Authors: Ren, G. & Fletcher, E.R., Health Policy Watch (March 3, 2020) Download
As the World Health Organization and WHO member states celebrate 15 years since the signing of the the Framework Convention for Tobacco Control (FCTC), the global uptake in e-cigarettes, as well as targeted advertising aimed at children and adolescents, threatens the worldwide gains that have been achieved in reducing tobacco use.
The convention is the only legally binding international treaty to have been led and negotiated by WHO. Since coming into force in 2005, some 181 UN member states, accounting for over 90% of the global population, have committed to the treaty to rollback tobacco use, which WHO has described as the “only legal drug” that kills so many users when “used exactly as intended by manufacturers.”
“Tobacco kills more than 8 million people every year, costs the world economy over a trillion dollars annually in medical expenses and lost productivity,” said the Head of the FCTC Secretariat Adriana Blanco Marquizo in an opening statement, at WHO’s 15th anniversary celebration of the FCTC Thursday in Geneva.
“The case is clear: implementing the WHO FCTC is a powerful means for Parties to improve the lives of their citizens and ensure a better future of their countries.”
Tobacco use has declined by some 60 million users since 2000, driven by more stringent national tobacco control policy measures, stimulated by Convention provisions, as well as sharp declines in use by women. For the first time in 20 years, WHO also released findings in 2019 indicating that tobacco use in men had plateaued, and is now projected to decline by more than 1 million users in 2020.
Since 2005, 90% of all countries that have signed the Convention have implemented bans on tobacco smoking in indoor workplaces, on public transportation, and in other public places. Some 60% of countries have facilitated more accessible and affordable pharmaceutical products for the treatment of tobacco dependence and 64% have prohibited or restricted imports of tax and duty free tobacco products by international travelers. A total of 34 countries have earmarked a proportion of their tobacco tax income for funding tobacco control measures, said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a keynote address at the celebration, which laid out the record of accomplishments. .
However, the progress in tobacco control does not mean that countries can “take their foot off the accelerator,” the Director-General said.
Notably, the unknown effects of long-term e-cigarette use is emerging as one potential threat to global tobacco control efforts. While there has been much debate about the benefits of electronic nicotine delivery systems (ENDS) for adults looking to quite combustible cigarettes, early this month, a WHO statement released on 5 February stressed that such devices are “undoubtedly harmful, should be strictly regulated, and most importantly, must be kept away from children.”
“Progress towards reducing tobacco use remains uneven…We’re increasingly concerned by the growing popularity of new products such as e-cigarettes, particularly for children and adolescents,” said Tedros. “Nobody can be left behind if we are to achieve a 30% reduction in tobacco use by 2025.”
Challenges to FCTC Implementation: Targeting Children & E-cigarette Use
There are still 15 countries that have not committed to the Convention at all. And many parties to the treaty have not yet fulfilled all of policy commitments made in the treaty. For example, one third of all parties to the Convention have yet to enact a comprehensive ban on all tobacco advertising, promotion and sponsorship.
The tobacco industry remains the “single greatest barrier” to full implementation of the FCTC, Sandra Mullin, senior vice president of Policy, Advocacy and Communication at Vital Strategies, a global health non-profit that works in tobacco control, remarked to Health Policy Watch.
Industry tactics to counter tobacco control efforts include: lobbying governments through third-party organizations; creating and funding front groups; hiring retired policy-makers and bribing governments; influencing upstream trade policies that create barriers to integrating public health concerns into tobacco trade policies; and producing and disseminating misleading research about tobacco use, according to a report published by Vital Strategies and STOP (Stopping Tobacco Organizations and Products).
Among the greatest concerns is predatory tobacco advertising for “novel and emerging products flooding the markets” – such as flavored e-cigarettes that are often targeted at children and adolescents, said Blanco Marquizo.
Notably, the Convention has defined a specific set of obligations that countries must fulfill to protect minors from tobacco use, including text prohibiting “the manufacture and sale…of tobacco products which appeal to minors.”
Youth tobacco consumption will be the focus of the ninth session of the Conference of the Parties to the WHO FCTC in November 2020, to be held in The Hague, Netherlands.
According to Dr Tedros, tobacco companies often use “threats of litigation to intimidate governments trying to implement tobacco control policies.”
However, as an international treaty, the FCTC has been used successfully to support legal defense arguments against industry challenges to tobacco control policies. Along with its sister Protocol to Eliminate Illicit Trade in Tobacco Products which came into force in 2018, the FCTC remains the strongest tool to “take on the tobacco industry,” said Dr Tedros.
“We have to keep up the momentum…Together we can reverse the global tobacco epidemic and save millions of lives,” he added.