Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research Successful countering of tobacco industry efforts to overturn Thailand's ENDS ban Roengrudee Patanavanich,1,2 Stanton Glantz ‍ 1

►► Additional material is ABSTRACT Thailand and countries that do not allow legal sale published online only. To view Background After Thailand enacted laws to ban the of ENDS, ENDS advocacy groups must revoke this please visit the journal online prohibition. (http://​dx.​doi.​org/​10.​1136/​ import and sale of all types of electronic nicotine delivery tobaccocontrol-​2020-​056058). systems (ENDS, including e-­cigarettes and heated In May 2020, the International Union Against tobacco products (HTPs)) in 2015, pro-­ENDS advocacy Tuberculosis and Lung Disease (The Union) 1Center for Tobacco Control groups pressured the government to lift the ban, supported ENDS bans, particularly in low and Research and Education, particularly after Philip Morris International (PMI) started middle income countries (LMICs), ‘In an abundance University of California, San Francisco, California, USA promoting its HTP IQOS in 2017. of caution, the sale of these products [e-cigarettes­ 2Department of Community Methods We reviewed information related to ENDS in and HTP] should be banned in LMICs; simi- Medicine, Faculty of Medicine Thailand between 2014 and 2019 from Thai newspaper larly, they should not be manufactured, imported Ramathibodi Hospital Mahidol articles, meeting minutes and letters submitted to or exported and should also be subject to TAPS University, Bangkok, Thailand government agencies, websites and social media (Tobacco Advertising, Promotion, and Sponsorship) platforms of pro-­ENDS networks and Thai tobacco bans and smokefree legislations’.5 This paper uses Correspondence to Professor Stanton Glantz, Center control organisations. Thailand to address the two questions: (1) What are for Tobacco Control Research Results The tobacco industry and the pro-­ENDS groups tactics that the TI and pro-­ENDS advocacy groups and Education, University of used five tactics to try to reverse the Thai ban on ENDS: have employed to pressure the government to over- California, San Francisco, San creating front groups, lobbying decision-­makers, running turn the ENDS ban? (2) How has public health Francisco, CA 94143-1390, successfully countered these tactics? USA; Stanton.​ ​Glantz@sonic.​ ​net public relations campaigns, seeking to discredit tobacco control advocates and funding pro-­tobacco harm Received 29 June 2020 reduction research. ENDS Cigarette Smoking Thailand METHODS IN Revised 8 August 2020 (ECST), a pro-­ENDS group in Thailand, worked in parallel We retrieved news relevant to ENDS between Accepted 26 August 2020 with Philip Morris Thailand Limited (PMTL) to oppose the January 2014 and November 2019 from iQNews- ban. The group connected with international coalitions Clip, a newspaper database covering over 30 Thai copyright. that promote harm reduction through the PMI-­funded newspapers (Thai and English languages) through Foundation for a Smoke-­Free World. the Mahidol University Library e-database­ service Conclusion Although ECST and PMTL continuously using English and Thai keyword ‘บุหรี่ไฟฟ้า’ (e-­cig- worked to revoke the ban since 2017, the government still arette: defined as all ENDS in Thailand) and the kept ENDS illegal as of October 2020. This decision resulted names of relevant actors beginning with ‘Philip from the strong commitment and collaboration among Thai Morris’ (PM), ENDS Cigarette Smoking Thailand tobacco control organisations and their shared vision to (ECST) and ECST’s members. We reviewed all posts protect the public’s health from harmful tobacco products. from ECST’s Facebook page from when the page http://tobaccocontrol.bmj.com/ The linkages between1, the pro- ENDS­ movement in Thailand was created (October 2014) to November 2019. and the tobacco companies could inform health advocates We then did snowball searches of relevant reports, and policy-makers­ in other low and middle income online information from websites and social media countries facing pressure to market ENDS. platforms (LINE, Facebook and Twitter) of Thai pro-­ENDS and tobacco control groups. Searches were conducted from October 2019 CONTROLto November 2019. Results were grouped into INTRODUCTION five domains of TI tactics (creating front groups, Electronic nicotine delivery systems (ENDS) were using public relation to promote ENDS, lobbying decision-­makers, seeking to discredit tobacco

introduced in 2004, entered the Europe and the on November 26, 2020 by guest. Protected USA in 2006–2007UNAVAILABLE1 and Thailand in 2010.2 When control advocates and funding research to promote ENDS), which were adapted from the eight domains ENDS were first introduced, the pro-­vaping move- 6 7 ment to influence policies consisted of ENDS users suggested by WHO and Fox et al. and retailers working independently of transnational There were 1108 newspaper articles related to tobacco companies (TTCs).3 By 2014, the tobacco e-­cigarettes in Thailand between January 2014 and ©VERSION Author(s) (or their companies started selling ENDS and these ENDS November 2019. There were 1112 posts on ECST’s employer(s)) 2020. No advocacy groups had amalgamated with TTCs and Facebook page between October 2014 (when the commercial re-­use. See rights page was created) and November 2019. and permissions. Published tactics used to undermine government’s tobacco by BMJ. regulatory efforts resembled the tobacco industry (TI) NOW 3 playbook that promoted combustible cigarettes. RESULTS To cite: Patanavanich R, Thailand was among 25 countries that had Regulation of ENDS in Thailand Glantz S. Tob Control Epub 4 ahead of print: [please banned the sale of ENDS as of October 2016. All ENDS are called ‘e-cigarettes’­ in Thailand, include Day Month Year]. TOBACCOUnlike the situation in countries where e-ciga­ - which include ‘liquid e-cigarettes’­ and ‘dry e-­ciga- doi:10.1136/ rettes were marketed legally and ENDS advocacy rettes’ (heated tobacco products (HTPs)). Beginning tobaccocontrol-2020-056058 coalitions worked to block ENDS regulations,3 in in 2010, major media outlets reported widespread

Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 1 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research sale of liquid e-cigarettes­ on the internet and teen use, which advocacy networks,30 including the International Network of raised concerns among the Thai government, tobacco control Nicotine Consumer Organisations (INNCO), which describes communities and parents.2 8 The survey of e-­cigarette use among itself as ‘represent[ing] consumers of low-­risk, alternative nico- Thai teens in 2015 found 5.4% of youth (7.7% of boys and tine products and to promote Tobacco Harm Reduction on 3% of girls) aged 13–15 years had tried e-­cigarettes and 3.3% the global stage’.31 Asa Saligupta, ECST’s director, was on the (4.7% of boys and 1.9% of girls) were current (past 30-day)­ INNCO board.32 users.9 Current use was high compared with other countries INNCO, established in 2017, has relationships with other pro-­ (eg, Mexico: 1%10; China: 1.2%11 and Greece: 2.8%).12 As of ENDS advocacy groups and industry-funded­ organisations. The August 2020, no subsequent survey of e-­cigarette use among US Consumer Advocates for Smoke-­free Alternatives Association youth in Thailand has been conducted. (CASAA) is a founding member of INNCO.33 Julie Woessner, Liquid e-cigarettes­ do not contain tobacco leaf so were not INNCO’s president, was CASAA’s president (2014–2 01834). At tobacco products under Thailand’s 1992 Tobacco Products least two former CASAA board members, Brad Rodu (2014– Control Act (TPCA),13 leaving their legal status unclear.14 In 2015)35 36 and Carl Phillips (2012–2014),35 37 had been funded 2011, the Ministry of Public Health (MOPH) Bureau of Tobacco by US Smokeless Tobacco, British American Tobacco (BAT), Control (BOT) planned to expand the definition of tobacco PM or RJ Reynolds.3 38 39 Several CASAA advisors worked with products to any products that contained nicotine in a proposed tobacco companies, including Riccardo Polosa, who received new TPCA,13 15 which the TI was opposing. funding from PMI and its Foundation for a Smoke-Free­ World In early 2014, BOT started working with the Ministry of (FSFW) and consulted for BAT.40 Gregory Conley, CASAA’s Commerce (MOC) to issue an administrative order prohibiting advisor and former legislative director, is a research fellow at importing ENDS and the Office of the Consumer Protection the Heartland Institute and president of the American Vaping Board (OCPB) to issue an order banning sales. Progress was slow Association (AVA); both organisations have been linked to the until the prime minister expressed concern about ENDS in a TI and fought US tobacco and e-­cigarette control.3 41 In 1999, speech during the ‘Return Happiness to the People Programme’ Heartland’s president wrote PM requesting $30 000 for opera- in August 201416 because he saw many teens using them. MOC tional support, ‘Heartland does many things that benefit Philip responded17 with strong support from BOT’s legal team in Morris' bottom line, things that no other organization does…’.42 December 2014, issuing a ministerial notification under the Heartland received money from Altria, PM’s owner, in 2011, Export and Import of Goods Act prohibiting import of hookahs, and annually from 2013 to 2016.41 AVA was sponsored by many electronic hookahs and e-cigarettes.­ 18 19 Violators faced up to a e-­cigarette companies, includingIN NicQuid, AltSmoke, Hoosier 10-­year jail sentence and a fine five times the price of imported E-­cig and Smokeless Image.43 INNCO received a 2018 $100 000 goods.19 In February 2015, OCPB issued an order banning 44 45

