Tag: Foundation for a Smoke-Free World

Transformation Index Finds ‘Differentiated’ THR Progress
Photo: ehabeljean
The world’s 15 largest tobacco companies have made limited progress since 2020 to reduce the harm of their products, with high-risk combustible products still accounting for around 95 percent of retail sales volume, according to the second edition of the Tobacco Transformation Index, an initiative of the Foundation for a Smoke-Free World.
The Index was created to accelerate the reduction of harm caused by tobacco use by ranking the world’s 15 largest tobacco companies on their relative progress or the lack thereof. The first Index was published in 2020.
Presented during the recent GTNF 2022 conference in Washington DC, The 2022 Index evaluates tobacco companies’ behavior across six categories and 35 underlying indicators that cover measures indicative of harm reduction, from product sales to capital allocation and marketing policies.
Swedish Match ranked first in the 2022 Index, with Philip Morris International, Altria and British American Tobacco in second, third and fourth places, respectively; Djarum of Indonesia ranked last.
The key takeaways from the 2022 Index findings are as follows:
Only Swedish Match sells a greater volume of reduced-risk products (RRPs) than substantially more harmful combustibles, due in most part to the popularity of its snus in Sweden and non-tobacco nicotine pouches in the U.S. A key feature underpinning the Index is its adoption of the Relative Risk Assessment, based on a systematic review of scientific studies of the health risks associated with 15 nicotine products.
Four Index companies directed the majority of capital and R&D investments toward RRPs. In addition, five Index companies, including three state-owned entities, made incremental investments or early indications of movement toward future production of RRPs during the review period.
However, tobacco companies are also failing to invest in harm reduction in low- and middle-income countries, with the vast majority of sales for their RRPs concentrated in markets with the highest disposable income. One obstacle is that several countries ban RRPs.
Transformation of the tobacco industry toward harm reduction remains inconsistent and in its early stages.
David Janazzo, FSFW
“Transformation of the tobacco industry toward harm reduction remains inconsistent and in its early stages,” said David Janazzo, Index program officer and interim co-president, executive vice president of operations and finance, and chief financial officer at the Foundation for a Smoke-Free World, in a statement.
“That said, the 2022 Index demonstrates that differentiation is forming across the largest tobacco companies, related to measures of commitment, performance and transparency. While some companies are making progress, others regressed. On the whole, they are all failing to deliver outcomes toward a world in which combustible, other forms of toxic tobacco, and smoking related death and disease are eliminated, in order to accomplish the Foundation’s mission of ending smoking in a generation.
“Based on the current trajectory of smoking rates, it is estimated that by the end of the current century up to 1 billion people will die of smoking. The majority of those will live in developing countries, which is why transformation of the tobacco industry is both essential and urgent.
“It is my hope that industry leaders will take heed of the findings in the 2022 Index to push forward and intensify efforts to strengthen harm reduction strategies and tactics.”

The 2022 Index is a reminder of how far tobacco companies have to go. The differing and at times hostile regulatory standards around the world have made implementation of harm reduction more challenging, but many opportunities are not yet fully maximized.
Erik Bloomquist, chair of the Index Technical Committee
“Institutional investors such as banks and pension funds are increasingly looking at harm and harm reduction. The Index is an important tool for those investors to constructively engage and encourage change in the market,” said Erik Bloomquist, chair of the Index Technical Committee.
“The 2022 Index is a reminder of how far tobacco companies have to go. The differing and at times hostile regulatory standards around the world have made implementation of harm reduction more challenging, but many opportunities are not yet fully maximized.”
The 2022 Tobacco Transformation Index can be accessed at www.tobaccotransformationindex.org
October 2, 2022
Leadership Transition at Smoke-Free Foundation

