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Furore over tobacco harm-reduction efforts

Most countries all over the world have banned smoking in public places and the popular advice is, “smoking is dangerous to your health… smokers are liable to die young.”

https://guardian.ng/features/furore-over-tobacco-harm-reduction-efforts/

Researches indicate that most deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease and pneumonia.

In Nigeria, most cities including Lagos have outlawed smoking backed with legislation but poor enforcement has been the pitfall. People still smoke in public places in all the nook and crannies in the country exposing the non-smoker and tender ones to secondhand smoke, which has also been associated with cancer of the lung and other ill-health effects.

According to the World Health Organisation (WHO), the tobacco epidemic is one of the biggest public health threats, killing more than seven million people a year. There are currently one billion smokers worldwide, with nearly 80 per cent of them living in low and middle-income countries, where the burden of tobacco-related illness is greatest.

Indeed, several studies have shown that smoking tobacco is the most harmful way of using nicotine, with the tars and gasses in cigarette smoke being harmful to health, however, many people find it difficult to stop smoking because they find it hard to go without nicotine.

A school of thought suggests that making lower risk products available may help people switch from smoking, ultimately helping avoid the risk of smoking known as “tobacco harm reduction”.

Tobacco harm reduction is a pragmatic approach to reducing the harm of smoking related diseases. People smoke because they are addicted to nicotine and seek a “hit”, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness, from smoked tobacco (that is cigarettes) at the top end of the harm/addiction spectrum, to medicinal nicotine (that is nicotine replacement therapy products) at the bottom end.

A harm reduction approach to tobacco control encourages those smokers that cannot, or are unwilling to, stop smoking, to switch to using nicotine in a less harmful form, and ideally would result in them ultimately quitting nicotine use altogether.

Potential harm reduction products include: Smokeless Tobacco (Snus); E-cigarettes; and Nicotine Replacement Therapy (under construction). The use of safer nicotine products is a rapidly evolving area, with many new non-combustible products emerging. The rapid development and use of these products raises a number of challenging scientific questions about their safety, who uses them and why, and the impact on smoking. These products also raise challenges for governments who seek to understand what kind of policy and regulation is appropriate.

To address these issues, the Global Forum on Nicotine (GFN) 2017 was held last month in Warsaw, Poland.

Reflecting commitment to the development and promotion of evidence-based policies and interventions, the theme of this year’s meeting was “Reducing Harm, Saving Lives”, drawing attention to the potential of safer nicotine products, such as e-cigarettes, oral tobaccos and “heat-not-burn” tobacco products, to reduce the global health burden of smoking.

Participants comprised of policy analysts, regulators and standards experts, academics and researchers, parliamentarians, public health professionals, consumer advocates, and makers and distributors of alternative nicotine products – all with an interest in nicotine and its uses.

This year’s programme examined the rapidly developing science in relation to nicotine use and the changing landscape, including policy responses and the influence of different stakeholders in this. The programme comprised plenary sessions, symposia, panel discussions and poster presentations – including video posters.

Several studies have shown that tobacco harm reduction has been controversial and divisive in public health, in particular where the debate has focused on a possible role for other tobacco products such as Snus, within a tobacco harm reduction strategy. One of the reasons harm reduction is a sensitive topic is that it could involve engaging with the tobacco industry, which has a history of manipulating public debate and public health policy.

Critics posit that to fully understand the harmfulness of potentially reduced risk products and their effectiveness for smoking cessation, tobacco industry investments and research into harm reduction and potentially reduced risk products should be carefully scrutinised. Who has paid for the research, which scientists, organisations and institutions are involved?

In fact, a number of scientists leading the debate on harm reduction and/or potentially reduced risk products are allegedly funded by the tobacco industry. Examples include: Jed E. Rose is director of the Center for Nicotine and Smoking Cessation Research (CNSCR) at Duke University in the United States (US), an institution with a long history of tobacco money. He is the inventor of the nicotine patch, and a nicotine aerosol technology. The Center, his research and his career are closely interlinked with the tobacco industry, more specifically Philip Morris.

