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Worldwide newsand commentThe theme for World No Tobacco Day2014 (WNTD), held on 31 May, was ‘Raisetaxes on tobacco’, a measure considered tobe the most cost effective for tobaccocontrol. In 2010, the World Health Reportindicated that a 50% increase in tobaccoexcise taxes would generate a little morethan US$1.4 billion in additional funds for22 low-income countries. If these fundswere hypothecated to health, governmenthealth spending in these countries couldincrease by up to 50%.
Evidence from around the world indicatesbest practice is for the final consumer priceof tobacco to consist of at least 70% tax.The 2013 WHO report on the globaltobacco epidemic showed that in the Africaregion, only two countries—Madagascarand Mauritius—met this benchmark for themost widely sold brand of cigarettes. In themajority of other African countries, taxmade up less than 50%. Other regions had ahigher number of countries with taxationabove 70%, but taxation levels lagged in lowand middle income countries in all regions,even while rising incomes have increased therelative affordability of cigarettes.
In this issue, we highlight two countrieswhere legislation to increase taxes haverecently been passed, Ukraine and Chile, aswell as the latest country to ratify the WHOFramework Convention on TobaccoControl (FCTC). Other reports fromWorldNo Tobacco Day will be posted on ourwebsite at http://blogs.bmj.com/tc/.
UKRAINE: 25% TAX INCREASE FROMJULY 2014Even amidst its current political turmoil,Ukraine will be among the countriesshowing the way on tobacco taxes follow-ing WNTD 2014, with a 25% excise dutyincrease to come into effect on 1 July2014. The draft law was signed by theacting president in late March.
The decision followed a public campaignled by tobacco control activists and advo-cates for a higher increase than 8%, whichwas initially planned by the Cabinet. TheSmoke Free Ukraine Coalition advocated anincrease of 30%, supported by analysis with
alternative calculations and budget incomeprojections by Life Regional AdvocacyCentre. The campaign was also supportedby the All Ukrainian Patients Union.Tobacco control advocates have warned
that the tobacco industry may try to ware-house stocks to avoid the increase, risking atax loss of US$30 million, according toSmoke Free Ukraine Project CoordinatorAndriy Skipalskiy, and have urged the gov-ernment to enact legislative measures toavoid this occurring.
CHILE: TAX INCREASED IN REFORMMEASURESThe Finance Committee of Chile’s lowerhouse of congress voted in favour of a10% tax increase on tobacco in April. Itwas approved as part of a range of taxreforms by the lower house on May 15,and is expected to pass the upper house.Although the country has among
the highest tobacco taxation rates inthe Americas region (and the world), theincrease will be an important measure,given Chile’s high smoking prevalence.
Around 33% of 13–17-year-olds in Chilesmoke, and tobacco consumption is esti-mated to be responsible for 16 000 deathsannually.
While the increase was welcomed byTobacco-Free Chile (Chile Libre deTabaco, CLT), there was some concernthat the rise may be small enough to beabsorbed by the tobacco industry, andtherefore not be sufficient to reduce con-sumption. CLT cited a recent study byeconomist Guillermo Paraje who esti-mated that a 20% rise in the retail priceof cigarettes would lead to a reduction insmoking initiation of between 3.9% and6.6% per year. He also noted that govern-ment revenue is less than the healthdamage and cost to the public healthbudget caused by smoking.
EL SALVADOR: LATEST COUNTRY TORATIFY FCTCEl Salvador ratified the FCTC in April,bringing the total number of countries inthe Americas which have ratified it to 30out of 35. The ratification was signed by
World No Tobacco Day 2014 infographics by the Southeast Asia Tobacco Control Alliance(SEATCA). Source: http://seatca.org/?p=3914.
All articles written by Marita Hefler unlessotherwise attributed. Ideas and items forNews Analysis should be sent to:[email protected]
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President Mauricio Funes in February, andapproved by the legislative assembly on 9April. Adult smoking prevalence is rela-tively low in El Salvador, at 11.7%.However 14.6% of youths consumetobacco, indicating the need for the fullrange of MPOWER measures to be imple-mented urgently to reduce prevalence early,and avoid the escalation in smoking-relatedmorbidity and mortality seen elsewhere.
