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November 7th, 2016:

WHO advises UK to ban vaping in public spaces

The UK, a country renowned for leading the way in endorsing vaping products as smoking cessation tools, and achieving a great outcome as a result, is told by the WHO to reconsider its position instead of being given a well deserved pat on the back.

After Public Health England had released a scientific report which found vaping to be at least 95% safer than smoking, the United Kingdom has been promoting vaping products as healthier alternatives to tobacco cigarettes, and offering them as smoking cessation tools. Since vaping mimics the action of smoking, it has been found that e-cigarettes are the preferred Nicotine Replacement Therapy of smokers.

This has resulted in the UK reporting the lowest numbers of smokers ever recorded, with a recent study finding that 18,000 smokers have given up smoking in the UK thanks to the devices. In line with this Public Health England has issued reports saying that public spaces should have designated vaping spaces, so that vapers are not forced to vape in smoking areas, and their efforts to quit cigarettes are not compromised.

WHO ignores evidence about e-cigarettes

But according to an article published by the Daily Mail, instead of commending the country’s efforts, the World Health Organization has issued an advice to ban the products from public spaces. This plea was issued right before the Framework Convention on Tobacco Control, (FCTC), taking place this week in Delhi, India, hence heated discussions related to the matter are to be expected at the convention.

The real concern is that smokers increasingly believe the inaccurate reports that vaping is as dangerous as smoking and are more likely to continue to smoke.
Professor Kevin Fenton, national director of health and wellbeing at Public Health England
Amongst the points mentioned by the WHO was the infamous ‘gateway’ theory on how youths may be lured into vaping with the candy flavoured e-liquids to then end up hooked on Nicotine and eventually start smoking, a theory that has been proven unsound from several studies. Another point was mentioned how certain metals such as chromium found in e-liquid vapor can supposedly cause more harm than the smoke emitted from tobacco cigarettes.

UK to keep proceeding towards harm reduction

In reply to the WHO’s plea, Professor Kevin Fenton, national director of health and wellbeing at Public Health England, said that the PHE will continue to monitor the evidence, adding: “The evidence remains clear, with PHE’s most recent review and the Royal College of Physicians both finding that while not completely risk-free, vaping carries a fraction of the risk of smoking – around 95% less harmful”, and concluded by stating “The real concern is that smokers increasingly believe the inaccurate reports that vaping is as dangerous as smoking and are more likely to continue to smoke.”

CoP7: A Tobacco Harm Reduction Expert Group to advise delegations

A coalition of leading tobacco harm reduction experts from science, economics and policy areas of tobacco harm reduction, has been formed to provide a balanced and evidence-based information on harm reduction at CoP7, the seventh Conference of the Parties (CoP7) that is being held this week in New Delhi, India.

The WHO has an opportunity now to improve radically the life expectancy of today􀀀s smokers by applying the principle of harm reduction that is already one of the core principles of WHO’s tobacco control strategy.

— Tobacco Harm Reduction Expert Group – CoP7, New Delhi, India

The worldwide success of e-cigarettes and the lobbying of tobacco giants in favor of new tobacco products have chilled down the enthusiasm of some government with regard to ENDS, helped in that by alarming messages from the media. This situation is leading to many restrictions, disproportionate sometimes, in many countries that prevent millions of people from accessing a safer alternative to combusted tobacco.

CoP7 will play a crucial role in shaping global policy in the field of tobacco harm reduction, especially for ENDS that remain under-evaluated in their harm-reduction role compared to combusted tobacco products.

Governments from 180 countries attending the conference will be asked to consider the appropriate policy for new nicotine products.

E–cigarettes, of course, are at a center position of the debates but other combustion-free novel tobacco products heat-not-burn cigarettes.

A coalition of experts has been formed, according to press release, in order to provide a guidance to the governments seeking to offer a legal perspective to e-cigarettes in their countries.