The story on Duke University, US, and the Tobacco Industry shows Philip Morris actively promoting the nicotine patch as a quitting strategy, with the research funded by the company and with the endorsement of scientists involved.

A 2012 editorial in the public health journal Addiction suggested we should not be fooled by industry investments in potentially reduced risk products like snus, highlighting that Philip Morris US is currently advertising its Marlboro snus “for when you can’t smoke”, thus encouraging dual use instead of smoking cessation.

Further evidence from the US, where smokeless tobacco is freely available, confirms that smokeless tobacco is being marketed as a tobacco alternative in smoke-free environments. This would suggest that contrary to the industry’s discourse on harm reduction, and the favoured approach by public health experts advocating tobacco harm reduction, the industry appears to have little intention of promoting Snus use as a permanent switch from smoking.

However, the GFN is changing that perception. Chair of GFN, Prof. Dave Sweanor from Canada, told participants at 2017 GFN: “GFN is the only international conference to focus on the role of safer nicotine products that help people switch from smoking. Safer nicotine products include e-cigarettes, oral tobaccos such as Swedish snus, and ‘heat-not-burn’ tobacco products. This is a rapidly evolving area with many new non-combustible products emerging.

“The first conference was held in 2014 and this year we see the fourth annual renewal. All the conferences to date have been in Warsaw. The conference is funded by registration fees and does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies.”

Sweanor said the programme is developed by an international programme committee and is supported by a Polish Host Committee. Knowledge-Action-Change (KAC) provides the administration for the conference. New data released at the GFN showed low risk nicotine product snus is 95 per cent safer than smoking and has the potential to stop 320,000 premature deaths across Europe each year.

The latest evidence, presented by Peter Lee, epidemiologist and medical statistician, indicates that snus is at least 95 per cent safer than smoking.

Analysis by Lars Ramström, snus researcher in Sweden, shows that if snus were made available in Europe –where it is currently banned with the exception of Sweden –and similar use levels to Sweden were adopted, up to
320,000 premature deaths could be avoided among men every year.

While 46 per cent of deaths due to smoking result from respiratory diseases such as lung cancer, chronic obstructive pulmonary disease and pneumonia, there is no evidence that using snus increases risk of these diseases. Nor does snus appear to increase the risk of other smoking related diseases including heart disease, stroke and a range of cancers.

In addition, the public health benefits of snus versus cigarettes are not only much lower, but the role of snus in both reducing initiation of smoking and increasing cessation of smoking is a key element in defeating the actual cause of tobacco-related ill-health caused by the cigarette.

Current European legislation does not allow snus to be marketed in any European country except Sweden. However, due to strong evidence behind its potentially life saving benefits, The New Nicotine Alliance (NNA), a United Kingdom (UK) consumer group supporting access to safer nicotine products, is calling for its legalization and has joined legal action case against the banning of snus, which has now been referred to the European Courts of Justice.

Gerry Stimson, Chair of the NNA stated, “Snus is a tobacco product that has consistently been proven to be less harmful to health than cigarettes. The ban on snus limits smokers choices of safer alternatives and has a significant negative impact on public health”.

Phillips Morris International (PMI) in its presentation at the Forum noted: “Harm reduction policies are based on the view acknowledged by virtually all public health organizations that tobacco use will continue well into the future. As the United Nation (UN) stated in 2004, even assuming current rates of decline in consumption, ‘the number of tobacco users would still be expected to increase to 1.46 billion by 2025.’

“The recognition that people will continue to smoke has led many public health authorities to the conclusion that developing tobacco products that have a reduced risk of causing disease is a crucial element of tobacco policy. This is contrasted with those groups who take an abstinence-based approach that focuses solely on preventing people from beginning to use tobacco products and encouraging people to quit using tobacco products.