EUROPE: FCTC ARTICLE 5.3COMPLAINTCorporate Europe Observatory (CEO), anot-for-profit research and campaign groupwhich works to expose and challenge cor-porate influence and lobby groups inEuropean Union (EU) policy making,lodged a complaint with the EuropeanCommission (EC) on 7 May. The complaintalleges that the EC has failed to properlyimplement Article 5.3 of the WHO FCTCto protect policy making from tobaccoindustry influence. It follows open letterssent by CEO to the Commission PresidentBarroso on 17 January 2013, and toEuropean Commissioner Maros Sefcovicon 11 December 2013, in addition to ques-tions on numerous other occasions.
The complaint points to controversyaround alleged tobacco industry attempts toinfluence the EU’s Tobacco ProductsDirective, the opaque scandal surroundingthe resignation of Commissioner John Dalliin 2012 (reportedly due to undisclosedmeetings with tobacco lobbyists), and thereappointment of Michele Petite (a lawyerwhose former clients included PhilipMorris International) to the Ad HocEthical Committee, which provides adviceon conflicts of interest and other ethicalissues. Mr Petite’s appointment was investi-gated by the European Ombudsman,sparked by a February 2013 complaint byLobby Control, Corporate AccountabilityInternational and CEO (detailed in the May2013 issue of Tobacco Control, available athttp://tobaccocontrol.bmj.com/content/22/3/180.full).
Included in the complaint are documen-ted examples of at least 14 undisclosedmeetings between EC officials and tobaccoindustry representatives, obtained throughfreedom of information requests, whichinclude meetings with President Barroso’scabinet, the Secretariat-General and othercommission departments. The complaintnotes that DG SANCO (Directorate Generalof Health and Consumer Affairs) does par-tially implement Article 5.3 guidelines bylisting and publishing minutes of meetingswith the tobacco industry online. However,it is the only Directorate General to do so,despite clear evidence that others, including
the office of the Secretary General, havebeen involved in decision making on theTobacco Products Directive.The complaint outlines a response from
Secretary General Catherine Day to a previ-ous letter from CEO (co authored byseveral other organisations), stating that theCommission has in place an ethical frame-work that is ‘fully compatible’ with theguidelines of Article 5.3. However, thecomplaint notes that undisclosed meetingsviolate Article 5.3 guidelines and numerousother specific recommendations are not fol-lowed. It also rebuts a claim by Ms Day thatreleasing documents under Freedom ofInformation regulations is sufficient to fulfilArticle 5.3 obligations, stating “this reactiveand restrictive approach is neither sufficientnor compatible with the FCTC Article 5.3guidelines”, noting it places the burden onthe public to investigate undue claims ofinfluence.Among the list of measures recom-
mended to bring the Commission intoline with Article 5.3, CEO recommendseffective measures to limit interactionswith the tobacco industry and ensuretransparency when these occur, imple-menting a code of conduct on relations,and ensuring registration and disclosure oftobacco industry lobbyists.Full details and text of the complaint
can be accessed at http://corporateeurope.org/power-lobbies/2014/05/ceo-submits-ombudsman-complaint-about-eu-commissions-failure-implement-un.
POLAND: ‘TRUTH’ STYLE COUNTERTOBACCO INDUSTRY CAMPAIGNPoland has launched its first counter cam-paign to the tobacco industry. ‘Sfajerowani’comes from two Polish words: ‘fajki’ meanscigarettes and ‘sfrajerować’ means decep-tion. The campaign was designed andstarted with the help of a grant from thePolish ministry of health.
The campaign is intended to fill the gapin Poland where no counter tobacco indus-try activities previously existed. It is mod-elled on the broad experience and proveneffectiveness of The Truth Campaign inthe USA, and used tools from the NationalSocial Marketing Centre in the UK.
A team of teenagers were established todesign the most effective messages andways to target youth. Based on online strat-egies featuring a website and social mediachannels, youth were encouraged tocreate pictorial memes and upload them tothe website http://www.sfajerowani.pl.Hundreds of memes were uploaded, eachof which have been further spread throughFacebook and other portals.
Ironically, the Sfajerowani campaignlaunch coincided with the Poland’s biggestfight as an ally of the tobacco industryagainst the recently published EU TobaccoProduct Directive. Although Poland is thesecond biggest tobacco leaf producer inEurope and a strong supporter of the indus-try, the Sfajerowani campaign shows thatanti-tobacco industry messages can reachaudiences even in pro-tobacco regions. As
A screenshot of some of the memes uploaded to the counter tobacco industry campaign websitehttp://www.sfajerowani.pl.
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in the case of this campaign, sometimes theyare even funded by the same governmentthat works alongside the tobacco industry.
