News analysis Tob Control: first published as 10.1136/tobaccocontrol-2021-056525 on 22 February 2021. Downloaded from

also called for, starting with a sharp reduc- aligned with Article 2.1 of the WHO Worldwide news tion in sales points. Vending machines FCTC, which states that “in order to should be removed as soon as possible, better protect human health, Parties and comment and tobacco and related products are encouraged to implement measures restricted to ‘estancos’ (regulated tobacco beyond those required by this Convention stores) as the only authorise selling points and its protocols.” SPAIN: CIVIL SOCIETY PRESSES for tobacco and related products, using This is an edited extract of an article GOVERNMENT FOR TOBACCO stronger ID policies to prevent underage originally published on the Tobacco ENDGAME BY 2030 youth purchases. Looking ahead, the Control website. The full article, with More than twenty civil rights associa- Declaration goes even further, calling for links to the Declaration and other refer- tions and public health organisations in a progressive phase out of the commercial ences, can be accessed at https://blogs.​ ​bmj.​ Spain have backed a Declaration asking sale of tobacco products, by not allowing com/​tc/​2021/​01/​19/​spain-​civil-​rights-​and-​ tobacco retailers to sell tobacco products the Spanish Government for a Tobacco public-​health-​organizations-​press-​govern- to people born after 2007. In other words, Endgame by 2030. The goal is ambitious: ment-​for-​a-​tobacco-​endgame-​by-​2030/. those who turn 18 on or after 2025 would to decrease smoking prevalence in Spain Laurent Huber be Spain’s first tobacco free generation. to under 5% by 2030. The Declaration Action on Smoking and Health, USA The creation of a fund to redress the outlines a range of measures to protect huberl@​ ​ash.org​ harms caused by tobacco is the final point Spanish citizens’ right to health, in line Ubaldo Cuadrado García de Arboleya, Raquel in the Declaration. Based on the “polluter with the government’s obligations under Fernández Megina & Leonardo Visconti pays principle”, the tobacco industry the WHO Framework Convention on NoFumadores.​ ​org, Spain would be subject to new levies, similar Tobacco Control (FCTC). These include to those enacted by France in 2016. smoke-­free public and private spaces, Given the negative impact of tobacco on MALAYSIA: DID THE TOBACCO increased prices and taxation, plain pack- both health and the economy, resources INDUSTRY COLLABORATE WITH MEDIA aging for tobacco products, phasing out should be allocated for smoking cessation TO DEFEAT TAX INCREASE? commercial tobacco sales, and a fund to treatments as well as supporting alterna- The Malaysian 2021 budget was an oppor- redress tobacco harms. tive livelihoods for those who currently tunity to raise tobacco taxes after 5 years The call for better protection from generate income through tobacco. with no increase. Instead, they remained secondhand smoke includes that both The Declaration was formally submitted static for the sixth year, following sustained indoor and outdoor areas of bars and to the Health Ministry on 29 December media coverage which was remarkably copyright. restaurants and all university campuses 2020. If adopted by the government, it favourable for the tobacco industry and become smoke free, as well as promoting will not only reverse a decade of increasing its arguments opposing tax increases. In protection from secondhand smoke in smoking prevalence, but also put Spain at addition to aligning with tobacco industry private homes. The latter is particularly the forefront of global tobacco control. framing, there was a distinct lack of public important for vulnerable people during Currently, tobacco use prevalence is health voices in the extensive media COVID-19 lockdowns. nearly 33%. Smoking prevalence reached coverage, as well as evidence of possible Pricing and taxation are essential issues a low point around 2010, when smoke-­ editorial interference to delay publication to address in Spain. A cigarette pack costs free laws were introduced for all closed of advocacy in favour of the increase. http://tobaccocontrol.bmj.com/ less than 5 euros, making tobacco prod- public spaces, including bars and restau- Taken together, these issues raise questions ucts cheaper than in many European rants. Unfortunately, since its implementa- about potential collaboration between the countries and easily affordable for youth. tion the law has been under attack with tobacco industry and media in Malaysia. As a result, the current age of smoking the hospitality sector starting a campaign initiation in Spain is 13.9 years. Increasing of civil disobedience, and setting up prices will not only decrease smoking enclosed outdoor terraces where smoking initiation and reduce smoking prevalence, is allowed. The current situation, in which but will also be a tool to help Spain during the hospitality sector feigns compliance its COVID-19 economic recovery period. while effectively disobeying the law, In addition to being a World Health clearly benefits the tobacco industry, and

