The World Health Organization has released a comprehensive set of tobacco cessation interventions, including behavioral support delivered by healthcare providers, digital cessation interventions and pharmacological treatments, in its first guideline on tobacco cessation.
The guideline focuses on helping tobacco users who want to quit all forms of tobacco. The recommendations are relevant for all adults seeking to quit various tobacco products, including cigarettes, water pipes, smokeless tobacco products, cigars, roll-your-own tobacco and heated-tobacco products.
“This guideline marks a crucial milestone in our global battle against these dangerous products,” said Tedros Adhanom Ghebreyesus, WHO director-general. “It empowers countries with the essential tools to effectively support individuals in quitting tobacco and alleviate the global burden of tobacco-related diseases.”
“The immense struggle that people face when trying to quit smoking cannot be overstated,” said Ruediger Krech, director of health promotion at the WHO. “We need to deeply appreciate the strength it takes and the suffering endured by individuals and their loved ones to overcome this addiction. These guidelines are designed to help communities and governments provide the best possible support and assistance for those on this challenging journey.”
Ada Moadsiri, World Health Organization representative in Cambodia, called for an increase in the special tax on cigarettes in the kingdom, reports the Khmer Times. According to Moadsiri, the current tax is not enough to discourage cigarette use or to raise enough revenues to offset the cost in terms of healthcare and economic output caused by tobacco-related illnesses.
Moadsiri said, at the Youth Forum on Tobacco Tax Measures event, that an effective increase in the special tax would require stakeholders to keep cigarette prices higher and make it more difficult for Cambodians to start smoking.
“We see that this delusion of the tobacco industry that claims that raising taxes on cigarettes will lead to tax evasion is fake, and I think the tobacco industry uses these fantasies for the sole purpose of preventing or delaying the special tax on cigarettes,” Moadsiri said.
A new World Health Organization report shows that tobacco use continued to decline in 2022, with one in five adults consuming tobacco compared to one in three in 2000, according to the WHO.
According to the report, 150 countries are successfully reducing tobacco use.
“Good progress has been made in tobacco control in recent years, but there is no time for complacency,” said Ruediger Krech, director of the WHO Department of Health Promotion. “I’m astounded at the depths the tobacco industry will go to pursue profits at the expense of countless lives. We see that the minute a government thinks they have won the fight against tobacco, the tobacco industry seizes the opportunity to manipulate health policies and sell their deadly products.”
The WHO report shows that six countries continue to see an increase in tobacco use: Congo, Egypt, Indonesia, Jordan, Oman and the Republic of Moldova. The WHO is urging countries to continue putting in place tobacco control policies and to continue fighting against tobacco industry interference.
In February, countries are set to meet in Panama for the 10th session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control, where the WHO claims the tobacco industry will attempt to influence countries’ tobacco control policies.
The World Health Organization (WHO) has released a new technical manual on tobacco tax policy and administration that shows countries ways to cut down on more than $1.4 trillion in health expenditures and lost productivity due to tobacco use worldwide.
According to the global health body, improved tobacco taxation policies can also be a key component of “building back better” after Covid-19, where countries need additional resources to respond and to finance health system recovery.
“We launched this new manual to provide updated, clear and practical guidance for policymakers, finance officials, tax authorities, customs officials and others involved in tobacco tax policy to create and implement the strongest tobacco taxation policies for their specific countries,” said Jeremias N. Paul Jr., unit head for the fiscal policies for health team in the health promotion department at the WHO.
“We hope this document sheds light on the significant advantages to raising tobacco taxation. The data and insights provided here should be an eye opener for policymakers worldwide,” he said.
Only 14 percent of the world has enough tax on tobacco, according to the WHO.
“In 2018, only 38 countries covering 14 percent of the global population had sufficiently high tobacco taxes—which means taxing at least 75 percent of the price of these health-harming products,” the organization wrote in a press note. “By implementing proven policies like tobacco taxes, the costs created by the tobacco industry to local communities and nations can be avoidable. It is a win for population health, revenue and for development and equity.”
Millions of vapers could feel forced to return to smoking if national governments adopt a proposal from the World Health Organization (WHO) on e-cigarettes, warns the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA)
A new report published by the WHO’s tobacco regulatory committee recommends nearly all vapes—especially “open systems”—be banned. It also demands existing restrictions on cigarettes be applied to emerging products, presumably so smokers won’t learn about them.