Łukasz BalwickiMałgorzata Balwicka-Szczyrba
Medical University of Gdansk, [email protected]
CZECH REPUBLIC: PRESIDENTS,PHILIP MORRIS…AND CATERINGPhilip Morris International (PMI) is thelargest tobacco manufacturer in the CzechRepublic. It monopolises about half of thecigarette market, and employs close to1500 people. The company also enjoyssupport at the highest levels. In 2009 a newpart of the PMI factory in Kutna Hora wasopened by president Vaclav Klaus.Continuing the tradition of high level polit-ical support, on 16 October 2013 his suc-cessor, Milos Zeman, visited the factory.Mr Zeman is a heavy smoker of 40 cigar-ettes per day. In his speech he asserted thatbecause he started to smoke at the age of27 when his body was fully developed,smoking could not cause any damage and itwas safe. He recommended to Czechs thesame practice, based on the entirely falsebelief that adult smoking is not harmful.During his visit a distinctly non-traditionalrefreshment was served alongside meat,bread and cheese: Philip Morris cigarettebrands Sparta and L&M.
Eva KralikovaCharles University & General University Hospital
in Prague, Czech [email protected]
WORLD: POOR SALES BLAMED FORFACTORY CLOSURESApril 2014 saw a spate of factory closuresannounced by Philip Morris International
(PMI) and Imperial Tobacco in Britain,France, the Netherlands and Australia.The most significant among these is
Philip Morris’ Bergen op Zoom factory inthe Netherlands, the largest PMI produc-tion facility worldwide in terms of capacity.The closure will eliminate 1230 jobs, 90%of the total workforce at the facility. PMIcited a decline in sales of 20% in 4 years asa reason, and also singled out the new EUtobacco-control law which will ban fla-voured cigarettes and mandate biggerwarning labels on packets (presumablyexpecting that the law will achieve exactlywhat it aims to do!)In mid April, Imperial Tobacco
announced that it was shutting itsNottingham plant in England, which willmark the end of cigarette production inBritain, and the loss of 540 jobs. Within theUK, this closure will leave only one factory,owned by Japan Tobacco International inNorthern Ireland.Imperial also will close the largest
Gauloises-producing factory in Nantes,France, with 320 job losses. It blamed theFrance and Britain closures on decliningsales in Europe, which it attributed totough economic conditions, increasingregulation, duty increases and growingblack market trade. It plans to shift pro-duction to Germany and Poland.Meanwhile in Australia, tobacco manu-
facturing has effectively become extinct,with Philip Morris International closing itsMelbourne factory and planning to moveto Korea. While Australia’s strong tobaccoand comprehensive tobacco control mea-sures would be the obvious reason fordeclining sales, and generic packaging likelyto continue to decrease uptake amongyoung people, PMI blamed the reduced firerisk requirements that were introduced in2010. As veteran Australian tobacco controlwarrior Simon Chapman noted on Twitter
“Gee, so sorry we tried to stop cig fires anddeaths”!
These closures are a welcome indicationof the progress in tobacco control in eachof the countries concerned. However, themove to more tobacco industry-friendlylocations highlights the need for ongoingsurveillance, and the urgency forimproved tobacco control legislation andenforcement in the new host countries.
GERMANY: INTERNATIONALVAPORFAIROn 26 and 27 April 2014 the first inter-national exhibition specialising in e-liquids,e-cigarettes, e-shishas and related products,VaporFair, took place in Frankfurt, Germany.The fair was organised for manufacturersand distributors to promote their products.Although primarily aimed at traders, it wasalso open to the public above 18 years.Several new innovations, such as variablevoltage or blue tooth e-cigarettes, shisha-to-go, e-pipes, traditional hookahs with elec-tronic heating element or inbuilt e-cigarette,and even cannabis e-cigarettes were ondisplay. An entire portion of the exhibitionwas dedicated to liquids, with one manufac-turer claiming ‘220 billion variations’.
A large number of flavours, with orwithout nicotine, were offered for trial‘vaping’ (inhalation of aerosol) at severalstalls. Vaping was promoted as a harmlesslifestyle activity and this was conveyed byusing descriptions such as ‘no nicotine, notobacco’, ‘no tar, no odour’ as well as‘natural’ or ‘pharmaceutical quality’.Claims such as ‘Made in Europe’, ‘certifiedquality’ or ‘developed with doctors’ wereused to create an impression of high qualityand healthy products.
