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Introduction

Identifying, documenting and countering instances of tobacco industry lobbying and meddling is important in efforts to implement the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Article 5.3. Many governments have singled out tobacco industry interference as their main obstacle to their tobacco control efforts.[i]

Low-and-middle-income countries (LMICs), remain the target of transnational tobacco companies where Philip Morris International (PMI), British American tobacco (BAT), Japan Tobacco International (JTI) and Imperial Tobacco (IT) are expanding their cigarette sales, while claiming to switch to new tobacco products and sabotage tobacco control efforts. During the pandemic, despite smoking being a risk factor for COVID-19 infection, the tobacco companies continued with their business and made big profits. IT for example has stated, “The Africa region continues to be an attractive portfolio of markets with opportunities for further value growth. … while our focus on local jewel brands delivered share gains in Burkina Faso and the Côte d’Ivoire.”[ii]

In 2021, civil society groups in 80 countries prepared their Tobacco Industry Interference Index (Index), coordinated by GGTC and published by STOP,[iii] to assess how well their government has been protecting tobacco control policies and efforts from being undermined and derailed by commercial and other vested interests.

This report presents select examples from across the globe to illustrate several ways in which their Index has been used by NGOs and by governments to strengthen tobacco control, support preventive measures, conduct media advocacy and create awareness among the non-health departments. These case studies on the use of the Index aim to inspire countries to be creative and resourceful in using their indices.

The Index is Used to Strengthen Tobacco Control

In several countries the index has been used to unblock delays in implementation of the law, create awareness among law makers and generate discussion, and strengthen the health ministry to act.

In Côte d'Ivoire, the Index has had a powerful impact to expose delays to the implementation of the law. According to local advocates (˙Case Study 1), since launching Côte d'Ivoire’s Index and having meetings with officials, they have seen its impact in implementing plain packaging of tobacco and track and trace measures of illicit tobacco products. “We don’t attend any meetings with government officials without the Index.”[iv] The Index has exposed tobacco industry interference with tobacco control and helped implement two clauses of Law No. 2019-676 of 2019 on tobacco control. Parts of the law had been withdrawn by a previous Council of Ministers and delayed in its implementation, which now has been carried out.  

In Mexico, the Index was presented in the Parliament. Two senators, together with Salud Justa Mx and Polithink, presented findings from the Index in the Senate Chamber upon request (Case Study 2). The index became a tool that contributed to the approval of the General Law for Tobacco Control in December 2021. According to advocates, this law is a historic milestone for Mexico that broke a thirteen-year legislative inaction and will now result in protecting public health through more smoke-free public spaces, measure cigarette emissions and a comprehensive ban on tobacco advertising, promotion and sponsorship, in compliance with the WHO FCTC.

In Sri Lanka, copies of the Index were sent to all 225 Members of Parliament to make them aware of industry interferences and to assist them to focus on the importance of implementing tobacco control policies (Case Study 3). The Parliamentarians found the information useful and have a better understanding of the obligations under the WHO FCTC and about industry meddling in health policy. Contrary to Article 16 of the WHO FCTC, the sale of single stick cigarettes is still allowed and the tobacco control community is advocating for a ban particularly since it is mostly smoked by the poorer segments of society.

In Bangladesh, the index’ compilation of evidence on how the tobacco industry uses pro-business departments to champion its business has equipped the Health Ministry to act decisively on industry interference. On 18^th May 2020, the Coordinator of the National Tobacco Control Cell, a unit under the Ministry of Health and Family Welfare (MoHFW), issued a letter to the Ministry of Industries requesting the withdrawal of the special permissions and called for a temporary ban on tobacco production and sale during the COVID-19 outbreak. Although MoHFW's request was turned down, such a bold move from the Ministry that oversees tobacco control in Bangladesh is unprecedented (Case Study 4).

Since the launch of the first Index in Kenya in 2019, advocacy using the Index has made it possible to mainstream tobacco control and establish industry monitoring amongst tobacco control advocates and organisations (Case Study 5). Tobacco industry monitoring is fast getting traction within government departments such as the Ministry of Health. Advocates found there is now a greater openness from the Ministry of Health officials to share information on instances of tobacco industry interactions with government compared to previously.

Government officials are increasingly vocal in calling out tobacco industry interference at national events and at international meetings such during the WHO FCTC COP9. The Ministry of Health is also more open to civil society exposé of tobacco industry interference at events where high-ranking government officials are present to support sensitisation and awareness creation across the government.