“Following a harm reduction policy does not preclude governments from pursuing the objectives of prevention of initiation and encouraging cessation. On the contrary, most proponents of harm reduction are vigorous supporters of those important goals. As we see it, tobacco harm reduction should complement prevention and cessation efforts — not compete with them.

“Our support of harm reduction follows two paths: one is through our research and development of products with the potential to reduce the risk of tobacco related diseases. The other path is through our support of regulation based on the principle of harm reduction.”

Big Tobacco Accused of ‘Dirty War’ Against Smoking Prevention in Africa

In the past, Big Tobacco has been accused of covering up the true extent of the health risks associated with smoking, as well as fighting government restrictions. Now, a new investigation suggests that Big Tobacco is using strong-arm tactics to resist regulations in many parts of Africa.

http://www.care2.com/causes/big-tobacco-accused-of-dirty-war-against-smoking-prevention-in-africa.html

The Guardian reports that after reviewing court documents and other materials, it has uncovered a systematic wave of bullying and intimidation by British American Tobacco. And BAT is soon to close a deal that would make it the world’s leading tobacco company.

The exposé highlights attempts made by BAT to defang, or resist outright, regulation and restriction. For example, the company used threats of economic damage to fight higher taxes on cigarettes, a plan that is standard in the U.S. and much of Europe.

The Guardian reports:

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.

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.

But we have seen these tactics before.

Starting as early as the 1970s, health warnings about cigarettes began to grab national attention. At that time, tobacco companies used every advertising and legal mechanism they could to prevent further regulation and to avoid plain packaging. As a result, some 70 years after the health dangers of cigarettes came to light, we are only now restricting tobacco in a way that seems appropriate to its risks.

While tobacco companies are in retreat in the West, African, Latin American and now Asian markets have become key areas of interest. As well as exploiting labor in these regions, tobacco companies now want to ensure that their products last long after the West has rejected cigarettes.

For its part, British American Tobacco has always claimed to abide by strict codes of conduct. The company has defended its use of the courts as a means to clear up ambiguous interpretations in local regulation and to ensure international regulations are being followed where appropriate.

British American Tobacco maintains that it does not oppose regulation per se and believes that reasonable restrictions on tobacco are warranted as, tobacco is a harmful product.

However, campaigners have long said that BAT falls short of that standard. Many African nations have signed on to the World Health Organization’s treaty on tobacco control, but that status still needs to be ratified, meaning that no uniform policies exist. Sub-Saharan Africa in particular has shown its vulnerability to manipulation by outside businesses with money.

The Guardian exposé highlights this clearly in one extract regarding tobacco regulation in Kenya:

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.

The Sunday Times has previously reported on an investigation which found that BAT sold cheaper, highly addictive cigarettes to Africans in the 1990s. The company also allegedly marketed smoking without sufficient health warnings.

BAT may dispute such claims or suggest that these are simply past infractions. However, more recent reports claim that people affiliated with BAT have attempted to bribe African officials to advance tobacco products in sub-Saharan Africa and to avoid certain regulations.

As of 2016, these allegations — made both by former BAT employees and by outside investigators — even prompted lawmakers in the U.S. Congress to call for a full investigation to determine whether BAT breached any laws due to its involvement in Africa.

Overall, tobacco use remains low across Africa. A major “Lancet” study published in 2010 puts cigarette smokers at about 14 percent of the total population — far below that seen in the Americas. However, data suggests that the rate of smoking uptake is rising at an alarming rate — by as much as four percent per year.

Will the Guardian’s revelations prompt further action against British American Tobacco? That remains to be seen, but we must do everything we can to help African nations get the full facts on tobacco’s health impacts and resist Big Tobacco’s strong-arm tactics.

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.

Inside the murky world of Nairobi’s smoking zones

The Kenyan government has cracked down on cigarettes with a ban on advertising and smoking in public, driving the habit into the shadows

https://www.theguardian.com/world/2017/jul/12/nairobi-kenya-smoking-zones-cigarette-crackdown

There is a wooden shed in the middle of Nairobi city centre, dark, full of fumes, crowded and deliberately built beside the public toilets. It feels like a place of shame.