From left to right, Derek Yach, David Janazzo and Heidi Goldstain
Foundation for a Smoke-Free World today announced that Derek Yach will no longer serve as president and board director. Heidi Goldstein, general counsel, and David Janazzo, chief financial officer and executive vice president of operations and finance, will serve as interim co-presidents, effective immediately, while the board conducts a search for a new president to lead the foundation and its vital mission forward.
“After careful consideration, the board has determined that now is the right time for a new leader to guide the essential efforts of the Foundation, its team and its work with partners around the world,” said Pamela Parizek, chair of the Foundation’s board of directors, in a statement. “As we continue to take urgent action to accelerate progress toward ending smoking in this generation, we look forward to this opportunity to take the Foundation to the next level of achievement.
“The Foundation remains squarely focused on its mission to improve global health by reducing death and disease caused by smoking, and Heidi and David, together with the rest of our talented team, will continue advancing our global research grantmaking, range of innovative programs and powerful public health collaborations without interruption.”
Parizek continued, “On behalf of the board, I want to thank Derek for helping to establish and build the Foundation. We deeply appreciate the contributions he has made to this team’s work and to communities around the world through decades of ground-breaking efforts in tobacco control and public health. We wish him all the best.”
“The Foundation’s ongoing work to end the world’s largest single preventable cause of death could not be more needed today,” said Yach. “I leave the Foundation with deep satisfaction that we now have an emerging cadre of hundreds of researchers, advocates and industry scientists dedicating themselves to this goal. My future efforts aim to complement them.”
October 25, 2021
Foundation Urges Smokers to Quit/Switch
Photo: auremar
Ahead of World No Tobacco Day (WNTD) on May 31, the Foundation for a Smoke-Free World (FSFW) is urging smokers to quit or switch to harm-reduction products.
The fact that more than 1 billion people still smoke and 8 million annual deaths are attributed to tobacco use proves that health policies and actions have been inadequate, according to the FSFW.
“The challenges that smokers face when trying to quit have been largely ignored,” the foundation wrote in a press note. “The calls by the World Health Organization (WHO) for smokers to quit using fairly ineffective interventions suggest we need new approaches. Technology innovation, in the form of harm reduction, offers a new way forward for smokers that complements classic cessation efforts.”
“Since my involvement in the first WNTD in 1988, we have focused narrowly on cessation, often without engaging smokers in developing ways they feel work best. Too many efforts have failed because they have not addressed the fact that while many smokers want to quit, they are not being presented with options that appeal to them,” said Derek Yach, president of the FSFW.
“There is growing evidence that a range of harm reduction products, including e-cigarettes (vapes), snus, nicotine pouches and heated-tobacco products, can help smokers quit or at least substantially reduce their harmful exposure to combustible cigarettes. The WHO, supported by heavily funded Bloomberg Philanthropies grantees, continues to blindly ignore scientific evidence, vilifying these products instead of promoting their use to save lives.”
The FSFW cites a study published this week in The Lancet in which the authors say the current level of tobacco control policy implementation is insufficient in many countries around the world and that evidence-based policies are needed to reduce smoking. According to the foundation, the study ignores the role for tobacco harm-reduction (THR) products as part of tobacco control policy.
“This study was funded by Bloomberg Philanthropies, which does not support the use of THR products as cessation aides,” said Yach. “This is likely one reason why they were not included in the report. Denying the value and benefits of THR products is irresponsible and blatantly discounts the research showing they can help smokers quit.”

There is growing evidence that a range of harm reduction products, including e-cigarettes (vapes), snus, nicotine pouches and heated-tobacco products, can help smokers quit or at least substantially reduce their harmful exposure to combustible cigarettes.
Derek Yach, president, FSFW
By contrast, The U.K. Royal College of Physicians (RCP) believes THR products should play a prominent role in tobacco control. In a recently released report, “Smoking and health 2021: A coming age for tobacco control?,” the RCP estimates that if the harm-reduction policies it advocated for in 1962 were adopted, smoking would have ended in the United Kingdom by now. The new report calls for doctors to play a more active role in helping their patients who smoke. “We argue that responsibility for treating smokers lies with the clinician who sees them and that our NHS [the U.K. National Health Service] should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact,” the report’s authors write. The RCP also recommends that the U.K. government invest in media campaigns to urge smokers to switch from tobacco to e-cigarettes, which are less harmful. Governments and doctors worldwide should heed their advice.
A new report by BOTEC Analysis, a public policy research and consulting firm, finds that the availability of regulated alternative nicotine-delivery systems (ANDS) like e-cigarettes and heated-tobacco products (HTPs), combined with traditional tobacco control efforts, such as tobacco taxes, smoke-free laws and cessation services, have helped to lower smoking rates in several countries. Titled “Investigating the drivers of smoking cessation: A role of alternative nicotine delivery systems?,” the report examines the policies in five countries that have long been considered international leaders in tobacco control: The United Kingdom, Canada, Australia, South Korea and Japan.
According to the FSFW, BOTEC’s key findings presented interesting results per country, including:
United Kingdom: A leader in tobacco control, the country has proactively helped smokers switch to e-cigarettes, which have been shown to be 95 percent safer than combustible cigarettes. While the country has some of the highest tobacco prices in the world, the government has chosen not to tax e-cigarettes as tobacco products, making them less costly. Access to regulated e-cigarettes appears to also support smoking cessation services.
Canada: Following the introduction of e-cigarettes in 2018, there has been a significant decline in conventional tobacco sales. As stringent regulations and higher prices apply more to traditional cigarettes than e-cigarettes, smoking rates and tobacco purchases have collapsed, especially among young Canadians. Still, the country may be poised to reverse these successes with proposed regulations that would implement a new tax on e-cigarettes and cap the nicotine content of e-liquids.
Australia: The country succeeded in driving cessation with a combination of health warnings, tax increases and effective publicity campaigns. The government has implemented de-facto bans on harm reduction products, but many Australians continue to use smuggled and unregulated e-cigarettes, reporting a desire to quit or reduce smoking as a primary motivation.
South Korea: The country has more than 250 public health centers that provide comprehensive clinical services, including counseling, prescription medication, nicotine-replacement therapy and text/email follow-ups. Over six months, more than 800,000 adult male smokers used these clinics, with an estimated 46.8 percent quit rate. Despite the South Korean government’s disapproving stance toward ANDS, both e-cigarettes and HTPs appear to be aiding cessation.
Japan: Although Japan has imposed an excise tax on cigarettes and banned e-cigarettes containing nicotine, HTPs are widely available and increasingly popular. Moreover, the uptake of HTPs appears to be causally associated with a reduction in demand for combustible cigarettes. However, a lack of regulatory distinction between HTPs and combustible cigarettes appears to limit the numbers of smokers who shift to exclusive HTP use, so their effect on cessation may be muted, thus reducing HTPs’ potential to aid smoking cessation.
BOTEC Analysis is one of several FSFW foundation grantees that are spearheading research to uncover new solutions to combat this global health epidemic. The FSFW collaborates with other nonprofit, advocacy and government organizations to advance smoking cessation and harm reduction science. The FSFW also supports the development of alternative products and methods that may reduce a smoker’s health risks and help them to stop smoking entirely.
“In light of the billion smokers that remain, one may assume that the world has made little progress since the first WNTD three decades ago,” the FSFW concluded in its press note. “Yet, from a scientific and technological perspective, we have seen profound change. As a result of transformational research and development, we now have harm-reduction products that could end death and disease from tobacco. Still, innovation translates into saved lives only when smokers have access to the full range of cessation and harm reduction options. Thus, in the same way that the foundation calls on smokers to quit, it also calls on policymakers and physicians to embrace the tools that will help them do so.”
May 28, 2021
This is a Man’s World