Organization-­identified “best buy” for must end. on September 26, 2021 by guest. Protected public health, raising prices and increasing A recent survey conducted by ​Nofu- taxes would also ensure the tobacco madores.​org suggests that anti-­smoking prevention policies of Spain’s neighboring laws have wide support in Spain, with countries are not undermined by visi- two thirds of the population asking for tors to Spain purchasing cheap tobacco more restrictions, around 60% in favour products. of plain packaging, and 70% of smokers Another call included in the Declara- wanting to quit. Clearly more needs to tion is for Spain to follow the urging of be done to protect the right to health of many health professionals to implement Spanish citizens, instead of protecting plain packaging of tobacco products. This tobacco industry profits. would bring Spain into line with its neigh- Spain must look to a future free from Coverage in the New Strait Times of BAT bours in nine European countries, and 18 tobacco-induced­ disease and death. It Malaysia’s sponsored ‘stop the black market’ other countries around the world. must accelerate the implementation of bus campaign. source: https://www.​nst.​com.​ Steps to progressively phase out the the WHO FCTC, and take leadership by my/business/​ ​2020/10/​ ​629116/bat-​ ​malaysia-​ commercial sale of tobacco products are implementing novel end game policies hits-street-​ ​stop-black-​ ​market-bus.​

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increase tobacco tax, but included indi- between the tobacco industry and super- All articles written by Marita Hefler and rect measures to tackle illicit tobacco, markets, involving payments to promote John Baker unless otherwise attributed. in line with what had been advocated in the sale of tobacco products. Payments Ideas and items for News Analysis should preceding media coverage. Both Japan varied from €10 000 to about €2 million be sent to: [email protected]. Tobacco International Malaysia and BAT per year. For example, supermarkets au. Malaysia welcomed the budget. agreed to let the tobacco industry decide Although direct and indirect tobacco on cabinet layouts, made exclusive deals advertising is banned in Malaysia, it with a tobacco company, and received In addition to TV interviews and webi- appears that messages from the tobacco bonuses for selling certain volumes of nars, at least 30 articles were published industry and its allies are transmitted by tobacco products. All 51 cases resulted throughout 2020, with several angles mainstream media, with few dissenting in the NVWA issuing fines, varying from about smuggling and the illicit tobacco public health perspectives. The Malaysian €45 000 to €450 000 for repeat offences. market. Themes included: that Malaysia government must require tobacco compa- The Dutch State Secretary of Health, has the worst reputation globally as the nies to report their marketing and promo- Paul Blokhuis, stated ‘It is extremely world’s largest tobacco black market, tional budget and sponsored programmes. worrying that supermarket chains are smuggled cigarettes are driving underage Similarly, the media must be required to receiving illegal payments from the smoking, a BAT Malaysia-sponsored­ disclose the nature of any collaborations tobacco industry to promote the sale survey showing public agreement that high with the tobacco industry. The public of tobacco and related products’. In his prices feed the black market, smokers are deserves to know if collaboration exists conversations with supermarkets the turning to cheaper smuggled cigarettes, and if so, be told the full details. main topic has been their responsibility in COVID-19 is fuelling the illicit market, This is an edited extract of an article promoting healthy choices for customers. and small businesses are hurt by the illicit first published on the Tobacco Control ‘The future is smoke free’, Mr Blokhuis tobacco market. website at https://​blogs.​bmj.​com/​tc/​2021/​ added. ‘Bonuses to boost tobacco sales are Green Zebras, a market research 01/​26/​malaysia-​did-​the-​tobacco-​industry-​ not consistent with this responsibility and company, released infographics, published collaborate-​with-​media-​to-​defeat-​tax-​ will have to become a thing of the past as in the New Straits Times, with the message increase. Mary Assunta of the Southeast soon as possible’. that the majority of Malaysians supported Asia Tobacco Control Alliance, provided The NVWA also carried out inspec- the government acting on illicit cigarettes. technical input for both versions. tions at bigger supermarket chains The company did not disclose the client Mohamad Haniki Nik Mohamed between July and September 2020. for this work. Several foreign voices also International Islamic University Malaysia The report found 3% of supermarkets copyright. weighed in which supported the tobacco Malaysian Association for Adolescent Health (two stores) did not implement the industry’s messages, including Retail haniki@​ ​iium.edu.