Jairus Masumba, Nairobi County’s deputy director of public health, calls it in jest the gazebo. It’s the public smoking place, created by his department. It is claustrophobic and filled with smoke, some of which drifts out through slats, but most of which hangs heavily in the fugged air inside.

Those who enter have to be desperate – and they’re usually men. A 27-year-old woman, who comes from the south of Kenya, is a rarity. She is heavily made-up and stands in the doorway. She smokes seven to 10 cigarettes a day. “It’s bad for you, no?” she says several times, though she knows the answer.

The men inside, barely visible as you enter because of the darkness and the fug, are smoking hard, standing up like a football crowd, all facing the same way though there is nothing to look at except the wooden slats of the far side of the shed. Music blares but nobody is dancing. They are grim faced, doing what they have to do. A young man, high probably on khat and cigarette in hand, chases some of the butts and the ash out with a broom, seeking money from the other smokers for cleaning up. He says he has a diploma in business marketing and another diploma in substance abuse counselling.

At the door are two cigarette sellers, doing a busy trade. It’s rare for anyone to buy whole packets. Packs of cigarettes in Kenya are broken up and sold by vendors as single sticks. That makes them cheap for women, children and the poor, despite manufacturers being banned from producing packets of less than 10. One of the two sellers sitting passively inhaling smoke is a woman who taps a packet of 20 and shakes them deftly out, one at a time, exchanging them for small coins. Men buy one, sometimes a couple, sometimes three. They will not all be smoked here. The sellers sit at the large red wooden boxes, with open lids that become the display cabinet. Most popular and cheapest is Sportsman at 100 shillings a pack (75p, 97 cents) or 5 shillings (less than 4p, 5 cents) for a single. Smokers buy sweets too, to take away the smell of tobacco when the worker goes back to the office.

The shed is vile, but few dare smoke even on the pavement outside in the cleaner air in the knowledge that the plain clothed official public health enforcers will be circling, ready to impose fines on anyone they catch. Nairobi city has got tough on smoking. The Kenyan government has banned advertising and marketing and smoking in public places, but it is up to the individual counties to interpret and enforce that and they all do it differently. Nairobi County has cracked down hard. Lighting up on the open street in the city centre can result in a stiff fine of 50,000 shillings (£374, $485) or even arrest. But it’s not so everywhere, or even outside of the city centre.

WHO-africa-deaths

Yusef, 58 and from Kenya’s second city, Mombasa, on the Indian Ocean coast, says people smoke openly in Mombasa. He has been smoking since the 1970s. His 28-year-old daughter died recently from colon cancer. That gives him a different perspective. “I’m more worried about GM foods,” he says.

Nairobi’s Uhuru Park is just under the nose of the ministry of health and has two small designated open-air smoking areas. On a Saturday, young women who are not smoking are there laughing and chatting with the young men who are. It’s somewhere to hang out. Elsewhere in the park, the same snack stalls proliferate. After 5pm, when the official public health enforcement officers go home, vendors and smokers relax. Cigarettes are sold and smoked openly.

Outside of the city centre, the restrictions do not appear to be enforced at all. In the High Ridge residential area, a predominantly Indian community, stall holders are grilling corn and frying cassava crisps on the street. Others run the small stalls selling sweets, biscuits, fizzy drinks and cigarettes, openly smoking themselves. People wander along the road with a cigarette between their fingers. A large lorry stops and a man jumps down to buy two sticks, lighting both and passing one to his fellow labourer before they unload.

These stalls are common near schools. A recent report compiled by the Consumer Information Network, a campaigning Kenyan anti-tobacco organisation, with Johns Hopkins University in the US, found such stalls selling sweets and single cigarettes within yards of primary schools across the country.