Along with Dr Konstantinos Farsalinos and Prof Riccardo Polosa, one can find Dr Christopher Russell, a British behavioural psychologist, Dr Amir Ullah Khan, an Indian economist, Julian Morris (Reason Foundation) the co-author, with Dr Amir Ullah Khan, of The Vapour Revolution: How Bottom Up Innovation is Saving Lives, and Prof Rajesh N. Sharan, an Indian biochemist and molecular biologist who recently co-authored a study on “Electronic Nicotine Delivery System (ENDS) as a substitute to conventional cigarette: an evidence-based audit” in India.

The coalition recalls that “One in two life-long smokers will die prematurely from a smoking related disease”, leading to a billion deaths from smoking-related diseases in the 21st century.

WHO’s FCTC identified harm reduction strategies as a core principle of tobacco control and has recently stated that: “If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health benefit.” A benefit that has also been pointed out by Public Health England when the agency emitted a report that finds the e-cigarette 95% safer than combusted tobacco.

The principle of a continuum of risk in tobacco products with on one side combustible cigarettes and on the other smokeless and new tobacco products, is the view that the coalition of experts will share with delegates to avoid counter-productive measures that provide a protective environment for tobacco cigarette sales while enhancing public health.

Reporters Banned From Global Anti-Tobacco Conference

A United Nations legislative body has voted to kick journalists out of its meeting Monday.

Delegates voted unanimously to ban journalists from the remaining sessions of the biennial legislative conference of World Health Organization’s Framework Convention on Tobacco Control (FCTC).

Journalists called the decision “outrageous” and “shocking,” while delegates refused to address concerns about denying press freedom.

The FCTC’s legislative body, known as the COP, or Conference of the Parties, is meeting this week in a Delhi, India suburb to discuss and vote on policy proposals that impact more than 90 percent of the world’s population. Global taxpayers spend approximately $13 million a year funding the FCTC and its conference. Every major nation has signed on to the UN tobacco control treaty except the United States, Switzerland and Indonesia.

At the event, delegates representing 180 nations set international guidelines for tobacco taxes, regulations on e-cigarettes, advertising bans, graphic health warnings and other efforts to reduce tobacco consumption. The delegates are generally high-ranking public health, finance and trade officials, such as finance ministers and secretaries of health.

During the closing minutes of Monday’s opening session of the conference, a delegate from Thailand proposed banning the media and the public from the remainder of the 6-day event in order to “have discussions in private.”

The proposal passed with no objections, meaning that each of the 180 nations, unanimously agreed to bar reporters from the taxpayer-funded legislative session, leaving journalists stunned.

“I, for one, was shocked,” said Faith Goldy, a reporter for The Rebel, a Canadian political news site. “I’ve covered a lot of conventions and this was totally unprecedented for me.”

When Golby asked a Canadian delegate why they supported banning the media despite Canada’s strong tradition of freedom of the press, the delegate refused to offer a comment.

Yaël Ossowski, a columnist covering the COP for the PanAm Post called the decision “outrageous.”

“Journalists are responsible for informing the public about the decisions such large international bureaucracies make,” Ossowski said. “How can this be done if the media is kicked out the second the real issues are discussed?”

“Every citizen should be concerned about what the WHO is up to.”

Delegates from Italy, Madagascar, Mexico and the Philippines all declined to speak to reporters after they voted to ban journalists.

One delegate from Mali expressed concern after his country went along with the decision to eject the media.

“Reporters should be allowed to stay,” said the Malian delegate who preferred not to be identified. “Without the media, the public doesn’t know what has happened.”

This is not the first time the COP has come under scrutiny for restraining press freedom. During the WHO’s most recent anti-tobacco convention in Moscow, journalists were physically removed from the COP meeting hall moments before a controversial vote regarding a minimum 70 percent tax increase on the retail price of tobacco products.

Reporters covering the conference now face the task of reporting on the meeting without access to the proceedings.

“For a conference with such a sweeping impact on every global citizen, it’s frankly an outrage that journalists are not allowed to freely report and do their jobs,” said a frustrated Ossowski


Cancer organisations have launched a new initiative to build a vigorous global coalition to support governments seeking to increase tobacco taxes.