grant from FSFW. Recognising INNCO’s longstanding ties to copyright. ENDS sales.20 Violators faced up to 5 years in jail and a fine up the TI, the WHO rejected its petition for observer status to the to 500 000 THB (US$16 500).20 Eighth Conference of the Parties of the Framework Convention Parliament approved the new TPCA in 2016 that defined on Tobacco Control (FCTC) in 2018.46 ENDS as tobacco products, which prevented their use in public areas where conventional cigarettes were prohibited.21 Using public relations to promote ENDS ECST used Facebook as its primary platform to connect with Thai tobacco control organisations ENDS users in Thailand. (In 2018, Bangkok was the city with Major tobacco control nongovernmental organizations (NGOs) http://tobaccocontrol.bmj.com/ the most active Facebook accounts and Thailand ranked eighth in Thailand that oppose ENDS are Action on Smoking and 47 1, globally in Facebook users. ) ECST’s Facebook page ‘What is Health Thailand (ASH), Thai Health Promotion Foundation 48 E-­cig’ was created in October 2014 and by 2019 had 85 000 (ThaiHealth) and Tobacco Control Research and Knowledge 49 50 followers. It presented five themes: (1) sharing ECST’s activ- Management Centre (TRC) (a tobacco research grant-­making ities such as meeting with policy-makers­ and attending public organisations and knowledge hub established in 2005 and events, (2) sharing selected news promoting ENDS, (3) dissemi- funded by ThaiHealth).22 23 ASH monitors the pro-­ENDS nating research findings promoting ENDS, (4) countering infor- network, plans communication media, informs policy-­makers mation on the adverse effects of ENDS provided by the tobacco and disseminates information on the adverse effects of ENDS CONTROL control community and (5) broadcasting on Facebook live to to the public. TRC funds research on e-cigarettes­ and distrib- communicate with their followers. utes findings to NGOs. ThaiHealth is a government-­supervised PMI prominently promoted ENDS in Thailand. In December, funding agency whose board is chaired by the prime minister.24 on November 26, 2020 by guest. Protected 25 2016, the Thai newspaper, Krungthep Turakij, reported the Tobacco control is one of ThaiHealth’sUNAVAILABLE priorities. ThaiHealth 51 launch of PMI’s HTP IQOS in the UK. Two weeks later, the provides funding and technical support to ASH, TRC and other PMI Thailand director of corporate affairs took Thai reporters tobacco control organisations, and runs antitobacco mass media to visit tobacco plantations in Nan province and briefed them communication campaigns. about PMI’s new ‘reduced-­risk products’.52 In March 2017, he VERSION announced PMI’s new English-­language website (pmi.​ ​com) to TI tactics provide information on IQOS, claiming IQOS was less harmful Thai pro-ENDS organisations than combustible cigarettes.26 PMI Thailand also proposed Shortly after the new TCPA took effect in early 2017, ECST, the working with the Thai government to reach PMI’s ‘smoke-­ NOW 26 only pro-­ENDS group in Thailand that appeared in Thai media free society’ goal, which was part of PMI’s IQOS marketing and newspapers, and PMI’s Thai subsidiary PM Thailand started campaign.53 54 Coincidentally, in June 2017, PMI Asia’s presi- campaigning against the ban.26 27 dent announced plans to launch IQOS in more Asian countries In 2019, ECST claimed it represented more than 400 000 based on its success in Japan and Korea because more than 28 TOBACCO29 55 Thai ENDS users while denying any relationship with the TI. 60% of smokers worldwide were in Asia. Between 2017 and In 2017, however, ECST partnered with international ENDS 2019, at least 10 Thai newspapers (Thai and English languages)

2 Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research wrote about PMI’s ‘reduced risk’ products and messages from regular participants of GFN. Asa Salipgupta, ECST’s director, PMI’s representatives (online supplemental table S1). Common spoke at GFN in 2018 and 2019.75 76 In September 2018, messages ECST and PMI used promoted ENDS as ‘less harmful’, FSFW launched its ‘Tobacco Transformation Index’ to measure ‘effective smoking cessation’ and ‘no impact on youth smoking’. tobacco companies’ shift from conventional cigarettes towards so-­called smoke-­free products77–79 (ie, IQOS and other HTPs). Lobbying decision-makers Between 2017 and 2019, ECST and PMI Thailand lobbied In July 2019, FSFW planned to hold ‘smoke-­free dialogues’ 80 81 government to lift the ENDS ban (table 1). These activities in Thailand. In response, ASH, TRC, WHO, Thai Health violated TPCA section 35, which prohibits any lobbying activ- Professionals Alliance Against Tobacco and the Global Centre for ities and sponsorships by the industry that could affect tobacco Good Governance in Tobacco Control held a press conference control policy, advertise tobacco products or promote consump- to expose the relationship between FSFW and PMI and argue 82 tion.21 The industry succeeded with non-­health government that the workshop was a PMI tactic to promote IQOS. They agencies, including the Ministry of Finance’s Excise Department, convinced all invitees not to participate and advised the govern- Ministry of Commerce Department of Foreign Trade, Ministry ment to employ its authority to block the workshop because it 82 of Sport and Tourism, and National Legislative Assembly, which violated TPCA section 35 and FCTC Article 5.3. The work- 83 tried to get the import ban reconsidered. shop was cancelled. PMI issued a press release to Thai news- papers claiming it was not involved in any FSFW’s activities.84 Seeking to discredit tobacco control advocates ECST employed standard industry tactics in efforts to discredit DISCUSSION tobacco control researchers and advocates and undermine policy-­ 56–61 Thailand has been dealing with the TI’s tactics since the 1980s; relevant research : criticise tobacco control advocates in the dealing with the TI’s past tactics has strengthened Thai tobacco press, attack advocates on its Facebook page, submit complaint control communities and allowed them to anticipate the activ- letters against tobacco control researchers to government agen- ities of pro-ENDS­ groups. First, the industry attempted to cies and use third parties, including physicians and researchers 28 62–69 establish their business in Thailand through joint ventures and to attack tobacco control advocates’ claims (online supple- licensing agreements,85 sports sponsorship and monitoring mental table S2). For example, ECST launched a campaign ‘We smuggling cigarettes.86 87 The industry prevailed in 1990 when don’t accept TRC’ on ​Change.​org to discredit TRC and oppose the United States used the General Agreement on Tariffs and it leading a study on the appropriate ENDS control policy for IN88 Trade to force open the Thai market. Since then, the industry Thailand.63 kept interfering Thai tobacco control policy to maximise their copyright. market shares such as preventing ingredient disclosure,89 inter- Funding research to promote ENDS fering with scientific research,90 challenging plain packs,91 using There were at least six conferences during 2017–2019 to trade treaties to pressure the government,92 funding allies and promote ENDS in Thailand that included speakers with rela- support groups,22 and delaying tobacco control legislation.22 tionships to the TI (online supplemental table S3). In 2019, the University of the Thai Chamber of Commerce and Rangsit Similar to these earlier battles since market opening in 1992, University, two private universities, accepted undisclosed grants the ‘money’ ministries remained important TI allies. Building from PMI Impact, a global PMI initiative nominally established on experience from these earlier battles, government health