You won’t see an advert for Dunhill or Rothmans in Kenya. At least, nothing that looks like an advert. Advertising and promoting cigarettes has been banned. But everybody knows what the large red wooden boxes and red wooden display trays at stalls at the side of roads contain. Red is the colour of British American Tobacco (BAT). The words have been stripped off the red umbrellas that protect street vendors from the sun or patched over, but the colour is a tacit reminder of what they used to say and what is still sold there.

BAT said 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.

“We are a company that takes its responsibilities very seriously, and we are naturally keen to look further into any instances that are brought to our attention, so we can take action if necessary.”

Pictures and video by David Levene. Multimedia editing by Ekaterina Ochagavia.

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”.

Towards a Smokefree Generation – A Tobacco Control Plan for England

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Proposal to tax heat sticks the same as cigarettes

A proposal to tax heat-not-burn tobacco products at the same rate as combustible cigarettes is before the National Assembly, the Korea Herald reported.

http://www.tobaccojournal.com/Proposal_to_tax_heat_sticks_the_same_as_cigarettes.54292.0.html

Legislation to revise three laws governing taxation of tobacco products reportedly has been introduced by Rep Kim Kwang-lim, a member of the Liberty Korea Party. All tobacco products are harmful and should be taxed at the same rate, according to the legislation. Heat-not-burn products are taxed at about half the KRW 3,323 (EUR 2.59) rate for combustible cigarettes, the Herald said.

San Francisco Menthol Ban Puts Millions in Tobacco Sales in Jeopardy

New law may cut tobacco category by 35%, city research says

http://www.cspdailynews.com/category-news/tobacco/articles/san-francisco-menthol-ban-puts-millions-tobacco-sales-jeopardy

Although California may be known for earthquakes, San Francisco could rock the c-store channel to its core, with its board of supervisors banning the sale of menthol cigarettes—a move that could slash the tobacco category in the city as much as 35% when the law goes into effect next year, according to one state estimate.

Through a press contact at the board of supervisors, CSP Daily News confirmed that the board’s unanimous approval of the menthol ban June 20 has led to its passage into law, with an implementation date set for April 2018.

The measure’s passing comes soon after Ted Egan, chief economist for San Francisco’s controller’s office, issued a report detailing the ban’s potential economic effects. In the report dated June 13, Egan said the ban—which affects all tobacco flavors, including menthol—could cost the city $50.5 million in annual sales, with an average smoker consuming 212 packs annually at a cost of $8.50 per pack.

While the ban’s goal of reducing tobacco use may be the result, the report also suggests that smokers may simply switch to other types of tobacco or buy flavored products in other cities or online.

Based on city records, the ban would affect 726 retailers.

“Most of these retailers are small convenience stores or gasoline stations that sell fewer than 20 packs of cigarettes per day,” the report said. “We have no information on how many sell flavored cigarettes that would be subject to the ban.”

The report, however, cited the California Department of Public Health as estimating 35% of cigarettes sold are menthol-flavored.

The legislation itself amends San Francisco health codes to prohibit local tobacco retailers from selling flavored tobacco products, including menthol cigarettes, flavored chewing tobacco and flavored liquids containing nicotine designed to be used with electronic cigarettes. It does not criminalize the possession or use of flavored tobacco, only its sale by retailers within the city.

In its original form, the law was supposed to take effect in January 2018, but according to the San Francisco Examiner, Supervisor Malia Cohen, who introduced the bill, pushed enforcement back by four months to April 2018 to address business concerns. According to the Examiner, Cohen said she would support increases in funding for small stores so they could transition their business models to reflect the city’s Healthy Food Retail program.

Since the measure’s initial proposal in April, San Francisco-area retailers and tobacco association representatives have expressed vigorous opposition to the measure, saying it would endanger the viability of their businesses.

