TODAY’S TEENS, TOMORROW’S CUSTOMERS: Baiting youths with new products to create a new generation of addicts

Authors Worrawan Jirathanapiwat and Jennie Lyn Reyes

Editorial team Southeast Asia Alliance (SEATCA)

Suggested citation Jirathanapiwat, W. and Reyes, J.L. (2020). Today’s teens, Tomorrow’s customers: Baiting youths with new tobacco products to create a new generation of addicts. Bangkok: Southeast Asia Tobacco Control Alliance.

Cover Design Nichamon Pichiansathian

Layout Watcharachai Ninthomya

Published by Southeast Asia Tobacco Control Alliance (SEATCA) Thakolsuk Place, Room 4D, 115 Thoddamri Road, Dusit, Bangkok 10300 Thailand.

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For more information, visit: www.seatca.org Executive Summary

The uses marketing and sales schemes to deliberately target the youth to expand its business. These tactics extend to electronic delivery systems (ENDS, such as e-, and e-shisha, that heat a nicotine-containing e-liquid) and heated tobacco products (HTPs, which contain tobacco) designed to be especially attractive for the youth and to current smokers, too.

Like cigarette advertisements, ENDS and HTPs ads are filled with youth-appealing themes-- such as being cool, having fun, success, and sensuality. Users of ENDS and HTPs are frequently portrayed in advertisements by young, stylish, and urban socialites. ’s early marketing campaigns were clearly youth-oriented – featuring rock music festivals, parties, and prominent celebrities and other references to pop culture. ENDS and HTPs also come in youth-appealing fruity flavors, candy and sweet flavors that reduce the perception of harm and are clearly attractive to youths.

Without a comprehensive ban on advertising, promotions, and sponsorships (including cross-border and online promotions) and use of flavors, the youths are particularly susceptible to the industries’ aggressive marketing ploys. Latest findings from Global Youth Tobacco Surveys (GYTS) show increasing exposures and prevalence of ENDS and HTPs use among youths in the ASEAN region.

The youth are exposed to brand advertising on social media platforms (e.g. Facebook, Instagram, Twitter, YouTube, etc.) through their own peers, top celebrities, or social media influencers. The shareability of social media content allows organic or promotional contents to spread across different platforms that can increase youth exposure to influencer marketing, which has been exploited by tobacco companies to promote their products.

In countries without a ban on point-of-sale (POS) cigarette display or retailer incentives, the youth are also exposed to ENDS and HTPs through retail display schemes that are very similar to cigarette POS displays, where promotional “power walls” are used to attract customers. Points-of-sale also often serve as vaping lounges where customers are invited to try vape flavors and test or modify their vaping devices.

E-commerce platforms, such as Lazada and Shopee, also provide easy access to ENDS and HTPs to the youth. A Reuters review of JUUL products advertised on e-commerce platforms concluded that retailers in the Philippines allowed online sales of JUUL devices and pods with no age verification. While already banned in Cambodia and Thailand, ENDS and HTPs products can still be bought online. In Cambodia, ENDS categorized under electronic devices and mobile phones can be bought via Khmer 24, a local e-commerce website. In Thailand, JUUL products can also be bought from a number of Facebook pages and other online platforms.

1 To delay and defeat policy measures to promote and London-based Knowledge Action Change Limited (KAC), protect the profitability of their business, tobacco and which has received over USD 1 million from FSFW. Many nicotine industries employ various tactics that interfere with of the GTNF speakers are also speakers at the GFN. governmentefforts to protect public health. These include news articles, social media adverts, lobbying policy In Asia, the Asia Harm Reduction Forum (AHRF) was makers, and presentations in international conferences. organized in 2017 and sponsored by harm reduction ENDS and HTP proponents attack governments like supporters. The AHRF has strategically held meetings in Singapore and Thailand for banning these products and Indonesia (2017), Philippines (2018), and South Korea aggressively promote them in countries without such a (2019) where ENDS and HTPs are not banned yet. ban, as in Indonesia, Malaysia, Philippines, and Vietnam, Various academics and health professionals have attended even promoting ENDS and HTPs as an economic invest- AHRF as speakers or panelists, some with clear relationships ment opportunity for countries. with the tobacco industry as research grantees.

Since 2018, the PMI-funded Foundation for a Smoke-free The World Health Organization has warned that ENDS World (FSFW) has been funding the establishment of multiple or e-cigarettes are not safer alternatives to regular research centers to support cigarettes, while there is still no evidence to demonstrate globally. By funding research into “reduced risk” tobacco that HTPs are less harmful than conventional tobacco products as it has done for cigarettes, the industry hopes products. to influence how ENDS and HTPs -- still unrestricted in many countries -- will be regulated in the future. Banning the manufacture, importation, promotion, distribution, sale, and use of these products is still the To increase public visibility and reach a wider network, most comprehensive approach. As of February 2020, 41 the tobacco industry organizes and funds international countries (including Brunei, Cambodia, Lao PDR, Singapore, conferences such as the Global Tobacco and Nicotine and Thailand) have banned the sale and distribution of Forum (GTNF), which provides a platform for the tobacco ENDS; while 65 countries (including Indonesia, Malaysia, industry to promote its products, as well as its efforts and Philippines) permit the sale of e-cigarettes with in tobacco harm reduction. A similar forum, the Global certain restrictions/regulations applied. In Myanmar and Forum on Nicotine (GFN), is organized annually by Vietnam, these products are not yet regulated / restricted.

