News analysis Tob Control: first published as 10.1136/tobaccocontrol-2020-056285 on 23 October 2020. Downloaded from

The intent of the promoters of the process to adopt strict Worldwide news initiative is that these minor constitutional legislation. According to a 2015 report, amendments would provide the legal basis approximately two-thirds­ of the Swiss and comment for the adoption of legislation that bans public supported banning tobacco adver- all forms of tobacco advertising for prod- tising in all locations except at the point of ucts that reach children and young people, sale, while 58% supported a comprehen- SWITZERLAND: GOVERNMENT THINKS such as in theatres, on posters and bill- sive advertising ban. PREVENTING YOUTH-FOCUSED boards, in magazines and on the internet, The annual costs of in Swit- TOBACCO ADVERTISING ‘GOES MUCH and at the point of sale. This would also zerland are estimated to be around CHF TOO FAR’ include ending the promotion of tobacco 5 billion (approximately 5.394 billion products and the event sponsorship by the In a recent message to parliament, the USD), far exceeding the revenues derived . Swiss research indicates from tobacco taxes. The Swiss govern- Swiss Government has rejected a popular nearly 57% of young people aged 24 to 25 ment has been blocked by parliament initiative aimed at protecting children years reported receiving a tobacco-related­ from increasing tobacco taxes since 2014. and youth against exposure to tobacco promotional gift. Only tobacco adver- Approximately 32% of young people aged advertising, arguing that such protection tising exclusively targeting adults would 15 to 25 years old in Switzerland , would threaten the economic interests still be permitted. and 27% of adults smoke. Tobacco use is of the tobacco industry. In the message, The initiative by the Swiss health orga- responsible for approximately 15% of all the government restated its policy to nizations expresses their exasperation preventable deaths in Switzerland. only support tobacco advertising restric- with the systematic opposition, over the If Switzerland wants to ratify the FCTC, tions that are “acceptable to the tobacco years, of both chambers of parliament it should adopt comprehensive tobacco industry”. against any form of effective tobacco advertising and sponsorship bans, increase The popular initiative is an instrument control legislation. taxes on tobacco products, and implement of direct democracy that allows citizens In 2014, Switzerland adopted a new strong measures to protect its tobacco to propose changes to the Swiss constitu- law on foodstuffs, with the aim of making control policy from the interference of tion, provided 100 000 signatures were it compatible with EU legislation. Tobacco the tobacco industry, which is its main collected in their support. The initia- products, which were treated as foodstuff problem today. tive “Yes to the protection of children until then, were excluded from the new Pascal Diethelm and youth against tobacco advertising” law, as they are not considered as food in OxyRomandie, Switzerland was launched by the major Swiss public the EU law. Switzerland thus needed a law

pascal@​ ​diethelm.me​ copyright. health organizations, under the leader- specifically dedicated to tobacco products. ship of Hans Stöckli, who is currently the The government produced its first draft President of the Council of States (Swit- tobacco products law (TPL) in the same US: CALIFORNIA PASSES LAW zerland’s Senate). The initiative aims at year. Although the draft law was very weak, PROHIBITING MENTHOL & FLAVOURED making two small changes to the Swiss keeping Switzerland at the bottom of the TOBACCO PRODUCTS federal constitution. Tobacco Control Scale in Europe rating for California has become the second U.S The first change (italicised) includes advertising bans, both chambers of parlia- state to pass comprehensive legislation