Here’s a quick update on California counties and cities that have banned or are considering bans on menthol as part of a larger pushback on flavored-tobacco products:

  • Menthol Bans. Municipalities with some form of flavor ban that includes menthol cigarettes: Yolo and Santa Clara counties in California, and Los Gatos, Calif., according to the Antioch Herald. San Francisco’s flavor ban, which includes menthol-flavored tobacco products, will take effect in April 2018.
  • Flavor Bans. Several cities have some form of flavored-tobacco ban involving menthol. For instance, the city of El Cerrito, Calif., banned the sale of flavored tobacco to youth under 21, according to the Antioch Herald. Other cities with various types of restrictions of menthol include Berkley, Hayward and Sonoma, Calif., said the East Bay Times.
  • Considering Flavor Bans. Contra Costa County in California will consider outlawing the sale of flavored tobacco to youth at either its July 11 or July 18 meeting, according to the Antioch Herald. Meanwhile, the city of San Leandro postponed a decision until September on a more encompassing tobacco ordinance that included a flavor ban, the East Bay Times said.

At a public rally in April, Orlando lawmakers stood in solidarity with legislators in San Francisco to ban menthol cigarettes, but according to the San Francisco Examiner, Orlando is still considering its own proposal on the matter.

One of the latest cities to consider an ordinance is Minneapolis, with councilmen introducing legislation June 16 that would include menthol in its current tobacco-flavor ban.

Alex Calls Out Government on Another Tobacco Control Plan Delay

The Government are making no progress on creating and publishing the Tobacco Control Plan and every delay is putting more lives at risk, argued Stockton North MP Alex Cunningham today.

Last week Alex used the parliamentary tool of submitting a written question to the Secretary of State for Health regarding the long-awaited tobacco control plan, and today received a response from a Health Minister simply saying that the Government are “developing the Tobacco Control Plan which will be published shortly”.

The Member of Parliament for Stockton North argued that this is just another delay in a long succession regarding the plan, which was announced in December 2015 to be published the following year. Since 2016, a number of MPs have added their voices alongside Alex to continue probing the Government on when they will release the plan.

The Tobacco Control Plan, when eventually published, will set out what must be done to identify and develop new measures for reducing smoking and smoking harm.

Speaking on the matter, Alex said:

“I know that the previous Government wasn’t known for its efficiency, but a near 18-month delay on the publication of an extremely important plan is beyond inefficient now.

“There are a significant number of organisations, charities, health workers, and patients that are waiting for this plan. We can’t sit around and allow more people to die from cancer and other smoking-related diseases whilst the Government ponders around making dodgy DUP deals to stay in Downing Street, and key parts of our health strategy are being pushed to the sidelines.”

Himachal govt bars its officials from participating in tobacco industry’s activities

The circular has been issued recently in view of the fact that different government departments end up taking sponsorship from tobacco industries, knowingly or unknowingly.

http://www.hindustantimes.com/india-news/himachal-govt-bars-its-officials-from-participating-in-tobacco-industry-s-activities/story-4YLg9v87SRBtgk0Rw5411I.html

Himachal Pradesh government has issued a circular barring its officials from participating in any activity related to tobacco industry.

“All the heads of departments in Himachal Pradesh are instructed not to participate in any event organised by tobacco industry and also not to accept any kind of direct or indirect sponsorship or funding from corporate engaged in tobacco business,” the circular read.

The circular has been issued recently in view of the fact that different government departments end up taking sponsorship from tobacco industries, knowingly or unknowingly.

“Sponsorship from tobacco companies will weaken our tirade against tobacco, in which, Himachal is doing really well,” director health safety and regulation department Raman Kumar Sharma said.

Sharma said there are some events organised by tobacco companies where doctors are invited as technical experts. “Head of departments should refrain from participating in such events. It is equal to endorsing their products,” he added.

The directions have been issued in view of the implementation of The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) or COTPA Act, 2003.

“Under the act, the direct and indirect advertisement of tobacco product is prohibited. But some tobacco giants sponsor government programme, which is a kind of endorsement of their activities,” health activist Ramesh Badrel said.