Select Committee on COVID-19 to inquire into the Australian Government’s response to the COVID-10 PANDEMIC.

Submission from: Non-Smokers’ Movement of Incorporated (NSMA) Thank you for the opportunity to comment on this important matter.

SUMMARY Australia was advised in early 2020, at the beginning of this Coronavirus COVID-19 pandemic that is highly risky for CoronavirusCOVID19 and that smokers should QUIT IMMEDIATELY. Conversely, the World was advised seventy years ago, in May 2020, that smoking kills. Approximately 20,000 Australians die each year from smoking (or from exposure to the toxins in second-hand tobacco smoke). With over 2,500,000 Australians still smoking, and with the very real possibility of them further risking their lives due to the dangers of Coronavirus COVID-19, all smokers should be given extra incentives and extra support to escape from their potentially deadly addiction. All of Australia’s Health Ministers were, of course, fixed on preventing deaths from the COVID-19 pandemic, but some simple preventive measures to avert even further, PREDICTABLE deaths (from tobacco) have not yet been taken. NSMA Inc. wrote to all Health Ministers on 4 April 2020, calling for speedier quitting assistance for smokers. Replies to date indicate no change. Rapid response from Australia’s Health authorities have fortunately led to far fewer COVID-19 deaths, currently 103, than had been anticipated. In the same spirit of saving lives, we call on Australia’s Governments to act quickly. AUSTRALIA MUST ACCELERATE QUITTING RATES IMMEDIATELY Australian Government’s Response to the COVID-19 pandemic. EARLY WARNINGS: Early and strong professional medical advice was given about the dangers of smoking and vulnerability to Coronavirus COVID-19 and potential complications due to reduced heart and lung capacity.” The Department of Health (Australia) is aware of evidence showing that smoking is a risk factor for COVID-19 disease progression” (14 May 2020 Response to NSMA letter). As the pandemic evolved and tough measures brought about, there were warnings about potential mental health problems, loneliness, domestic and child abuse (including sexual abuse,) homelessness, financial and anxiety problems. At NSMA Inc., we acknowledge those latter warnings but we have little or no expertise about how they should be addressed. We do, however, have wide experience and knowledge of the dangers of smoking, to both smokers and to innocent bystanders who are assaulted by potentially deadly toxins in second-hand tobacco smoke from those 2,500,000 smokers. Non Smokers’ Movement of Australia Inc. was formed in 1977, fighting for everybody’s right to breathe clean air, free from the toxins in second-hand tobacco smoke, as well as against Big Tobacco’s (the ) influence in politics and on politicians. Between 2,500,000 and 2,600,000 people smoke in Australia. (Aust. Bureau of Statistics ABS). That results in an awful lot of toxic second-hand tobacco smoke for everybody to avoid. In October 2019, at the Oceania Conference, hosted by Council NSW in Sydney, we were advised at Conference Opening by Federal Health Minister Greg Hunt that the latest smoking figures are now available (the first update on smoking figures in 15 years, since 2004-5). He told us: Smoking in Australia costs close to $137 billion annually (up from $31.5 billion in 2004-5) Tobacco use is linked to about 20,000 PREVENTABLE deaths each year 90% of people who start smoking regret it or want to quit. Comments from Non-Smokers’ Movement of Australia Inc.: There is no basic human right to smoke, but there is a basic human right to breathe clean air, free from the potentially toxins in second-hand tobacco smoke, which can trigger potentially deadly heart and lung conditions such as , Asthma, COPD (Chronic Obstructive Pulmonary Disease), and SUIDS (Sudden Unexplained Infant Death Syndrome). Smokers now have easy access to approved, affordable ALTERNATIVE nicotine replacement products (not suggesting untested e-cigarettes, vaping nor water- pipes), as well as free or subsidised Quitting programs. Non-smokers have NO ALTERNATIVES for breathing – they must use nose and mouth. Following the advice about the potential dangers to smokers of Covid19, NSMA Inc. wrote to all Australia’s Health Ministers, calling on them to advise and assist smokers to quit in order to avoid those potential COVID-19 complications. We made several suggestions, including that smokers be given free approved alternative quitting aids (patches, gums, sprays, lozenges). (See attached NSMA letter dated 4 April 2020) Ministers’ responses agree that COVID-19 is a risk factor but none of the four responses so far have committed any further effort or funds to reduce smoking rates. Indigenous smoking rates have reduced recently but, in comparison to non-Indigenous rates, remain obscenely high. Australia’s Government is an early signatory, and all levels of Government are bound by the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC), which aims to protect people in all countries from the health, social, environmental and economic effects of tobacco. Now, on another COVID-19 Matter: Regarding the COVID-19 EXIT STRATEGY which is mentioned occasionally. We refer the COVID19 committee to an Online article in Insight, dated 18 May 2020, authored by highly respected tobacco – control experts, Emeritus Professor Mike Daube AO and Professor Rob Moodie (and attached): Title: “Exit Strategy: We can do it for COVID19, why not tobacco?” Comment from Non-Smokers’ Movement of Australia: WHY INDEED NOT? PS POTENTIALLY LESS FIRES STARTED IN COMING FIRE SEASON Finally, by reducing health danger dramatically (as has occurred in the fight against COVID19, less smoking would mean there will be less chance in the coming FIRE SEASONS of tossed butts causing more of the horrific fires Australia has experienced in recent seasons. We are advised that tossed cigarette butts are by far the most numerous item littered around Australia – many are not extinguished properly and start fires. In 2005, approximately 4000 fires were started by discarded butts. (Per NSW Fire Brigade). We are aware that not all fires start from tossed butts or carelessly extinguished cigarettes, but it would be excellent to reduce that particular risk.