Photos courtesy of the Foundation for a Smoke-Free World
Bridging the gender gap will strengthen Malawi’s economy.
By Stefanie Rossel
Imagine you own a piece of land, but you are not free to decide what to grow on it. You do most of the farm work in your family, but you earn only a fraction of the income of your male partner. You lack basic reading and writing skills, and you cannot easily get a loan with the bank because you do not own assets that can be used as collateral. That’s the situation for many women in Malawi’s tobacco sector.
Women represent a little more than half of Malawi’s estimated 21.2 million people, but they provide more than 70 percent of agricultural labor in the country. Malawi is one of the poorest countries in the world, with a young, fast-growing population. Its economy is heavily based on agriculture, which contributes 90 percent of exports and represents 22 percent of gross domestic product (GDP). Productivity is below 40 percent of potential because there is limited access to modern technologies such as mechanization and irrigation as well as to competitive financing and competitive structured markets.
With tobacco accounting for 54 percent of merchandise exports in 2019 and about 15 percent of GDP according to Trendeconomy.com, landlocked Malawi is one of the world’s most tobacco-dependent economies. It is also the 11th largest tobacco producing country. Ninety-five percent of the tobacco grown in Malawi is burley, supplied mostly by smallholder farmers (80 percent). Of these, less than 10 percent are female. Tobacco marketing is managed through two systems—auction (20 percent) and contract farming (80 percent).
According to the United Nations, poverty is a gendered phenomenon in Malawi, with female-headed households disproportionately represented in the lowest quartile of income distribution. Most Malawian women working in tobacco cultivation do not own farms but work as farm laborers. “Tobacco is predominantly a man’s crop,” says Candida Nakhumwa, country director for Malawi at the Foundation for a Smoke-Free World (FSFW). “The man is the tobacco farmer. The woman and other family members just support him. It’s the man who is on the payroll, but in terms of the work on the ground, you find that the bulk of that is still performed by women. They are involved in terms of land preparation, planting, weeding and reaping of the tobacco or grading when they’ve harvested.”
In addition to their farm tasks, women spend time on childcare and household chores, such as preparing food, fetching water and collecting fuelwood. “While women are actively involved at every stage of tobacco production, they are rarely present at the marketing stage. Tobacco marketing is mainly handled by men,” Nakhumwa says. “As such, proceeds from tobacco cultivation and decisions on use of this money are mainly in the hands of the man. Even among the roughly 10 percent of women who are tobacco smallholder farmers themselves, you can still observe that when it comes to marketing of the crop, they still look for a male figure to support them.”
Because tobacco is a labor-intensive crop and most of the labor is supplied by the family members, farmers in some parts of Malawi marry a second or third wife to have more support. “The more family labor you have, the more advantage you have,” Nakhumwa points out. For the most part, education levels among female smallholder farmers are low, and that makes them more dependent on the husband, who is the bread winner.

