal calling for countries to limit support for tobacco growers was weakened. “This is a very positive result,” wrote Chris Koddermann, a Philip Morris executive, in an email. REUTERS/Philimon Bulawayo

“I’m angry that you’re focusing on that, rather than the real issues that matter to real people.”

Philip Morris executive Andrew Cave, when asked about the company’s interaction with FCTC delegates

Reuters analyzed the rosters of the almost 3,500 accredited delegation members who have attended the seven FCTC conferences since 2006. The analysis found that there were more than six health delegates for every finance-related delegate in 2006. In Delhi last year, that ratio had fallen to just over three health delegates for every finance delegate. The number of delegates from finance, agriculture and trade fields has risen from a few dozen in 2006 to more than 100 in recent years.

Vietnam’s delegation, for example, has changed markedly. At the first FCTC conference in 2006, none of its four delegates were from finance or trade ministries. By 2014, in Moscow, there were 13 delegates, with at least four from finance-related ministries, including the chief delegate. Vietnam’s foreign ministry did not respond to questions about the delegation.

Da Costa e Silva isn’t opposed to having delegates from trade ministries, but she says their primary focus needs to be on health. And she was concerned by the makeup of the Vietnamese delegation. In a letter to the Vietnamese prime minister in late 2015, she asked that tobacco industry employees be excluded from the delegation. If they weren’t, she wrote, Vietnam might be “unable to play a full part in discussions.”

In 2016, Vietnam brought 11 delegates to the conference, of whom six were from health agencies, including the chief representative.

Some tobacco-control activists who attended the Delhi meeting in November say it was the worst so far in terms of passing new anti-smoking provisions.

Matthew Myers, who heads the Campaign for Tobacco-Free Kids, said multiple countries came prepared to consciously block action. He said he heard delegates making arguments “I haven’t heard in 25 years.”

A Nigerian delegate, for instance, asked to remove a reference to “the tobacco epidemic” from a draft proposal on liability for tobacco-related harm, according to notes taken by anti-smoking groups.

Asked for comment, Christiana Ukoli, head of the delegation in Delhi, said the “Nigerian delegation strongly dissociates itself from [that] statement.”

The Delhi conference ended as it began, with treaty Secretariat officials not knowing where Philip Morris had been or what it had done. The company had flown in a team of executives, used a squad of identical vans to ferry officials in New Delhi, and then left town without a trace.

Watering down

Just days after the FCTC conference in Moscow ended in October 2014, Philip Morris executive Gustavo Bosio sent an email to colleagues highlighting what he said was the company’s success in pushing back on three treaty proposals related to trade issues. “These excellent results are a direct consequence of the remarkable efforts of all PMI regions and markets during the past two years and throughout the intense week in Moscow,” wrote Bosio, then manager for international trade. The first two columns in each tab below show the initial proposal and the final outcome, and are from an analysis Bosio attached to his email. The third column contains extracts from his email explaining what happened in each case.

fctc1

fctc2

fctc3

 

Source: Internal Philip Morris documents; emphasis added by Philip Morris. Note: “AMRO” refers to the Americas regional office of the World Health Organization.

Additional reporting by Joe Brock in Johannesburg, Ami Miyazaki in Tokyo, Mai Nguyen, My Pham and Minh B. Ho in Hanoi, Elias Biryabarema in Kampala, Enrico Dela Cruz in Manila, Stephen Eisenhammer and Anthony Boadle in Brasilia, Alexis Akwagyiram and Ulf Laessing in Lagos, and Patturaja Murugaboopathy in Bengaluru.

The Philip Morris Files
By Aditya Kalra, Paritosh Bansal, Duff Wilson and Tom Lasseter
Graphics: Jin Wu
Design: Troy Dunkley
Photo editing: Tom White and Altaf Bhat
Edited by Peter Hirschberg

Nations that cannot fight tobacco industry should raise taxes, says WHO

World Health Organization says many governments have neither funds nor expertise to take on big tobacco companies

https://www.theguardian.com/world/2017/jul/12/nations-that-cannot-fight-tobacco-industry-should-raise-taxes-says-who

African nations whose attempts to regulate cigarettes are increasingly bogged down in the courts by wealthy tobacco companies should impose high taxes to deter people from developing a smoking habit, the World Health Organization says.

Vinayak Prasad of WHO’s Tobacco Free Initiative said many African governments were at a disadvantage in the fight against the industry over regulatory controls, like graphic health warnings on packs, which are the norm in the west. They have neither the funds nor enough expertise to deal with the big tobacco companies’ threats, intimidatory letters and law suits.

His comments follow the exposure by the Guardian of the attempts by multinational tobacco companies to delay and dilute regulatory controls in Africa through litigation and threats. At least eight African governments have been pressured by the industry.

“Just focus on getting the tax raised,” urged Prasad. WHO, the World Bank and others were trying to encourage and assist countries in changing their tobacco taxation, which countries from the Philippines to India had demonstrated could raise millions of dollars for healthcare or other essential government spending.

Developing nations do not have enough money or staff devoted to public health, he said. Often those in government who lead on tobacco control are also the key players for other areas, such as mental health.