Several manufacturers have recognisedsome mandatory regulatory guidelineswhich will come into force with the new EUTobacco Products Directive. Accordingly,their products have child-proof caps, andpackages carry more or less visible warningssuch as “not suitable for pregnant, nursingor people sensitive to content”, “toxic incontact with skin”, “toxic if swallowed”,“nicotine fluid is addictive and harmshealth”, “keep out of reach of children”,“do not sell to minors (<18)”, “not for non-smokers”. However, it appeared that manu-facturers do not solely address adultsmokers, but also young people. The widerange of fruit and candy flavours andproduct packaging are likely to be highlyattractive to children and adolescents. Someof the flyers and glossy pamphlets withphotos of sophisticated and glamorousyoung people are reminiscent of cigaretteadvertising and are likely to be appealing toyoung people, particularly young women.
Refreshment served to Czech president Milos Zeman, during his visit to the Philip Morris factoryin Kutna Hora in late 2013. Photo: František Vlček/MAFRA/Profimed.
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A novel vending machine for e-cigarettesand liquids with an in-built age-verificationsystem was prominently displayed. Suchmachines will make e-cigarettes availableround the clock. This easy availability andaccessibility, in combination with the highattractiveness of the products to youngpeople, is a matter of great concern, giventhe already reported global increase in theuse of e-cigarettes and e-shishas among ado-lescents. Initiation with appealing flavourscan easily progress to include nicotine.
VaporFair highlighted the urgent needfor effective regulation to prohibit market-ing and sales to minors of all electronicinhalation products such as e-cigarettes ande-shisha, regardless of nicotine content.
Katrin SchallerGerman Cancer Research Center (DKFZ)
MALAYSIA: EMPOWERING DENTISTSINTO SMOKING CESSATIONIn December 2013 at the MalaysianDental Deans’ Council meeting, smokingcessation became part of the MinimumCompetency Exit list for undergraduatedental curricula nationally under the dis-cipline of Preventive Dentistry. For the
first time, this commits all dental schoolsin Malaysia to have a minimum level oftobacco control training.This milestone can be traced to 2009,
when the nascent Nicotine AddictionResearch and Collaborating Centre at theUniversity Malaya Centre of AddictionSciences (UMCAS), undertook a survey ofthe involvement of dentists in tobaccocontrol in Malaysia. A key finding of theresearch was the almost complete absenceof tobacco cessation education in dentalundergraduate curricula. Only one univer-sity, University Kebangsaan Malaysia, had atobacco cessation counselling programmein their undergraduate programme, estab-lished in 2006. This study also found thatgiven enough training and support, the den-tists who participated were committed andconfident to provide tobacco cessationservice.In late 2010, another positive step
forward was the inclusion of tobacco ces-sation as a key performance indicator inthe National Oral Health Plan 2010–2020 (NOHP). Little else happened until2012, when the UMCAS research findingswere presented at a national symposiumthat included dentists in the scientific pro-gramme. Later that year, UMCAS invited
academics in medical and dental schoolsacross the nation to work together todevelop a standard tobacco control cur-riculum for undergraduate health profes-sionals. Since then, three dental schoolshave incorporated tobacco cessation intheir curriculum.
In 2013, a major national tobacco aware-ness campaign organised by a dental spe-cialist group, the Malaysian Association forDental Public Health Specialists(MADPHS), included the launch of atobacco control quarterly newsletter forhealth personnel, initiated by UMCAS, thatreserved a segment specifically for dentists.The campaign was launched by Malaysia’sDeputy Minister of Health, giving the pro-fession the impetus to move forward.
MADPHS and UMCAS are continuingto work together to promote tobaccocontrol education at both undergraduateand postgraduate dental curricula. InMarch 2014, they led a workshop at theFirst Biennial Dental Public HealthConference, with an unexpectedly highturnout. The same leadership is urgentlyneeded amongst other health professionalgroups—in particular medicine—and mightjust be the ‘tipping point’ needed to pushMalaysia into fast forward on tobaccocontrol.
Amer Siddiq Amer NordinRahimah Abdul Kadir
University Malaya Centre of Addiction Sciences,Malaysia
Christopher BullenNational Institute for Health Innovations,
New Zealand
NEW ZEALAND: DUTY FREETOBACCO LIMITS CUTTobacco duty free limits in New Zealandwill be reduced from November 2014,from 200 cigarettes to 50 cigarettes or 50 gof tobacco products, in line with a similarmeasure introduced in Australia in 2012.The new limit was announced in the Maybudget, which also included abolishing aduty free gift allowance that had previouslybeen allowed on tobacco products sentfrom abroad, and plans to reduce the pricedifferential between retail and duty freetobacco over the next 2 years.
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Examples of products and promotional pamphlets with high youth appeal as seen at VaporFair,Germany.
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