Backbone of Agriculture
Women take on a significant part of the farm work in most tobacco-growing countries. They represent about 43 percent of the global agricultural labor force and almost 50 percent in Sub-Saharan Africa, according to a 2011 U.N. Food and Agriculture report. A 2016 study commissioned by the Public Health Institute in Oakland, California, USA, looked at the role of women in tobacco farming in China, Kenya and Tanzania. In China, the world’s largest leaf-producing country, women spend 30 percent to 50 percent of their time in tobacco farming, according to the study. This amounts to six hours to eight hours per day on average and more than 16 hours during the harvesting season. Their husbands spend only 30 percent of their time in tobacco farming.
What’s more, female seasonal workers earned less than men, the study found. In Tanzania and Kenya, both women and men spend about 40 percent to 50 percent of their time on tobacco cultivation. Awareness of the health risks of tobacco cultivation was low in all three countries, and pregnant women were often working in the field.
In contrast to their African counterparts, however, most female tobacco farmers in China were decision-makers or joint decision-makers regarding farming activities and finances. Almost 55 percent of Chinese respondents, the study states, were the sole signatory to the contract with tobacco companies, with access to bank accounts and the payment from the tobacco companies. In Tanzania and Kenya, the situation was very different, according to the study authors.

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Substantial Disparity
In Malawi, women are mostly seasonal workers providing their labor to other farms. “These women may even own a small piece of land where they can grow other crops, such as maize, groundnuts or soybeans. But if they spend more time offering themselves as casual laborers, it compromises the amount of time they can invest on their own farms,” Says Nakhumwa. “Hence, these farmers tend to be food-insecure. They are not able to produce food that will last them from one harvest to another. So the food security dynamics for women are still a challenge.”
With an average of 6.6 family members, tobacco farmer households are larger than the national average, which stands at four family members, and this also influences the food availability of farmers’ households. Malawian farmers own far less land than their counterparts in Zambia and Mozambique. Coupled with low productivity among smallholders, tobacco cultivation does not guarantee a profit if the crop is grown on less than 0.75 ha. “This is not economically viable. The land women own is even smaller—that’s why they go out and offer their labor to other farmers,” says Nakhumwa.
Most of the smallholder land in Malawi is inherited. There are two types of inheritance. In the central region and southern regions, a matrilineal society prevails, so the inheritance is through the mother. The northern region has a patrilineal system, where inheritance is through the father. However, in the central region—the hub of tobacco growing—the married woman relocates to stay at the husband’s home. “In this situation, the woman cultivates land that belongs to her husband,” Nakhumwa says. “Therefore, these women do not control land nor other productive assets. In terms of decisions on how to make use of her land, she will still be looking up to a male figure. This could be her husband, but in most cases, it will be her uncle who is considered the owner of the clan.”
The fact that the women don’t control the land ends up affecting issues such as whether they are able to access financing from a commercial bank. “If you don’t own the land, it means you cannot present it as a collateral to access finance,” says Nakhumwa. “This also limits women in terms of which part of the value chain they participate in. Tobacco is a high-input crop, so if you cannot get access to financing for inputs, then it’s no longer your preferred crop, whereas for a man, because they are controlling the land, they can easily go to the bank and get a loan.”
Men are also the ones who negotiate the contracts with leaf companies because they benefit from larger land ownership than women. To be contracted, farmers need to demonstrate that they own enough land to be able to rotate tobacco with three other crops.
The pattern of women passing on responsibility to a male figure is deeply rooted. Families will dedicate their limited resources to the education of their male child, as he is expected to take on more responsibility over the woman he will marry, while the girl child is expected to get married and be taken care of by her husband. “This is also linked to a lot of school dropouts and early marriages among girls,” says Nakhumwa. “Around 10 percent of girls are married before the age of 15. Fifteen percent are married before the age of 18.” Laws against child marriages are in place, but enforcement is weak.