The American Cancer Society’s Economic and Health Policy Research (EHPR) programme – the technical lead for the initiative – has developed a portfolio of easy-to- understand fact sheets and tools to support governments and civil society.

The EHPR team’s main tool is a dynamic model that can predict the tax increase necessary for a country to reach the WHO target of a 30-percent reduction in smoking prevalence by 2025 (with 2010 as the base year).

The team has already used publicly available data to model tobacco tax increases for 72 countries. For example, for Albania to reach the target, cigarette prices would need to be increased to 542.61 Albanian Lek per pack by 2025, which is a 4-fold tax increase. (See figure.)

The WHO target was adopted at the Sixth Conference of FCTC Parties in 2014. Achieving it would help countries reach the United Nations Sustainable Development Goal (SDG) of reducing premature mortality from noncommunicable disease (NCD) by one-third by 2030, but a recent report from WHO indicates that most countries aren’t on track to meet that target.

The cancer community has a vested interest in this issue. Around 20 percent of global cancer deaths are related to tobacco. As Harpal Kumar, Chief Executive Officer of Cancer Research UK, said at the World Cancer Congress last week:

“Global tobacco use remains, by far, the most important modifiable risk factor for cancer, and an area where cancer organizations could make a meaningful difference if we
worked together.”

According to Gary M. Reedy, Chief Executive Officer of the American Cancer Society (ACS): “The time is right for this campaign. There is an urgency for governments around the world to respond to the WHO’s call for a 30 percent relative reduction in adult smoking prevalence by 2025. The most plausible way for governments to reach this target is by raising tobacco taxes.”

Article 6 of the WHO FCTC commits governments to raising tobacco excise taxes in order to reduce the affordability of tobacco products. This is one of the most effective tools to prevent initiation and promote cessation of tobacco use, with studies proving that it is particularly effective among the young and the poor. As detailed in the Addis Ababa Action Agenda last year, it is also a recommended means of generating millions of dollars annually in sustainable government revenue that can be reinvested in health and development priorities – including cancer screening, diagnosis and treatment. These revenues could easily fund the implementation of the WHO FCTC’s provisions, too, and the strategy could deliver significant savings in future health care costs, thanks to a reduction in tobacco related disease.

In spite of these clear benefits, many countries have been slow to implement effective tax and price measures. Barriers to high tobacco taxes include a lack of information in clear, non-technical language that can help potential proponents of tobacco tax reform to effectively make their case – particularly in the face of misinformation promoted by the tobacco industry. Moreover, governments and their nongovernmental allies sometimes lack the technical capacity to implement a successful tobacco
taxation programe.

The cancer community’s tobacco tax initiative aims to increase understanding within the global public health community – and within Ministries of Finance and Ministries of Health – of the power of tobacco taxation as an effective measure for reducing tobacco use, preventing NCDs, such as cancer, and raising sustainable revenues for national governments. Assistance is available to support stakeholders wishing to be part of the campaign, especially for those who have not worked in the field of tobacco taxation before.

The dynamic model can also be adjusted for country-specific needs to use data provided by in-country experts and to reflect other, perhaps more ambitious, scenarios for tobacco tax increases. The model also accounts for changes in the affordability of tobacco products, changing price elasticities, and any country’s tax structure.

Cancer organisations are ready to take a lead in raising the prominence of tobacco taxation as an essential intervention for cancer prevention, but ultimately it is only through a true partnership among motivated governments and nongovernmental stakeholders – the people attending COP7 this week – that an effective tobacco tax strategy can be realised.

The EHPR team attending COP7 – Jeff Drope, Michal Stoklosa and Jacqui Drope – are available to discuss this initiative and provide advice on tobacco taxation. Fact sheets for 72 countries are available upon request and at the FCA booth. To arrange a discussion with an EHPR representative, or to be kept up-to-date with developments, please email

New evidence e-cigarettes are gateway to tobacco

There’s more evidence that electronic cigarettes may be enticing teens to try the tobacco ones.