Thank you, from Margaret Hogge President, Non-Smokers’ Movement of Australia Inc.

(Attachments 1 and 2 follow.) Attachment 1.

Message to all Health Ministers re SMOKING and COVID 19 4/4/2020

Call to reduce potential COVID19 death rate by Helping Smokers to Quit Australians have been advised, from the early onset of Coronavirus COVID 19, that smokers are at a high risk of serious health damage from contracting the virus. (Dr Norman Swan, ABC Adviser, February 2020) We call on all Australia’s Health Ministers and Authorities to help stem the effect of Coronavirus COVID19 by helping smokers to escape their addiction to nicotine and to quit smoking. Australia’s Federal Minister for Health Greg Hunt announced in October 2019 that the annual cost of smoking in Australia is $137 billion (health, productivity and social costs) and that tobacco kills about 20,000 (twenty thousand) Australians each year. At the same time he would add $5 million to the already allocated $20 million over four years to help combat smoking (total $25 million for four years) Professor Sanchia Aranda, CEO, Cancer Council Australia said “About two and a half million people are still smoking every day in Australia and tobacco continues to be Australia’s leading cause of preventable disease”, Oct. 2019.

Those 2,500,000 Australians who smoke are using a highly addictive product which is easily available at corner shops, petrol stations, supermarkets, pubs, clubs, and tobacconists. Most smokers, however, want to quit. About 80% try quitting, several times.

Many Australian smokers would now – understandably - be living in fear of contracting Coronavirus COVID 19. Their consumption of tobacco has possibly increased due to loss of jobs, social isolation, mortgage/rental worries, and increased stress.

Suggestions: 1. Increase Health Funding rapidly to help 2,500,000 Australian smokers escape their addiction to nicotine and quit smoking.

2. Immediate Pro-Quitting Campaign using historically successful ideas.

3. FREE approved Nicotine Replacement Therapies (patches, gums, lozenges and sprays). Universally available.

4. Free and Timely Quitting Advice - Virtual Help Groups, etc..

5. Incentive Smokers’ Licensing Program, such as that suggested by Professor Simon Chapman – smokers could recover costs by quitting early. We understand that this call for drastic-sounding tobacco-control measures may sound opportunistic, coming from Non-Smokers’ Movement of Australia, a smoke-free movement. After all, we have been fighting for smoke-free rights, everywhere, since 1977.

But right now “we are all in this together”. We have not yet heard of any special measures to help this huge but diverse group of vulnerable Australians (2,500,000 smokers) quell some of their fears, quit tobacco, and thus help them attain a healthier future, despite the current crisis.

Let’s do this.

(Ms.) Margaret Hogge President, Non-Smokers’ Movement of Australia Inc.

