By Ulysses Dorotheo
BANGKOK, Thailand, Jan 26 2024 (IPS)

A hot debate on electronic smoking devices is expected to engage governments, scheduled to meet in Panama from 5-10 February for the tenth session of the Conference of Parties (COP) to the WHO Framework Convention on Tobacco Control (WHO FCTC).

The WHO FCTC, the first health treaty, was developed to address the global tobacco epidemic and to ensure that governments are supported in implementing comprehensive and effective tobacco control strategies.

Earlier in 2016, the governments during COP8 made a decision to either prohibit or restrict the manufacture, importation, distribution, presentation, sale and use of electronic nicotine delivery systems (e-cigarettes). Since then, more than 45 countries and jurisdictions have banned e-cigarettes as a precautionary principle (Figure 1).

Figure 1: Countries that have banned e-cigarettes

Electronic smoking devices (ESDs), which include e-cigarettes (or vape products) and heated tobacco products (HTPs), has grown into a multi-billion dollar industry estimated to be worth about USD 18 billion in 2022 to about USD 46 billion by 2030.

While the tobacco and vape industries claim these devices are safer than traditional cigarettes and can be used by smokers to quit, no country has approved them as cessation tools. ESDs cannot help smoking cessation as studies show the nicotine in ESDs keeps its users addicted to tobacco products, and most smokers who took up ESDs to quit smoking ended up using both ESDs and traditional cigarettes (dual use).

ESDs are not harmless. Current research indicates that ESD pose health risks, as aerosols from these devices contain nicotine as well as toxic chemicals, volatile organic compounds, and heavy metals that may damage the lung and heart.

WHO warning to act urgently on e-cigarettes

Last month, the WHO issued an urgent call to control e-cigarettes to protect children and the general population. According to WHO’s statement, “E-cigarettes with nicotine are highly addictive and alarming evidence has emerged of adverse population health effects.”

According to WHO, 88 countries have no minimum age at which e-cigarettes can be bought and 74 countries have no regulations for these harmful products.

A number of high-income countries with declining smoking prevalence but who legalized e-cigarettes are now grappling with increasing youth vaping, such as Canada, New Zealand, U.K. and USA. Low-and-middle-income countries who are already struggling to overcome the burden of the tobacco epidemic now face a double burden with nicotine addiction.

But despite the growing evidence that ESDs are dangerous and highly addictive, the tobacco and nicotine industry aggressively market these devices, particularly to youth.

The industry and its lobbyists pressure governments to approve sales of these new products with routine arguments about loss of taxes and smuggling, while simultaneously exaggerating their virtues.

Youth targeted in new nicotine products

The ASEAN region’s 213 million youths are an easy target for the tobacco industry which employs a host of marketing tactics to lure these young people. In 2019, about 14% of Filipino adolescents aged 13 to 15 years reported using ESDs, alongside nearly 15% (2022) of Malaysian and 11% (2018) of Indonesian teens.

ESDs come with a variety of flavors, most of which are made to attract young people, such as fruity, candy-based, and dessert-like flavors. Over 16,000 e-liquid flavors are sold in the market currently, and there is clear evidence these flavors harm the body.

Food flavors are meant to be used in foodstuff to be digested, not inhaled into the lungs which harms the respiratory system. This harm is seen in cases where young vapers have suffered collapsed lungs and have been admitted to intensive care.

Promoted as cool, lifestyle must-haves, the tobacco industry also entices the youth to use ESDs through social media platforms such as Instagram and Facebook, and through sponsorships of events and concerts.

To ban or restrict electronic smoking devices

In the ASEAN region Singapore imposed a ban on these devices in 2011 to prevent unchecked use of ESDs. They also consider ESDs as starter products which may cause nicotine addiction and lead consumers to use both ESDs and cigarettes later in life.

Hong Kong, like Singapore, banned ESDs in 2022 as a response to the growing youth uptake for these products. Other countries who have banned ESD in the ASEAN include Thailand, Laos and Brunei. Indonesia, Malaysia and the Philippines legalized e-cigarettes and face a big youth vaping problem.

Australia adopted a prescription only approach to e-cigarettes, while HTPs are banned. The United States, through its Food and Drug Administration regulates ESDs on the basis of age restrictions, health warning labels, ingredients disclosure, and marketing restrictions.

Some governments have implemented stringent regulations on the basis of price or tax measures, product standards control, health warning labels and restrictions on marketing and advertisements. Policies however should also cover age restrictions, flavor bans, and smoke-free regulations.

Eight million deaths due to tobacco are eight million deaths too many. With ESDs, history cannot repeat itself. At COP10, governments will be presented with a once-in-a-generation opportunity to ensure that the tobacco industry cannot deceive anymore. Governments must perform their mandate to protect the people’s right to good health and well-being and to work towards a healthy, tobacco-free world.

Dr Ulysses Dorotheo is the executive director of the Southeast Asia Tobacco Control Alliance. He is also a member of the World Health Organization’s Civil Society Working Group on Non-Communicable Diseases and the World Heart Federation Tobacco Experts Group.

IPS UN Bureau

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By Ulysses Dorotheo
BANGKOK, Thailand, Apr 11 2019 (IPS)

The image of a smoking toddler from Indonesia horrified the world but did little to motivate local policy makers to enact measures to protect children and youth from the harms of tobacco use. Indonesia has one of the world’s highest smoking rates where two out of three men and about 40 percent of adolescent boys smoke.