70 http://tobaccocontrol.bmj.com/ to combat illegal tobacco trade. Coincidentally, in March authorities and advocates successfully defended Thailand’s ban 2019, Rangsit University held a seminar on ‘Illicit Economy, on ENDS despite pressure from the industry and its allies by 71 1, Law, and ENDS’. We do not know if this event was spon- educating the public and policy-­makers on ENDS’ dangers and sored by the TI, but the topic aligned with the PMI grant. Both actively exposing the links between PMI and the nominally inde- founders of ECST, Asa Saligupta and Maris Karanyawat, spoke pendent pro-­ENDS organisation, ECST (table 2). 71 at the seminar. Aunkung Lim, a professor in economics with The Thai government prohibited ENDS before they were a long relationship with ECST who received research funding widely marketed. This situation differed from the USA and 72 from PM in 2006, was another speaker. The seminar rarely CONTROLseveral countries that allowed ENDS, but was somewhat similar discussed illicit tobacco products, and instead focused on the to Australia where ENDS could only be imported for personal disadvantages of the ENDS ban and concluded with a recom- use, and not sold or marketed. As a result, rather than working mendation to the government that it withdraw ban and regulate to block the enactment of regulations to control ENDS, the Thai 73 on November 26, 2020 by guest. Protected them. Following the seminar, BOTUNAVAILABLE warned the universities that vaping advocacy network worked to overturn the existing ban accepting TI research grants could violate the TPCA, and both (similar to the Australian Tobacco Harm Reduction Association, 70 stopped accepting PMI funding. which has a close link with the vaping industry).93 ECST began campaigning against the Thai ban in early 2017, the same time The Foundation for a Smoke-Free World PMI began promoting IQOS in Thailand. Since then, ECST TheVERSION establishment of FSFW in 2017 fueled a strong connection worked in parallel with PMI to promote ENDS legalisation. among pro-­ENDS networks globally. The 2018 FSFW’s tax return Although it denied any financial relationship with the tobacco listed 28 grantees in 13 countries,44 45 including several with addi- industry, ECST was linked to PMI through INNCO and FSFW.44 tional tobacco links. For example, INNCO’s members included Legalising ENDS could also boost PMI’s market shares in 31 pro-­e-­cigaretteNOW organisations in 28 countries, including Thailand over the Tobacco Authority of Thailand (TOAT, the ECST in Thailand.33 Knowledge Action Change Limited (KAC), state-­run Tobacco Monopoly), which had not yet engaged in another FSFW grantee, organised the Global Forum on Nicotine ENDS business because of concern over the ENDS legislation.94 (GFN), the annual globalTOBACCO conference of pro-­ENDS researchers Between 2010 and 2017, the domestic market shares of TOAT and advocates, with most speakers from industry-­linked harm and PMI were steady (62%–68% for TOAT and 25%–29% for reduction and ENDS organisations.74 ECST and INCCO were PMI).95 PMI’s share has doubled since 2017 as a result of the

Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 3 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research

133

130 ASH 133 130 Continued ­ cigarettes. 123 cigarettes are more ­ TTCs would fight Thailand’s ban. Thailand’s TTCs would fight cigarettes were 95% less harmful was unreliable. ­ cigarettes were 95% less harmful was 133 This was a victory for TC advocates who blocked ECST’s ECST’s TC advocates who blocked a victory for was This attempt to repeal the ban. director Dr Prakit Vathesatogkit informed the public that Vathesatogkit director Dr Prakit claim e- The working group consisted of MOC, MOPH, Ministry of MOPH, working group consisted of MOC, The Custom Department, Excise Department, Tourism, Sport and Office of the Narcotics Control Consumer Protection Board, Chamber of Commerce and Board Police, Thai Royal Board, Authority of Thailand. of Thailand and Tobacco of Trade ASH and BOT held a public seminar ‘E- held a public seminar ASH and BOT public about the dangerous than you think’ that warned and Thailand, outside of TTCs were marketing new HTPs predicted    ASH issued a press release urging the 2018, In January the ban. Assembly not to revoke National Legislative TRC and ASH, At the MOC 31 October 2018 meeting, presented information to convince MOC and ThaiHealth other agencies to continue the ENDS ban and opposed participation in the MOC meeting on grounds ECST’s which commits Article 5.3, WHO FCTC that it violated parties to insulating public health policy decisions from the TI. meeting concluded with a recommendation to form The working group to review the current laws on e-   TC activities ­ free 124 136 137 133 . 134 Participants included 54 representatives Participants 133 132 ­ cigarettes. ­ cigarettes to parties’ representatives.

131 IN copyright. 135 129 138–140 27 : 128 000 signatures asking for the right to use less harmful products than traditional 000 signatures asserting that ENDS laws violated the rights of consumers to a

122 1, http://tobaccocontrol.bmj.com/ 127 125 126 96 The government should adopt a clear policy on the import and use of ENDS and may use ENDS as an alternative cessation government should adopt a clear policy on the import and use of ENDS may as an The tool. Ministry of Industry should set industrial standard conditions for ENDS devices. All sales and imports must be should set standards for the safety and quality of ENDS refill containers. FDA Thai and the products should be considered as drugs or medical devices authorised by FDA ENDS should be sold only at healthcare facilities and drug stores. who are willing to quit and allow them access ENDS. government should set up a registration system for smokers The taxed and restricted similar to alcohol or cigarette products. ENDS should be controlled,