The following WHO FCTC-based measures can also specifically prevent and reduce ENDS and HTPs uptake by the youth: • Prohibiting the use of flavorings to reduce palatability and attractiveness • Applying a comprehensive ban on all forms of advertising, promotion and sponsorschip, including POS advertising and display, cross border advertising, online / internet promotion, and retailer incentives • Taxing at a rate that reduces affordability

2 01 INTRODUCTION

“ Today’s teenager is tomorrow’s potential regular customer…. The patterns of teenagers are particularly important to Philip Morris. ” - Philip Morris internal memo, 1981 1 -

For decades, the tobacco industry has used marketing and market them plug into a youth’s natural curiosity and sales schemes to deliberately target the youth to expand eagerness to try trendy new things, like sleek and hi-tech its cigarette business. More recently, these tactics have gadgets (which e-cigarettes are designed to be).2 The extended to its newer nicotine products -- from appealing need to be accepted and belong socially by following the product design to specially crafted marketing campaigns latest trends (by mimicking their peers or famous social -- that are designed to attract and hook new generations of influencers) is also very high among this age group. users. Other manufacturers of nicotine products have joined the bandwagon. Latest findings from the Global Youth Tobacco Surveys (GYTS) show increasing exposures and prevalence of ENDS Electronic nicotine delivery systems (ENDS, such as and HTP use in many countries (Figure 1), despite the rapidly e-cigarettes, e-cigars, e-pipes, and e-shisha, that heat a growing evidence of harm. The ASEAN region is home to 213 nicotine-containing e-liquid or e-juice without tobacco) and million youths (aged 15-34),3 where regulatory frameworks heated tobacco products (HTPs, which contain tobacco) and enforcement of public health policies are constantly are designed to be especially attractive for the youth, while challenged by industries demanding to self-regulate, if not simultaneously appealing to current smokers. Strategies to thwarting, weakening, and delaying these very policies.

Figure 1: Youth Smoking and Vaping Prevalence

3 The young ASEAN population, which has internet access and is social media savvy (Table 1), is a huge potential for ENDS and HTPs promotion and market expansion, and saying that this has the makings of another public health catastrophe is not exaggerated. It is urgent for governments and stakeholders to take collective action in exposing and countering the industries behind ENDS and HTPs and to protect our youth from this growing epidemic.

Table 1: Social media use in ASEAN 14

Population Median Age Internet Users Active Mobile Country Social Media Users Social Media Users (millions) (years) (millions) (millions) (millions) Brunei Darussalam 0.44 32.4 0.41 0.41 0.35 Cambodia 16.3 25.6 12.5 8.4 8.1 Indonesia 268.2 29.3 150 150 130 Lao PDR 7 24.4 2.7 2.7 2.6 Malaysia 32.2 29.9 25.3 25 24 Myanmar 54.1 29.1 21 21 21 Philippines 107.3 25.2 76 76 72 Singapore 5.8 42.4 4.9 4.6 4.2 Thailand 69.2 40.1 57 51 49 Vietnam 96.9 32.6 64 62 58

This report reviews the ENDS and HTP business in the ASEAN region and how youths are targeted as potential customers and have access to these products, identifies proponents of these products who influence policy, and provides recommendations to policymakers to protect the youth.

02 TOBACCO COMPANIES MAJOR MANUFACTURERS OF ENDS AND HTPS

Major producers of ENDS and HTPs include Altria Group, market is estimated to grow by USD 29.53 billion between Inc. (owner of Philip Morris USA), British American 2020-2024, with a year-over-year growth rate forecast at Tobacco (BAT), Imperial Brands, International Vapor 15.14% for 2020.17 North America was the largest market Group, International (JTI), NicQuid, JUUL in 2019, while countries from the Asia-Pacific region, Labs, Inc., Philip Morris International, Inc. (PMI), R.J. including ASEAN member states, were considered as Reynolds Vapor Company, Nicquid, Shenzhen IVPS fast-growing e-cigarette markets.18 As of October 2019, Technology Co., Ltd., and Shenzhen KangerTech The United States-based JUUL, the most popular brand Technology Co., Ltd. 15 The top five (5) e-cigarette brands among US teens, controlled 64.4% of the US e-cigarette in the world in 2018 were owned by Altria Group, BAT, market and as high as 75% in July 2019.19 In December Imperial Brands, JTI, and NJOY. 16 The global e-cigarette 2018, Altria bought a 35% stake in JUUL Labs.