In the open system, which is the preferred way of vaping for many people across Asia, the consumer manually refills the liquid to be vaporized. According to the WHO, this system allows for the addition of substances that could make the product more harmful.
“The latest recommendation from WHO defies all logic,” said Nancy Loucas, the executive coordinator of CAPHRA, in a statement. “If countries adopt the recommendation to ban open system vapes, years of hard work by ex-smokers as well as good public policy will be rendered meaningless.”
“Let there be no doubt: Vapers will then go back to cigarettes, which is the worst possible outcome.”
“Banning any product is not the answer nor is applying blanket cigarette rules to all emerging products. Bans encourage the black market. Bans do not allow for proper consumer protection,” Loucas said.
CAPHRA is calling on governments to adopt evidence-based, common sense regulations for all vaping products.
“Just last week, the U.K.’s leading health agency, Public Health England (PHE), concluded that nicotine vaping products were the most popular aid used by smokers trying to quit,” Loucas said.
“On the one hand, you have a local public health agency looking into the evidence and ways in which smokers can be encouraged to quit smoking and vape, and on the other, you have a global agency stuck in their old ways of believing prohibition is the answer to everything.”
“WHO’s attitude to e-cigarettes has been devastating for millions and millions of smokers and vapers alike all around the world,” Loucas said.
CAPHRA said it’s only through regulating products that vapers can remain protected, encouraged to stop smoking and, as a result, achieve good public health outcomes.
Committing to the FCTC objectives while manufacturing cigarettes requires extraordinary moral acrobatics.
By Stefanie Rossel
Since entering into force in 2005, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) has suffered from an inherent, difficult-to-reconcile conflict: While the treaty requires signatories “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure,” 17 of its 182 member states own at least 10 percent of a tobacco company.
Eight countries—China, Iran, Iraq, Lebanon, Syria, Vietnam, Thailand and Tunisia—own 100 percent of at least one tobacco company. Together, these states control almost 50 percent of the global tobacco industry by volume. In Algeria, Bangladesh, Egypt, India, Japan, Laos, Malawi, Moldova and Yemen, governments own between 13 percent and 91 percent of tobacco companies (Cuba’s tobacco industry is around 75 percent state-owned, but the country has declined to sign the FCTC).
Daniel Malan
“It is not unlawful to sign a convention that requires you to oppose something that you also support, but it is unethical,” says Daniel Malan, assistant professor in business ethics at Trinity Business School, Trinity College Dublin. “Imagine an international convention against drug trafficking that allows some organs of state to be involved in the activities that it tries to prevent.”
During the 2020 Global Tobacco & Nicotine Forum, Malan presented a study, “Contradictions and Conflicts,” highlighting the issue. The conflict, he states, is one reason that at 0.25 percentage point per year, the decline of global cigarette consumption since 2000 has been disappointing.
FCTC Article 5.3, Malan argues, follows a flawed logic: It requires parties to protect their policies against the commercial and vested interests of the tobacco industry. If a party has a vested interest in the form of a state-owned tobacco company (SOTC), it is obliged to follow Article 7.2 and ensure that any investment in the tobacco industry does not prevent it from fully implementing the FCTC. To achieve this, however, such a party must protect its policies against the commercial and vested interests of the tobacco industry—which is where the circular argument comes to its close: The government cannot have an investment in tobacco.
Since its inception, Article 5.3 has become a public health dogma, considered so important that it has been enriched with implementation guidelines, handbooks and “toolkits” as well as a knowledge hub in Thailand. But even in their most recent version, published in September 2018, the recommendations for governments with SOTCs remain vague. The WHO also fails to address the issue in its reports on the “global tobacco pandemic.” The 2019 edition, Malan notes, makes more than 20 references to companies such as Philip Morris International and British American Tobacco, each of which holds 14 percent of the world’s cigarette market but never mentions the China National Tobacco Corp. (CNTC), which with a global market share of 44 percent is by far the world’s largest tobacco company.
With a global market share of 44 percent, the China National Tobacco Corp. is the world’s largest tobacco company by a wide margin. (Photo: Taco Tuinstra)
Ethically undesirable, economically viable
Why the FCTC was shaped that way is anybody’s guess, but an international treaty excluding countries representing only half of the globe’s smoking population would have looked feeble. “Perhaps that conflict wasn’t a priority in the bigger picture,” speculates Malan. “Or they wouldn’t want to alienate governments and exclude China as the biggest one. It’s a Catch-22 situation.”