A nationwide survey of teens who never smoked shows that nearly 60 per cent who tried the flavored electronic ones intend to start smoking tobacco.

And the majority of e-cigarette users started out with sweet, candy-like flavors.

“Due to a proliferation of e-cigarette flavors on the market, flavored e-cigarette use among youth in the U.S. has increased significantly,” study author Hongying Dai said.

The number of teens who use e-cigarette devices to “vape” has nearly quadrupled since 2013.

Flavored e-cigarettes aren’t prohibited in the United States.

Although the F-D-A has imposed new rules on electronic cigarettes, it doesn’t have legal authority to regulate the flavors.

Nearly 500 brand with more than 7-thousand flavors are currently on the market.

Dai’s team looked at the nearly 16,500 teens answering the survey who had never smoked cigarettes but used e-cigarettes.

The researchers also looked at more than 1,300 current smokers and assessed if they intended to quit. Finally, the investigators looked at nearly 21,500 teens to assess their perception of the dangers of tobacco.

The study found that just over 2,000 teens said they had used e-cigarettes in the last 30 days.

Among current tobacco smokers, 68 percent of those who also “vaped” said they had used flavored e-cigarettes.



There is strong international support to strengthen and accelerate full implementation of Article 14 of the WHO Framework Convention on Tobacco Control (FCTC), as evidenced by the World Conference on Tobacco or Health Declaration in 2015 that “By 2018, at least 50% of FCTC Parties will have developed and published an official national tobacco dependence treatment strategy, in accordance with Article 14 Guideline recommendations”.

Most of the substantive FCTC Articles, especially 6, 8, 11, 12, 13 and 14, promote tobacco cessation (as opposed to discouraging young people from starting) in one way or another. It is important to note that only effective cessation will have a sufficient effect on mortality in the 9 years left to reach the UN/ WHO goal of a 25 percent reduction in premature mortality from NCDs by 2025.

The 2014 WHO Global Progress Report on FCTC implementation suggests good progress in FCTC implementation but notes that some treaty articles are being implemented more quickly than others. The report adds that only half of Parties said they were implementing Article 14 by 2014.

Evidence from MR’s group’s survey (at Nottingham University, UK) suggests perceived cost to be one concern about tobacco cessation support, another may be lack of clarity about the role of such support, including about its effectiveness and cost effectiveness.

Helping tobacco users stop is a cost effective healthcare intervention, which saves lives and improves population health.

Every day that smokers over 35 years old continue to smoke they lose about 3–6 hours of life, thus for the estimated 500 million current adult smokers, 62 million days of life are lost every day.

Some of these tobacco users will stop unaided, others will stop only after repeated attempts over time, and many more will die before they can stop, principally because
tobacco use is so addictive. The unaided population tobacco cessation rate after 1 year is very low, only about 3–5 percent, meaning that the majority of smokers who try to
stop without help fail. Adding comprehensive cessation support can be up to about four times more effective, at about 20 percent after a year, but even brief advice has a
worthwhile effect.

One key reason why the majority of ex-smokers stopped without help is because the majority do not have access to help.

According to WHO, just 15 percent of the world’s population have access to appropriate cessation support.

Arguably, cessation support should be provided alongside measures that prompt cessation attempts, like those in Articles 6, 8, 11, 12 and 13.

Given a genuine need for cessation support, the fact that globally most tobacco users don’t have access to it, and that providing it implies at least some basic infrastructure, can anything be done quickly to improve the situation, something that low and middle income countries can afford?

I think countries could consider the following relatively low-cost measures to build core infrastructure:

1. Conduct a national situation analysis, as recommended in the FCTC Article 14 guidelines;
2. Develop a national cessation strategy;
3. Mandate recording tobacco use in all medical notes;
4. Offer mobile phone text messaging systems;
5. Integrate brief advice to all tobacco users into the healthcare system.