4 03 MARKETING OF ENDS AND HTPS

Similar to cigarette promotions and advertisements now sweet, fruity, candy-like flavors to mask the natural harshness banned in many countries in accordance with Article 13 and taste of tobacco and increase the palatability and of the WHO Framework Convention on Tobacco Control attractiveness of their products among the youth.25 In 2018, (FCTC), ENDS and HTP advertisements are filled with there were 15,000 reported flavored vaping products26 youth-appealing symbolisms and imagery -- such as including fruity ones (e.g. blueberry cheesecake, mango, being cool, having fun, success, and sensuality.20 Users of cinnamon, and lemon crumble cake) and candy and sweet ENDS and HTPs are frequently portrayed in advertisements flavors (e.g. gummy bear, cookies ‘n cream, and cotton candy) by young, stylish, and urban socialites.21 JUUL’s early that reduce the perception of harm and are clearly attractive marketing campaigns that were promoted heavily in to youths.27 Where a comprehensive ban on advertising, social media were clearly youth-oriented – featuring rock promotions, and sponsorships (including cross-border adver- music festivals and parties, and resorting to visual cues tising, online / internet promotions, and retailer incentives) with prominent celebrities and references to pop and on the use of flavors is lacking, or where enforcement of culture22 E-cigarettes are frequently promoted online these regulations is weak for ENDS and HTPs (as with tobacco), through company-sponsored videos and content on youths are particularly susceptible to these industries’ exten- YouTube and Twitter.23 Vaping trick videos on mobile sive and aggressive marketing ploys. Youths may be exposed video sharing service TikTok, the latest social media through a range of channels including social media/social in- platform to emerge and dominated by teenagers and fluencers, product displays in shops that resemble electronics young adult users, have accumulated hundreds of stores, and advertisements outside of stores.28 millions of views.24 The following are examples of how ENDS and HTPs are ENDS and HTPs also come in youth appealing flavors in the advertised, promoted, and eventually retailed in the same manner that tobacco companies strategically used ASEAN region.

Social media marketing and influencers

Youths are exposed to brand advertising on social media through various sources such as their own peers or social media celebrities, people who have built areputation for their knowledge and expertise on a specific topic and have large followings 29 (“influencers”). Influencer marketing stems from celebrity endorsement, which is a major influence on the purchasing decision of young people30 and which has been exploited by tobacco companies to promote their products.31 The shareability of social media content allows organic or promotional contents to spread across different platforms, whichcan increase youth exposure to marketing by influencers.32 Facebook, Instagram, Twitter, and Pinterest are among the top platforms for social media and e-commerce marketing, where user-generated content (hashtags or mentions, photos of products in hand, photos taken while inside stores, etc.) can also be reused as sponsored or promotional content by product-owners.33

5 In Myanmar, for example, a number of Facebook pages promote ENDS and HTPs through celebrities. Vape City (Photo 1) is one of the most popular ENDS Facebook pages in Myanmar, with more than 64,000 followers (as of May 2020).34 Vape City has vaping stores located across Yangon and promotes its products and branches through actors and actresses as endorsers. The owner of Vape City is married to a well-known local actress and uses her NOT ADVERTISING popularity to attract clients, who are also celebrities and entertainers.35

Local celebrities also promote ENDS and HTPs via Facebook Live. Frontier Myanmar reported a Facebook Live video of a local actress puffing an Photo 1: Vape City – Myanmar Facebook Page e-cigarette and blowing smoke clouds towards the camera, while another video is of a singer-actress showing her unbox a Chinese e-cigarette brand before explaining the prices and different flavors.36

With a perceived reputation for their knowledge and expertise, big owners also act as social media influencers. In Cambodia, Mr. Free, who has NOT ADVERTISING more than 107,000 Facebook followers (as of May 2020), regularly posts vaping videos to promote different products sold in his shop.37 Photo 2: Customers featured on Vaping House Manila’s Facebook Page cover photo

Testimonial is a common advertising technique that uses celebrities and well-known personalities to endorse products and services. A variation of this technique called plain folks utilizes common people to provide these testimonials.38 Vaping House Manila (Photo 2) in the Philippines, with more than 10,000 Facebook followers (as of May 2020), uses this technique to promote e-cigarettes so that viewers can better relate themselves to the products.39 NOT ADVERTISING Despite Instagram’s announcement in December 2019 that it would ban influencers from promoting vaping and will begin enforcement in the coming weeks,40 a quick look at Indonesia’s top vape influencers on Instagram, which include vape brands and shops and even young Photo 3: Indonesia’s second top vape influencer on Instagram43 female influencers,41 shows that content (photos or videos) promoting vaping products are still prevalent.42

6 Point-of-Sale product displays and advertisements

Brunei Darussalam 44, Singapore 45, and Thailand 46 have banned the sale of ENDS and HTPs, hence these cannot be advertised or promoted, including at points-of-sale (POS); these three countries also already prohibit displays at POS. On the other hand, in ASEAN countries without a ban on POS cigarette display or retailer incentives,47,48 ENDS and HTPs retail display schemes are very similar to cigarette POS displays, where promotional “power walls” are used to attract customers.