additional wording to Article 41: “The http://tobaccocontrol.bmj.com/ ment rejected it, asking the government to to prohibit the retail sale of menthol and Confederation and the cantons undertake, submit a new, weaker draft law. The argu- flavoured tobacco products from January in addition to individual responsibility ments were that “the law goes much too 1 2021. The prohibition includes pen-­style and private initiative, to ensure that […] far as it interferes with the principles of electronic (e-cigarette)­ pods, children and young people are encour- the market economy” and that “there is no tank-­based e-cigarette­ systems, menthol aged to become independent and socially evidence to date that a general ban on adver- and chewing tobacco; however responsible persons and are supported in tising will reduce tobacco consumption.” premium cigars and tobacco are their social, cultural and political integra- The government then submitted a exempt. tion and that their health is promoted.” watered-down­ draft to parliament (with no Similar legislation was proposed in The second change makes the following restriction on tobacco advertising in news- May 2019, however it was retracted after addition (shown in italics) to Article 118 papers, at the point of sale, with no spon- significant amendments led health advo- Health protection: “Within the limits of sorship ban etc.), which was still opposed cates to withdraw their support. The state on September 30, 2021 by guest. Protected its powers, the Confederation shall take by economic circles and their parliamen- Senate voted again in August 2020 and measures to protect health. It shall legis- tarian proxies. At the time of writing, the gave final approval to Senator Jerry Hill late on: […] the control of communicable new draft law is still being debated. It has (D-­San Mateo), who stated the approval is diseases, widespread diseases and partic- been slightly amended by the Council of “a huge win for our kids and the health of ularly dangerous diseases of humans and States, with the arguable claim that it is our communities throughout California.” animals; in particular, it shall prohibit all now compliant with the WHO’s Frame- California Governor Gavin Newsom forms of advertising for tobacco products work Convention on Tobacco Control signed the bill into law through a Zoom that reach children and young people.” (FCTC). Nevertheless, even with those ceremony with health advocates. new changes, Switzerland would still be This legislation is in response to the at the last place of the Tobacco Control tobacco industry targeting flavoured Scale in Europe for advertising bans. The tobacco products to young people and All articles written by Marita Hefler and draft law will be deliberated by the Swiss to people of colour. A study undertaken John Baker unless otherwise attributed. National Council in 2021. by the Centers for Disease Control and Ideas and items for News Analysis should The popular initiative is a civil society Prevention in 2018 found that 49% of be sent to [email protected]. response to the inaptitude of the political middle school students and 67% of high