​ ​my display ban at all, while almost 50% of and Trade Brands Advocacy (RTBA) sampled supermarkets (33 stores) had based in Melbourne, a coalition of busi- implemented the legislation but did not ness, retailers and trademark holders. Its THE NETHERLANDS: RETAILERS meet all requirements. For example, Managing Director is the former Director CAUGHT BREACHING TOBACCO some supermarkets stored other prod- of Policy, Government and Corporate DISPLAY & ADVERTISING BANS ucts next to tobacco products, resulting Relations at the Australian Retailers Asso- In December 2020, the Netherlands Food http://tobaccocontrol.bmj.com/ in the tobacco cabinets being accessed ciation. The Washington DC-based­ group, and Consumer Product Safety Authority more often than strictly necessary. The Consumer Choice Centre, a lobbying (NVWA) published the results of two group which has received tobacco industry investigations regarding possible breaches NVWA imposed 30 fines and issued 3 funding, was also quoted in the media of tobacco regulations. One investigation official warnings. The fines amount to coverage. BAT Malaysia launched a 'Stop focused on illegal payments related to €450 each and can increase to €4500 for The Black Market' campaign, including product placement agreements from the subsequent breaches. a bus which was driven around Kuala tobacco industry to supermarkets. Such The results from the NVWA reports Lumpur, including near the Parliament payments do not align with legislation come after the Dutch Government house. The campaign received uncritical preventing advertising and sponsorship of announced that supermarkets, which media coverage. tobacco and tobacco-related­ products in make up approximately 55% of all tobacco

In early October, I sent a letter to the The Netherlands. The second investiga- sales in the country, will not be allowed to on September 26, 2021 by guest. Protected opinion page of the New Straits Times tion focused on possible breaches of the sell cigarettes or other tobacco products protesting BAT’s campaign bus, which display ban for tobacco products, which from 2024. Cigarette vending machine is a form of sponsorship, and called for entered into force in supermarkets on 1 sales will also be banned from 2022. a tobacco tax increase. It was briefly July 2020. The display ban entered into These retail sales bans will reduce tobacco published on 7 October but was pulled force for other tobacco retailers on 1 points-­of-­sale significantly. The Nether- within several hours. In response to a January 2021. In both investigations the lands also introduced plain packaging for query to the NST editor, the newspaper NVWA found breaches of tobacco control tobacco products in October 2020. The said, “We have withdrawn the article regulations. introduction of these laws support part of temporarily. This has to do with in-house­ In 2020 the NVWA investigated whether the Dutch government’s plans to gradu- matters. We will re-­publish it in a short supermarkets received payments from the ally phase out tobacco sales, where only while.” NST’s “short while” stretched into tobacco industry that constituted a viola- specialist retailers would be allowed to sell 3 weeks before the letter was republished tion of the advertising and sponsorship tobacco products. on 29 October 2020. ban after illegal payments were uncovered Daniëlle Arnold On 6 November, the Finance Minister during earlier inspections at tobacconist Health Funds for a Smokefree Netherlands announced the 2021 budget. It did not shops. The NVWA found 51 agreements danielle.​ ​arnold@gvrv.​ ​nl

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INDIA: CHANGES TO TOBACCO Retailers Associations. The Federation of wp-​content/​uploads/​2020/​12/​BFFP-​2020-​ CONTROL LAWS PROPOSED All India Farmers’ Associations (FAIFA), Brand-​Audit-​Report.​pdf. In January 2021, the Indian Government a non-­profit organisation representing Tobacco product-­related plastic waste announced plans to introduce a number farmers and farm workers of commercial is unique among those found in the of draft changes to the ‘Cigarettes and crops across India, claims the amendments audit as the only products which have no other Tobacco Products (Prohibition of would adversely impact the legal cigarette useful or beneficial purpose for humanity. Advertisement and Regulation of Trade trade while helping the “ever-growing­ However, new laws in the European and Commerce, Production, Supply and illicit cigarette business in India”. Union which will come into effect from Distribution) Amendment Act, 2020.’ Sanjay Seth, head of tobacco control 3 July 2021, may go some way towards The proposed changes include an at non-­profit Sambandh Health Founda- raising consumer awareness and reducing increase in the minimum sales age for tion, said “It is a much needed proposal as waste, by requiring all products containing tobacco products from 18 to 21 years. there were some gaps previously. The key single use plastics to be labelled. The law Violation of the minimum sales age laws is going to be enforcement of the law once is designed to inform consumers of the could lead to a 2 year prison sentence or passed.” It is hoped that these proposed presence of plastic in the product, inform a fine of up to Rs100,000 (£1002). A changes will lead to further de-­normalisa- them of the negative impact of littering second conviction could lead to a prison tion of tobacco use in India, where nearly and ensure appropriate waste disposal. sentence of up to 5 years or a fine of up 1.35 million people die each year from to Rs500 000(£5015). The proposal also tobacco-related­ illnesses and diseases. USA: NEW INDEX HIGHLIGHTS includes provisions to prohibit smoking Contributors to this article: Prakash TOBACCO INDUSTRY INTERFERENCE IN zones in hotels, restaurants and airports. Gupta - Healis Sekhsaria Institute of POLICY MAKING The penalty for smoking at restricted Public Health, Sanjay Seth – Samband Tobacco use remains the leading cause areas will increase from Rs200 (£2.00) to Health, Ravi Mehrotra – India Cancer of disease and early death in the U.S., Rs2000 (£20.00). Research Consortium. accounting for 480 000 deaths annually, The government has also introduced including 41 000 attributable to second- draft changes to prevent the sale of hand smoke. Premature smoking-­related individual (‘loose’) cigarettes and bidis death is usually preceded by years of through mandating that only sealed packs illness, with the CDC claiming “For every of tobacco that adhere to the prescribed American who dies because of smoking, at minimum number of cigarettes can be sold. least 30 are living with a serious smoking-­ The proposed changes also aim to prevent copyright. related illness.” and reduce the sale of illicit tobacco prod- The U.S. Tobacco Industry Interfer- ucts, with a 1 year prison sentence and a The new label required on tobacco products in ence Index 2020 highlights many ongoing fine of Rs50 000 (£501) for those caught the EU which contain single use plastics, from tactics employed by the tobacco industry selling, while the fine for manufacturing July 2021. to defeat, weaken, or delay proposed illicit cigarettes could lead to 2 years’ public health measures so as to maintain or imprisonment and a fine of Rs100,000. increase tobacco use, ensure that tobacco Proposed changes have been made WORLD: PHILIP MORRIS AMONG TOP users remain addicted, and protect and http://tobaccocontrol.bmj.com/ to tighten existing tobacco advertising TEN PLASTIC POLLUTERS increase their profits. legislation, with the draft laws stating Free From Plastic, a global movement Although the U.S. has signed but not yet “No person shall directly or indirectly working to reduce single use plastic and ratified the WHO’s Framework Conven- advertise cigarettes or any other tobacco develop solutions for the plastic pollution tion on Tobacco Control (WHO FCTC), products through any medium and no crisis, published its third global report on The FCTC is the basis for the U.S. report. person shall take part in any advertise- branded plastic pollution in late 2020. The FCTC Article 5.3 mandates protection ment that directly or indirectly promote report Branded Volume III: Demanding of tobacco control policy from tobacco the use or consumption of cigarettes or Corporate Accountability for Plastic Pollu- industry interference. any other tobacco products.” In 2015, tion, reports on branded plastic waste In the report, the U.S. received an inter- India proposed comprehensive changes to collected by nearly 14 000 volunteers in ference score of 66/100, with a higher its tobacco control law, but after pressure 55 countries. score demonstrating a higher level of on September 26, 2021 by guest. Protected from the tobacco industry, the proposal For the second year running, Philip tobacco industry interference. Although was dropped. In 2017, an investigation Morris international was identified as a the U.S. score improved slightly from 2019 by Reuters found that Philip Morris Inter- top global polluter, coming eight among (72/100), this is only a modest improve- national (PMI) was allegedly violating the top 10. In the 2019 report, it was ment. These scores place the U.S. among Indian tobacco control laws by deploying ninth. Its products were found in 28 the worst of the 57 countries participating marketing tactics, including advertising at countries. The most common PMI prod- in the latest global report. kiosks. The Indian Government threat- ucts found were Parliament, Merit and The U.S. stood out as one of the worst ened PMI with “punitive action” and the Marlboro. Smoking materials – ciga- performing countries for tobacco industry tobacco advertisements were removed rette butts, lighters and cigar tips - were interference in the category of policy from a number of retailers. the second most common product type development. For example, the tobacco Tobacco industry representatives have found in the audit after food packaging industry has a constant presence at the already stated they will object to the and ahead of household products such as federal level in the Food and Drug Admin- new proposals through public consulta- personal hygiene and household cleaning istration’s Tobacco Products Scientific tion. The proposed Amendment Bill has product packaging. The report is available Advisory Committee, with three non-­ also been criticised by Restaurants and at https://www.​breakfreefromplastic.​org/​ voting tobacco industry representatives.