NOT ADVERTISING NOT ADVERTISING

Photo 4: ENDS display in Myanmar (left) 49 and cigarette display in Malaysia (right) 50

In addition, points-of-sale often serve as vaping lounges where customers are invited to try vape flavors or test or modify their devices with the guidance of vape shop owners or staff.

E-commerce platforms

E-commerce refers to the buying and selling of goods or services using the internet, and the transfer of money and data to execute these transactions.The tobacco industry has been documented exploiting online platforms to target new customers, especially young people using the internet.51 The same is true for ENDS and HTPs. For example, in Malaysia, HTPs such as IQOS (PMI) and glo (BAT) are sold online via popular e-commerce platforms, such as Lazada , 52,53 and Shopee54 (Photos 5 and 6). In the Philippines, IQOS devices and sticks can also be bought from Shopee55 and Lazada56 , JUUL via Shopee 57 and assortment of e-cigarette kits and e-liquids / e-juices via both platforms58,59 (Photos 7,8, and 9).

NOT ADVERTISING NOT ADVERTISING

Photo 5: Glo for sale on Shopee Malaysia Photo 6: IQOS for sale on Lazada Malaysia

7 NOT ADVERTISING NOT ADVERTISING

Photo 7: IQOS devices and sticks available on Lazada Philippines Photo 8: JUUL available on Shopee Philippines

NOT ADVERTISING

Photo 9: E-cigarettes available on Shopee Philippines

Entry of JUUL in ASEAN

Despite having been hit with multiple lawsuits in the US there are no JUUL kiosks in the US, JUUL set up kiosks for misrepresenting the safety of its products and targeting inside malls in Jakarta and Bali that also host children’s teens in advertisements,60 JUUL Labs expanded its market events and operate children’s stores.64 E-cigarettes to the ASEAN region, with its eye on large tobacco were sold in these kiosks and in sleek JUUL-branded consumption markets like Indonesia and the Philippines. retail shops that mimic Apple stores. 65 Copying cigarette marketing tactics, JUUL also hired “ambassadors” - often To legally import their products into Indonesia, JUUL Labs attractive young women - to promote JUUL in bars partnered with local company PT Erajaya Swasembada, a and nightclubs.66 In February 2020, JUUL “indefinitely” retailer of mobile devices for major brands including Apple, suspended selling its products, claiming that it could not Xiaomi and Huawei.61 This exclusive distribution deal with stop retailers from selling its high-nicotine e-cigarettes to Erajaya allowed JUUL products to be sold in the Greater young people.67 Jakarta area, , and Bali by the end of June 2019.62 In the Philippines, JUUL Labs entered the market in June Although JUUL routinely claims that it only wants adult 2019 and partnered with Gokongwei-owned Better for smokers to use its products, Ken Bishop, the company’s You Corporation (BFY). Rappler reported that a JUUL executive in the Asia Pacific region, acknowledged that spokesperson told them that JUUL targeted the Philippines attracting young adult smokers was important to its success because it has one of the highest concentrations of in Indonesia. A former employee and another source tobacco users in Asia.67 JUUL also met privately with familiar with its Asia strategy corroborated that JUUL had Philippine policymakers and tried to engage the medical targeted customers aged 19 to 35.63 The company community to promote its products,70 influence vaping promoted its products in places frequented by young laws, and lobby for lowering of taxes as it has done people such as malls, movie theaters, and bars. While across the world.71

8 NOT ADVERTISING NOT ADVERTISING

Photo 10: JUUL device and pods promoted in Indonesia 68 Photo 11: JUUL mall kiosk in the Philippines 75

JUUL kiosks are commonly located inside malls. Initially available in Central Square in Bonifacio Global City in Taguig City and Robinsons Galleria in Quezon City,72 JUUL has now set up in different mall chains including SM, Ayala, and Megaworld with branches across Metro Manila.73

According to a Reuters review of JUUL products advertised for sale on Asian e-commerce platforms, retailers in the Philippines have allowed online sales of JUUL devices and pods with no age verification.74

ENDS and HTPs marketed in countries where they are banned by law

An IQOS Facebook page (typically named, IQOS [name of country]) exists for nearly all ASEAN countries, including those that have banned HTPs (Table 5), and some of these pages are operated by influencers. In Malaysia, an IQOS Facebook page exists for nearly all individual states. IQOS Pilipinas, besides promoting IQOS, provides repair services.