PO Box K860 Haymarket NSW 1240 Attachment 2.

This online Article from InSight 18 May 2020

Exit strategy: we can do it for COVID-19, why not tobacco

Authored by MIKE DAUBE ROB MOODIE Issue 19 / 18 May 2020

COVID-19 was first identified in December 2019 and declared a pandemic by the World Health Organization in March 2020. Australia is now seen as a world leader in taking action based on public health advice. This has entailed profound restrictions on social and economic activity, adverse impacts on many industries, and massive expenditure by government, resulting in extensive population-level behaviour changes, with strong community support. Our governments deserve praise for their early and effective action, as do many others, from health professionals to the wider community which has adhered so well to the restrictions.

There is another pandemic, stealthier and even more lethal, that we have known about for exactly 70 years. It causes 8 million deaths a year globally, 20 000 in Australia. We know the cause, the harms, the vector and the comprehensive public health approach recommended to bring it to an end. But tobacco, unlike COVID-19, is knowingly generated, promoted and sold by an industry with a history of lies, deceit and aggressive opposition to action that reduces the death, disease, misery and economic costs its products cause.

The two articles that first clearly identified smoking as a cause of lung cancer were both published in 1950 – Wynder and Graham’s as a possible etiologic factor in bronchiogenic carcinoma – a study of 684 proved cases, in JAMA on 27 May 1950, followed by Doll and Hill’s BMJ article, Smoking and carcinoma of the lung, on 30 September 1950. The years since have seen countless further reports confirming smoking and as the causes of an extraordinary range of diseases. Fifty years ago, on 15 May 1970, the World Health Assembly passed its first resolution calling for action on smoking. For over 40 years, authoritative reports have recommended a comprehensive approach to combat this epidemic, with the same broad themes of public education, regulation, taxation and cessation support.

So how does Australia measure up, 70 years on?

Governmental action initially entailed little more than posters and leaflets. The first television advertisements about smoking, generated in 1971 by the pioneering Director of the Cancer Council Victoria, Dr Nigel Gray, were initially rejected by television stations. Substantial government media campaigns started in the 1980s, albeit at levels well below those for commercial products. The introduction of protective regulatory measures around the nation has been hard-fought against fierce opposition from the tobacco lobby. The Australian Government is a signatory to the WHO Framework Convention on Tobacco Control, including Article 5.3, specifying that tobacco companies should play no role in public health policy. The current federal Minister for Health, Greg Hunt deserves great credit for maintaining strong governmental resistance to relentless tobacco industry lobbying. He and his state and territory counterparts have also insisted on a strong, evidence-based approach to the regulation of e-cigarettes, with a special focus on protecting children and young people from the products and promotions that have caused much concern in the US and elsewhere. After World War II, almost three-quarters of adult males were smokers, and smoking was increasing among females. The latest national surveys show 12% of adults as regular daily smokers (with further encouraging reports from some jurisdictions), and regular smoking among school students fell from 24% in 1984 to 5% in 2017 (3% in children aged 12–15 years). After plain packaging was implemented, the Imperial Brands company reported dolefully that “Australia is the darkest market in the world”. A recent study in Lung Cancer shows that if present trends in Australia continue, between 2016 and the end of the century, 1.9 million premature deaths will have been averted from lung cancer alone. Australia is widely recognised as a global leader, from advocacy to action, and from research to implementation.

But smoking remains a national catastrophe — our largest preventable cause of death and disease. Two in every three deaths among smokers can be attributed to smoking. Disadvantaged groups suffer disproportionately – Indigenous people, people with mental health problems and people with lower levels of education. Further, our successes in reducing smoking and achieving measures such as plain packaging and increases in the cost of cigarettes have led to unwarranted complacency. The reinforcing action that we needed has not occurred; we have good strategies, but little immediate action; and despite overwhelming evidence supporting well funded public education (and tobacco tax revenue of $17 billion p.a.), the last national media campaign was in 2012.

Now, more than ever, we have clear evidence about exactly what is needed to end the tobacco epidemic. Business as usual will result in some 20 000 tobacco deaths annually for decades ahead. Seventy years on from the certainty that smoking kills, this is unacceptable. The time is long overdue for Australian governments to plan an end to this preventable pandemic.