“The tobacco epidemic has already reached the African continent. Countries have started to prioritise it but inherently the systems are weak. They need to build human resource capacity and technical capacity to respond to industry threats,” he told the Guardian. “We are working extremely hard [to help them] but we need to do more.”

Reacting to the Guardian’s reports, former public health minister Caroline Flint said: “It is sad to see firms like BAT fighting African governments for years over health warnings on cigarette packages and modest taxes. In any western nation they would have conceded these issues years ago. It speaks volumes about their approach to Africa that the tobacco giants appear willing to fight on all fronts to protect their sales.”

Lord Rennard, the vice chair of the all-party parliamentary group on smoking and health, said a tax on the profits of firms “could provide funds for legal support to governments in poorer countries seeking to resist tobacco damaging the health of their local populations”.

The tobacco industry also vigorously opposes hikes in the taxation of cigarettes, which is proven to reduce the numbers who smoke. The companies and tax advisers who intervene on their behalf with governments claim that tax hikes lead to smuggling from countries where the prices are lower. Prasad says that is not so if taxation is simplified, so that the same sum is levied on every carton regardless of brand.

Deborah Arnott, chief executive of campaigning group Ash, said the revelations showed that the industry had not turned over a new leaf, focusing on vaping and aiming for a smoke-free future, as it claims. “The Guardian has thrown a spotlight on the dirty truth, the leopard hasn’t changed its spots, it’s still promoting the same old lethal products the same way it always did, in countries where it can get away with it,” she said.

“Last century 100 million people died from smoking; if Big Tobacco isn’t stopped then this century a billion will be killed by their lethal products and most of them will be from low and middle income countries. The tactics being used in Africa of denial, deception and delay were used very successfully in the UK in the last century, but they’re no longer being allowed to get away with it here and smoking rates have plummeted as a result. Africa needs to learn from our experience, if you regulate the industry strictly the smoking epidemic can be halted and reversed.”

Dr Tom Frieden, former director of the Centers for Disease Control and Prevention in the US, said in a tweet that the revelations showed the “outrageous and shameful activities of tobacco industry in Africa”. US senator Richard Blumenthal, who spent his career promoting anti-smoking legislation, and was one of 46 state attorneys general to secure hundreds of billions of dollars in damages from tobacco companies in a 1990s settlement, said that in developing markets “tobacco companies have actively resisted” health regulation. “They have actively intervened with governments, and particularly so in Africa.”

José Luis Castro, president and chief executive officer of Vital Strategies, an organisation that promotes public health in developing countries, said: “The danger of tobacco is not an old story; it is the present. The industry is using every tool at its disposal to hook new smokers, especially kids, in Africa and other parts of the world.” There is a huge gap between what the industry says and what it does, he said. “It’s time this sham was called out in every country and in every public forum. When the tobacco industry gets near government, it poisons efforts to protect health.”

The multinational companies say they do not oppose tobacco regulation that is sound and evidence-based. “However, where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it,” British American Tobacco told the Guardian.

Imperial Tobacco also said it supported regulation, but it would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

Philip Morris International said it has contact with public authorities on a range of issues, “such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best”.

This content is funded, in part, by Vital Strategies.

Threats, bullying, lawsuits: tobacco industry’s dirty war for the African market

Revealed: In pursuit of growth in Africa, British American Tobacco and others use intimidatory tactics to attempt to suppress health warnings and regulation

https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market

British American Tobacco (BAT) and other multinational tobacco firms have threatened governments in at least eight countries in Africa demanding they axe or dilute the kind of protections that have saved millions of lives in the west, a Guardian investigation has found.

BAT, one of the world’s leading cigarette manufacturers, is fighting through the courts to try to block the Kenyan and Ugandan governments’ attempts to bring in regulations to limit the harm caused by smoking. The giant tobacco firms hope to boost their markets in Africa, which has a fast-growing young and increasingly prosperous population.

In one undisclosed court document in Kenya, seen by the Guardian, BAT’s lawyers demand the country’s high court “quash in its entirety” a package of anti-smoking regulations and rails against what it calls a “capricious” tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

BAT in Uganda asserts in another document that the government’s Tobacco Control Act is “inconsistent with and in contravention of the constitution”.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

Extract – court document

“The Regulations are unlawful in their entirety as a result of procedural impropriety … The warning requirements [on cigarette packets] constitute an unjustifiable barrier to international trade.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, 16 April 2015

BAT denies it is opposed to all tobacco regulation, but says it reserves the right to ask the courts to intervene where it believes regulations may not comply with the law.

Later this month, BAT is expected to become the world’s biggest listed tobacco firm as it completes its acquisition of the large US tobacco company Reynolds in a $49bn deal, and there are fears over the extent to which big tobacco can financially outmuscle health ministries in poorer nations. A vote on the deal by shareholders of both firms is due to take place next Wednesday, simultaneously in London at BAT and North Carolina at Reynolds.

Professor Peter Odhiambo, a former heart surgeon who is head of the government’s Tobacco Control Board in Kenya, told the Guardian: “BAT has done as much as they can to block us.”

Experts say Africa and southern Asia are urgent new battlegrounds in the global fight against smoking because of demographics and rising prosperity. Despite declining smoking and more controls in some richer countries, it still kills more than seven million people globally every year, according to the WHO, and there are fears the tactics of big tobacco will effectively succeed in “exporting the death and harm” to poorer nations.