Table 2: Some IQOS Facebook pages in the ASEAN region

Country Facebook Page

Cambodia IQOS Cambodia,76 IQOS Cambodia Community,77 IQOS Phnom Penh Cambodia,78 IQOS Cambodia Online shop79 Indonesia IQOS Indonesia, 80 IQOS Indonesia Community81 IQOS Owner Community Indonesia82 Lao PDR IQOS Laos, 83 IQOS in Laos by JN 84 Malaysia IQOS Malaysia Online Store, 85 IQOS Johor Bahru,86 IQOS Penang,87 IQOS East Malaysia,88 IQOS Sarawak, 89 IQOS Malaysia Kaki Lang, 90 Geng IQOS Malaysia,91 IQOS EVERYTHING MALAYSIA 92 Myanmar IQOS Myanmar,93 IQOS Lovers Myanmar,94 IQOS Store Myanmar 95 Philippines Shop IQOS Manila, 96 IQOS Pilipinas, 97 IQOS Marketplace Philippines, 98 IQOS Love Manila 99 Singapore IQOS Sg 100 Thailand IQOS Thailand Bangkok2, 101 IQOS Thailand BKK 102 Vietnam IQOS Original Vietnam,103 Thành Lâm Heat Not Burn 104

9 Since 2014, e-cigarettes have been banned in Cambodia by the National Authority for Combating Drugs through its Circular on Measures to Prevent and Terminate Consumption, Sales, and Imports of Shisha and E-Cigarettes. However, in 2019 alone, a tobacco industry monitoring team was able to detect and document at least 34 Facebook pages and 12 YouTube channels that continue to advertise and promote ENDS and 105 HTPs in violation of Cambodia’s Photo 12 : Vape Shop Cambodia Facebook page tobacco control laws. Although the monitoring team contacted Facebook page administrators and YouTube channel managers to inform them about the law, violations remain (Photos 12 and 13).

ENDS products remain available online via social media sites (i.e., Facebook) and e-commerce platforms such as Khmer 24 – a local e-commerce website in Cambodia selling ENDS under the category of electronic devices and mobile phones. 106 Photo 13 : Vape products available for sale on Khmer 24

In Thailand, JUUL products were sold online via the ‘JUUL Thailand ไทย’ Facebook Page. The page was active from August 2018 to November 2019, when it was removed or deactivated. 107

However, other webpages and Facebook pages are selling the products online.

Photo 14: JUUL Thailand Facebook page

10 04 TOBACCO INDUSTRY INTERFERENCE TACTICS TO INFLUENCE THE PUBLIC AND POLICYMAKERS

The tobacco and nicotine industries work strategically to A known tobacco industry strategy to mislead the public delay and defeat policy measures across the globe in order about the harms of ENDS and HTPs is to speak through to promote and protect the profitability of their business, academics. Since 2018, the PMI-funded Foundation for a employing various tactics that interfere with government Smoke-free World (FSFW) has been funding the efforts to protect public health,108 such as news interviews establishment of multiple research centers to support and articles, social media adverts, lobbying policy makers, tobacco harm reduction globally.109 Accepting tobacco and presentations in international conferences. industry money for research was widely accepted until the 1990s, butrevelations about the way the industry manipulated Appearing to come from various sectors to create a research data, hid smoking risks from the public, and used perception of diversity and legitimacy, ENDS and HTP science to sow confusion and doubts (which prevented proponents sing the same misinformed tune to effective tobacco control policies) made such funding governments and policymakers -- that ENDS and HTPs increasingly taboo for academics.110 By funding research into are safer alternatives to conventional cigarettes, can help “reduced risk” tobacco products as it has done forcigarettes, smokers stop smoking, and therefore should be allowed the industry hopes to influence how ENDS and HTPs -- still and regulated, rather than banned. As such, they attack unrestricted in many countries -- will be regulated in the future.111 governments like Singapore and Thailand that have a ban on ENDS and HTPs and aggressively promote these Figure 2 presents categories of ENDS and HTPs proponents in products in countries without such a ban or where ASEAN and their messages to support their cause. The Policy regulatory frameworks are still weak as in Indonesia, Dystopia Model 112 was used to categorize and analyze Philippines, and Vietnam. They also promote ENDS information collated from daily medi monitoring from and HTPs as an economic investment opportunity for Indonesia, Philippines, Thailand and Vietnam, with additional countries. information from Malaysia, between January and September 2019. Figure 2: Voices and messages of ENDS and HTPs proponents in ASEAN

TI Representives 16 Safer / Smoking cessation 31

Pro ENDS groups 12 Pregulated, not ban 12

Health Institutes / Experts 11 Products for adults 11

Goverment officials 3 Many users 11

Academics 3 Academic support 9

Journalists 2 Govt & ENDS groups collaboration 4

ENDS user 2 Reduce tax 3

Unidentified 1 Frequency of news Income generation to people 3 Frequency of news

Lawyers 1 Income generation to govt 1

Definitions - TI representatives: TI staff such as managers - Pro-ENDS groups: group of people promoting ENDS/HTPs - Products for adults: tactic portraying ENDS/HTPs as forbidden fruits for the youth but disguised as protecting youth - Many users: argument that the government cannot ban ENDS/HTPs because many people are using the products.