There is evidence that the WHO is aware of that contradiction; in 2015, the director of the WHO’s regional offices in the Philippines in Tobacco Control commented on a study of the subject published by Scott L. Hogg and others from the College of Medicine and Veterinary Medicine of the University of Edinburgh. However, the WHO declined an interview request by Tobacco Reporter.
Arguing that from an ethical viewpoint it is undesirable for governments to be invested in tobacco, Malan looks at the business case, i.e., whether it makes commercial sense for governments to own tobacco companies. Most of the 17 tobacco-invested FCTC members can be classified as middle income. Japan, of course, is high income and Malawi is low income.
Due to the sheer size of its tobacco industry, China is an outlier in the group. According to 2019 WHO data, the country generates $200.4 billion from tobacco tax. Malan believes that actual figure is around 30 percent higher because the WHO estimate excludes excise duties, value-added taxes and import duties, among other taxes. China is followed by Japan ($17.78 billion), India ($2.87 billion), Bangladesh ($2.65 billion), Egypt ($2.36 billion), Algeria ($2.11 billion) and Thailand ($2.1 billion).
In Bangladesh (0.97 percent), Egypt (0.94 percent), Algeria (1.22 percent), Tunisia (1.08 percent) and Moldova (0.93 percent), tobacco tax accounts for at least 1 percent of the gross domestic product (GDP), according to WHO data from 2019. With 1.47 percent of its GDP, China again leads the group.
Malan also investigates how the 17 countries with tobacco monopolies have implemented FCTC rules. FCTC signatories are required to report biannually to the WHO on their progress. In the most recent round of country submissions, Algeria, China, Japan and Moldova failed to provide updates on the headway they made implementing Article 5.3.
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Different paths
So how could the conflict in the FCTC be resolved? A rewording of Article 5.3 is unlikely because changes to the FCTC require agreement from all parties, including those with state-owned tobacco companies. Whether the subject will be brought up during the next FCTC Conference of the Parties (COP9) in November 2021 remains to be seen.
For his 2015 research, Hogg investigated whether tobacco industry ownership represents a conflict of interest or an opportunity for tobacco control. Hogg offers three perspectives on the conflict of interests. In an “intrinsic or fundamental conflict,” governments relying on the income from tobacco companies will be less inclined to implement tobacco control policy. While in such cases privatization of SOTCs may appear as the most appropriate policy response, past SOTC privatizations, Hogg argues, have resulted in these companies being more successful businesses, thus doing a disservice to tobacco control efforts.
The “institutionally mediated conflict” relates to the tension created by the dual responsibility of managing a state-owned company and implementing tobacco control policies at the same time. China, where the State Tobacco Monopoly Administration (STMA) is responsible for industry-related aspects as well as coordinating the implementation of the FCTC, is an example of such a conflict. The dispute could be potentially mediated by institutional arrangements, such as a firewall between different government institutions, an approach for which Thailand is often praised as a best-practice example (the country is nevertheless expected to fail the WHO’s voluntary target of a 30 percent relative reduction in smoking by 2025).
A third, less prominent perspective, which Hogg calls “interest alignment,” suggests that governments owning tobacco companies radically alter their approach, allowing public health interest to override the commercial interest to advance tobacco control.
In his report, Malan highlights another potential pathway for change, a pragmatic option that he calls “shift gear.” It entails an acknowledgement of the existing conflicts of interest and a commitment to manage them. This would allow governments to make decisions without considering short-term financial performance as publicly traded companies must do. They could potentially transform the tobacco industry by being more innovative, Malan says, for example by focusing on tobacco harm reduction (THR). At the time the FCTC was created, THR was an underdeveloped area extending only to nicotine-replacement therapy and snus, but 15 years on, there are a large variety of electronic nicotine-delivery systems (ENDS) and other reduced-risk products, such as new oral nicotine, available.
Eleven of the 17 FCTC signatories with SOTCs permit sales of e-cigarettes containing nicotine. Japan allows only sales of nicotine-free e-cigarettes. Five of these countries ban e-cigarettes; China prohibits online sales. Given the WHO’s anti-THR attitude, it’s surprising that there aren’t more bans. “For the WHO, it is difficult to acknowledge that something less harmful that could have a positive impact could come out of the tobacco industry,” says Malan. Massive funding from “philanthrocapitalists,” such as Michael Bloomberg and Bill Gates, sustain the WHO’s anti-THR stance (see “Uphill Struggle,” Tobacco Reporter, December 2020).