As resources become available countries can consider adding the following:

6. Develop and disseminate national cessation guidelines;
7. Make affordable medicines available;
8. Establish mass communication and education programmes that encourage cessation and encourage tobacco users to use cessation support;
9. Offer specialist tobacco cessation support.

The availability of new, low-cost interventions and methods to help countries select affordable treatments (will remove significant barriers to the development of tobacco cessation support and make Article 14 implementation both feasible and a significant contributor to global health.

Martin Raw, Director, International Centre for Tobacco Cessation, London, UK; Visiting Scholar, New York University Medical School, New York, USA and Thomas Glynn, Consulting Professor, Stanford University Preveniton research Center, School of Medicine, Palo Alto, California, USA

This article draws extensively on a comment published in the Lancet in January: Raw M, Mackay J, Reddy S. Time to take tobacco dependence treatment seriously. Lancet, 30 January 2016. Further references and sources can be obtained from MR at


RECENT AGREEMENTS BETWEEN GOVERNMENTS & TOBACCO COMPANIES Over the past year, governments across the globe have continued to make new agreements with the tobacco industry, as shown above. However there is a ray of hope from Namibia, which is choosing to grow more food crops.

Over the past year, governments across the globe have continued to make new agreements with the tobacco industry, as shown above. However there is a ray of hope
from Namibia, which is choosing to grow more food crops.

The tobacco industry is very angry that the Conference of the Parties (COP) is using Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect the policy-making process from industry interference.

The industry has hijacked the “public space” of the COP. FCTC Parties have responded in recent sessions by not allowing participation from the “public”, which is dominated by industry representatives. For COP7, FCA is recommending Parties adopt pre-screening processes for the public and for the media. (Presently, media is in the category public).

The industry has gone on the offensive: conducting an international campaign to attack and discredit the COP and the World Health Organization (WHO) about lack of transparency. Industry representatives have written angry letters to both the COP and WHO and published many statements in the media criticising the COP’s lack of ‘transparency’, which strikes a chord with broader society.

The industry throws a tantrum whenever it does not get its way, and has no qualms in criticising the 180 governments that are FCTC Parties. In one statement, a representative of Japan Tobacco International (JTI) said the industry wants to see change, (read, “we want to influence the COP”), and that it needs to “keep raising our voice about these censorship practices”.

Since the tobacco industry has no credibility to criticise the COP and tobacco control, it has recruited front groups, think tanks and sympathetic individuals to sing from its song sheet.

The Institute of Economic Affairs (IEA) is one such close ally. It advises the industry to talk more about “due process and fairness and less about the specifics of tobacco policy in drawing attention to this issue”.

According to the IEA, “With regard to [Article] 5.3 and COP, the industry needs to find allies amongst groups who take an interest in transparency, openness and constitutional structures. Such groups needn’t be sympathetic to the regulatory agenda of the industry; indeed they may even be antagonistic to the industry and tobacco products in general. That needn’t matter—the issue here is about the manner in which policy is developed and created, not the exact content of the policy.”

Another industry funded group, the International Tax and Investment Centre (ITIC), has stepped up its efforts to protect industry interests ever since the FCTC Secretariat issued a Note Verbal in 2014 about its activities. Earlier this year, an ITIC consultant, Gary Johns, wrote to several civil society groups involved in tobacco control taking issue with the critiques they had done on the ITIC’s skewed research. In a 36-page letter he sent to the Southeast Asia Tobacco Control Alliance (SEATCA) earlier this year Johns wrote, “vested interests are not the problem – debate behind closed doors is”.

The letter was riddled with false accusations against SEATCA, mischaracterisations of fact and law, disparaging comments about the WHO, the Framework Convention Secretariat and FCTC Parties. SEATCA published an open letter in response.

In September, Johns, a former Australian Labour Minister, released a publication attacking WHO for not conducting its business in “transparent fashion and in public view.” The tobacco industry publicised his report in the Tobacco Reporter.