11 To increase public visibility and reach a wider network, another strategy of the tobacco industry is to organize and fund international conferences and fora such as the Global Tobacco and Nicotine Forum (GTNF),113 which provides a platform for the tobacco industry to promote its products, as well as its effortsin tobacco harm reduction. A similar forum, the Global Forum on Nicotine (GFN), 114 is organized annually by London-based Knowledge Action Change Limited (KAC), which in 2017 and 2018 received over USD 1 million from FSFW. 115 Many of the GTNF speakers are also speakers at the GFN.

Photo 15: The first Asia Harm Reduction Forum in Jakarta, Indonesia, 2017 116

In Asia, this saw the birth of the Asia Harm Reduction Pangestu (Singapore) and Amaliya (Indonesia), who have Forum (AHRF) in 2017. It is an annual travelling been vocal in promoting these products for their so-called road-show sponsored by harm reduction supporters. The lower risk and potential health benefit.117 AHRF has strategically held its meetings in Indonesia (2017), Philippines (2018), and South Korea (2019) where Besides academics and health professionals from the ENDS and HTPs are not banned yet. Various academics region, AHRF has invited international speakers, who and health professionals have attended AHRF as speakers have travelled around Asia to promote “safer alternatives or panelists, some with clear relationships with the to smoking” products, premised on the dangers of tobacco industry as research grantees. Academics from cigarette smoking (Table 3).118 ASEAN, who have participated in AHRF, include Tikki

Table 3: AHRF international speakers with TI connections

Konstantinos Farsa- Cardiologist and researcher at Onassis Cardiac Surgery Center, University of Patras, linos Greece. The institution has received funding from e-cigarette companies for some AHRF 2017 and 2019 studies.Participated in GFN 2019 and GTNF 2019. 119

Marewa Glover Director, Center of Research Excellence on Indigenous Sovereignty and Smoking, AHRF 2018 and 2019 New Zealand. One of the FSFW-funded research centers on tobacco harm reduction. 120

David Sweanor Adjunct Professor, Faculty of Law, University of Ottawa, Canada. AHRF 2019 Regular speaker at GFN.

Every year, the forum releases press statements calling on governments to reverse or relax any restrictive regulatory policy and prevent bans on ENDS and HTPs from being enacted. During the 3rd AHRF (2019) in South Korea, statements from AHRF were widely reported in Malaysia,121 Philippines, 122 and Thailand. 123 AHRF’s Seoul Declaration also called on the governments of Thailand, India, and the Philippines to address their planned ban or restrictive policies on tobacco harm reduction products such as ENDS and HTPs.124

12 How all these have influenced policymakers in ASEAN

Five states in Malaysia (Johor, Kedah, Penang, Kelantan, However, pro-ENDS and HTPs groups such as Indonesian and Terengganu) have banned e-cigarettes since 2016, Personal Vaporizer Association have called on the based on the National Fatwa Council’s 2015 declaration of vgovernment for public discussions with stakeholders the use of e-cigarettes and vaping as haram for Muslims;125 before imposing any restrictions.129 that same year, the Malaysian Cabinet decided to regulate the use and sale of ENDS (and non-nicotine varieties) Towards the end of 2019, Philippine Congress passed a bill under the purview of three ministries: Ministry of Health (Republic Act 11467) imposing measures that increased (MOH), Ministry of Domestic Trade, Cooperatives and taxes on alcohol, tobacco products (including HTPs), and Consumerism and Ministry of Science, Technology and ENDS.130 In February 2020, the President also issued an Innovation, contrary to MOH’s recommendations to fully executive order (EO 106) to include vaping or the use of ban these products. Following the decision, the MOH will ENDS and HTPs in an existing nationwide smoking ban include ENDS in its draft bill to amend or replace the (except in designated smoking areas), and banning the Control of Tobacco Product Regulations 2004, while the sale, manufacture, marketing, distribution and importation Ministry of Domestic Trade and Consumer Affairs will draft of unregistered ENDS and HTPs devices.131 a new law relating to the control of e-cigarettes and vapes within the next two years.126 To date, the government is However, an in-depth analysis report 132 by Health Justice still looking to introduce stricter regulations on the sale Philippines unearthed how the tobacco industry, while and use of these products under a single law that would discreet in terms of lobbying representation, has been prohibit promotions and advertising, use in public areas, a major actor in influencing policy formulation for ENDS and use by minors, while the MOH continues to propose and HTPs during the last session of Congress. The report a total ban.127 revealed that of the nine bills proposed at the time, six were oriented to adopting ENDS industry positions, while In Indonesia, the government expressed its intention four bills show the involvement of PMI to preempt the to ban vaping and e-cigarettes following the report of regulation of HTPs, such as its IQOS brand. According to a Filipino teenager, who smokes cigarettes and started HealthJustice, this is the first observation globally of this vaping for six months, was diagnosed with a lung injury.128 strategy of tobacco industry interference.

