News analysis Tob Control: first published as 10.1136/tobaccocontrol-2021-056941 on 23 August 2021. Downloaded from

estimated 10.9% of products were exposing the company to large fines. Worldwide news illicit, the reported 22% will pay US$40 million over 6 years for 2017 and 24% in their latest report, to North Carolina, which will use the and comment in 2019. funds to provide e-­ cessation and Chile became a party to the Framework prevention programmes, and for e-­ciga- Convention on in 2005. rette research. CHILE: ILLICIT TRADE OBSERVATORY Since then, the Chilean government has As part of the settlement, the company OPENS THE DOOR FOR TOBACCO tried to implement the measures proposed agreed that it would not advertise to INDUSTRY INFLUENCE therein. However, the creation of the Illicit people under 21 years of age through The Global Tobacco Industry Interference Trade Observatory goes against the guide- traditional or social media platforms, their Index 2020 revealed that Latin America lines proposed by Article 5.3 of the FCTC products would only be sold behind the faces some of the highest rates of industry and the 2018 Protocol to Eliminate Illicit counter by retailers that have identifica- interference in the world. Partnerships Trade in Tobacco Products, which Chile tion scanners, and the company would between government and tobacco compa- has yet to ratify. In addition to producing limit the quantity of products sold online nies over the illicit tobacco trade have reports that over-estimate­ the scale of to those living in the state. In its settlement enabled this interference to continue the problem, the Observatory promotes with North Carolina, the company did not despite longstanding evidence of the unnecessary interactions between the admit intentionally targeting youths. tobacco industry’s complicity in the illicit government and the tobacco industry via This is the first settlement of its kind in tobacco trade. activities such as training government civil the US, however since February 2020, 39 The illicit tobacco trade benefits tobacco servants, journalists, and media represen- other U.S state attorneys have examined companies by increasing the accessibility tatives, as well as monitoring and evalu- Juul’s practices and filed lawsuits against of their products, and decreases govern- ating public policies on track and trace. the company. There are also a large ment revenues that could be used for Chile is not alone with this type of number of personal injury lawsuits from tobacco control and public health efforts. industry influence. Costa Rica also has a customers and families of young people In 2016, the Illicit Trade Observatory in similar entity called the Mixed Commis- claiming they were addicted to or hurt by Chile was created by the Chilean Chamber sion Against Illicit Trade, which is made Juul products. of Commerce, as a public-­private part- up of public and private actors, where “Juul sparked and spread a disease-the­ nership, “whose objective is to generate the tobacco industry enjoys direct access disease of addiction. They did it relevant information for the generation to government officials . Costa Rica, like to teenagers across North Carolina and this country simply to make money…(this) of public policies aimed at combating all Chile, is also a party to the FCTC and copyright. forms of illegal trade”. The Observatory subject to Article 5.3. court order will go a long way towards is composed of 13 public institutions, Chile has a significant history of ensuring that their e-­cigarette product is including the ministry of finance, the tobacco industry interference and the not in kids’ hands, its chemical vapour is Chilean law enforcement agency, and Illicit Trade Observatory is perpetuating out of their lungs, and that the nicotine the national customs and border control this influence. Countries that are parties does not poison or addict their brains.” department, and several private actors to the Framework Convention on Tobacco North Carolina Attorney General Josh Control should seek to progress its imple- Stein said.