There are an estimated 77 million smokers in Africa and those numbers are predicted to rise by nearly 40% from 2010 levels by 2030, which is the largest projected such increase in the world.

In Kenya, BAT has succeeded in delaying regulations to restrict the promotion and sale of cigarettes for 15 years, fighting through every level of the legal system. In February it launched a case in the supreme court that has already halted the imposition of tobacco controls until probably after the country’s general election in August, which are being contested by parliamentarians who have been linked to payments by the multinational company.

Extract – court document

“[A proposal for a new 2% tax on the industry in Kenya] … is arbitrary, capricious and inaccessible … it will have a significant effect on cigarette manufacturers and importers putting at risk further investment and direct and indirect employment opportunities in Kenya.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, April 16th 2015

In Uganda, BAT launched legal action against the government in November, arguing that the Tobacco Control Act, which became law in 2015, contravenes the constitution. It is fighting restrictions that are now commonplace in richer countries, including the expansion of health warnings on packets and point-of-sale displays, arguing that they unfairly restrict its trade.

The court actions are brought by BAT’s local affiliates, BAT Kenya and BAT Uganda, but approved at Globe House, the London headquarters of the multinational, which receives most of the profits from the African trade. In its 2016 annual report, BAT outlined the “risk” that “unreasonable litigation” would be brought in to control tobacco around the world. Its response was an “engagement and litigation strategy coordinated and aligned across the Group”.

‘Focus on emerging markets’

At its annual meeting in March, chairman Richard Burrows toasted a “vintage year” for BAT, as profits rose 4% to £5.2bn after investors took their cut – their dividend had increased by 10%. When asked about the legal actions in Africa, he said tobacco was an industry that “should be regulated … but we want to see that regulation is serving the correct interests of the health mission and human mission which should lie behind it”.

Extract – court document

“Your Petitioner alleges and shall demonstrate that the Tobacco Control Act, read as a whole, has the effect of unjustifiably singling out the tobacco industry for discriminative treatment.”

A petition of British American Tobacco Uganda in the constitutional court against the Ugandan government’s Tobacco Control Act

So, “from time to time it’s necessary for us to take legal action to challenge new regulation” which he said was led by “the local board”.

BAT says it is “simply not true that we oppose all tobacco regulation, particularly in developing countries”. Tobacco should be appropriately regulated as a product that has risks to health, it said, but “where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it”. It was opposed to only a handful of the issues in Kenya’s regulations, not the entirety, it said in a statement.

Although most countries in Africa have signed the World Health Organisation (WHO) treaty on tobacco control, none has yet fully implemented the smoking restrictions it endorses.

The WHO predicts that by 2025, smoking rates will go up in 17 of the 30 Africa-region countries from their 2010 level. In some countries a massive hike is expected – in Congo-Brazzaville, from 13.9% to nearly half the population (47.1%) and in Cameroon from 13.7% to 42.7%. In Sierra Leone it will be 41.2% (74% among men) and in Lesotho 36.9%.

In contrast, research showed last year that just 16.9% of adults smoke in the UK; and last month new figures showed UK heart disease deaths had fallen 20% since that country’s indoor smoking ban.

“The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continent’s patchwork tobacco control regulations and limited resources to combat industry marketing advances,” said Dr Emmanuela Gakidou and colleagues at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, publishing an analysis of smoking prevalence around the world in the Lancet in April.

Extract – letter

Uganda’s economy has “benefitted… significantly” from BAT’s tobacco business, employing 200 Ugandans and 1500 extra in the tobacco buying season. “This has helped to alleviate poverty and improve welfare in urban and rural areas …”

Extracts of a letter from Jonathan D’Souza, managing director of BAT Uganda to the chairperson of the Uganda Parliamentary committee on health, 14 April 2014

Africa’s growing numbers of children and young people, and its increasing wealth, represent a huge future market for the tobacco industry. The companies deny targeting children and cannot sell packs smaller than 10, but a new study carried out in Nairobi by the Johns Hopkins school of public health in the US and the Kenya-based Consumer Information Network found vendors selling cigarettes along the routes children take to walk to primary schools.

WHO-congo-smoke

Stalls sell single Dunhill, Embassy, Safari and other BAT cigarette sticks, costing around 4p (5 cents) each, alongside sweets, biscuits and fizzy drinks. The vendors split the packets of 20 manufactured by BAT. “They are targeting children,” said Samuel Ochieng, chief executive of the Consumer Information Network. “They mix cigarettes with candies and sell along the school paths.”

BAT said that its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, “given our investment in the brands and the fact there are clear health warnings on the packs.

“Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.”

Links with politicians

The Kenya case, expected to be heard after the elections on 8 August, is seen as critical for the continent. If the government loses, other countries will have less appetite for the long and expensive fight against the wealthy tobacco industry.

BAT has around 70% of the Kenyan market; its Kenyan competitor, Mastermind, has joined in the legal action against the government.

Extract – letter

“If these measures are brought into effect, the economic and social impact will be extremely negative. They could even threaten the continuation of our factory which has operated in Bobo Dioulasso for more than fifty years with more than 210 salaried employees.”

Excerpt from letter from Imperial Tobacco to the prime minister of Burkina Faso, 25 January 2016, concerning new regulations on plain cigarette packaging and large graphic health warnings.