Philippines case study: policy interference by pro-ENDS-and-HTPs groups

Pro-ENDS-and-HTPs groups in the Philippines are working understanding of e-cigarettes in the service of users, aggressively to support the regulation of ENDS and HTPs community and country.133 As of January 2020, PECIA and to undermine proposed tobacco control policies, has 250 members whose businesses are registered with especially those calling for a ban on these products. One the government to operate.134 According to its Facebook of these groups is the Philippine E-cigarette Industry page, PECIA works to “meet with the government at local Association (PECIA). and national levels to serve as the industry voice when it comes to drafting legislation affecting the industry. Registered in 2013, PECIA identifies itself as a trade It coordinates with law enforcement to stamp out fly- association composed of store owners, suppliers, and by-night operators that did not pass PECIA accreditation manufacturers of e-cigarettes and related products in the standards and defies government regulations regarding Philippines. One of its missions is to promote the greater sales to minors.”

13 In March 2018, 135 PECIA and The Vapers Philippines On March 4, 2020, the PECIA President issued a statement (TVP) were invited to attend a public hearing by the on its Facebook page (Photo 16) to supposedly extend Committee on Trade and Industry of the House of cooperation with the DOH and Food and Drug Administration Representatives to provide input to several pending bills (FDA) following a technical working group meeting of seeking to regulate e-cigarettes. PECIA and TVP also the Committee on Trade and Industry in the House of submitted the 2018 Evidence Review of E-Cigarettes and Representatives, during which PECIA proposed to allow HTPs commissioned by Public Health England (PHE),136 certain flavors139 in a pending bill on ENDS. which is often cited for its favorable position on e-cigarettes in contrast to medical organizations and authorities in Working as a regional network, pro-ENDS-and-HTPs many other countries, who are opposed to ENDS and HTPs. groups present similar evidence and operate as mouthpieces for the industry. These groups are also In April 2019, PECIA collaborated with other pro-ENDS- collectively working to deliver one-sided messages to and-HTPs groups, including the Coalition of Asia Pacific the government as stakeholders in policy development. Tobacco Harm Reduction Advocates (CAPHRA), an affiliate When these groups refer to similar actions from other member of the FSFW-funded International Network of pro-ENDS-and-HTPs networks, it may be perceived to Nicotine ConsumerOrganizations (INNCO),137 to participate carry some weight to persuade governments to follow in Department of Health’s (DOH) public consultation their recommendations that ultimately favor tobacco and on the Draft Amendment of Administrative Order No. nicotine industries. 2014-008 or “Rules and Regulation on Electronic Nicotine Delivery System”, which covers e-cigarettes.138

Photo 16: PECIA Facebook page post attempting to co-opt DOH and FDA 140

14 05 LEGISLATIVE ACTION

In light of the intensified industry effort to promote weak or problematic, while on the other end of this scale ENDS and HTPs as harm reduction tools and their is to restrict these products.143 To this end, the WHO has popularity among users, WHO has warned that ENDS called on governments that have not banned ENDS to con- or e-cigarettes are not safer alternatives to regular sider regulating them as harmful products, while subjecting cigarettes,141 while there is still no evidence to HTPs to the same policy and regulatory measures applied demonstrate that HTPs are less harmful than conventional to all other tobacco products in line with the WHO FCTC. tobacco products.142 Many governments have applied the precautionary Given the lack of evidence to support the long-term principle and taken action to protect their citizens. benefits or safety of ENDS and HTPs, the precautionary As of February 2020, 41 countries have banned the sale principle should apply when regulating these products. At and distribution of ENDS; 65 countries permit the selling one end of this regulatory scale is to prohibit or ban the of e-cigarettes but provide sales restrictions/regulations manufacture, importation, promotion, distribution, sale, (Table 4); and of these 65 countries, 32 regulate the and use of ENDS and HTPs, a particularly logical approach amount of nicotine in e-liquids). 144 where the regulatory framework or enforcement may be

Table 4: Global Status of E-cigarette ban and regulation (2020)

Sales/distribution ban Sales restriction/regulation

Antigua and Barbuda*, Argentina, Australia, Bahrain**, Afghanistan, Austria, Belgium, Bulgaria, China, Canada, Barbados**, Bhutan, Brazil, Brunei Darussalam, Croatia, Cyprus, Czech Republic, Denmark, Djibouti, Cambodia, Colombia, Costa Rica**, Ethiopia*, Gambia, Ecuador, Egypt, Estonia, Fiji, Finland, France, Georgia, India, Iran, Japan, N. Korea, Kuwait**, Lao PDR, Germany, Greece, Honduras, Hungary, Iceland, Lebanon, Mauritius**, Mexico, Nepal, Nicaragua, Oman, Indonesia***, Iraq, Ireland, Italy, Ivory Coast, Jamaica**, Palestine, Panama, Qatar, Seychelles, Singapore, Sri Jordan, S. Korea, Latvia, Libya, Liechtenstein, Lithuania, Lanka, Suriname, Syria, Thailand, Timor-Leste, Turkey, Luxembourg, Malaysia, Maldives, Malta, Moldova, Morocco, Turkmenistan, Uganda, Uruguay, Vatican City, Venezuela* Netherlands, New Zealand, Norway, Palau, Pakistan, Philippines, Poland, Portugal, Romania, San Marino, Saudi Arabia, Slovakia, Slovenia, Spain, Sudan, Sweden, Switzerland**, Tajikistan, Togo, Tunisia, Ukraine, United Arab Emirates, United Kingdom, Yemen*