Long Way to Go
On the bright side, recognition of the hazards involved in tobacco growing, such as green leaf sickness, is improving, according to Nakhumwa. More leaf companies are working to create awareness about farm safety. “In a country where more than 80 percent of tobacco is contracted, more than 80 percent of farmers should get the message,” she says. “However, mostly male farmers take part in these awareness creation meetings, so it’s up to them to inform the women at home, but it’s not the extent to which this happens.”
While many leaf companies supply their farmers with protective gear, this is helpful only if enough equipment is provided for all farm workers rather than just for the men, Nakhumwa notes. “More needs to be done for women to understand the dangers of tobacco cultivation,” she says. Yet even if women know about the risks, they will likely continue working in tobacco fields because they have few alternatives, according to Nakhumwa.
Gender equality is one of the 17 U.N. Sustainable Development Goals (SDGs) supposed to be reached by 2030, which seems like an extremely ambitious target. Much work is needed to improve the situation of women working in Malawi’s tobacco sector. “The key priority is to provide women with increased opportunities and access to quality education,” says Nakhumwa. “If they attended school longer, their decisions would be different. They’d have access to other opportunities. Furthermore, we need to empower and enable women to have access and control over factors of production such as land and competitively priced finance, among others, to help them engage effectively in agriculture. If this happens, they can be involved in production and marketing of commodities other than tobacco.
“The third area is that women need to be empowered to be involved in nonfarm activities and in decision-making to reap the benefits of the labor they are putting in and get control over the money they have made. I think education and empowerment will help us close this gender gap and also deal with issues of population in which women play a big role.”
To close the gender gap, she continues, the men need to be taken along. “If this capacity building targets both the man and the woman to help them understand how much more they can do if they work as a unit, they might embrace that. I think men will be able to support women to be better off. In some communities, men and women are supported to have a joint vision for their families—if they don’t do that, you see that they are pulling in different directions. The man needs to understand that a woman is a critical player in this field and that he cannot leave her behind.”

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Diversification is Key
Elected in June 2020, Malawi’s new government is committed to reducing the country’s dependence on tobacco. Its “Malawi Vision 2063” plan aims to turn Malawi into a wealthy, self-reliant nation. The country is also a signatory to the African Continental Free Trade Area Agreement (AfCFTA), which is estimated to boost intra-African trade by 52 percent by 2022.
“For Malawi to be successful in this, our agricultural exports need to be competitive and prioritize value addition,” Nakhumwa explains. “Otherwise, we may be the losers and fail to exploit the 1.3 billion population AfCFTA market. Further, the total value of food imports in Malawi has more than doubled between 1998 and 2020. These imports mostly consist of products from crops that the country produces itself, which is cereals and oil seeds. This demonstrates the readily available domestic market and points to some of the things we have to focus on as part of an import substitution strategy.”
To support the country in its transition toward a more sustainable, diverse agriculture sector, the FSFW awarded a grant to a consortium led by Land O’Lakes Venture 37 to set up and manage the Centre for Agricultural Transformation (CAT) in Malawi in 2019. The CAT addresses an objective of Article 17 of the Framework Convention on Tobacco Control to assist tobacco farmers in the development of alternative livelihoods. The CAT includes several initiatives such as the science, technology, innovation (STI) program and business and incubation cohort (BIC), both of which will help smallholder Malawian farmers make economically viable, data-driven decisions for diversifying their livelihoods. The center facilitates the development of new technologies, partnerships and income opportunities to help farmers achieve greater economic success in the coming years, with a special focus on women and youth. Numerous programs under the CAT are dedicated to encouraging women and youths to engage in agriculture, link up farmers to markets to sell their produce at competitive prices or training them on vital entrepreneurship.
In addition, through a policy program led by Michigan State University, FSFW is supporting targeted policy reforms while also working closely with Malawi’s National Planning Committee. Michigan State University has also supported the establishment of the Malawi Agriculture Policy Advancement and Transformation Agenda Institute. Institutions play an important role in helping women to develop a vision of what they want to do and where they want to be. Policies have been aligned accordingly, Nakhumwa says. “What we have to do as development partners is to ensure that we generate evidence that supports these policies so that governments recognize that if they change certain aspects in existing policies, women will benefit. There is need for legal review to ensure that all policy and legal instruments are tailor-made to support equality between men and women.”
FSFW is also contributing toward human capital development efforts to strengthen the capacity of researchers and professionals, both men and women, in high-priority fields that will help the country transform its agricultural sector. Scholarships have also been awarded to candidates based in Malawi who are pursuing their master’s degrees and doctoral degrees and advancing their postdoctoral research in agriculture, business, data science, economics, ecology/environment and engineering. This effort is in addition to institutional capacity building and business incubation support offered through the CAT and policy programs.
Nakhumwa says that diversification will be good because other commodities will allow women to participate in production and marketing. However, she notes, women will benefit from diversification only if certain conditions are met. “To support farmers, we need to enhance access to improved technologies for women so that they can experience increased productivity in production of the crops or livestock they will be producing. If they continue to produce at low productivity, the women will still fall behind.
“We also need to help the woman to access competitively priced finance so that when she goes to the farm, she will be able to invest the required amounts of inputs and produce the volumes and quality that she can take to the market. Through the STI and BIC pillars of the CAT, tailor-made programs have been launched for women to learn about and access improved agricultural technologies and capital as well as develop necessary technical and entrepreneurship skills to grow their businesses. Focus on women and youth is at both the enterprise level—women and youth-led agri-enterprises—and the business model level, with emphasis on women and youth inclusion.”
Other important factors include investing in labor-saving technologies as well as ensuring that women get access to structured and competitive markets as well as control over land. Nakhumwa emphasizes that to benefit from diversification, the woman needs to be empowered to upgrade in the value chain.
“Instead of being laborers only, women need to be supported to own strategic factors of production and begin to add value to what they are producing to maximize the value they earn from their efforts. I also believe that when these women farmers are organized in groups, they can benefit from economies of scale. They can easily be taught new technologies and management practices. Finally, we need to deal with cultural barriers that exist so that even in these new commodities, the woman is treated like an equally important partner.”