ECST met with the director (Patchara Anuntasilpa) to support legalisation of e- ECST met with the director (Patchara 2. 3. 4. 5. 6. and mobilised convinced that ENDS should be controlled rather than banned, ECST publicly declared that the Committee was support from its members to pressure General Singsuk Singpai. 1. ECST submitted its Change.org petition with 17 ECST submitted its Change.org ECST made a public proposal to MOPH legalise ENDS. to change the status of ENDS from a banned controlled product. ECST launched a petition campaign on Change.org cigarettes. ECST met and submitted its Change.org petition supporting legalisation of e- ECST met and submitted its Change.org from 19 organisations, including 2 members from ECST and 4 TC advocates from ASH, TRC and ThaiHealth. TRC and ASH, TC advocates from including 2 members from ECST and 4 from 19 organisations, ECST wrote and sought meetings seeking to lift ENDS ban, claiming ENDS were less harmful than combustible cigarettes and ECST wrote and sought meetings seeking to lift ENDS ban, good alternatives for current smokers. society. less harmful product and claimed the ban would negatively affect tourism. TI activities Thailand to achieve a smoke- pleased to present its research findings about HTP these agencies for PMI announced it was MOPH and ECST to review the the Commerce Subcommittee held two formal meetings with MOC, in December 2017, As a result, ban on ENDS. both the risks and benefits of Committee Chair General Singsuk Singpai suggested the government to consider In March 2018, ENDS and recommended six options to control them CONTROL petition with 40 ECST submitted its Change.org issues. meeting on 31 October 2018 to consider ECST’s MOC called a stakeholders’ Anuntasilpa) and the Excise Department (Patchara the director of government’s ECST (Asa Saligupta and Maris Karanyawat), Leelarasamee) supported legalising ENDS. industries (Dr Nilsuwan Thai of Federation not because they are not a drug, Excise Department is ready to tax ENDS be a legitimate product ‘The director announced, The This people to use ENDS. want MOC banned imports as proposed by MOPH that did not in the past, However, a weapon of war. it affects tourists Importantly, causes problems for both consumers in countries that smuggled these products personal use. is becoming a bigger problem’. This who carry ENDS with them. appeared Local Power) Thai Liberal, Thai House from three political parties (Chart Pattana, Thai At least three candidates for the the ban if elected. pledging to revoke Facebook on ECST’s cigarettes and actions of TC advocates between January 2017 and November 2019 TC advocates between January ­ cigarettes and actions of UNAVAILABLE on November 26, 2020 by guest. Protected Thai Liberal and Thai VERSION and Labour of the National Legislative Assembly Pattana, Democrat, Pattana, Local Power Thai Ministry of Finance Ministry of Industry Technology Ministry of Science and MOC MOPH Government agencies TI approached NOWMOPH Authority of Thailand Tobacco Tourism Ministry of Sport and MOC ECST Excise Department ECST Industry Committee on Commerce, Advocacy group ECST Office of Ombudsman TI lobbying activities to lift the ban on e- TOBACCO November 2018 August 2017 ECSTOctober 2017 ECSTNovember 2017 MOPH government Thai March 2019 ECST Chart Bhumjaithai, parties: Political January 2017January ECST Office of the Prime Minister Table 1 Table Date April 2017 PMI Ministry of Finance September 2018

4 Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research 145 The The prime 143 143 ­ cigarettes were harmful ­ cigarettes’ risks and problems in The next day, the prime minister also vowed next day, The 142 minister also ordered MOPH to educate people about ENDS’ harm and crack down illegal sale of ENDS. Thailand. After the meeting, the Minister announced he did After the meeting, Thailand. not intend to lift the ban because e- to youth. In August 2019, ThaiHealth held its first executive board ThaiHealth August 2019, In the newly Anutin Charnvirakul, meeting under new chair, ASH and ThaiHealth appointed Minister of Public Health. Vathesatogkit ASH director Dr Prakit planned to have inform the new chair on e- Public health communities issued a press release thanking the Minister of Public Health for supporting ban.  TC activities to retain the ban on ENDS; he said, ‘Making decisions on he said, to retain the ban on ENDS; the government cannot simply consider this matter, health ENDS will also impact people’s economic impact. and an extra burden on healthcare budget’. 146 144 ­ free society (ie, free society (ie, We do not know if there was a discussion about do not know if there was We

147 IN copyright. 141 1, http://tobaccocontrol.bmj.com/ hosted a reception for Thai PM and representatives during the United Nations General Assembly (UNGA) in New York. Assembly (UNGA) in New PM and representatives during the United Nations General Thai ­ hosted a reception for PMI’s plan to introduce IQOS to Thailand. plan to introduce IQOS PMI’s PMI met with these agencies and recommended revoking the ban claiming that its ENDS products would help Thailand Thailand would help PMI met with these agencies and recommended revoking the ban claiming that its ENDS products tremendously reduce smoking rates. TI activities to retain the ban. ECST submitted a letter opposing the ban after prime minister and Minister of Public Health vowed PMI co- participants to share its vision of a smoke- to engage UNGA’s PMI announced on its website that it wanted CONTROLpromote IQOS and harm reduction) its scientific findings about HTP.

146 on November 26, 2020 by guest. Protected

UNAVAILABLE ­ archa, at, Government at,

VERSION ­ general to the prime Excise Department Ambassador to the United States; Ambassador and Srivihok, Vitavas Representative to the Permanent Distat Hotrakitya, United Nations; secretary- Witchu Vejjajiva, Spokesperson; Department of Director General, Affairs; American and South Pacific Director, Norasucha, Vorawan New Board of Investment, Thailand Poonlabat, Alongkorn and Office; York Advisor to the Minister of Senior Agriculture and Cooperatives). Government agencies TI approached the seven opposition parties) government representatives (Don Minister of Foreign Pramudwinai, Affairs; Varawut Silpa- Permanent Busaya Mathelin, minister; Affairs; Secretary of Foreign Narumon Pinyosinw NOW Minister of Natural Resources and Thongphakdi, Thani Environment; Advocacy group PMI Thai Prime Minister and 10 Continued TOBACCO July 2019 PMI MOC Table 1 Table Date August 2019 ECSTSeptember 2019 (as a core member of Party Thai Pheu Heated HTPs, Administration; and Drug Food FDA, Control; Tobacco Convention on Framework FCTC, electronic nicotine delivery systems; ENDS, Thailand; ENDS Cigarette Smoking ECST, Control; Tobacco Bureau of BOT, Thailand; Action on Smoking and Health ASH, Control Research and Knowledge Management Tobacco TRC, tobacco industry; TI, Health Promotion Foundation; Thai ThaiHealth, tobacco control; TC, Philip Morris International ; PMI, Ministry of Public Health; MOPH, Ministry of Commerce; MOC, tobacco products; transnational tobacco companies . TTCs, Center;

Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 5 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research