Cigarette prices in Indonesia are among the cheapest in the region, where a pack of Marlboros is sold for as little as US$ 1.70, while local brands or loose sticks are dirt cheap ($ 0.05 per stick), easily affordable to the nation’s 65 million smokers.

Indonesia has a complex tobacco taxation structure of 12-tiers, dividing between machine-made white cigarettes, machine-made Kretek cigarettes, hand-rolled cigarettes, size of manufacturing factories, and more. Annual increases in tobacco tax are small, having little impact on cigarette prices to reduce consumption, especially among the poor, who form the bulk of smokers.

In 2017, the Ministry of Finance issued a Regulation on Tobacco Excise Tax to increase tax for 2018 and at the same time stipulated a roadmap for the simplification of tax tiers, reducing from 12 tiers to 5 tiers by 2021.

The tier simplification roadmap was viewed as a win for public health, as fewer tiers will close the tax and price gaps and reduce the incentive for smokers to switch to cheaper cigarettes. However, a year later, in November 2018, the simplification roadmap was suddenly revoked thereby cancelling the tax increase and tier reduction.

In his review of hundreds of news articles, Mouhamad Bigwanto, a public health researcher from the University of Muhammadiyah Prof. Dr. HAMKA, saw pro-tobacco industry groups unfold a systematic, tactical plan that led to the defeat of the tobacco tax increase and tiers simplification.

Documented in Tobacco Industry Interference Undermined Tobacco Tax Policies in Indonesia, released by the Southeast Asia Tobacco Control Alliance (SEATCA), his findings illustrate the tobacco industry’s plan to present the industry as being crucial to the economy, while simultaneously undermining and derailing the tobacco excise policy through a coordinated multi-pronged strategy.

In mid-2018, the Coordinating Ministry of Economic Affairs released a new Tobacco Roadmap on the importance of the industry. This Tobacco Roadmap was the product of Independent Research and Advisory Indonesia (IRAI), a think-tank that the Ministry engaged, whose founder and head was the former CEO of Sampoerna Foundation, the charity arm of PT HM Sampoerna, which is owned by one of the world’s biggest cigarette manufacturers. IRAI lists Sampoerna Strategic, a tobacco-related entity, as one of its clients.

The pro-industry Tobacco Roadmap rationalizes the importance of the tobacco industry to the economy and argues for its protection and growth until 2045, rehashing past arguments used by the industry to oppose tobacco control.

It formed the basis to initiate and support measures to reject tobacco tax increase and simplification. The Roadmap was introduced and explained to various government departments including with the Ministry of Health.

Various pro-tobacco industry front groups were mobilized to build support and create public pressure. These groups vocalized a consistent main message that increasing tax will ruin the industry that employs 6 million workers, resulting in massive unemployment and reduction in government revenue.

The messages of these groups were all well-aligned, echoed, and re-echoed to reinforce one another. Media coverage of their messages reached a crescendo at the appropriate time. On cue, academics and research institutes generated and released evidence that rejected tax increase and tiers simplification.

A prominent religious organization which has a powerful voice in the Muslim majority country issued a clear message that the government must revoke the excise simplification plan. Champions from relevant government ministries, such as Labor and Industry, made pro-industry statements that influenced the decision-making process up to the highest executive level (President’s level).

In contrast, voices from health groups supporting tax increase and simplification were less in frequency and magnitude compared to the pro-tobacco industry voices, such that at the end of 2018, following strong pressure from various pro-tobacco industry groups and institutions and systematic interference from the tobacco industry, the Government announced it will not increase the excise tax in 2019 and revoked the simplification roadmap.

The cancellation of the tax increase and annulment of the simplification roadmap show both the might of the tobacco industry in influencing policy makers and the vulnerability of the Government to industry interference.

While the tobacco industry’s strategy to defeat tax increase may not be new or novel, the willingness of policy makers to respond positively to the industry is astounding when juxtaposed against current global awareness on the harms of tobacco use.

Across the globe countries are setting target dates to become tobacco-free, but the Indonesian government is moving purposefully in the opposite direction to protect the tobacco industry for the next two decades, unmindful that about 230,000 Indonesians are killed annually by tobacco-related diseases.

Paradoxically, at high level meetings, Indonesia has committed to implement the UN Sustainable Development Goals (SDGs), which include a target to achieve health for all by reducing tobacco use.

Clearly other measures are needed to protect public health policy from being undermined by commercial interests. These include:

• • Adopting a government code of conduct that regulates interactions with the tobacco industry and its affiliates to ensure transparency and prevent industry interference.

• • Prohibiting institutions and individuals with tobacco industry ties from developing tobacco control policies because of their clear conflict of interests.

• Requiring political parties to disclose their funding sources as part of good governance.

*SEATCA is a multi-sectoral non-governmental alliance promoting health and saving lives by assisting ASEAN countries to accelerate and effectively implement the evidence-based tobacco control measures contained in the WHO FCTC. Acknowledged by governments, academic institutions, and civil society for its advancement of tobacco control movements in Southeast Asia, the WHO bestowed on SEATCA the World No Tobacco Day Award in 2004 and the WHO Director-General’s Special Recognition Award in 2014.

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