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Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

May 1, 2021
Wake-Up Call

Derek Yach
To speed up the demise of combustible cigarettes, the Framework Convention on Tobacco Control needs serious modifications, says Derek Yach.
By Stefanie Rossel
The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) made headlines on its 15th anniversary in 2020. Unfortunately, the news was not that it was an overwhelming success but that progress toward getting rid of combustible tobacco was slow. Over the past two decades, overall global tobacco use has fallen, from 1.397 billion in 2000 to 1.337 billion in 2018, or by approximately 60 million people, according to the WHO. Eight million people still die every year from tobacco-related diseases. Critics warn that if the FCTC doesn’t modernize, a smoke-free world will remain a distant goal.
“The FCTC remains essentially frozen in time,” says global health expert and anti-smoking advocate Derek Yach, founder and president of the Foundation for a Smoke-Free World (FSFW). As a cabinet director and executive director of the WHO, Yach was instrumental in the development of the FCTC. “With the FCTC, which is a fairly ambitious document, we achieved our first goal to put tobacco use on a much higher footing within global health—and it has had its impact,” he continues. “In the late 1990s, global health meant infectious disease control to most people, and now it includes noninfectious diseases as well, such as heart disease, diabetes, cancer and mental health. Smoking prevalence has started to decline slowly in some parts of the world, although there are still countries where smoking rates are extremely high and rising.”
Eighty percent of the world’s smokers live in low-income and middle-income countries (LMICs). Applying the FCTC to these regions is the biggest challenge of the treaty, Yach says. “When looking at the single most impactful component of the framework convention—increased excise taxes—most LMICs have yet to even partially meet FCTC targets.
“I suspect this has to do with the universal problems of treaties. It’s nice to sit in Geneva and think about what laws will work in developing countries. If you take your examples from advanced industrialized countries instead of understanding the harsh realities of adapting regulations in poor countries where enforcement potential is low and political priorities are very different, things are a lot easier. In countries such as India or Indonesia or certain parts of Africa, we have not seen success, mainly because there’s weak legal enforcement on the tax side, a lot of corruption in the system and no political will or capacity to put smoke-free public policies in place. Some of the marketing bans have worked, but the tobacco industry continues to interfere with legislation in many countries, and this undermines anti-smoking laws.” Yach predicted that, even if the full range of FCTC recommendations was implemented, annual smoking-related deaths would still increase to 10 million by 2030.