Tob Control November 2020 Vol 29 No 6 601 News analysis Tob Control: first published as 10.1136/tobaccocontrol-2020-056285 on 23 October 2020. Downloaded from school students who used tobacco prod- SPAIN: COVID-19 PROMPTS SMOKING higher risk of SARS-­Cov-2 transmission ucts in the last 30 days had used flavoured REGULATION IN STREETS AND due to smoking in outdoor public places, tobacco products. More than half of youth TERRACES mainly because of the emission of drop- smokers ages 12–17 years smoke menthol Spain has been heavily affected by the lets and their diffusion with smoke or cigarettes, a higher rate than any other age COVID-19 pandemic. From the first other aerosols (in addition to the hand-­ group. Approximately 94% of African-­ diagnosed case on January 31 this year to mouth movements and manipulation of American youth smokers use menthol August 13, there were 337 334 cases, 129 face masks, and the risk of relaxing of tobacco products compared with 85% 009 hospitalizations and 28 605 deaths. distancing). Following this policy brief of African-American­ adult smokers. Phil After a growing number of daily cases of recommendation, and statements from Gardiner, co-­chair of the national African coronavirus across the country in recent other scientific societies and profes- American Tobacco Control Leadership weeks, Spain is going to regulate smoking sional associations (national committee Council, stated that “The tobacco industry in public outdoor spaces such as streets on smoking prevention, society of public has lured our kids into addiction for too and terraces, based on the rationale that health, society of respiratory medicine, long, using menthol and other flavours… smoking can spread the virus. and the federation of physicians’ colleges) By signing…the Governor sent a strong Despite the Spanish tobacco control in early July the Ministry of Health recom- message to the tobacco industry that Cali- law already having a smoking ban in some mended avoiding tobacco consumption in fornia’s kids are off-­limits.” outdoor areas, including schools, health- community and social settings. On July In response to the proposed bill, the care campuses and children’s playgrounds, 30, the NGO “Nofumadores.​ org”,​ with tobacco industry ran a campaign that there is only a partial ban in terraces, 20 scientific societies, consumers organ- called the proposal discriminatory toward based on overall coverage and the number isations and health professional associa- Black and Latino adult smokers. Tobacco of walls. Smoking in open public places is tions, including the European Network companies sent mailers to voters’ homes very common in Spain, where 24 of the for Smoking and Tobacco Prevention urging them to tell their state representa- and ASH United States, sent a manifesto adult population . The national tives to vote against the bill, and bought to the Minister of Health requesting the regulation of smoking in outdoor places print, television and online advertising urgent prohibition of smoking on terraces follows the initiative from the regional space. Advertisements accused the bill of of hospitality premises, and all outdoor Government of Galicia, announced on being bad for communities, and claimed public places. These requests have been August 13. Prompted by this announce- that menthol cigarettes were part of Black widely covered by the media and social ment, several other regional governments culture. Approximately 80% of menthol networks. publicly indicated they were going to cigarettes sold are consumed by African-­ While public health and tobacco implement the measure. After an express copyright. American smokers, which contributes to control stakeholders welcome this step meeting of the Council of the National the 45 000 deaths from heart disease, lung forward, a real and permanent ban of Health System, the Minister of Health , stroke and other diseases caused smoking in terraces and outdoor spaces announced a smoking ban in outdoor by tobacco among this group each year. has not been passed. The agreement public places if a two metre distance is not San Francisco Supervisor Shamann of the Council of the National Health possible. Walton, said “Tobacco companies have System on tobacco or other tobacco or been allowed to market their deadly prod- The significant impact of COVID-19 similar products use states that smoking ucts in our communities without regard and new outbreaks in several regions of in the streets or in outdoor spaces is http://tobaccocontrol.bmj.com/ for black lives and health for far too the country after the 100 day lockdown forbidden when a minimum two metre long. California’s lawmakers must join us (between March 15 and June 21) partly distance could not be achieved. Hence, and protect the next generation of black explain this measure aimed at curbing smokers are allowed to remove their face and brown lives from deadly the resurgent disease. Previous campaigns mask while smoking in outdoor places addiction.” from both non-­governmental organi- whereas non-­smoking people have to In December 2019, the State of Massa- sations (NGOs) and scientific societies, wear it, since the use of masks is manda- chusetts was the first to introduce a ban on together with a favourable anti-­smoking tory in public places. the sale of flavoured and menthol tobacco social climate, also triggered its adoption. The Spanish regulation of smoking in products at nearly all tobacco retailers. In May, the Spanish Government made outdoor spaces is consistent with the WHO Smokeless tobacco, cigars, pipe tobacco, the use of face masks compulsory in streets statement on tobacco use and COVID-19, hookah tobacco, electronic cigarettes and and other outdoor spaces, and in all public the risk for inhalation exposure to corona- on September 30, 2021 by guest. Protected vapour products were included in the indoor places where physical distancing of viruses in microscopic respiratory droplets legislation and the ban came into effect at least 1.5 metres is not possible. This that could likely be enhanced by smoke and on June 1 2020. Other states including requirement expanded the requirement aerosols exhaled by smokers or users of New York and have also to wear masks for all transport and work- other electronic devices, and that outdoor banned flavoured e-­cigarette products. In places, which had already been passed as smoking bans have good acceptance and addition, 78 cities and counties in Cali- part of the lockdown. Early in June 2020, support by the population. Governments fornia, including Los Angeles County, had the NGO “Nofumadores.​ org”​ launched in other jurisdictions should take note of previously passed legislation to restrict the campaign “Smoke-­free terraces, right the Spanish experience to contribute to sales of flavoured tobacco products. It is now!” through the platform change.​ org​ curbing the COVID-19 epidemic, prevent anticipated that other cities, counties and which has collected almost 89 000 signa- new outbreaks and potential new waves. States in the U.S will enact similar legisla- tures to date. This is an edited version of an article tion to that introduced in California and At the same time, the working group first published on our website. The to protect young people on tobacco control of the Spanish Society fully referenced article and complete and people of colour from the significant of Epidemiology wrote a fact sheet and author affiliations can be read at: harms caused by tobacco use. launched a press release pointing out the https://​blogs.​bmj.​com/​tc/​2020/​09/​05/​