Another industry front group, the International Tobacco Growers Association (ITGA), which routinely rounds up its members to rabble rouse at COP sessions, has stepped up its misinformation campaign. ITGA’s Indian member Federation of All India Farmer Associations (FAIFA) has been applying pressure on the Indian government to allow its members to the COP using arguments of “principles of transparency and equity”.

ITGA’s president has also claimed that the FCTC had banned dozens of officials representing tobacco-growing countries from participating in COP7. A similar statement was made by a new NGO representative cum journalist, who claimed, “The policy of banning delegates having associations with tobacco production is said to be so broad that it will almost certainly prohibit finance ministers, economic development secretaries, public health officials, and even presidents and prime ministers …”

In September, ITGA members from North and South America, India, Europe, Africa, and Indonesia were in New Delhi for a two-day seminar to prepare their protests for COP7.

The ITGA claims COP decisions are being made “only by health officials and activists”. This is simply not true. Government delegations have included officials from non-health departments, such as ministries of agriculture, industry and trade, as official COP records show (Table 1).

In 2008, FCTC Parties adopted Article 5.3 guidelines. They include recommendations 4.9 and 8.3, which explicitly state that Parties should not nominate any person employed by the tobacco industry, or any entity working to further the industry’s interests, to serve on delegations to COP or other FCTC meetings, nor should any representatives of state-owned tobacco industries be included on government delegations.


The report of the Secretariat of the Framework Convention on Tobacco Control (FCTC), “Global Progress in Implementation of the FCTC”, (document FCTC/COP/7/4), notes the incredible advances we’ve made in implementing the life-saving measures of the treaty – often despite aggressive attempts by the tobacco industry to block, weaken, and delay them.

And the long-awaited legal victories in Uruguay and Australia over Big Tobacco have been wind in the sails of public health officials globally.

However, the summary also notes one incredibly important conclusion: “the tobacco industry continues to be the most important barrier in implementation of the Convention”.

This stark reminder highlights the urgency of national-level implementation of FCTC Article 5.3, which states: “In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

Article 5.3 is the most powerful tool at Parties’ disposal to neutralise the money, power, and influence of this deadly industry and its allies. Implementation of this powerful measure at the national level, which safeguards and facilitates implementation of all other articles of the treaty, must be prioritised by the Parties at COP7. This means reviewing lessons learned from both the progress and challenges contained in the Secretariat’s report, but also a renewed commitment to prioritising implementation of Article 5.3 and its guidelines at the national level, coupled with additional investment and resourcing.

To date, dozens of governments have begun to implement measures in line with Article 5.3 at the national level, and more are expected to follow suit.

For instance, Norway has divested more than US$2 billion from the tobacco industry. Uganda incorporated almost all of the Article 5.3 guidelines into a national tobacco control bill signed into law this year.

Brazil adopted ethical guidelines for representatives of its tobacco control commission, CONICQ, requiring that it has no ties with the tobacco industry.

The European Union has terminated its agreement with Philip Morris International. Australia publishes all meetings between government officials and the tobacco industry on a public website. And the Philippines has barred public officials from interacting with the tobacco industry unless strictly necessary for regulation.

When Parties prioritise implementing Contiued on page 8 measures in line with Article 5.3, it pays huge dividends for tobacco control across the board. By investing time and energy up front into cleaning up the policymaking process and changing the culture within government to recognise the fundamental and irreconcilable conflict of interest between the tobacco industry and public health, Parties find it much easier to pass any and all tobacco control measures into law.

Yet it remains clear that more work needs to be done. For one, though many health ministries have implemented policies in line with Article 5.3, other agencies, such as trade and agriculture, often have not, opening the door to tobacco industry influence. In addition, Article 5.3 is more akin to a good governance measure than a public health measure per se. This can be a barrier for public health officials who don’t have the expertise to implement and enforce, for example, conflict of interest policies for government employees. It also requires coordination across agencies to ensure the article and guidelines are enforced beyond the ministry of health.

Several COP7 agenda items will address the tobacco industry.

Civil society will be watching governments closely.

John Stewart
Deputy Campaign Director: Water & Tobacco, Corporate Accountability International