Tobacco continues to play a prominent role in Chinese social interactions. (Photo: Tobacco Reporter acrhive)
The case of China
Due to its sheer size, China represents the greatest opportunity to resolving the conflict of interest—and the greatest challenge. According to the most recent available WHO data—from 2014—the negative effects of tobacco consumption cost the country $57 billion. They are dwarfed, however, by the value of China’s tobacco industry, which is estimated at at least $14 trillion.
“In my view, it’s unlikely to see the Chinese government to change its stance towards tobacco control to a significant degree in the near future, although they have implemented some tobacco control policies,” says Amei Zhang, China analyst at TMA. “The major reason is that the Chinese tobacco sector has maintained its monopoly system for making huge fiscal contributions that the central government has highly depended on over the past decades.”
Besides, tobacco continues to play a prominent role in Chinese social interactions. Zhang cites a 2006 study comparing smoking behavior across 22 countries. Uniquely among the surveyed cultures, 40 percent of Chinese smokers reported carrying two packs of cigarettes with them—one for themselves and the other for social uses. “As you can imagine, cigarettes for socialized purpose are more expensive,” says Zhang.
Zhang doesn’t see any signs that Thailand, where two separate authorities oversee tobacco control and tobacco manufacture, could become a role model for China. “The STMA and the CNTC are two agencies with one set of people. The tobacco authority may be the only authority in China that has not been separated from the enterprise yet,” she explains.
In 2007, China established the Inter-Ministerial Coordination Leading Group for the Implementation of the Framework Convention on Tobacco Control. The group originally comprised eight government institutions: the Development and Reform Commission; the Ministry of Health; the Ministry of Foreign Affairs; the Ministry of Finance; the General Administration of Customs; the State Administration for Industry and Commerce; the General Administration of Quality Supervision, Inspection and Quarantine; and the State Tobacco Monopoly Administration.
“This arrangement has received fierce criticism from tobacco control people,” says Zhang. “Tobacco control experts suggest that the tobacco industry’s interference with tobacco control must be eliminated and that the tobacco industry should separate the administration from the enterprise; they suggested that the composition of the inter-ministerial coordination leading group for the implementation of the FCTC should be adjusted, and when CNTC and STMA still combine, the STMA should withdraw from the coordination mechanism for the eight ministries and commissions on tobacco control compliance.”
Yet, more than a decade later, the STMA is still on the tobacco control leading group. “This means that those who produce and sell cigarettes will still participate in tobacco control,” says Zhang. She is more optimistic about THR. The Chinese government encourages its affiliated tobacco companies to produce less harmful cigarettes, Chinese herb cigarettes and heat-not-burn products, but at the same time it bans the online sale of vapor products.
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Wanted: an FCTC update
To cut the FCTC’s Gordian knot, Malan acknowledges that there is no one-size-fits-all option. “China is very different from any other country in its state control, centralized planning and looking ahead 30 [years] to 50 years,” he says. “What might be more pragmatic could be a plan that doesn’t fit exactly into the FCTC but fits their plans.”
The shift from combustible cigarettes to reduced-harm products, he argues, will ultimately be determined by consumer preferences. “First and foremost, consumers need accurate and reliable information to be able to make informed decisions,” says Malan. “This seems more likely in advanced democracies like Japan. However, the impact of long-term centralized planning could also be positive in terms of tobacco control, provided that responsible decisions are made. Behavior change will always depend on both carrots and sticks, and it is difficult to make general recommendations when the contexts are radically different.”
To move forward, he suggests that a neutral body establish a platform acceptable to public health advocates to invite potentially objective organizations willing to discuss. The aim should be to create a group of interested stakeholders who could then put together a paper ahead of COP9 to put forward amendments to the FCTC. “If it’s a solid proposal from independent agents, it will be hard to ignore. I believe that there should be an effort to amend the FCTC to reflect a new context. If there is sufficient commitment from all stakeholders, this is not unthinkable. But it will require pragmatism from all, and the creation of a negotiating platform acceptable to all, which will not be easy.”
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.
The World Health Organization (WHO) has reminded its member states of their tobacco obligations under the Framework Convention of Tobacco Control (FCTC) in relation to heat-not-burn products (HNB).