Table 2 Summary of tobacco control actions on ENDS ban in Thailand Objectives Key actors Actions Advocate for specific laws to ban ASH ►► Updated the definition of tobacco control products in the TPCA. ENDS BOT ►► Worked with MOC to issue a ministerial notification banning the import of e-cigarettes.­ ►► Worked with OCPB to issue an administrative order banning the sale of ENDS. Educate public and policy-­makers ASH ►► Provided updated information about the risk of ENDS via social media, newspapers, television, radio, conferences and on danger of ENDS TRC meetings. THPAAT ►► Targeted key policy-­makers. ThaiHealth ►► Addressed three key issues: ENDS are harmful, not approved as effective quitting tools and raise initiation among teens. Counteract pro-­ENDS advocates ASH ►► Opposed ENDS advocates serving on the government established working group or committee to consider e-cigarette­ TRC policy. ►► Blocked TI research funding to Thai researchers. ►► Disclosed relationship between ENDS advocates and the TI. ►► Supported policy-­makers to keep the ban. ASH, Action on Smoking and Health Thailand; BOT, Bureau of Tobacco Control; ENDS, electronic nicotine delivery systems; MOC, Ministry of Commerce; OCPB, Office of the Consumer Protection Board; ThaiHealth, Thai Health Promotion Foundation; THPAAT, Thai Health Professionals Alliance Against Tobacco; TI, tobacco industry; TPCA, Tobacco Products Control Act; TRC, Tobacco Control Research and Knowledge Management Center. change in cigarette excise tax structure.92 If PMI manages to Non-­health government agencies accepted ECST as a consumer legalise ENDS, it could dominate the Thai market. group and held meetings to discuss ECST’s requests and allowed Claims frequently used by ECST and PMI in efforts to persuade it to participate in formal and informal discussions. The link the Thai government and public to revoke the ENDS ban between ECST and PMI confirms that actions taken by ECST resembled claims pro-­ENDS advocacy groups used elsewhere, and PMI to intervene in the ENDS ban violated TPCA section including that ENDS provide harm reduction and promote ciga- 35 and FCTC Article 5.3. Health authorities in the Thai govern- rette cessation.3 Both ECST and PMI aggressively promoted ment need to instruct these agencies to implement Article 5.3 just Public Health England’s statement that e-cigarettes­ are 95% less as they promptly responded to have the University of the Thai harmful than combustible cigarettes96 97 that is based on a paper Chamber of Commerce and INRangsit University withdraw the by Nutt and colleagues98 that has been heavily discredited by funding from PMI when they received evidence from tobacco the public health community.99 100 This study was supported by control advocates. copyright. Euroswiss Health and Lega Italiana Anti Fumo,98 whose chief As of March 2020, 29 countries had banned the sale of liquid scientific advisor, Riccardo Polosa, was a tobacco industry e-­cigarettes, 6 banned the sale of nicotine-­containing liquid e-­cig- grantee and consultant,101 102 and coauthor of the Nutt paper.98 arettes,107 and at least 7 countries banned the sale of HTPs.108 109 Karl Fagerström, another coauthor, was an advisory board of Although prior research indicates that countries with e-cigarette­ Swedish Match tobacco company and received consulting fees bans have lower prevalence of awareness, trail and current use from Nicoventures, BAT’s e-­cigarette company,103 partly for than countries that allow marketing and sales of e-cigarettes,­ 10 lobbying the Australia on the benefits of e-cigarettes.­ 102 104 ECST e-­cigarette awareness is likely to increase, particularly among and PMI’s reliance on the discredited 95% figure suggest that young people.110 http://tobaccocontrol.bmj.com/ they had no real evidence to back their reduced risk claims. India banned all types of e-­cigarettes, including HTPs, The tobacco industry’s use of third parties1, to discredit its in September 2019.108 Not surprisingly, pro-ENDS­ groups opponents is not new.57–60 For example, PM’s 1995 ‘Action responded immediately. Plume Vapour and Woke Vapours, two Plan: Scientists’ said, ‘We must not only watch [scientists and e-­cigarette importers, challenged the law before the Indian High researchers], we must react publicly. When appropriate, we must Court.108 Samrat Chowdhery, Association of Vapers India and raise the issue of their credibility and their integrity. We must INNCO’s Vice President,33 argued that the law should exclude also become more proactive, utilizing credible third parties more personal use.111 Because of the strong commitment to ban ENDS, effectively’.56 59 ECST employed this strategy to attack TRC’s CONTROLParliament approved the Prohibition of Electronic Cigarettes Act credibility and pressure the government to not have TRC coor- in December 2019.112 dinate ENDS policy research for the government’s decision on In July 2020, Australia tightened its ENDS regulation that

whether to repeal the ban. ECST also used well-known­ doctors previously allowed the product for personal use to ban import on November 26, 2020 by guest. Protected and researchers, including a formerUNAVAILABLE professor in medicine at of all ENDS and nicotine-­containing refills unless on prescrip- Siriraj Medical School, Thailand’s oldest medical school, to tion from a doctor.113 Pro-­ENDS groups responded against the boost its credibility and attack its opponents. TTCs’ reliance on ban immediately with a ‘Legalise Vaping Australia’ campaign renowned people and organisations had also occurred in Thai- that made arguments similar to those in Thailand114 115 and the land a decade ago when PM established a connection with the health minister postponed the ban for 6 months.116 ChulabhornVERSION Research Institute, a WHO collaborating centre Lessons learnt from the tobacco industry tactics on manip- in environmental toxicology in Thailand to influence public ulating regulatory frameworks to enhance ENDS markets in perception about the risk of second-hand­ smoke.90 This tactic Thailand can inform public health efforts in other countries to was also recommendedNOW by BAT’s Project Viking, which worked defend current policies that make ENDS illegal, particularly by to counter pressure for smoke-­free environments by ‘find[ing] a illuminating how the tobacco companies use third parties, often sympathetic doctor who can be demonstrated to take a largely tied to the FSFW, to mobilise public pressure to open the market independent stance [and advocate for the industry position]’.105 to ENDS. Understanding these networks has become even more Non-­health governmentTOBACCO agencies and ministries remain important since April 2019, when the US Food and Drug Admin- susceptible to the tobacco industry in Thailand. Only MOPH istration (FDA) misapplied the public health standard in the US adopted an Article 5.3 code of conduct under TPCA.106 law and authorised PM to market IQOS in the USA.117 PMI then

6 Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 Tob Control: first published as 10.1136/tobaccocontrol-2020-056058 on 23 November 2020. Downloaded from Original research started using FDA’s marketing authorisation, including quoting playbook to expand markets for their conventional products. FDA’s Centre for Tobacco Products, director Mitch Zeller, to Creating front groups, running public relations campaigns, advertise that FDA had determined that IQOS was ‘appro- lobbying decision-­makers, seeking to discredit health authorities priate for the protection of the public health’.117 This situation and funding pro-­tobacco harm reduction research were tobacco was aggravated in July 2020, when the FDA authorised PM to industry tactics used by Thai ENDS advocacy groups. Although advertise that IQOS reduces exposure to some toxic chemicals ECST and PMI Thailand have continuously worked to revoke compared with cigarettes.118 (Significantly, FDA specifically the ban since 2017, the government had kept ENDS illegal as refused to authorise PM to make its requested reduced health of October2020. The government’s decision resulted from the risk claims. Nevertheless, PMI is already using the FDA authori- strong commitment and collaboration among Thai tobacco sation to claim that IQOS reduces risk.) The Thai experience control organisations and their shared vision to protect the highlights the importance of public health advocates and health public’s health from tobacco products. The linkages between the ministries being proactive in anticipating and heading off these pro-­ENDS movement in Thailand could inform health advocates claims, including by stressing that the US law governing FDA and policy-makers­ in other countries where there are INNCO decisions does not apply in other countries and that the USA is members and funding from FSFW. Tobacco control advocates not a party to the FCTC. can use the Thai experience to anticipate and counter industry The Thai experience also provides practical lessons for efforts to expand the ENDS market. implementing the union’s recommendation to ban e-­cigarettes 119 and HTPs in LMICs in part because ‘LMICs lack both the Twitter Stanton Glantz @ProfGlantz resources and the enforcement mechanisms required to fully 5 Contributors RP developed the idea for the study, collected the data and support comprehensive e-cigarette­ and HTP regulations’ similar wrote the first draft of the manuscript. SG assisted with revising and refining the to what the FDA is trying to implement in the USA. manuscript. The Thai experience also reinforces the importance of the Funding This work was supported by National Cancer Institute grant CA-087472 public and policy-­makers being alert to tobacco industry activ- and the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. ities in other alternative markets such as marijuana, a common The funding agencies played no role in study design; collection, analysis, and product used with ENDS, and tobacco industry-created­ nicotine interpretation of data; writing the report; or the decision to submit for publication. replacement therapy, which many smokers use in combination Competing interests RP was a deputy director of Tobacco Control Research and with cigarettes.120 (The cigarette companies were considering Knowledge Management Center from September 2018 to April 2019 and worked for Thai Health Promotion Foundation from September 2015 to April 2017. entering the marijuana business as far back as the 1970s.121) IN Tobacco product innovation, alternatives and market locations Patient consent for publication Not required. may change over time, but the tobacco industry tactics and Provenance and peer review Not commissioned; externally peer reviewed. copyright. strategies remain unchanged. A whole-of-­ ­government approach Data availability statement All data relevant to the study are included in the should be applied in tobacco control and the government should article or uploaded as supplementary information. All data used to prepare this fully comply with FCTC Article 5.3 to prevent tobacco industry paper are available from the cited sources. interference in public health policies. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-­reviewed. Any opinions or recommendations discussed are solely those Limitations of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and This study relied on publicly available information such as news- responsibility arising from any reliance placed on the content. Where the content