In Bolivia the Index helped resume talks with the Ministry of Health to promote the Regulation of the 2020 Tobacco Control Law that has been delayed (Case Study 6). The Index identified where and how the interference took place to influence health policy. Bolivia has weak tobacco control measures including one of the lowest tobacco tax in the region, resulting in low cigarette prices. Cigarettes are still sold in loose sticks.

Although industry interference has a stronghold on Argentina and it remains a non-Party to the WHO FCTC, it has not deterred advocates from preparing and using the Index. The Index was impactful in countering the tobacco industry and supporting tobacco control policy at the provincial level. In October 2021, the deputy head of the local council requested the collaboration of FIC Argentina to counter the opposition from the industry (Case Study 7) by presenting findings of the index on the tactics of the industry and its interference to frustrate policy efforts. A joint strategy of advocacy and sensitization of legislators was executed. The Pampas legislature invited FIC to participate in a meeting of the Committee where the tobacco control was discussed with the legislators.

Representatives of the tobacco industry and its front groups also presented their arguments.  Following the industry arguments, counter arguments based on scientific evidence and the principles of the right to health in the format of the index were presented. The document was sent to all legislators and was added as an annex to the documentation on the bill. Finally, after sharing these documents with legislators, and building their capacity, in November 2021, the law was enacted in La Pampa province without any modifications or loopholes.

Similarly in 2021, in the province of Buenos Aires, where a comprehensive tobacco control policy was being discussed, the Index was a key document to expose various attempts of interference by the industry and its front groups. Based on earlier experience of the 2020 Index, FIC Argentina prepared documents with counter-arguments to inform legislators and stop the attempts of the industry and its front groups to undermine tobacco control.

In Mongolia, key findings and recommendations of the Index were presented to representatives of the Ministry of Health, Ministry of Construction and Urban Development, the Cabinet Secretariat of Government of Mongolia, Governor’s Office of Capital City and Governors’ offices of the districts of Ulaanbaatar City (Case Study 8).

Following the Index launch, a “Healthy City” training for Mongolian cities on Anti-Tobacco Revolution campaign was held focusing on good practices in workplaces in Mongolian cities. At this training, the participants who comprised government officials agreed to take action to require transparency from the tobacco industry in Mongolia.

In Zambia, policy makers became aware of tobacco industry interference after receiving the index on how the interference is blocking tobacco control measures (Case Study 9). Since the tobacco industry operates behind closed doors when it meets with government officials, no one has called this out as “interference”.

Media advocacy played an important part in escalating tobacco control higher up the political agenda. The index made front page news and was featured prominently in the media. The newspaper coverages were sent to policy makers to illustrate what constitutes interference and that it warranted their serious attention.

Tobacco control faces special challenges when the industry is a state-owned enterprise as in the case of Egypt where the government owns more than 50% of the main tobacco company in the country, Eastern Co SAE. The advocates keep the pressure by ensuring the media covers the interferences exposed in the Index (Case Study 10) since 2019 and illustrate how the industry operates to obscure the harms caused by tobacco.

  

Supporting Preventive Measures

In December 2018 the Lao PDR Ministry of Health issued a code of conduct for its officials to provide guidance on interacting with the tobacco industry. Regularly documenting instances of tobacco industry interference through the Index and providing information to the government proved useful and in 2021 specific preventive measures were included in the amendments to the Tobacco Control Act which will apply to the whole government (Case Study 11).

According to the Act, government officials are prohibited: to be involved in the tobacco industry, except in cases where it is necessary on the basis of transparency, openness and accountability according to the Laws; to recruit the representatives of tobacco companies, tobacco business operators to be members or consultant in the Tobacco Control Committee; and to directly or indirectly accept any sponsorship and support from tobacco companies, including accepting the corporate social responsibility of tobacco companies for commercial purposes.

Uganda’s Tobacco Control Act (TCA) is one of the strongest in the world which includes clear measures to curb industry interference based on WHO FCTC Article 5.3 guidelines. [v]  To prevent its implementation, the tobacco industry has been resorting to frivolously challenging the constitutionality of Uganda’s tobacco control law in the court. Exposing the industry’s tactics to derail government efforts and implementing the law is important to protect public health.

The launch of Uganda’s Index (Case Study 12) indicated the need to provide further guidance to government officials on their interaction with the tobacco industry in accordance with Part VIII of the TCA. With strong commitment from the Ministry of Health to protect the health measures from industry interference,[vi] the process of drafting an addendum of guidelines for necessary interactions with the industry began late 2021.