such as British American Tobacco and the http://tobaccocontrol.bmj.com/ Chilean Chamber of Commerce. Since its mentation, avoiding unnecessary interac- E-­cigarette use among teenagers signifi- inception, every report published by the tions with the tobacco industry, including cantly increased in the US after Juul was Observatory on the illicit tobacco trade on tobacco illicit trade issues. The FCTC launched in 2015, leading the US Food has either been conducted or commis- recommends that countries ratify the and Drug Administration (FDA) to declare sioned by British American Tobacco. Illicit Trade Protocol. Countering tobacco an epidemic of vaping among teenagers in Unfortunately, the lack of independent industry interference is a challenge faced 2018. “The evidence is clear that Juul’s data around illicit trade means govern- by many different countries around the high-­dose nicotine products caused the ments rely on the statistics and reports world and should be given priority in youth e-cigarette­ epidemic,” said Matthew prepared by the tobacco industry and its tobacco control efforts. Myers from the Campaign for Tobacco-­ allies. Organisations such as the Transna- Mercedes Carballo Free Kids. Tobacco Tactics, Tobacco Control Research The US Centres for Disease Control tional Alliance to Combat Illicit Trade, on September 24, 2021 by guest. Protected funded by Philip Morris International Group, University of Bath and Prevention stated that e-­cigarette use and the Latin American Alliance against Research Partner of the Bloomberg Philanthro- among teenagers dropped significantly Contraband (ALAC), whose members pies funded STOP project. between 2019 and 2020, with approx- include transnational tobacco companies, M.​ ​Carballo@exposetobacco.​ ​org imately 20% of high school students produce reports that tend to overestimate stating that they had recently used e-cig­ - the illicit tobacco trade. In Chile, while arettes in 2020, down from 28% in 2019. independent studies conducted by civil USA: JUUL PAYS SETTLEMENT TO Although this decline may be a temporary society and academic institutions in 2017 NORTH CAROLINA pandemic-­related effect, federal restric- In June 2021 e-cigarette­ manufacturer tions on e-cigarette­ flavours and legisla- Juul agreed to settle with the State of tion to raise the age limit for tobacco and North Carolina for unfair and deceptive e-­cigarette sales to those aged 21 years and All articles written by Karen Evans-­ practices that targeted young people. In over may have also influenced the reduc- Reeves and John Baker unless otherwise May 2021 Superior Court Judge Orlando tion in e-­cigarette use among youth. attributed. Ideas and items for News Hudson stated that Juul, partly-­owned by In September 2021, the FDA will deter- Analysis should be sent to k.a.evans-­ Altria Group, had ignored court orders mine whether to grant Juul a Premarket [email protected] and destroyed documents, potentially Tobacco Product Application (PMTA) as

Tob Control September 2021 Vol 30 No 5 481 News analysis Tob Control: first published as 10.1136/tobaccocontrol-2021-056941 on 23 August 2021. Downloaded from a safer alternative to combustible ciga- operations. Both British American The NZ government’s commitment to a rettes to enable the continued sale of its Tobacco (BAT) and PMI have also invested smokefree goal in 2011 was a response to e-­. A large number of health in COVID-19 vaccine programmes, an a recommendation from the Māori Affairs and medical organisations, including the investment which the companies then use Select Committee of the NZ Parliament. American Heart Association, the Amer- to promote their corporate brands. It followed sustained advocacy by Māori ican Cancer Society’s Cancer Action To illustrate this point, on December 2, (the Indigenous peoples) leaders for the Network, and the American Academy of 2020 in Greece (a country which has one ‘Tupeka Kore’ goal for the elimination of Paediatrics, have asked the FDA to reject of the highest rates in Europe), tobacco products, which were introduced the application. the country’s Prime Minister alongside to Māori by colonisation, from NZ. This article is based on content origi- the Vice President of the US Chamber of Smokefree 2025 was defined as minimal nally reported by Sheila Kaplan for the Commerce and the CEO of Pfizer and prevalence of smoking and minimal avail- New York Times on 28 June 2021. other corporate figures, met to discuss ability of tobacco products. However, the impact of COVID-19 coming hot progress has been slow, and under its off the heels of Pfizer’s November 2020 ‘business as usual’ approach, New Zealand GLOBAL: TOBACCO INDUSTRY’S announcement that it had produced a was on track to miss the goal by a wide TACTICAL RESPONSE TO COVID-19 vaccine. Among the participants at this margin, particularly for Māori, Pacific and REVEALED IN NEW DATABASE high-­level public health discussion, was low-SES­ populations which have much Few organisations have done more in André Calantzopoulos, then CEO of higher smoking prevalence. opposition to public health than Philip PMI. The discussion document sets out a Morris International (PMI), and few Now, as the pandemic progresses, comprehensive strategy to achieve rapid industries have killed more customers tobacco companies are now switching to and equitable reductions in smoking. than the tobacco industry, yet tobacco the language of “COVID-19 recovery”, The proposed plan also includes struc- companies have featured heavily during in public statements, reports and share- tural changes to strengthen the tobacco the COVID-19 Pandemic, harnessing the holder meetings. The industry’s future control system – most importantly to pandemic as a corporate social