While there is rightly much planning about COVID-19 exit strategies, we must also plan for a tobacco exit strategy. There is now serious discussion internationally about the agenda for an end point – a target date for phasing out tobacco sales (here, here and here). This will require an agreed national strategy with a realistic date after which cigarettes and other tobacco products are no longer sold as standard commercial products. Importantly, this is not a strategy for banning smoking, but for phasing out commercial sales of tobacco products.

The strategy should comprise public education, regulation, and cessation support, with additional support for disadvantaged groups that suffer disproportionately from the health and economic harms caused by smoking and appropriate means of access for those remaining adults who are unable to quit. Nothing in this strategy would approach the constraints that have been so well accepted in relation to COVID-19.

In the COVID-19 context, WHO and other health authorities have emphasised evidence on the importance of smoking as an avoidable risk factor for COVID-19 and a poorer prognosis for smokers who are hospitalised as yet another incentive for smokers to quit (here, here, here, here and here). Early evidence from the United Kingdom suggests that more than 300 000 smokers there may have quit because of COVID-19 concerns.

Ironically, tobacco companies have sought to use the COVID-19 pandemic to promote their image through means such as philanthropy, and even to assert their concerns for health protection. The Philip Morris company closed a facility in Italy temporarily to protect its employees “out of an abundance of caution”, phrasing also used by Altria Tobacco. Sadly, the “abundance of caution” does not prevent these and other companies from selling and promoting products they have known are lethal for 70 years.

Moves to phase out tobacco sales will generate well funded and aggressive opposition from the tobacco companies that operate in Australia (albeit based overseas). Their concern will be twofold: first, the loss of a lucrative market; second, an awareness that, as with plain packaging, once approaches previously considered impossible have been successfully introduced in one country, others will follow, including in low and middle income countries, where their annual market growth is some 20 times greater than in high income countries. But even despite the industry’s lobbying, there is widespread awareness that, as summarised by a 2016 British Supreme Court judgement, this industry “facilitates and furthers, quite deliberately, a health epidemic. And moreover, a health epidemic which imposes vast negative health and other costs”.

All those now selling cigarettes have long been aware that they are selling a lethal product. This further applies to all who support the operations of tobacco companies, including public relations agencies, lobbyists, lawyers, accountants and front groups. The Australian tobacco market is dominated by supermarket chains, but they and smaller outlets would have time to plan for the end of their tobacco business in the knowledge that people will still be able to spend – although on healthier products. There should also be scope to provide corner stores with some support for transition from the government’s tobacco revenues. Treasury would have to plan for an end to those revenues, but also for an end to the much greater social and economic costs that smoking engenders.

Within weeks of evidence demonstrating cause for concern, Australian governments responded strongly to the COVID-19 pandemic, acting on the basis of public health recommendations. This will have prevented thousands of deaths. Just as we need to get to the other side of the COVID-19 pandemic, after 70 years, we also need to get to the other side of the tobacco pandemic. We have made great progress in reducing smoking, but we need a new sense of urgency. Even now, the tobacco giants are running global public relations and lobbying campaigns seeking to circumvent the WHO Framework, and to present themselves as responsible, even health-focused companies. Meanwhile, we daily see further examples of the ways they seek to counter and chill public health action, market their products to young people and vulnerable populations, attack and undermine health organisations and experts, and ensure further increases to the global tobacco death toll.

World No Tobacco Day is on 31 May 2020. Seventy years on from Wynder and Graham and Doll and Hill, Australian governments have shown over the years that determined governments working with well organised health coalitions can take on and beat Big Tobacco. They are currently seeing the substantial health benefits that accrue from relying on public health advice in response to a global pandemic without a commercial vector. Now they can show the world that a tobacco exit strategy is feasible. They should develop a plan to phase out the commercial sale of tobacco products in Australia by 2030.

Emeritus Professor Mike Daube AO is with the Faculty of Health Sciences at Curtin University. Professor Rob Moodie is currently Deputy Head of School and Professor of Public Health at the University of Melbourne’s School of Population and Global Health (MSPGH), and Professor of Public Health at the College of Medicine, University of Malawi.(Non-Smokers’ Movement of Australia Inc. responded in support, online.)