“Heated tobacco products are tobacco products, meaning that the WHO FCTC fully applies to these products. [Rules] obliges Parties, to prohibit ‘all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any means that are false, misleading or deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions,” the health body wrote in a statement.
The WHO claims that reducing exposure to harmful chemicals in HNB products does not render them harmless, nor does it translate to reduced risk to human health. “Indeed, some toxins are present at higher levels in [HNB] aerosols than in conventional cigarette smoke, and there are some additional toxins present in [HNB] aerosols that are not present in conventional cigarette smoke,” the WHO wrote. The organization also claims that the health implications of exposure to HNB products are unknown.
The WHO statement comes after the U.S. Food and Drug Administration (FDA) authorized Philip Morris International to make a modified exposure claim about its IQOS HNB device in the United States.
The WHO says there is no proof that HNB products are safer than cigarettes. “Given that health may be affected by exposure to additional toxins when using [HNB], claims that [HNB] products reduce exposure to harmful chemicals relative to conventional cigarettes may be misleading.
“Moreover, the relevant orders grant a temporary market authorization within the U.S. and are based on factors specific to the US, which is not a Party to the WHO Framework Convention on Tobacco Control.”
It’s official. The Trump administration has withdrawn the United States from the World Health Organization. The news comes as the Covid-19 pandemic continues to grip the globe and infections spike across the U.S.
Withdraw requires a years notice, so it will not go into effect until July 6, 2021. This raises the possibility the action could be overturned.
Congress received formal notification of the decision on Tuesday, more than a month after President Donald Trump announced his intention to end the U.S. relationship with the WHO and blasted the multilateral institution as a tool of China, according to an article in USA Today.
Democrats said the decision was irresponsible and ill-considered, noting it comes as the pandemic is raging and international cooperation is vital to confront the crisis.
“This won’t protect American lives or interests – it leaves Americans sick & America alone,” Sen. Bob Menendez, the top Democrat on the Senate Foreign Affairs Committee, tweeted after receiving the White House’s notification. “To call Trump’s response to Covid chaotic & incoherent doesn’t do it justice.”
The formal withdrawal comes as the United States nears 3 million reported coronavirus cases and more than 130,000 deaths, according to Johns Hopkins University data. Globally, there have been 11.6 million cases and almost 540,000 deaths, according to the story.
Trump and his advisers have blasted the WHO for failing to press China to be more transparent about the scope and severity of the Covid-19 outbreak, which began in Wuhan, China.
Trump has said that China “has total control” over the WHO, even though it contributes far less than the US to the health organization’s budget. The U.S. has contributed approximately $450 million dollars a year, according to the story.
Amanda Glassman, a public health expert and executive vice president of the Center for Global Development think tank, noted the world doesn’t just face today’s threat of Covid-19 but also the threat of future pandemics, which are more likely because of increased zoonotic transmission.
President Donald Trump said Friday that the U.S. will be terminating its relationship with the World Health Organization. He said that the UN agency failed to adequately respond to the coronavirus because China has “total control” over the global organization.
He said Chinese officials “ignored” their reporting obligations to the WHO and pressured the WHO to mislead the world when the virus was first discovered, according to an AP story.
He noted that the U.S. contributes about $450 million to the world body while China provides about $40 million.
The U.S. is the largest source of financial support to the WHO and its exit is expected to significantly weaken the organization. Trump said the U.S. would be “redirecting” the money to “other worldwide and deserving urgent global public health needs,” without providing specifics.
The World Health Organization (WHO) has published three reports to inform countries on the current state of scientific knowledge and policy options available for novel tobacco products such as electronic nicotine delivery systems (ENDS), electronic non-nicotine delivery systems (ENNDS) and heated tobacco products (HTPs).
ENDS and ENNDS, commonly known as e-cigarettes, are available in more than 100 countries while HTPs can be bought in about 40 countries.
The WHO insists that many of the new products are harmful to health.
“HTPs expose users to toxic emissions similar to those found in cigarette smoke, many of which can cause cancer, while ENDS on their own are associated with increased risk of cardiovascular diseases and lung disorders and adverse effects on the development of the fetus during pregnancy,” the WHO stated in a press release.
Because of the damaging and addictive nature of these products, the WHO says regulation is crucial to protect populations, particularly youth.
The publication of the briefs coincides with World No Tobacco Day 2020 on May 31. This year’s theme is “protecting youth from industry manipulation and preventing them from nicotine and tobacco use.”