Concerns have been raised about links between politicians and the tobacco companies. “There are allegations of some of them having been bribed in the past,” said Joel Gitali, chief executive of the Kenya Tobacco Control Alliance.

BAT whistleblower Paul Hopkins, who worked in Africa for BAT for 13 years, told a British newspaper he paid bribes on the company’s behalf to the Kenya Revenue Authority for access to information BAT could use against its Kenyan competitor, Mastermind. Hopkins has also alleged links between certain prominent opposition Kenyan politicians and two tobacco companies, BAT Kenya and Mastermind. Hopkins, who says he alerted BAT to the documents before the company made him redundant, claimed BAT Kenya paid bribes to government officials in Burundi, Rwanda and the Comoros Islands to undermine tobacco control regulations. Gitali is concerned about the outcome of the election: “If the opposition takes over government we shall be deeply in the hands of the tobacco companies.”

BAT denies any wrongdoing. A spokesperson said: “We will not tolerate improper conduct in our business anywhere in the world and take any allegations of misconduct extremely seriously. We are investigating, through external legal advisors, allegations of misconduct and are liaising with the Serious Fraud Office and other relevant authorities.”

Extract – letter

“Once the decision to smoke is taken by an adult smoker, the pack provides adult consumers with pertinent information”

British American Tobacco letter to the prime minister of Gabon, 1 January 2012

‘We grow up dreaming we can be one of them’

Tih Ntiabang, regional coordinator for Africa of the Framework Convention Alliance – NGOs that support the WHO treaty – said the tobacco companies had become bolder. “In the past it used to be invisible interference, but today it is so shameful that it is so visible and they are openly opposing public health treaties like the case in Kenya at the moment … Today they boldly go to court to oppose public health policy. Every single government is highly interested in economic growth. They [the tobacco companies] know they have this economic power. The budget of tobacco companies like BAT could be as much as the whole budget of the Africa region.

“Our health systems are not really well organised. Our policy makers can’t see clearly what are the health costs of inaction on tobacco control because our health system is not very good. It puts the tobacco industry at an advantage on public health.”

The sale across the whole of Africa of single cigarette sticks was a serious problem because it enabled children to buy them. “They are extremely affordable. Young teenagers are able to purchase a cigarette. You don’t need £1 for a pack of 20,” he said.

WHO-africa-deaths

BAT has a reputation in Africa as an employer offering steady and well-paid jobs, said Ntiabang, based in Cameroon. “When I was about 10, I was always dreaming I could work for BAT. They have always painted themselves as a responsible company – a dream company to work for. All the staff are well-off. The young people think ‘I want to work for BAT’. They promote a lot of events and make their name appear to young people. We grow up dreaming we can be one of them.”

In Uganda in 2014, BAT managing director, Jonathan D’Souza, sent a 13-page detailed attack on the tobacco control bill, then going through parliament, to the chair of the government’s health committee.

BAT was contracting with 18,000 farmers and paid them 61bn Ugandan shillings for 16.8m kg of tobacco in 2013, said the letter. The economy has “benefited significantly” from BAT Uganda’s investments, it said. “This has helped to alleviate poverty and improve welfare in urban and rural areas,” it says.

Extract – letter

“The draft regulations which you have published deal with a wide range of issues which will have a massive impact not only on the tobacco industry but also on a wider scale on the Namibian economy at large.”

Excerpt from a letter from the general manager of BAT in Namibia to the minister of health and social services, 17 November 2011

BAT Uganda (BATU) agreed tobacco should be regulated while “respecting the informed choices and rights of adults who choose to smoke and the legal rights of a legal industry”. But it cited 11 “areas of concern”, claiming there is no evidence to support a ban on tobacco displays in shops, that large graphic health warnings on packs are ineffective, that proposals on bans on smoking in public places were too broad and that prohibiting smoking under the age of 21 was unreasonable, since at 18 young people are adults and can make up their own mind.

Documents made public by the University of Bath show that BATU had another concern: the ban on the sale of cheap single cigarettes. Adults should be “free to purchase what they can afford”, says an internal leaked paper. BATU also took action against the MP who sponsored the bill. A letter informed him that the company would no longer be contracting with the 709 tobacco farmers in his region. There is evidence that the company also lobbied other MPs with tobacco farmers in their constituencies.

The Tobacco Control Act became law in 2015, and in November last year, BAT sued. Many people choose to smoke, said an affidavit to the court from managing director Dadson Mwaura and it was important to ensure regulation did not lead to “unintended consequences that risk an untaxed and unrestrained illegitimate trade in tobacco products”. BATU’s legal product contributed to the Ugandan economy “in many dimensions”.

The Guardian has seen letters showing that at least six other African governments have faced challenges from the multinational tobacco companies over their attempts to control smoking.

Democratic Republic of Congo: Letter to the president sent in April 2017 by the Fédération des Entreprises du Congo (chamber of commerce) on behalf of the tobacco industry, listing 29 concerns with the proposed tobacco control regulations, which they claim violate the constitution, international agreements and domestic law.