respon- tactics are likely to be informed by the strengthen Māori governance of the sibility (CSR) opportunity. Now, a new desire to appear on the right side of public smokefree programme. It includes several resource from the University of Bath’s health. In doing so, tobacco corporations world-­leading measures, including two Tobacco Control Research Group is hope to avoid increased taxation of their ‘endgame’ measures that could drive the shining a spotlight on these CSR activities vast profits to help pay for the costs of the profound reductions in smoking preva- with a new COVID-19 database. pandemic, profits made at the expense of lence that are required. copyright. Tobacco companies have donated venti- overburdened healthcare systems. First, the discussion document proposes lators, personal protective equipment The TobaccoTactics COVID-19 data- greatly reducing the retail availability of (PPE), cash, food products and more, to base reveals pandemic activities by the smoked tobacco products and gradually governments struggling under the strain of “Big Four” (PMI, BAT phasing out sales altogether. Strategies the pandemic. While observers may view International, Imperial Brands) that include markedly decreasing the number such acts as virtuous, they are variously correlate to well-worn­ industry tactics of stores able to sell these products (to described as a “Trojan Horse” or “Tax-de- that protect profits and challenge the around 5% of the current number), ductible lobbying” by tobacco control regulation of tobacco products. The data- requiring tobacco retailers to have a http://tobaccocontrol.bmj.com/ experts who emphasise the fact that these base provides data collected by the group licence and restricting tobacco sales to companies continue to market and sell and their global partners and is searchable specialist stores or community pharma- products that kill. by Tobacco Company, Date, Country and cies. It also puts forward a ‘smoke-free The clearest consensus is that smokers Tactic. generation’ policy, where the legal age of are at greater risk of severe and fatal cases In addition, Tobacco Tactics has created purchase for smoked tobacco products of Coronavirus. Nevertheless, the media an animated video to explain the discon- would increase by 1 year every year, effec- have widely reported that smoking may be nect between the real motives of the tively meaning that future generations will a protective factor for those contracting tobacco industry and their CSR activities. never be able to legally purchase tobacco the virus. This misinformation originated Louis Laurence products and sales would eventually cease. with studies that are linked with the Tobacco Tactics, Tobacco Control Research Second, it proposes removing virtu- tobacco industry. The European Respi- Group, University of Bath ally all the nicotine from cigarettes and on September 24, 2021 by guest. Protected ratory Journal retracted a paper that Research Partner of the Bloomberg Philanthro- tobacco, so these become much less suggested smokers were at lower risk of pies funded STOP project. addictive. COVID-19 because some of the authors L.​ ​Laurence@exposetobacco.​ ​org Additional measures include banning had undeclared financial links to the product design innovations that may tobacco industry. The journal said “if these appeal to young people, such as flavour conflicts of interest had been disclosed at NEW ZEALAND: GOVERNMENT ‘crushballs’ in cigarettes; and banning the point of manuscript submission, the PROPOSES WORLD-LEADING ACTION filters to prevent filters misleading editors would not have considered the PLAN TO ACHIEVE SMOKEFREE 2025 people who smoke about health risks article for publication.” GOAL and to greatly reduce the environmental Public donations by harmful industries In April 2021 the New Zealand (NZ) harm caused by cigarettes. The plan also give companies access to policy makers and government published a discussion docu- proposes enhancing ‘business as usual’ a chance to improve their public image, ment with a proposed action plan for approaches such as mass media and social while the relatively small sums donated Smokefree 2025. The sponsor is Associate media promotions to promote quitting pale in comparison to the huge financial Minister Dr Ayesha Verrall, a physician and deter smoking uptake, increased and human costs of tobacco company and newly elected member of Parliament. support for priority

482 Tob Control September 2021 Vol 30 No 5 News analysis Tob Control: first published as 10.1136/tobaccocontrol-2021-056941 on 23 August 2021. Downloaded from populations, and community-based­ CHINA: SMUGGLING NETWORKS Europe: Police records obtained by smokefree interventions. LINKED TO CHINA TOBACCO REVEALED OCCRP provide evidence tying a CNTC Other proposed changes include IN OCCRP INVESTIGATIVE SERIES official to organised crime groups in improved research, monitoring and evalu- The China National Tobacco Corpora- Europe. A high-­level executive at CNTC’s ation; and strengthened enforcement and tion (CNTC) has grown into the world’s factory in Romania apparently collab- compliance-­enhancing activities. biggest cigarette company by feeding orated with smugglers in pretending The plan is notable for its compre- the addiction of China’s approximately to send 17 tons of cigarettes to Libya hensive and ambitious approach, and 300 million smokers. But now the state-­ via Italy, thus avoiding excise taxes. In has attracted global attention due to the owned giant is ready to take over the rest reality, the shipping container was filled inclusion of several innovative policies not of the globe. with junk, while the real product was put yet introduced at country level anywhere Since jumping on China’s “Belt and into an identical container destined for else in the world. If implemented in full, Road Initiative” in 2015, CNTC brands the Italian black market. it appears to provide a realistic roadmap have increasingly been found around the The Romanian factory produces CNTC brands like Regina and Marble, to Smokefree 2025, which will protect the world, including in countries where there which appear to be marketed to Euro- health of current and future generations is no legal market for them. pean smokers. But reporters also found of young people by greatly increasing The Organised Crime and Corruption that the factory also sold cigarettes to quitting among people who smoke and by Reporting Project (OCCRP) and 12 more companies in conflict zones like Syria, minimising the risk that young people will media outlets recently published “China where tracking tobacco products is experiment with, and become addicted to, Tobacco Goes Global,” an investigative series revealing how CNTC has pushed nearly impossible. smoking. New Zealand’s experience could The Romania investigation was a provide crucial evidence for other jurisdic- into new nations using methods that are ethically dubious, and sometimes outright collaborative effort between OCCRP tions wanting to eliminate the health loss, and RISE Romania illegal. inequity and economic burden caused by Ukraine: CNTC’s Romanian factory Taking a leaf from the playbook of the tobacco epidemic. sold hundreds of millions of cigarettes to Transnational tobacco companies that An initial consultation on the action Ukrainian companies under investigation have long dominated the sector interna- plan closed on 31 May 2021. Key NGOs for cigarette smuggling. One of its top tionally, CNTC has been flooding illegal and public health organisations in New customers is now co-­owned by Vadym markets with its brands before lobbying Zealand have warmly welcomed the Sliusariev, a politically connected former governments to legalise them. plan, as have many international health border official. Here are some of the stories OCCRP copyright. researchers and public health experts. The Ukraine story was a collaborative and its partners have published so far: Local experts, in collaboration with inter- effort between OCCRP and the Kyiv Latin America: Reporters discovered national colleagues, have published a Post. that CNTC is connected to a network series of blogs commenting on the plan Brazil: China is complying with of Panama-­based companies that have and its specific proposals. recommendations under a global treaty shipped huge amounts of its cigarettes to However, not everyone has been so to decrease the amount of land under Latin American countries where there is supportive. Indeed, the newly ‘trans- tobacco cultivation—but much of this no legal market. http://tobaccocontrol.bmj.com/ formed’ tobacco industry has opposed production has simply shifted overseas. One of the firms, Overseas United, had the plan with their principal argument Brazil has become a major supplier, with its export permit revoked by Panamanian being that it will boost illicit trade. British farmers working under difficult condi- authorities after its cigarettes were found American Tobacco has been caught out tions to grow tobacco for Chinese ciga- on the local market. But executives at orchestrating retailer opposition. Philip rettes. Reporters looked into alleged Overseas United were able to send over labour rights abuses in Brazil’s tobacco Morris International (PMI), which has 632 tons of Chinese cigarettes abroad loudly proclaimed its desire to achieve a industry tied to tobacco-leaf­ buyer China using another company in the network, Brasil Tabacos Exportadora SA, which smokefree world, has been conspicuously Finta Inc. silent on a plan that provides a potential doubled its profits in 2020. Two legal representatives of Finta were The tobacco-leaf­ buyer was founded roadmap to do just that (PMI NZ does also executives of the other two compa- by local subsidiaries of CNTC and the not appear on the list of submitters to the on September 24, 2021 by guest. Protected nies in the Panama network exposed in U.S. company Pyxus International. Pyxus consultation process). this investigation. In Colombia, they has been penalised by U.S. government The next steps are that the submissions sent cigarettes to a convicted smuggler. authorities for breaching labour rights, will be analysed and considered and the In Ecuador, $34 000 worth of cigarettes yet, despite being the largest tobacco Minister will prepare a final version to were sent to the Chinese embassy, which company in the world, CNTC has take to Cabinet. Smokefree advocates are told reporters the huge shipment was avoided such scrutiny. hoping that implementation of some of simply “diplomatic material.” The Brazil investigation was a collab- the key measures will begin in 2022. The Latin American story was a collab- orative effort between the OCCRP and Richard Edwards, Janet Hoek, Andrew orative effort between OCCRP and the Intercept Brasil. Waa Concolón and Cuestión Pública. OCCRP will publish additional ASPIRE 2025 Research Centre, University of USA: The Panama-based­ network China Tobacco investigations in the Otago, New Zealand of companies uncovered by OCCRP coming weeks, which you can follow by richard.​ ​edwards@otago.​ ​ac.nz​ is also linked to illegal Chinese ciga- subscribing to its weekly newsletter. If you An earlier version of this article rettes seized in Texas, according to have information about CNTC cigarettes with links and author information was a paywalled report published in the sold in illegal markets, please contact published on the Tobacco Control blog. Houston Chronicle. OCCRP journalists at info@​ ​occrp.​org.