* Included based on information from No Fire, No Smoke: The Global State of Harm Reduction, 2018 (GSTHR) ** Conflicting information found *** Appears to be “legitimized” only by being subject to tax law

15 Status of legislation in ASEAN countries

Five ASEAN member states, Brunei, Cambodia, Lao PDR, apply to ENDS and HTPs, but the Ministry of Finance Singapore, and Thailand have already banned the manu- (MOF) initiated a taxation scheme, effective since 2018, facture, importation, distribution, sale, use, promotion, and that covers excise fee for “Other Tobacco Processing advertisement of ENDS and/or HTPs. Indonesia, Malaysia, Products (Hasil Pengolohan Tembaku Lainnya (HPTL)” and Philippines have put in place new policies to regu- that include tobacco extract (e-cigarettes), vape, snuff late and/or have existing legislations that were applied to tobacco, or chewing tobacco. 145 restrict ENDS and HTPs. In Myanmar and Vietnam, these products remain unregulated and unrestricted. In Malaysia, HTPs are regulated similarly to cigarettes, 146 while ENDS with nicotine- containing e-liquid are banned In Indonesia, there are no domestic laws that specifically under the Poison Act.

Table 5: ENDS and HTPs ban and regulation in ASEAN

BR KH* ID LA MY MM PH SG TH VN

Complete ban (manufacture, importation, distribution, sale, use, promotion ✓ ✓ ✓ ✓ ✓ and advertisement)

Regulated (manufacture, distribution, sale, ✓ ✓ ✓ use, promotion and advertise- ment)

No regulation / Restriction ✓ ✓

*Does not cover HTPs

In the Philippines, ENDS are regulated by DOH and the The definition of tobacco in Vietnam’s Tobacco Control FDA through an administrative order (AO)147 that covers Law allows HTPs to be regulated;148 however, the the distribution, importation/ exportation, and sales government does not have specific guidelines to determine (through a license to operate application). The AO also whether these products will be regulated as conventional imposes a comprehensive ban on any form of advertising, cigarettes or differently. The Ministry of Health is promotion and sponsorship, including corporate social currently proposing a complete ban on ENDS, HTPs, responsibility (CSR) campaigns by the industry. In the and shisha, while the Ministry of Trade and Industry is absence of national legislation that standardizes ENDS also working to legitimize ENDS and HTPs manufacture product control and monitoring, the legal regime permits and distribution in Vietnam. restriction or regulation at the local level.

16 06 PROTECTING ASEAN’S CHILDREN

In February 2020, WHO released a statement149 stressing that ENDS are undoubtedly harmful, should be strictly regulated, and most importantly, must be kept away from children. Highly addictive nicotine found in most e-cigarettes and in all HTPs and tobacco products pose risks to health, and the safest approach is to not consume them. This statement gives emphasis to this year’s World No Tobacco Day theme of protecting the youth from industry manipulation and preventing them from tobacco and nicotine use.

Given the dangers of using ENDS and HTPs, banning the manufacture, importation, promotion, distribution, sale, and use of these products is still the most comprehensive approach.

If governments determine that the most effective way to regulate ENDS and HTPs is to regulate these as tobacco products, restrictions should include WHO FCTC-based measures such as:

• Covering the ENDS/HTPs/nicotine industry and front groups under WHO FCTC Article 5.3 restrictions as the unity of their interests with the tobacco industry is palpable • Prohibiting use in public places to protect people from secondhand exposure to the chemical aerosols emitted by these products and their users • Requiring prominent pictorial health warnings and messages on all packaging

In addition to these, the following WHO FCTC-based measures can also specifically prevent and reduce ENDS and HTPs uptake by the youth:

• Prohibiting the use of flavorings to reduce palatability and attractiveness • Applying a comprehensive ban on all forms of advertising, promotion and sponsorship, including POS advertising and display, cross border advertising, online / internet promotion, and retailer incentives • Taxing at a rate that reduces affordability

Based on these measures, while not exhaustive, governments of ASEAN member states can plug loopholes and strengthen their existing legislations as well as enforcement.

17 Annex 1: Examples of ENDS and HTP brands by tobacco companies

Company ENDS brands HTP brands

Philip Morris International (PMI) Nicocig, Vivid, IQOS MESH IQOS, TEEPS

Altria/Philip Morris USA Mark Ten,* Green Smoke,* sells PMI’s IQOS in USA owns 35% of Juul

British American Tobacco (BAT) Vype, Chic, VIP, glo, glo iFuse

Japan Tobacco International (JTI) Logic, Ploom Ploom Tech, Ploom Tech+, Ploom S

Imperial Brands blu Pulze

RJ Reynolds (owned by BAT) Revo,* Eclipse*

*Discontinued

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