Burkina Faso: Letter sent in January 2016 to the minister of health from Imperial Tobacco, warning that restrictions on labeling and packaging cigarettes risks economic and social damage to the country. Previous letter sent to the prime minister from the US Chambers of Commerce in December 2013 warning that large health warnings and plain packaging could put Burkina Faso in breach of its obligations to the World Trade Organisation.

Ethiopia: Letter sent in February 2015 to the ministers of health and science and technology by Philip Morris International, claiming that the government’s tobacco directive banning trademarks, brands and added ingredients to tobacco breached existing laws and would penalise all consumer retailers.

Togo: Letter to the minister of commerce in June 2012 from Philip Morris International opposing plain packaging, which “risks having damaging consequences on Togo’s economy and business environment”.

Gabon: Letter from BAT arguing that there is no evidence that plain packaging reduces smoking, citing the Deloitte report of 2011, alleging its introduction would put Gabon in breach of trade agreements and promote smuggling.

Namibia: Letter to the minister of health from BAT, warning that planned tobacco controls will have “a massive impact … on the Namibian economy at large”.

Extract – memo

“As a country whose economy heavily relies on exports, Togo can ill afford to anger its international partners by introducing plain packaging.”

Excerpt from memo on plain packaging from chief executive of Philip Morris West Africa to the minister of commerce of Togo, to reiterate its concerns following a meeting, 21 June 2013

Bintou Camara, director of Africa programs at Campaign for Tobacco-Free Kids, said: “British American Tobacco, Philip Morris International and other multinational tobacco companies have set their sights on Africa as a ‘growth market’ for their deadly products”. Throughout Africa, tobacco companies have tried to intimidate countries from taking effective action to reduce tobacco use, the world’s leading cause of preventable death, he added.

“Governments in Africa should know that they can and should move forward with measures aimed at preventing and reducing tobacco use – and that they do so with the support of the many governments and leaders around the world that have taken strong action to protect public health.”

Cloe Franko, senior international organizer at Corporate Accountability International, said: “In Kenya, as in other parts of the world, the industry has resorted to frivolous litigation, aggressive interference … to thwart, block, and delay lifesaving policies. BAT’s actions are emblematic of a desperate industry grasping to maintain its hold over countries and continue to peddle its deadly product.”

Philip Morris said it is regularly engaged in discussions with governments. “We are approached by or approach public authorities to discuss a range of issues that are important for them and for us, such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best.” It said that it supports effective regulation, “including laws banning sales to minors, mandatory health warnings, and advertising restrictions”.

Imperial Tobacco said it sold its brands “where there’s a legitimate and existing demand for tobacco and take the same responsible approach in Africa as we do in any Western territory”. A spokesman said it supported “reasonable, proportionate and evidence-based regulation of tobacco”, including “health warnings that are consistent with global public health messages”. But, it said, Imperial would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

Is Vaping As Harmful As Smoking Cigarettes? Here’s What You Need To Know

Vaping seems to have taken the mantle of becoming the healthier alternative to smoking, along with the fact that they were designed with the motive to help smokers eventually quit.

http://www.indiatimes.com/health/healthyliving/is-vaping-as-harmful-as-smoking-cigarettes-here-s-what-you-need-to-know-324703.html

In fact, the trend has caught on so rampantly that it’s set to outsell traditional cigarettes by the end of 2023!

With the FDA regulating these products since 2016, it comes as no surprise that vaping is due to become the norm, surpassing traditional smoking in time to come.

In a report on the use of e-cigarettes in Canada, a report previously stated that “Among those whose primary reason for use is to help to quit tobacco, a similar proportion no longer smoke (24%), and this may be considered the success rate for this method of smoking cessation.”

How is vaping different from smoking?

To differentiate itself from tobacco products, vaping is the process of smoking nicotine without inhaling the other harmful substances in tobacco—out of which there 70 known carcinogens. Some products contain little to no nicotine in them. Canada for instance still does not approve of nicotine-containing e-cigarettes.

These battery-powered devices heat the liquid that contains nicotine and/or other flavours, which in turn is inhaled as the vapour.

There is no smoke without fire, however

Since the key objective of switching to e-cigarettes is to cut down the number of cigarettes you smoke, researchers have been assessing the ‘relative harm’ vaping can cause to your tissues.

A study conducted by Jessica Wang-Rodriguez, a head and neck cancer specialist at the University of California at San Diego and her team found that cells lining human organs sustained up to twice the DNA damage seen in unexposed cells. They were also five to 10 times more likely to wither and die than unexposed cells even if the vapour contained no nicotine, the addictive ingredient in conventional and most electronic cigarettes, as reported in New Scientist.

“Without the nicotine, the damage is slightly less, but still statistically significant compared with control cells,” says Wang-Rodriguez, who led the research.

The toxins from the flavouring are another cause of concern

“E-cigarette vapour is known to contain a range of toxins which include impurities in the e-cigarette liquids and toxins generated when solutions are heated to generate vapour,” says John Britton, a toxicologist at the University of Nottingham, UK. “Some are carcinogenic, so it’s likely some long-term users of e-cigarettes will experience adverse effects on their health, and the authors fo the study conducted by Rodriguez and company are correct to point out that these products should not be considered risk-free,” he says. But if smokers can’t give up completely, e-cigarettes are safer than smoking, he says, as reported in New Scientist.