paper articles, online information and information on social includes any translated material, BMJ does not warrant the accuracy and reliability http://tobaccocontrol.bmj.com/ media. We were unable to identify if there was a direct financial of the translations (including but not limited to local regulations, clinical guidelines, relationship between ECST and PMI or if1, ECST was a formal terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. part of PMI’s IQOS marketing strategy. ORCID iD CONCLUSION Stanton Glantz http://orcid.​ ​org/0000-​ ​0003-​4620-​6672 Tactics employed by PMI and allied pro-ENDS­ advocates in Thailand to repeal Thailand’s ENDS ban and open the Thai REFERENCES market to HTPs, including PMI’s IQOS repeated the TTCs’ CONTROL 1 Collaco JM, Drummond MB, McGrath-­Morrow SA. Electronic cigarette use and exposure in the pediatric population. JAMA Pediatr 2015;169:177–82. 2 Daily News. บุหรี่ไฟฟ้าทะลัก ห่วงวัยรุ่นฮิตสูบ สธ.เร่งสกัดด่วน Daily News

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120 Apollonio D, Glantz SA. Tobacco industry research on nicotine replacement therapy: 134 Naew Na. ผู้ใช้บุหรี่ไฟฟ้าหารือ าครัฐ หนุนสรรพสามิตจัดเก็บ าษี 2018;10. "If anyone is going to take away our business it should be us". Am J Public Health 135 Khaosod. สรรพสามิตเล็งเก็บ าษีบุหรี่ไฟฟ้า. 2018;6. 2017;107:1636–42. 136 Posttoday. พรรคการเมืองหนุนเลิกแบนบุหรี่ไฟฟ้า 2019:B6. 121 Barry RA, Hiilamo H, Glantz SA. Waiting for the opportune moment: the tobacco 137 Thairath. พรรคการเมืองหนุนเลิกแบนบุหรี่ไฟฟ้า หาแนวทางควบคุม ชง industry and marijuana Legalization. Milbank Q 2014;92:207–42. เป็นทางเลือก, 2019. Available: https://www.​thairath.​co.​th/news/​ ​local/bangkok/​ ​ 122 ENDS Cigarette Smoke Thailand. ขออนุญาตเข้าพบเพื่อนำ�เสนอแนวทางควบคุม 1527023 [Accessed 12 Nov 2019]. บุหรี่ไฟฟ้าในร่าง พ.ร.บ.ควบคุมผลิต ัณฑ์ยาสูบ พ.ศ. Chair of Ad hoc Committe 138 What is E-cig.­ อีกหนึ่งพรรคการเมืองที่ต้องการหยุดความล้าหลังของกฎหมาย on Tobacco Products Control Bill B.E. Facebook "What is E-­cig" 2017. บุหรี่ไฟฟ้า, 2019. Available: https://www.​facebook.​com/​pg/endsthailand/​ ​posts/?​ 123 Action on Smoking and Health Foundation Thailand. บุหรี่ไฟฟ้าอันตรายมากกว่า ref=​page_​internal [Accessed 12 Nov 2019]. ที่คุณคิด, 2017. Available: https://​ashthailand.​or.​th/th/​ ​news_page.​ ​php?id=​ 1027​ 139 What is E-cig.­ พื้นที่ชลบุรี เบื่อมั้ยกับการตั้งด่านจับบุหรี่ไฟฟ้า, 2019. Available: [Accessed 13 Nov 2019]. https://www.facebook.​ ​com/​pg/​endsthailand/​posts/?​ref=page_​ ​internal [Accessed 12 124 ENDS Cigarette Smoke Thailand. ลดระดับบุหรี่ไฟฟ้าจาก “สินค้าต้องห้าม” เป็น Nov 2019]. “สินค้าควบคุม”, 2017. Available: https://​goo.​gl/​2mnCCv [Accessed 13 Nov 2019]. 140 What is E-cig.­ มุมมองใหม่ๆ เปิดใจ เพื่อเข้าใจ, 2019. Available: https://www.​ 125 Post Reporters. Network fired up over electronic cigarette ban. Bangkok post, 2017. facebook.com/​ ​pg/endsthailand/​ ​posts/?ref=​ ​page_internal​ [Accessed 12 Nov 2019]. Available: https://www.​bangkokpost.com/​ ​thailand/general/​ ​1378195/network-​ ​fired-​ 141 Hicks W. Pmi tries lobbying against e-­cigarette ban. Bangkok Post 2019:B1–5. up-over-​ ​electronic-​cigarette-​ban [Accessed 12 Nov 2019]. 142 Matichon. อนุทิน' ถกสสส.ปิดตายบุหรี่ไฟฟ้า 2019;3. 126 Posttoday. ประชาชนยื่นรายชื่อหยุดแบนบุหรี่ไฟฟ้า 2017:B8. 143 Bangprapa M. Pm to keep e-­cigs illegal. Bangkok post, 2019. Available: https:// 127 Committee on Commerce Industry and Labor National Legislative Assembly of www.bangkokpost.​ ​com/​thailand/​general/1733799/​ ​pm-to-​ ​keep-e-​ ​cigs-illegal​ Thailand. รายงานการพิจารณาศึกษาเรื่อง การขอความเป็นธรรมในการ [Accessed 12 Nov 2019]. พิจารณาทบทวนประกาศกระทรวงพาณิชย์ในการห้ามนำ�เข้าบุหรี่ไฟฟ้า 2018. 144 The National Assembly Radio and Television Broadcasting Station. ส.ส. กทม. พรรค 128 Naew Na. กมธ.พาณิชย์ฯเสนอแนะอย่าปิดกั้นบุหรี่ไฟฟ้าทางเลือกใหม่/รัฐได้ เพื่อไทย รับหนังสือจาก ตัวแทนเครือข่ายผู้ใช้บุหรี่ไฟฟ้า "กลุ่มลาขาดควัน าษี 2018:1–2. ยาสูบ" (ECST) ขอให้ส าผู้แทนราษฎร แก้ไข พ.ร.บ.ยาสูบ, 2019. Available: 129 Muang B. เครือข่ายบุหรี่ไฟฟ้าพอมีหวังกมธ.พาณิชย์ยอมรับฟังข้อมูล, 2018. https://www.parliament.​ ​go.th/​ ​ewtadmin/ewt/​ ​parliament_parcy/​ ​ewt_news.​ ​php?nid=​ ​ Available: https://www.​banmuang.co.​ ​th/news/​ ​economy/104983​ [Accessed 12 Nov 59131&​filename=​welcome2019 [Accessed 12 Nov 2019]. 2019]. 145 Matichon. แพทย์-นักวิชาการชื่นชนอนุทิน 2019;7. 130 Matichon. แพทย์ค้านสนช.ทบทวนบุหรี่ไฟฟ้า ยันมีสารพิษกลุ่มกลีเซอรีนก่อมะ 146 US-­ASEAN Business Council. US-­ABC and U.S. chamber of Commerce convene U.S. เร็ง 2018;7. business leaders to honor Thai prime minister Prayut Chan-­o-­cha on sidelines of un 131 Matichon. กลุ่มลาขาดควันยาสูบ ร้องผู้ตรวจการฯ สอบปมแบนบุหรี่ไฟฟ้า, General assembly, 2019. Available: https://www.usasean.​ ​org/press-​ ​release/2019/​ ​ 2018. Available: https://www.matichon.​ ​co.​th/​news-monitor/​ ​news_1132236​ 09/25/​ ​us-abc-​ ​and-​us-​chamber-commerce-​ ​convene-us-​ ​business-​leaders-honor-​ ​thai-​ [Accessed 12 Nov 2019]. prime [Accessed 12 Nov 2019]. 132 Thai Post. พาณิชย์จ่อถกแก้ปมปลดล็อคบุหรี่ไฟฟ้า ชงเลิกห้ามนำ�เข้า! 2018;6. 147 Phillip Morris International. Why was PMI in New York during UNGA 2019? 2019. 133 Department of Foreign Trade. รายงานการประชุมเรื่อง ทบทวนมาตรการห้ามนำ� Available: https://www.​pmi.com/​ ​our-initiatives/​ ​itstime/why-​ ​is-pmi-​ ​in-new-​ ​york-​ เข้าบุหรี่ไฟฟ้า 2018. during-​unga-​2019 [Accessed 14 NovIN 2019]. copyright.