602 Tob Control November 2020 Vol 29 No 6 News analysis Tob Control: first published as 10.1136/tobaccocontrol-2020-056285 on 23 October 2020. Downloaded from spain-​covid-​19-​prompts-​smoking-​regula- for any human use, therapeutic or non-­ products via the SAS and APS path- tion-​in-​streets-​and-​terraces/. therapeutic, although it is unlikely that a ways. The proposed regulatory changes health practitioner would prescribe nico- may create a supply model that resem- tine for a non-­therapeutic purpose as it bles current arrangements for medicinal would fall outside their scope of profes- cannabis in Australia. However, many sional practice. Nicotine in smoking questions remain about whether there cessation aids that use transdermal or will be an adequate prescription and oral delivery, or in combustible tobacco supply network in place before the ban products remain exempt from drugs and on personal importation commences. poisons scheduling and can continue to Australians who want to obtain nicotine be sold in general retail outlets without a vaping liquid will need to find an Austra- prescription. lian medical practitioner who is willing to Changes to importation of nicotine provide a prescription and organise the vaping products, announced in June, are supply of nicotine vaping products via the expected to commence from 1 January SAS, APS or compounding pathways. Simi- 2021. All importers will require a permit larly, pharmacists will need to be willing from the Office of Drug Control, with to compound, or supply imported finished strong penalties (fines of up to $222,000) products via these pathways. As has been imposed for importing or attempting to done for medicinal cannabis products, an import nicotine vaping products without approved product standard will be needed a permit. for nicotine vaping products. The changes continue the country’s It is unclear how the changes will impact Spain smoke-­free signage Smoke-­free signage relatively restrictive approach to regu- Australians who use smokeless tobacco. at a cafe in Tarragona, Spain. Photo credit: Inés lating non-­smoked nicotine products, Domestic sales of smokeless tobacco were Raigón. compared with similar countries such as banned federally in 1991 under the Trade Esteve Fernández the United Kingdom, , the Practices Act 1974, but personal importa- Cristina Martínez United States, and Canada, where nico- tion of quantities not exceeding 1.5 kg is WHO Collaborating Center for Tobacco Control tine vaping products are sold as consumer permitted, with larger quantities requiring Catalan Institute of Oncology, Spain goods. a permit to import. It is unknown if the

efernandez@​ ​iconcologia.net​ The main impact of the scheduling requirement for a medical prescription copyright. change will be to reduce confusion on will be enforced for imported smokeless AUSTRALIA: CHANGES TO NICOTINE which schedule applies to nicotine vaping tobacco. PRODUCT REGULATION INCLUDING products. This should lead to a more There are no proposed changes to the PRESCRIPTION REQUIREMENTS consistent interpretation of the Poisons regulation of nicotine in cigarettes and A number of changes to the regula- Standard with respect to nicotine across other combustible tobacco products in tion of nicotine products are underway Australian states and territories. The Australia. These will remain exempt from ban on importation without a permit

in Australia. These changes primarily TGA regulation and continue to be widely http://tobaccocontrol.bmj.com/ affect non-therapeutic­ nicotine products, will have greater impact. Because there sold as a consumer product by general including nicotine vaping products and are no nicotine vaping products listed retailers, such as supermarkets, conve- smokeless tobacco products, such as oral on the Australian Register of Thera- nience stores and petrol stations, a situa- snuff and chewing tobacco. peutic Goods, Australians with a medical tion that points to some obvious questions An interim decision by the Austra- prescription can only access them via one about regulatory coherence and consis- lian Therapeutic Goods Administration of four exemption pathways for accessing tency regarding products that cause harm. (TGA), which is expected to be finalised in unapproved therapeutic goods: personal Coral Gartner early 2021 and implemented from 1 June importation, the special access scheme University of Queensland, Australia 2021, will remove the ‘dangerous poison’ (SAS), the authorised prescriber scheme c.​ ​gartner@uq.​ ​edu.au​ (Schedule 7 of the Poisons Standard) (APS) and extemporaneous compounding.

classification for any nicotine products Without the personal importation option, © Author(s) (or their employer(s)) 2020. No commercial on September 30, 2021 by guest. Protected intended for human use. Industrial and patients will need to rely on health prac- re-­use. See rights and permissions. Published by BMJ. agricultural products containing nicotine titioners supplying their nicotine vaping will still be classed as dangerous poisons. products to them. The current “prescription only medi- The government announced that a cine” (Schedule 4) classification will be streamlined process would be set up to Tob Control 2020;29:601–603. expanded to include nicotine products allow patients to obtain nicotine vaping doi:10.1136/tobaccocontrol-2020-056285

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