They caused considerable damage to your key blood vessels; similar to normal cigarettes

A study conducted by researchers at the European Society of Cardiology Congress in Rome states that vaping has an impact similar to the what normal cigarettes have on the stiffening of you heart’s aorta, as reported the Independent, UK.

The lead researcher, Professor Charalambos Viachopoulos of the University of Athens said, “We measured aortic stiffness. If the aorta is stiff you multiply your risk of dying, either from heart diseases or from other causes. “There could be long-term heart dangers. They are far more dangerous than people realise.”

The problem lies with the rising number of teens taking to smoking E-cigarettes

A 2014 high school survey conducted in the US found that 17 percent of 12th graders reported the use of e-cigarettes compared to 14 percent who smoked traditional cigarettes. The lower price points at which they are promoted, their perception of being safer than traditional cigarettes, the various flavours they come in and the fact they’re in trend make it a very attractive option for the youth.

Adolescents and young adults who try e-cigarettes are more than three times as likely to take up smoking traditional cigarettes as their peers who haven’t tried the devices, states a recent research review published in Reuters Health.

E-cigarette use, or vaping, was as least as strong a risk factor for smoking traditional cigarettes as having a parent or sibling who smokes or having a risk-taking and thrill-seeking personality, the researchers found.

“E-cigarette use among teens and young adults could increase the future burden of tobacco by creating a new generation of adult smokers who might have otherwise not begun smoking,” said lead study author Samir Soneji of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire.

“To the extent that e-cigarette use mimics the behaviour of smoking a cigarette—handling the e-cigarette, the action of puffing, and the inhalation of smoke—it sets the adolescent up for easily transitioning to smoking,” added Soneji. “Like transitioning from driving a Tesla to driving a Chevy.”

Dr Brian Primack, a researcher at the University of Pittsburgh stated that “Young people report that there is a lot of pressure among e-cigarette only users to smoke a ‘real’ cigarette,” Primack said by email. “It may be somewhat analogous to the fact that teens who use flavoured alcohol are often pressured socially to step up their game to harder forms of alcohol.”

Although e-cigarettes claim to be less harmful than conventional cigarettes it could make sense to pay heed to the lack of conclusive long-term evidence

Cigarette smokers are well aware of the perils of smoking normal cigarettes. The New England Journal of Medicine states that smoking tobacco reduces your life span by at least 10 years. But studies on smoking e-cigarettes remain largely inconclusive.

A review of studies published in the journal Tobacco Control reveals that the long-term effects of the vaporised form are not known yet. For instance, it is not known if the chemical propylene glycol, which is mixed with the other chemicals in e-cigarettes known to irritate the respiratory tract, could result in lung problems after decades of vaping, says Dr Michael Siegel, a tobacco researcher and professor of community health sciences at the Boston University School of Public Health in Live Science.

Besides, “because e-cigarettes have been on the market for only about 10 years, there have been no long-term studies of people who have used them for 30 to 40 years. Therefore, the full extent of e-cigs’ effects on heart and lung health, as well as their cancer-causing potential, over time is not known,” says Stanton Glantz a professor of medicine and the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco to Live Science.

 

Sunday Interview: Dr Mackay, tobacco industry’s worst nightmare

ANTI-TOBACCO advocate Professor Dr Judith Longstaff Mackay has been identified as ‘one of the three most dangerous people in the world’ by the industry. She was instrumental in developing the World Health Organisation’s Framework Convention on Tobacco Control. In her recent visit to Malaysia, she shares her experience campaigning against tobacco in Asia since 1984.

“I HAVE been described as a ‘psychotic human garbage, a gibbering Satan, an insane psychotic, power-lusting piece of meat, Hitler and a nanny’ and they (the tobacco industry allies) threatened to destroy me. But such threats and offensive words never once diverted me from my cause,” says Professor Dr Judith Longstaff Mackay.

Dr Mackay, 73, wears many hats. The World Health Organisation (WHO) senior policy adviser is also senior adviser to Vital Strategies, part of the Bloomberg Initiative to Reduce Tobacco and director of the Asian Consultancy on Tobacco Control.

Her recent visit was part of her capacity as a visiting professor at the University Malaya Centre of Addiction Sciences.

A recipient of British Medical Journal Lifetime Achievement Award (2009) and a Special Award for Outstanding Contribution on Tobacco Control (2014), she has published 200 papers, and addressed over 460 conferences on tobacco control.

Dr Mackay has received many international awards in recognition of her contribution on tobacco control. She was selected as one of Time’s 60 Asian Heroes (2006) and of Time’s 100 World’s Most Influential People (2007).

Question: Born in Britain, you moved to Hong Kong in 1967 after earning a medical degree from the University of Edinburgh in 1966. What led to your resignation as a physician in 1984, and then becoming a leading campaigner and advocate for tobacco control for the last 30 years?

Answer: I had a complete career change from cure to prevention and there were three main reasons for making the shift.

First, when I was working in a hospital in Hong Kong, we had a maxim on our male medical wards that every person we admitted was a smoker with tobacco illnesses, like heart diseases, cancer and chronic chest problems, which were often too late and too advanced to be cured.

I realised we had to go a step “higher upstream” to prevent this rather than merely providing the ambulance services at the end-stage.

I came to feel that hospital medicine was important but it works like a band-aid in comparison with prevention.