In 2021, Coalition for a Tobacco Free Palau (CTFP) officially released its Tobacco Industry Interference Index at Palau’s President’s weekly press conference, simulcasted live on radio, TV, and YouTube. Immediately following the press conference, CTFP made a strategic in-depth presentation of the report to top level officials - the President of the Republic of Palau, his Cabinet of Ministers that included leadership from the Ministry of Health and Human Services, and leaders of the Palau National Congress represented by the Senate President and Speaker of the House of Delegates and chairmen of their respective committees on health, education, and finance. CTFP’s presentation provided a status update on the overall state of the country’s progress in implementing its commitments to the WHO FCTC with a focus on Article 5.3. Government officials at the presentation appraised the Index and expressed their genuine support for tobacco control as well as resistance to tobacco industry interference (Case Study 13).

Conducting Media Advocacy with the Index

Tobacco control needs the media and journalists welcome good stories they can report. The Indices provide many newsworthy stories that advocate are telling around the world.

In Brazil, ACT Health Promotion found a new avenue to publicise the findings of the 2021 Index. ACT partnered with a team of investigative journalists from Ciência Suja (Dirty Science) who discussed industry interference as a form of scientific fraud and the spread of misinformation. This was shared through podcast and was popular with the public garnering high level of engagement particularly on social media (Case Study 14). In Bolivia advocates used various media platform is a good strategy to reach a broader audience (Case Study 6).

French tobacco control group, Comite National Contre Le Tabagisme (CNCT), in France has used the awards route to call out the industry or those who represent its interest in interfering and awarding those individuals and organizations who implemented Article 5.3.

These awards generate media coverage which highlights the development or hindrance to tobacco control (Case Study 15). The Article 5.3 Award on ‘Independence’ was given to an organization who applied good practices in addressing interference from the tobacco industry, 5.3 Award on ‘Political and Legal Initiative’ to the author of a bill or an amendment to a bill, to protect public health, 5.3 Award on ‘Information’ to a journalist or whistleblower for an exposé.

On the other hand, the ‘Butt of Interference’ was awarded for both the worst form of interference in France and those individuals who were supportive of the industry. The ‘Le Mégot de la langue de bois’ determined the worst form of unethical practice and greenwashing, and the ‘Le Mégot du hors-la-loi’ for the worst regulatory circumvention.

Similarly, the National Coalition for a Smoke-Free in Kazakhstan, has used the Dirty Ashtray Award (Case Study 16) to expose the tobacco industry and those who thwart tobacco control. In 2021, the Dirty Ashtray[vii] was used to reveal how Philip Morris, together with a high-profile pro-industry group, National Industrial Chamber, lobbied the Ministry of Trade to develop new national technical regulation on heated tobacco products (HTPs) and vapes. They aimed to exclude HTPs from the Health Act (article 110) which regulate all tobacco products.[viii] The Ministry of Health in collaboration with the Coalition blocked this industry initiative and revealed the lobby tactics through the Dirty Ashtray award which was widely covered in the media.[ix]^,[x] With the MOH’s firm position, the amendments were finally approved on 13 May 2021 by the Parliament.

Advocacy Center LIFE in Ukraine preparing the Index has expanded the capacity of advocates who work on anti-corruption issues to consistently monitor and expose the tobacco industry’s lobbying and interference and highlighting it in the media. Exposing the findings from the Index is playing a crucial role in keeping the industry accountable and preventing state officials from engaging unnecessarily with the industry (Case Study 17).

Additional materials to supplement the Index is helpful. LIFE’s short video[xi] exposing how Philip Morris and Glovo Delivery Service were selling HEETS to minors showed a 16-year-old volunteer ordering two packs of HEETS through the App and paying in cash. LIFE issued a press release exposing how tobacco companies and delivery services were selling tobacco products online to kids. This raised a wave of outrage on the Internet.

In Nigeria, the Index was release through a press briefing which was followed up with many interviews on TV, radio and newspapers. Findings of the index received wide coverage in the media. This was possible because the tobacco control advocates have built a close relationship with the media. As the media reported on the industry’s “web of interactions”,[xii] it is important the officials received the Index and were able to consider the evidence on industry interference (Case Study 18). The index was distributed to various policy makers including the Ministry of Health and the Federal Competition and Consumer Protection Commission.

In Switzerland the publication of the Global Tobacco Industry Interference Index (GTI) came at the right time, during civil society’s “children without tobacco” campaign to ban tobacco advertisements aimed at minors.  The vote was passed on February 13, 2022. [xiii] The results of the GTI played an important role in garnering support for the campaign (Case Study 19). Within the first week of its release in November 2021, a media wave presented the poor ranking of Switzerland in the GTI, making the public aware of the strong tobacco lobby present throughout the government system.