Framework deficiencies
One challenge is that 17 of the FCTC’s signatories own significant shares in tobacco companies. These companies account for almost 50 percent of the global tobacco industry (see “The Contortionists,” Tobacco Reporter, January 2021). They tend to have a real conflict between their revenue and tax-raising needs, and a need to reduce the health effects of tobacco. Other shortcomings include the FCTC’s neglect of adult tobacco consumers who are trying to quit, which contributes to smoking rates staying high. “If you only focus on children not taking up smoking, you will see health benefits 50 years from now, but we want that impact in 15 [years] to 20 years,” Yach says. “For that to occur, better cessation strategies and the global rollout of harm reduction products are critical.”
FCTC recommendations that weakly impact tobacco use, such as health warnings on cigarette packs, have been widely introduced. Cessation assistance has not been promoted, and there is only slow implementation of the FCTC’s Articles 17 and 18, which stipulate the need to develop alternative livelihoods for tobacco farmers. Governments have also not been willing to hold the tobacco industry accountable for its actions, which is specified by the FCTC’s article 19.
Finally, promoting tobacco harm reduction (THR) products, which was part of tobacco control efforts in 2003 when the FCTC was drafted, remains undeveloped and currently only includes nicotine-replacement therapy (NRT). One reason for this is that governments remain deeply suspicious of tobacco industry claims that their new products will cut death and disease. Governments are also unwilling to seriously consider industry research, which they think is self-serving.
However, an examination of scientific output and patent filings shows that current research, regardless of the sponsor, is leading to new technologies capable of transforming the industry. “When we drafted the FCTC, we never anticipated this and as a result neglected the role of intellectual property rights,” says Yach. “At the time, we did not think something innovative and lifesaving could come out of tobacco companies, so why bother about intellectual property? How wrong we were!”
Filling the gaps
A nonprofit organization established in 2017, the FSFW aims to accelerate progress. The FSFW focuses on identifying and filling gaps in FCTC implementation and transforming the tobacco industry. It has developed a three-year strategic plan around three pillars—health, science and technology; agriculture and livelihoods; and industry transformation.
The FSFW’s approach and philosophy differ substantially from other philanthropies that support the FCTC. Yach pointed out that Bloomberg and the Gates Foundation support selected elements of the FCTC but actively back campaigns against THR products. “We’ve been very clear that we support provisions that children should never vape or smoke. However, our main objective is to help adult smokers quit by making cessation aids accessible and to support adult smokers switching to approved harm reduction products. These include snus, e-cigarettes, heated-tobacco products and nicotine pouches,” says Yach. “In the long term, tackling cessation together with harm reduction is the only way to bring smoking rates down relatively soon. If today’s adult smokers quit or switch, even into their fifties or sixties, they will see improvements in their quality of life.”
The FSFW strongly believes in investing in building research capacity in the nations in which it is doing research. No other major funders do this. “The health of a whole country improves when it has strong national scientific research capacity,” says Yach. “The scientists in a country become advocates for good policy in time, whereas keeping the money in the U.S., or doing all the work there and flying the experts in, undermines the development of tailored solutions that actually work.”
As the FSFW’s first strategic plan comes to an end, Yach says the Foundation is pretty much on target. “We have created a network of outstanding grantees who are producing work and scientific research that did not exist before, such as the second issue of the Global State of Tobacco Harm Reduction (GSTHR), which was released in November 2020.” (See “Uphill Struggle,” Tobacco Reporter, December 2020.)
In polls, the FSFW has tried to assess how important people’s perceptions of risk are to ending smoking. “We found out that knowledge of the risks of smoking is good in most countries but not in countries such as India or South Africa,” says Yach. “The intention to quit is often very high, but the resources available to [smokers] to do so successfully is often low. Access to NRT and reduced-risk products (RRPs) is almost zero in LMICs, yet we know that the countries doing best, such as the U.K. or Japan, are not just providing good cessation services and high-quality harm reduction alternatives, they are also helping smokers get access to these products, which is a big missing element in other countries. Our polls, however, show that more people now believe that nicotine causes cancer than they did two years ago. It does not. That view impedes smokers switching to reduced-risk tobacco products.”
Tools to drive change
The FSFW is supporting three institutions to drive change: the Center of Excellence for the Acceleration of Harm Reduction at the University of Catania in Italy; the Center of Research Excellence: Indigenous Sovereignty & Smoking in Auckland, New Zealand; and the Rose Research Center in North Carolina in the United States. Led by Jed Rose, co-inventor of the nicotine skin patch, the Rose Center is working on novel compounds and innovative treatments to improve the efficacy of smoking cessation therapy and harm reduction products.
The publication of the first Tobacco Transformation Index (see “Incentivizing Transformation,” Tobacco Reporter, April 2020) was another milestone. The index will help investors get a good idea of what tobacco companies are actually doing to address the health impacts of tobacco use, which will guide their investment policies. “For the investor, the question is where do I place my money to maximize my return and also maximize my impact on the environment and health,” says Yach. “We think the Tobacco Transformation Index is helpful guidance for them.”
The FSFW also has a hands-on approach to the FCTC goal of creating alternative livelihoods for tobacco farmers. It has set up the Center for Agricultural Transformation in Malawi, one of the most tobacco-dependent countries in the world. According to trendeconomy.com, unmanufactured tobacco accounted for $498 million, or 54 percent percent, of Malawi’s merchandise exports in 2019.
“Malawi has had a change in government, and the new administration is deeply committed to reducing dependence on tobacco,” Yach says. “We have signed a memorandum of understanding with the government and the National Planning Committee on accelerating alternatives and have created and supported the first National Policy Center that brings together government, industry, NGOs and academics. We support entrepreneurial agriculturalists, smallholder farmers and women. As a result, there have been new vegetable and dairy production projects as part of a broader portfolio. We see an upward movement, not only in agriculture, but in the economy.” The foundation is currently building a campus at Malawi’s major national agricultural university.
Challenging the COP9
The Foundation has many new research projects in the pipeline and will focus even more intensely on how change can be fast-tracked, how to counter misinformation on THR products and how to connect with doctors and health professionals in 2021, Yach says. Certainly the most important event this year is the Ninth Session of the Conference of the Parties to the FCTC (COP9), which had to be postponed until November of 2021 because of the Covid-19 pandemic. Article 28 of the FCTC addresses amendments to the convention. In a 2020 article published in Drugs and Alcohol Today, Yach provided a detailed agenda on how COP9 could modernize the FCTC, principally by a change in philosophy.
“I hope that the FCTC will align its policy to where the science is going, which would mean creating policies and actions that support harm reduction,” says Yach. “In addition, we seek progress on smoking cessation. It is long overdue that the COP discuss the pricing and availability of THR products in LMICs. I suspect many governments are likely to reverse their initial reactions to THR products based on emerging science and in response to the U.S. Food and Drug Administration’s decisions related to snus and IQOS. Historically, U.S. FDA decisions have been regarded as the gold standard of norm setting. That should be as true for THR products as it is for pharmaceuticals, vaccines and food.”
Yach is confident that even FCTC article 5.3, which excludes the tobacco industry and those it funds from the dialogue, might be overcome. The FSFW was immediately boycotted by the WHO because, even though the organization is independent, it receives funding from Philip Morris International Global Services.
“The voices [against dialogue with the tobacco industry] are loudest from a very small group of people who grew up in tobacco control decades ago and got stuck in their careers with a very strong view,” says Yach. “However, there’s a new generation coming out of new areas of science and IT. They look at science in a different way than we did. They believe in private partnerships. They seek real change and not endless rhetoric. They are less interested in what the tobacco industry did decades ago than in what it can do today to save their mother or father.”
Because there is no internationally accepted research agenda on smoking reduction, there are significant research gaps in many countries and scientific fields, and most of them center around THR products. Yach thinks these products must be incorporated into the FCTC, and he indicated that the foundation is leading efforts to define research that could improve tobacco harm reduction in any way and guide and accelerate the end of smoking. Addressing these gaps will involve people in academia, regulatory bodies and industry. The list should be completed later this year.
“My view is that there will be an inevitable rise in the use of THR products and a decline in the use of combustible cigarettes. My hope is that we can speed that process up. If we do that, 3 million to 4 million tobacco-related deaths could be avoided every year over the next four decades. It’s worth pushing hard to achieve that goal.”
Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