1, http://tobaccocontrol.bmj.com/ CONTROL

UNAVAILABLE on November 26, 2020 by guest. Protected VERSION NOW TOBACCO

10 Patanavanich R, Glantz S. Tob Control 2020;0:1–10. doi:10.1136/tobaccocontrol-2020-056058 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Successful Countering of Tobacco Industry Efforts to Overturn the Thai ENDS Ban Supplemental Tables Roengrudee Patanavanich MD LLM PhD Stanton A. Glantz PhD

Table S1. Selected statements claimed by ECST, PMI appearing in Thai newspapers or social media between January 2017 and November 2019 ECST PMI 6 Mar 2017 (H) The company believes that tobacco control laws in the future should consider other options for reducing tobacco hazards such as smoke-free products, as an alternative to consumers who want to use less harmful products.1 19 Apr 2017 (H) Previously, research results from many reliable organizations from many countries e.g. Public Health England, Royal College of Physician, and Cancer Research UK indicate that electric cigarettes are 95% less harmful than conventional cigarettes because theyIN contain no smoke and no combustion poison which is the main cause of various diseases.2 18 Sep 2017 (H, Y) Electronic cigarettes should be promoted as a smoker's choice because they are 95% safer than cigarettes and no study reports [e-cigarettes] attract youths and non-smokers to use.3 23 Oct 2017 (H) Electronic cigarettes are considered as 95% safer than conventional cigarettes. Public health agencies in many countries e.g. US FDA, PHE, and NZ Health Ministry recommend electric cigarettes as an alternative for those who want to reduce the danger from conventional cigarettes.4 16 Nov 2017 (Q) Currently, there are 3 million e-cigarette1, users in UK, and half of them are able to quit smoking completely.5 14 Dec 2017 (Q) The ban deprives cigarette smokers of the chance to turn to e-cigarettes which help wean them off conventional cigarettes...6 24 Dec 2017 (H) Recently, UK Committee on Toxicity announces important research findings regarding smoke-free products, concluding that the smoke-free products are less CONTROL 7 likely to be harmful to health than conventional cigarettes. 10 Jan 2018 (H) Public Health England concludes that e-cigarettes are 95% safer than conventional cigarettes.UNAVAILABLE8 VERSION NOW Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 TOBACCO BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Table S1. Selected statements claimed by ECST, PMI appearing in Thai newspapers or social media between January 2017 and November 2019 ECST PMI 5 Mar 2018 (H, Q) PHE confirms e-cigarettes help reduce risk from smoking We are pleased that PHE, an independent, international trustworthy and recommends increasing access to e-cigarettes among organization and the administrative unit of the UK Ministry of Public Health smokers because evidence shows e-cigarettes increase the realizes that smoke-free products may be less harmful than smoking.10 number of cigarette quitters in UK.9 22 Jul 2018 (H) PMI scientific assessment program found aerosol from smoke-free products contains less harmful substances than the smoke caused by conventional cigarettes 90-95%.11 11 Oct 2018 (H) Several international studies conclude that aerosol from e- cigarettes contain less toxin than combustible cigarettes. This provides an answer to public health agencies about concern on the safety of e-cigarettes.12 30 Oct 2018 (Y) WHO has not concluded that e-cigarettes lead to regular smoking among youths.13 7 Nov 2018 (Q) After use [of e-cigarettes], I don't want conventional cigarettes. After 2-3 days, I can't go back to smoking. I IN can't stand the smell of smoking.14 23 Nov 2018 (H) Today, Thai law permits only combustible cigarettes, which is extremely disappointing because we believe that millions of Thai smokers deserve the opportunity to access smoke-free products that are less harmful than cigarettes like other smokers around the world.15 21 Jan 2019 (Q) Public Health England supports the use of e-cigarettes as quitting aids.16 7 Apr 2019 (Y) A report from Public Health England shows that although the number of youths who have tried e-cigarettes increases, the number of regular use of e-cigarettes is still low. Also, the smoking prevalence among youth continue to decrease.17 1, 30 Apr 2019 (Y) We believe the legalization of e-cigarettes would protect youth from the toxic effect of smoking and prevent access to e-cigarettes among youths.18 30 Apr 2019 (H) E-cigarettes with and without nicotine have less effects on cardiovascular and respiratory diseases than combustible cigarettes.19 2 May 2019 (Q) In only 2 years, 7.3 million smokers worldwide quit and change to smoke-free producCONTROLts.20 23 Jul 2019 (Y) The US FDA certified that the heated tobacco product of Philip Morris is an alternative product that is appropriate for the protection of the public health from 3 reasons: 1. less toxic substances, 2. not attractive to non-smokers UNAVAILABLEincluding youth, and 3. similar nicotine level compared to regular cigarettes.21 VERSION NOW Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 TOBACCO BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Table S1. Selected statements claimed by ECST, PMI appearing in Thai newspapers or social media between January 2017 and November 2019 ECST PMI 29 Jul 2019 (Y) We are adamantly opposed to any technology or new product that is attractive to non-smokers, so you don't end up with any products that have flavour, packaging or any other factors that will attract youth.22 1 Aug 2019 (H) Smoke-free products are safer alternatives than smoking and reduce the health risk.23 6 Sep 2019 (H) Thailand is losing an opportunity to offer a product that maybe less harmful to its 10.7 million smokers.24 8 Sep 2019 (Q) A study published in the New England Journal of Medicine indicates that e-cigarettes can help smokers quit.25 29 Sep 2019 (H) Studies from Public Health England and US FDA show evidence that e-cigarettes are less harmful than conventional cigarettes and many countries support the use of e-cigarettes as an alternative for those who want to quit smoking.26 IN 10 Oct 2019 (H, Y) Although [the product] is not risk free and addictive, it is less harmful than smoking. Until recently, there is no evidence of concern that former smokers, non-smokers, and youth are using our products.27 *Themes: H: E-cigarettes are less harmful Q: E-cigarettes help smokers quit Y: E-cigarettes are not attractive to youth and have not gateway effect to smoking