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The report also highlighted state and local com/​tc/​2021/​01/​20/​monitoring-​and-​ examples of tobacco industry interference, exposing-​tobacco-​industry-​interference-​ exposing their multi-­tiered approach. This in-​u-​s-​public-policy/.​ is so pervasive in the U.S. that only a Nichelle Gray small percentage of occurrences could be Action on Smoking and Health, USA included in the report. grayn@​ ​ash.org​ The tobacco industry successfully liti- Kathleen Hoke gated to secure state preemption of local Legal Resource Centre for Public Health Policy tobacco control in Maryland. In 2020, & University of Maryland, USA local health officials joined with public Doug Matheny health advocates to seek a statewide law TSET Health Promotion Research Centre, USA Philip Morris advertisement as shown prohibiting sales of flavoured tobacco on the Washington Post website www.​ products, an initiative beaten back by washingtonpost.​com. Screenshot supplied by U.S.: PMI’S DIGITAL PR CAMPAIGN TO the tobacco industry. Local public health Jon Krueger. leaders and community advocates are now PROMOTE ‘SMOKE-FREE’ MESSAGES In April 2019, the U.S. Food and Drug Philip Morris International (PMI) has been prioritising regaining local authority to Administration (FDA) approved the sale on a public relations offensive in recent curtail industry impact. of IQOS, PMI’s heated tobacco product, months. Several major US newspapers, Though there have been pockets of which is sold in the US by Philip Morris including the Washington Post and New progress, all states’ tobacco control laws USA under an exclusive licensing agree- York Times, have carried PMI advertise- continue to fall short of best practices. ment with PMI. Although promoted by ments promoting ‘less-­risky,’ ‘smoke-free,’­ Many existing state tobacco control laws PMI as a “better alternative” to smoking, and ‘better’ alternatives to conventional were written or heavily influenced by the device has not been scientifically tobacco products as the solution to a tobacco companies. shown to reduce overall smoking-related­ public health catastrophe that it fuels, and Many thousands of lives could have been health risks or help smokers quit. In July from which it continues to reap most of saved if not for tobacco industry interfer- 2020, the FDA concluded that IQOS does its profits. The ads convey a message of ence in lawmaking. Regular monitoring reduce a person’s exposure to harmful science-­based solutions, transformation, and reporting of such interference is now chemicals, but denied PMI’s application to transparency and openness. The ads stand a moral imperative. By exposing tobacco market it as a product that reduces the risk in stark contrast to the ubiquitous adver- industry interference, advocates can help of tobacco-related­ disease. The FDA stated tising of PMI’s ever-expanding­ range of neutralise its impact, thereby reinvigo- cigarette products in ‘growth markets’ in “…these products are not considered safe copyright. rating stalled tobacco control initiatives low and middle income countries such as nor ‘FDA approved’”. PMI’s marketing in and accelerating adoption of effective Indonesia, its contribution to plastic pollu- digital advertisements suggests otherwise, laws. Norms related to tobacco industry tion, and its ongoing attempts at public stating “…better alternatives, backed interference will change within legislative policy interference. by science, are real, and they have the bodies only when tobacco companies and potential to deliver a huge public health their allies are held publicly accountable. opportunity.” The U.S. Tobacco Industry Interference

Index 2020 offers eight recommendations © Author(s) (or their employer(s)) 2021. No http://tobaccocontrol.bmj.com/ to help advance these efforts, scalable and commercial re-use­ . See rights and permissions. adaptable for every state and community. Published by BMJ. The time is now. This is an edited version of an article Philip Morris advertisement as shown first published on the Tobacco Control on the Washington Post website www.​ website. The full article and link to the washingtonpost.​com. Screenshot supplied by Tob Control 2021;30:121–124. report are available at https://blogs.​ ​bmj.​ Jon Krueger. doi:10.1136/tobaccocontrol-2021-056525 on September 26, 2021 by guest. Protected

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