You may be able to save hundreds of lives in a lifetime in hospital medicine, but millions of lives could be saved if you work in prevention. It is a completely different ball game, and yet the money, prestige and attention all go to curative medicine; and that is similar around the world.

Second, was the realisation that although women’s health those days was defined very gynaecologically, more women were being killed by tobacco than by every method of contraception combined. I was particularly concerned that the tobacco industry was enticing women with promises of beauty, fame, emancipation and freedom.

The third reason was that the tobacco industry felt Asia was theirs for the taking.

They said it themselves — when asked about their future in the 1980s, “What do we want? We want Asia”.

Q: Why did the tobacco industry had their eyes set on Asia?

A: They wanted the huge populations and the large number of men already smoking who could be persuaded to smoke their brands of cigarettes.

They galloped into Asia with the dream of converting the 60 per cent of men who smoked local cigarettes to switch to international brands, and the second dream of persuading Asian women to start smoking. If this happened, their markets would be enormous.

It would not matter if every smoker in Britain stopped smoking tomorrow if they could capture the massive Asian markets.

Also, Asia was becoming more affluent, so, it was easier for people to afford cigarettes.

Thirdly, when I wrote an article in the South China Morning Post on banning cigarette advertising, a tobacco giant came down on me and labelled me as “entirely unrepresentative and unaccountable”.

The tobacco industry claimed that they were the best source of information on tobacco and they even said it has not been proven that “illness was actually caused by smoking”.

I was so outraged that it was just one of those tipping points in life in 1984. Everything came together and I realised that I really had to work on prevention rather than cure.

Ever since, I have been working principally with governments on the policy level to try and get the tax and the laws in place in tobacco control.

Q: You are known as one of the three most dangerous people in the world by the tobacco industry. What do you have to say about this?

A: Well yes, I’m proud of that. The reason that I got that title was essentially location. I happen to be in Asia and the tobacco companies wanted Asia. They saw this region as their future, but I set about thwarting their goals.

I went early on to countries like China, Indonesia, Malaysia, Mongolia, Vietnam and Cambodia and more recently to North Korea upon learning that British American Tobacco had gone into the country to get laws in place.

Q: In campaigning against tobacco use, what are some of the challenges you have faced?

A: I have had many problems, and was subjected to verbal abuse and even had death threats from allies of the tobacco industry.

Twice, I was threatened by the tobacco industry publicly, saying they would take me to court.

Nothing came of it, so it was either an attempt to intimidate me or to cast doubt on my credibility in the minds of the public.

In a television interview in South Africa, I openly said “I’m not a suicidal type, and if I were to be found knocked down by a bus, you need to find out if the tobacco industry is behind it before you look anywhere else.” And the industry was apparently furious with me for saying that.

However, their tactic now is not so much to attack people individually, but to threaten governments.

They threaten them under Constitutional Law on the rights of their products to advertise, and on freedom of speech and they attack them under trade treaties.

This is intimidating to governments and it can cost anything up to US$50 million (RM214 million) to fight these threats.

Q: You were one of the key persons in formulating the Framework Convention on Tobacco Control (FCTC), the first international treaty on public health. Malaysia is currently drafting the Control of Tobacco and Smoking Bill after lobbying for it since 2004 and they have sought your expertise. What do you have to say about this?

A: If you look at Malaysia and Hong Kong, many of the things that these two jurisdictions have done in the last 30 years are similar, yet Hong Kong has managed to half its male smoking rate.

Hong Kong is down to 10 per cent smokers now, whereas prevalence rates in Malaysia have not really decreased (at around 22.8 per cent). I understand it is not something that can be done overnight.

But the fact that the prevalence has not decreased is either because the excise tax imposed on cigarettes is not high enough, or that the laws that have been passed are not being enforced. In the case of the tobacco bill, the tobacco industry has been an unseen hand behind the scenes.

Q: The Health Ministry plans to increase prices of cigarettes from RM17 to RM21.50 in the near future to deter people from smoking. Several industry players were quick to say that increasing the tax would only lead to increased sales of illicit cigarettes. Is this true? What is the link between the increase in excise tax and contraband cigarettes?

A: There is zero truth in this. This sounds to me suspiciously just like what the tobacco industry would say. Economists, tax, finance and customs officials know, or they should know, that putting up a tobacco tax is not related to any increase in smuggling.

Our Customs chief in Hong Kong, for example, had said quite categorically there is no relationship between the amount of tax that is put in place and smuggling, and that is the position of the WHO too. But the tobacco industry keeps repeating it so often that some governments have come to believe it.

This is one of their tactics. A United States-based non-governmental organisation (NGO) has been going around the world, saying “don’t put up the tax, otherwise, there will be a rise in illicit cigarettes”. What many governments do not realise is that it is funded by the tobacco industry.

Q: WHO proposes that the tax imposed on cigarettes should be at least 75 per cent of the retail price. How efficient would this be in reducing smoking prevalence particularly among Malaysia’s young as compared with other measures, such as school education programmes?

A: Ten experts from around the world were present at a conference held in Hong Kong and, each speaker was asked “If you have one thing to do in tobacco control, what would that be?” and every single one said “tax”. This is because higher prices make cigarettes unaffordable to young people.