1, CONTROL UNAVAILABLE VERSION NOW Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 TOBACCO BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Table S2. Tobacco industry’s tactics to discredit tobacco control advocates in Thailand, 2019 Date TI Tactic Description TC Actions Jan 2019 Direct criticism In January 2019, the worst level of particulate (PM2.5) air Ignored criticism and continued informing public about and spread the pollution was reported in Bangkok, which lasted for about a dangers of ENDS. attack through month. TRC held a demonstration with other tobacco control social media. advocates showing that e-cigarette use also produced elevated 28 PM2.5. ECST called TRC unprofessional and a joke, using the insulting phase “3rd world propaganda.”29 Mar 2019 Submit complaint ECST opposed MOC appointing TRC to lead a study on the Ignored criticism and TRC continued coordinating research letters against appropriate ENDS control policy for Thailand.30 ECST wrote on ENDS and submitting a policy recommendation to MOC tobacco control MOC and FDA, an agency under MOPH which had legal on September 24, 2019 to keep the ban.36 researchers to authority to control the safety and quality of ENDS if they government were legalized, claiming that TRC was not neutral, agencies. unprofessional and distorted information on e-cigarettes.31-33 In the letter, ECST attached a comment from Dr. Konstantinos Farsalinos, a researcher funded by e-cigarette 32-34 companies, claiming the TRC’s demonstration of PM2.5 IN from e-cigarette aerosol was “like a funny amateur experiment than a scientific test.”35 May 2019 Direct criticism ECST held a public event to oppose TRC and launched its Ignored criticism and TRC continued coordinating research and spread the “We don’t accept TRC” campaign on Change.org to collect on e-cigarettes and submitting a policy recommendation to attack through 10,000 signatures directed to MOC as the chair of the MOC on September 24, 2019 to keep the ban.36 social media. working group. As of December 6 2019, there were 3,380 signatures on the petition.37 Jun 2019 Direct criticism ECST attacked Dr. Stanton Glantz, an author of this paper, TRC and ASH responded immediately by posting correct and spread the whom TRC invited to speak about the global public health information on TRC’s website, also noting that it was a attack through emergency regarding e-cigarettes during the 18th National tactic ECST tried to discredit the expert who inform the social media. Conference on Tobacco or Health in Bangkok.38, 39 ECST public about the dangers of e-cigarettes.40 raised the issue of credibility1, and integrity of Dr. Glantz on its Facebook page asserting he had been accused of sexual harassment and was criticized by the American Cancer Society that he interpreted his research findings with bias.39 Sep 2019 Use third parties ECST quoted Dr. Somchai Bovornkitti, a well-known chest Continued informing public about dangers of e-cigarettes. such as physicians physician and a member of the Royal Society of Thailand, and researchers to who said Thailand should control rather than ban e- attack claims by cigarettes.41, 42 In 2018, Dr. Bovornkitti said in a publishedCONTROL tobacco control article that he received a call from two PMI executives advocates and introducing him to HTPs which he agreed could assist spread the attack smoking addicts.43, 44In June 2018, Dr. Bovornkitti was among Thai researchersUNAVAILABLE that PMI invited to join a meeting about VERSION NOW Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 TOBACCO BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Table S2. Tobacco industry’s tactics to discredit tobacco control advocates in Thailand, 2019 Date TI Tactic Description TC Actions through social HTPs in Bangkok.42 Between July and September 2019, Dr. media. Bovornkitti published a mini review, “Tobacco Harm Reduction”45 and an opinion “About Cigarettes”46 to support the argument that ENDS were alternatives to reduce harm from smoking on Crimson Publishers, a predatory journal on the Beall’s list47, which charges processing fee for a mini- review from $431-$663 and for an opinion from $316-$528.48 He did not disclose funding sources for either article. Nov 2019 Use third parties Dr. Bovornkitti told the press, “e-cigarettes only contain ASH sent out an argument to its tobacco control networks such as physicians nicotine. No other additives are added. In general, people who to correct the “misunderstanding of Prof. Dr. Somchai and researchers to smoke and become addicted are only nicotine. … although the Bovornkitti” via LINE (a social media platform similar to attack claims by nicotine is harmful. But there are also advantages to prevent Whatapp, that is very popular in Thailand), saying that e- tobacco control Parkinson's disease which will stimulate the brain cells to cigarettes not only contain nicotine, but other chemical advocates and prevent this disease.”49 substances.50 spread the attack IN through social media.

1, CONTROL UNAVAILABLE VERSION NOW Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 TOBACCO BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

Table S3. Conferences in Thailand in 2017-2019 to support the legalization of ENDS Date Host Events/Panelists 7 July 2017 Thai Public Broadcasting Seminar "ENDS/Truth/Future" on Thai PBS TV Channel. Service (Thai PBS) Panelists: Maris Karanyawat and Aunkung Lim51 6 & 13 Dec National Institute of Seminar "Coal-fired power plant & ENDS" at Asia Hotel, Bangkok 2017 Development Panelists: Kornkasiwat Kasemsri, Chalee Charoenlapnopparat, Prasart Administration (NIDA) Meetam, Urich Atchakosit, Pinyo Meechamna, Anuchart Palakawong Na Center for Research & Ayutthaya, Maris Karanyawat and Aunkung Lim Moderator: Siwatt Development of Disaster Pongpiachan52, 53 Prevention & Management 31 Mar 2018 NIDA Center for Seminar "ENDS Ban: Thailand gains or loses?" at Asia Hotel, Bangkok Research & Development Panelists: Siwatt Pongpiachan, Asa Saligupta, Maris Karanyawat, of Disaster Prevention & Rattapong Sornsuparp, Kerdphol Kaewkerd, Nilsuwan Leelarasamee and Management Wittawat Siriprachai54 6 Mar 2019 College of Social Seminar "“Illicit Economy, Law, and ENDS" at Rangsit University Innovation, Rangsit Panelists: Sangsit Phiriyarangsan, Asa Saligupta, Maris Karanyawat, University Rattapong Sornsuparp, Kerdphol Kaewkerd and Aunkung Lim55

18 May 2019 ECST Seminar "Smoking and vaping lung" at The Emerald Hotel, Bangkok Panelists: Asa Saligupta and Maris Karanyawat30 24 Jun 2019 Royal Society of Thailand Symphosium “Environment Medicine: Environment Pollution Harm Reduction” at Sukosol Hotel, Bangkok IN Speakers: Siwatt Pongpiachan, Siam Aroonsrimorakot, Manoon Leechawengwongs, Yuwadee Pitakpatapee, KC Wan, Alex Wodak, Somchai Bovornkitti, Shakrit Rimpanit 56 Alex Wodak is a director of Australia Tobacco Harm Reduction Association (ATHRA), which received a grant from Knowledge Action Change Limited (KAC) (funded by the tobacco industry through PMI funded FSFW) in 2018.57 Asa Saligupta and Maris Karanyawat are ECST founders. Aunkung Lim received research funding from Philip Morris in 2006.58 Rangsit University appeared on the grantee list of the PMI Impact in 2019.59 Shakrit Rimpanit was invited by PMI to speak “Evidence Review from The National Academic of Science and Medicine (NASEM)” in its meeting on smoke-free products on June 23, 2018 in Bangkok.42 He was also a speaker at the 1st Asia Harm Reduction Forum (AHRF).60 This forum was criticized by the Southeast Asia Tobacco Control Alliance as “an annual travelling road-show sponsored by the harm reduction supporters….to persuade governments to reverse any 1, 34 restrictive policy or prevent bans from being put in place.” The AHRF was hosted by Yayasan Pemerhati Kesehatan Publik Indonesia, which is affiliated with INCCO’s affiliated organization: Coalition of Asia Pacific Tobacco Harm Reduction Advocates.60-62 Somchai Bovornkitti was invited to attend the PMI meeting on June 23, 2018. He reported that he received a call from two PMI executives about HTPs and was convinced by the conversation that HTPs could help with smoking cessation.42- 44 CONTROL UNAVAILABLE VERSION NOW TOBACCO

Patanavanich R, Glantz S. Tob Control 2020; –10.:10 doi: 10.1136/tobaccocontrol-2020-056058 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Tob Control

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