Tob Control September 2021 Vol 30 No 5 483 News analysis Tob Control: first published as 10.1136/tobaccocontrol-2021-056941 on 23 August 2021. Downloaded from

Charles Turner permitted (e.g. branded merchandise paid to reach marginalised groups with Organized Crime and Corruption Reporting such as umbrellas, tote bags etc) higher smoking rates, such as those at a Project (OCCRP) 4. Significantly reduce the availability of disadvantage through socio-­economic info@​ ​occrp.org​ tobacco and related products status, immigration, mental health condi- 5. Effectively protect people from sec- tions or incarceration. GERMANY: A STRATEGY FOR TOBACCO- ondhand smoke and ensure complete- Tobacco-F­ ree Germany 2040 is synony- FREE GERMANY 2040 ly tobacco-­free living environments mous with the recently published Europe‘s According to the WHO, Germany is a 6. Consistently implement children’s Beating Cancer Plan that states it would high burden country regarding tobacco rights with regard to tobacco and im- like to achieve a smoking prevalence of use. Approximately 16 million people are prove the protection of minors less than five per cent across the European current smokers, and 127 000 people die 7. Conduct regular campaigns to raise Union (EU) by 2040. Without great prog- from the health effects of smoking every awareness of the risks of tobacco use, ress in Germany, the EU will not be able to year. In addition, Germany has the worst motivate people to quit and make liv- achieve this. tobacco control policy implementation ing tobacco-­free the norm The development of the strategy was out of 36 European countries and lags 8. Support tobacco control initiatives led by the German Cancer Research far behind other non-­European countries and alternatives to tobacco cultiva- Centre in collaboration with a working like Australia, New Zealand or Brazil. On tion within the framework of devel- group of experts from academia, public World No Tobacco Day 2021, more than opment cooperation health and civil society for a multidis- 50 public health and civil society organ- 9. Effectively protect political decisions ciplinary approach. It was presented to isations published the “Strategy for a from the influence of manufacturers the public in the days before World No Tobacco-F­ ree Germany 2040”. It is a call of tobacco and related products and Tobacco Day and achieved overwhelming on the government to implement tobacco their associations media coverage. It was sent to federal and control measures that will lead to less than 10. Regularly review, adapt and further state politicians and will support advocacy five per cent of adults and less than two develop the measures activities during and after the campaigns per cent of adolescents in Germany using Rather than individual level inter- for the upcoming federal elections in tobacco products, e-­cigarettes or other ventions which place responsibility September 2021. related products by 2040. on smokers for smoking, the outlined The strategy was welcomed by several The organisations call on legislators measures focus on political action and political decision makers and has already and the government to adopt a binding, population level interventions which aim been cited in a federal parliamentary

sustainable tobacco control strategy with to change the role of smoking in society debate. The authors hope that it will be copyright. a mandatory timeline for the implementa- to create a tobacco-free­ Germany. They the starting point for a profound change in tion of the following ten measures for a are based on evidence and on the Frame- tobacco control in Germany and that the tobacco free Germany 2040: work Convention on Tobacco Control. next government will include a strategy 1. Significantly increase tobacco taxes They aim at largely restricting the tobacco for a tobacco-free­ Germany 2040 into the every year industry‘s ability to market its products, to next governing coalition’s agreement. 2. Support smokers in quitting and en- promote cessation and support smokers Laura Graen and Katrin Schaller sure that the costs of tobacco depen- who want to quit, and to prevent young Cancer Prevention Unit, German Cancer http://tobaccocontrol.bmj.com/ dence treatment are covered people from taking up smoking. The Research Centre 3. Completely ban advertising of tobac- strategy covers both tobacco and related WHO Collaborating Centre for Tobacco Control co and related products and intro- products such as heated tobacco products laura.​ ​graen@dkfz-​ heidelberg.­​ ​de duce plain packaging (currently in and e-cigarettes­ because these products Germany advertising is still permitted are also addictive and harmful to health. © Author(s) (or their employer(s)) 2021. No commercial in cinema for films 18+, at point of The Strategy for a Tobacco-F­ ree Germany re-­use. See rights and permissions. Published by BMJ. sale and on billboards, the latter will 2040 adopts the precautionary principle be phased out between 2022 and towards novel products whose risks are 2024, sponsorship of national events not yet fully quantified. such as festivals and promotional Throughout the strategy, it is empha- Tob Control 2021;30:481–484. product brand extensions are also still sised that special attention needs to be doi:10.1136/tobaccocontrol-2021-056941 on September 24, 2021 by guest. Protected

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