February 1, 2021
Foundation to Probe Menthol Bans and Social Justice

Photo: Viachaslau Bondarau | Dreamstime.com
The Foundation for a Smoke-Free World has begun a series of surveys analyzing the behaviors of adult smokers in several countries before and after the EU menthol cigarette ban that came into force on May 20, 2020.
While there is solid science to suggest that a ban of menthol combustible cigarettes would ultimately improve public health, the foundation says it is crucial that legislation does not put already vulnerable communities in even greater danger.
The organization hopes that the findings from its survey will help inform other jurisdictions considering similar measures.
Last November, Massachusetts became the first U.S. state to ban the sale of menthol cigarettes. And in February of this year, the House of Representatives approved a bill to eliminate the sale of these cigarettes at the federal level.
Yet many researchers point out that the use of menthol cigarettes is disproportionately high among U.S. ethnic minority groups, especially African Americans. Democratic Congresswoman Yvette Clarke noted that nationwide menthol bans would have little effect on white smokers, while “black smokers could face even more sweeping harassment from law enforcement if the hint of menthol smoke can justify a stop.”
June 9, 2020
Poll: Lockdowns Boost Smoking

Image by Free-Photos from Pixabay
A new poll from the Foundation for a Smoke-Free World shows that the lockdowns and stay-at-home orders put in place to prevent the spread of the coronavirus have led to higher smoking and tobacco usage rates.
“Nearly 40 percent of smokers increased use of these products in recent weeks, which could equate to elevated use by more than 50 million smokers in the five countries polled,” according to a press release. Smokers have upped their tobacco and nicotine usage as a way to cope with stress and mental health issues during the social distancing orders.
The survey looks at tobacco and nicotine users in the United States, the United Kingdom, Italy, South Africa and India. Rates of tobacco usage rose more in countries where the sale of tobacco products has been banned due to the virus outbreak, such as South Africa and India.
Derek Yach
“When this pandemic curve subsides, there will be a heavy mental and physical toll on all people,” said Derek Yach, president of the foundation. “Prior to the Covid crisis, smokers were at greatest risk of lung cancer, chronic lung disease and heart attacks. They will continue to have these excess risks as the pandemic recedes. Never forget that 7 million people will die globally this year as a result of their tobacco use.”
May 12, 2020