Taxation is the most effective approach to controlling the spread of tobacco. Creating smoke-free areas is the second measure, followed by things like advertising bans and smoking cessation.

Some people say health education in schools is crucial. Certainly, everybody likes health education, but it has not been proven effective in bringing down the prevalence of youth smoking.

And you can tell it is not effective because the tobacco industry does not oppose it. They oppose tax increases, plain packaging and smoke-free areas. And because the tobacco industry fights them, we know these are the measures that work.

Q: What needs to be done to improve our health education programmes at schools?

A: School health promotion programmes do not work because traditionally they say that if you smoke, you will get cancer when you are 60 years or heart attack when you are 70 years. If you are only a 11-year-old child, it is totally meaningless.

We need to do much more to revitalise and revamp health promotion and health education. Smoking and non-smoking youth have, in fact, the same level of health knowledge about the harms of smoking. The difference between the two groups is whether they think smoking is cool or a dirty expensive habit.

We have got to make it attractive to be a non-smoker in the teenage years.

Q: The Control of Tobacco and Smoking Bill currently being drafted would see the minimum age for buying cigarettes raised to 21 years old, ban on displaying tobacco products and making it illegal to smoke in vehicles with children inside, among others. How effective would this be in tackling smoking prevalence?

A: (People aged) 8 to 23 years is a vulnerable period. If you can stop children from smoking at this age, they are less likely to smoke. Whereas before that, they do not have the kind of mature judgment to analyse what it will mean to actually smoke.

The tobacco industry is very interested in youth and young adults because one has to only smoke 100 cigarettes and he or she will become lifelong smokers. It is so addictive.

Q: Besides health effects, what are the other impacts of cigarette smoking to the country and its people?

A: Two out of every three smokers die from cigarette smoking, so, you are losing skilled workers. One in every three fires in the world is caused by careless smoking.

There is also loss of productivity. Smokers go out for seven minutes to smoke. So, that’s seven minutes every time they smoke. Smokers are sicker and die on average a decade before non-smokers, so families lose their bread-winner.

There are medical and health costs. There is smoke damage to buildings and fabric.

And then there is a massive cost of cleaning up all the litter, billions of cigarette ends, packets, matches and lighters that are discarded every day in the world.

The tobacco industry claims that tobacco control would harm workers and farmers. This is not true. We have got so many projects now, including right in the heart of tobacco-growing in China showing that if farmers grow alternative crops they actually earn more.

The second fallacy is that if restaurants go smoke-free, they would lose revenue. Nowhere in the world has that happened. The revenue, including in Hong Kong and California, where they have introduced smoke-free policies, has gone up and not down.

Another fallacy is the government would lose money if it puts up the tax.

This does not happen. Some smokers will still pay more for cigarettes, so the revenue goes up. The number of smokers will come down particularly among the young and the poor.

There are so many economic fallacies that some non-governmental organisations propagate. Sometimes, governments almost innocently believe these economic arguments.

Q: If the situation is so dire, why can’t countries impose a blanket ban on cigarettes?

A: No country has put a blanket ban on cigarettes. Authorities have learnt from the prohibition of alcohol in the United States (1920-1933), for example, that it leads to much bigger implications particularly with crime and corruption cases.

So, the idea is to slowly push tobacco use back, so that the reduction is genuine and it is done throughout the community. This is what every government is really trying to do rather than actually ban it.

Q: Malaysia aims to be smoke-free (the End Game of Tobacco) by 2045. Are we moving in the right direction?

A: I strongly commend Malaysia for the foresight in establishing the 2045 goal and targets; few countries have yet to do this.

Recently the prevalence of male smokers has begun to decrease.

It is going to require a major commitment by the government and a huge effort by academia as well as non-governmental organisations in achieving this goal.

The Health Ministry has worked out a year-by-year plan of reducing prevalence up to 2045. It has developed a roadmap and has filled in what needs to be done each year to achieve the goal.

But it is not a quick process: if a country reduces its prevalence by one per cent a year, it is doing quite well.

So, it’s possible for Malaysia, but it will be challenging.

WHO China launches smoke-free campaign targeting youth

The World Health Organization (WHO) started a “smoke-free generation” media campaign in Beijing Thursday targeting young Chinese.

http://www.china.org.cn/china/2017-06/03/content_40957899.htm

China is in the grip of a national tobacco epidemic, and children are most susceptible with cigarettes portrayed as fashionable and alluring in popular culture, said Bernhard Schwartlander, WHO Representative in China at the launch event.

According to WHO, over half of Chinese adult men smoke, two thirds of whom started as young adults. By 2014, 72.9 percent Chinese students had been exposed to secondhand smoke.

“There is nothing cool about smoking, but there is something empowering about choosing to live a healthy, smoke-free life,” said Schwartlander.

Since China ratified the WHO Framework Convention on Tobacco Control in 2005, the country has made a number of tobacco control efforts, including banning tobacco advertisements, increasing tobacco taxes and putting forward regional smoking bans.

As of 2016, 18 cities, including Beijing, Shanghai and Shenzhen, had implemented regional smoking bans.

China has set a target to reduce the smoking rate among people aged 15 and older to 20 percent by 2030 from the current 27.7 percent, according to the “Healthy China 2030″ blueprint issued by the central authorities last October.