The media publicised the rankings of the countries and what the industry has been doing globally through “name and shame” articles. Such classifications that compared Switzerland to other countries enabled tobacco control advocates to contact journalists in advance to elevate their arguments. A proactive approach in contacting several journalists early ensured a selection of newspapers publish articles on exclusive information.[xiv] There was a broader reach by translating the Swiss Index and issuing a press release in all 3 national languages.

Within the first week, more than 60 online and print articles and radio-news published the results of Switzerland’s ranking in the GTI. The Die Zeit article referred to, Switzerland as “The fogged land”, a strong title describing the country being shrouded in a smoky fog caused by the tobacco lobby, which caught the attention of the public and politicians. The extent of the tobacco industry’s interference in the country was clear.

The Index Impacts the Non-health Sector

In Bangladesh, the release of the Index, tracking Bangladesh’s ranking annually and follow-up with officials has created greater awareness on industry interference. This has helped senior officials including ministers, health officials and policymakers from non-health departments more supportive to introduce measures to address industry interference according to Article 5.3. For example, in mid-2021, the Ministry of Industry and Commerce issued a new policy that prevents tobacco manufacturers and related companies from receiving the prestigious President’s Award for Industrial Development, which they previously received in 2018 and 2019.

In Solomon Islands, since policy enforcement fall under the duty of police officers, Global Youth Leadership Nexus (GYLN) conducted a series of presentations on the Index findings and recommendations to key provincial and city commanders of the Royal Solomon Islands Police Force (RSIPF). The participants welcomed the presentations as these not only provided insights to tobacco industry interference but also fostered awareness among public officials on the country’s commitments to the WHO FCTC and their duty in regulating their interactions with the industry (Case Study 20). As a result of its active engagement with the RSIPF, a memorandum of agreement between GYLN and RSIPF will be signed in 2022 to roll out a strategic tobacco enforcement plan in Honiara City and in the provinces.

Next Steps

Both the Global Tobacco Index and individual country indices are tools that can be used multiple times to support and advance policy to protect public health. This report has captured the various ways in which advocates and governments around the world are using their Index. No doubt there are more experiences from countries to be shared as advocacy continues.

[i] WHO FCTC Convention Secretariat. Information Note on classification of novel and emerging tobacco product. Geneva. 2019 Mar 15. Available from: https://bit.ly/3HI71QE
[ii] ATCA. Africa – Imperial Tobacco’s “unloved asset to a platform for future growth”. 9 Feb 2022. Available from: https://bit.ly/3LF38MG
[iii] Assunta, M. Global Tobacco Industry Interference Index 2021. Global Center for Good Governance in Tobacco Control (GGTC). Bangkok, Thailand. Nov 2021. Available from:  https://bit.ly/3OpnJ9z
[iv] Tall, L. Comité Unesco Universitaire pour la lutte contre la drogue et autres pandémies (CLUCOD). 2022 March.
[v] Ministry of Health. Uganda Tobacco Control Act 2015. Available from: https://bit.ly/3neqTS5
[vi] WHO Uganda. Uganda Intensifies fight against Tobacco Consumption. 10 February 2020. Available from: https://bit.ly/3lF4kos
[vii] No Smoke KZ. Press Release. 14 April 2021. Available from: https://bit.ly/3N1y6iL
style="font-size: 10px;">[viii] Sadykova, J. (21 April 2021). Facebook. 
[ix] Nur KZ. The minister and the deputy were “awarded” by activists. 14 June 2021. Available from: https://bit.ly/3xtAWqW and  https://bit.ly/3HAhgGr
[x] Gerber, V. Minister Sultanov was handed an ashtray with cigarette butts. Majilisman Peruashev has two of them. 11 June 2021. Available from: https://bit.ly/3tHBHM2
[xi] LIFE. Deadly delivery: Philip Morris and GLOVO sell sticks to children for IQOS (Video). 28 April 2020. Available from: https://bit.ly/3b6zR0y
[xii] Vanguard Nigeria. 8 November 2021: Interference report justifies our call to de-normalize tobacco industry CSR- CAPPA. Available from: https://bit.ly/3qmnuSV
[xiii] AT Schweiz. Die Schweiz sagt «JA» zum Schutz der Kinder und Jugendlichen vor Tabakwerbung. 13 February 2022. Available from: https://bit.ly/3QuzgGa (available only in German, French and Italian)
[xiv] AT Schweiz. Global Tobacco Industry Interference Index. Available from https://bit.ly/3HwJIck

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