Over 35 national consumer organizations under the International Network of Nicotine Consumer Organisations (INNCO) sounded the alarm over foreign grants on local health regulators that may adversely affect efforts to reduce the harm caused by combustible cigarettes in low and middle-income countries including the Philippines.
INNCO particularly cited the influence exerted by non-government organizations supported by Bloomberg Initiative on regulators such as the Philippines Food and Drug Administration.
“There is also an element of corruption aided by the Bloomberg NGOs, who are co-opting tobacco policy through the sheer force of money. The legislators in Philippines recently questioned the conflict of interest in their FDA receiving funds from these NGOs while pushing anti-vaping policy,” Samrat Chowdhery, president of INNCO and a leading tobacco harm reduction advocate, said during the recent virtual presentation of “Burning Issues: The Global State of Tobacco Harm Reduction (GSTHR) 2020” published by UK public health agency Knowledge Action Change (KAC).
Chowdhery was referring to the Philippines FDA’s admission that it received foreign grants from American business interest groups Bloomberg Initiative and The Union while in the process of drafting regulation on e-cigarettes and heated tobacco products (HTPs).
During an online public consultation on the guidelines for e-cigarettes and HTPs, a ranking FDA official admitted that the agency received grants from foreign anti-tobacco advocates when confronted by Nueva Ecija Rep. Estrellita Suansing and Deputy Speaker and Ilocos Sur Rep. Deogracias Victor Savellano.
The GSTHR report also records various kinds of opposition to low-risk products being mounted by anti-vaping organizations such as the position paper by the influential Paris-based Union which called for a ban on vaping and HTPs in LMICs.
“This is, of course, highly discriminatory, will increase health gaps between western and developing nations, and is a prime instance of the philantro-capitalism kind of thinking that is highlighted in the GSTHR report,” said Chowdhery.
He said that aside from bans in LMICs, there was also a growing number of restrictions on vaping and other risk-reduced alternatives — from higher taxation and restrictions on online sales, to the new favorite of tobacco control, which are flavor bans. He said this is happening across many US states and in Europe.
Chowdhery said the war was also heating up on oral nicotine pouches — a new innovation that is like snus but without tobacco and low on the harm spectrum, close to nicotine gums in risk. “We are seeing attempts to ban them in Baltic countries and the Bloomberg network is doing the same in Africa by spreading misinformation and overstating risks without any concern that they are affordable, less risky, and effective in helping smokers switch,” he said.
Chowdhery noted that these bans and restrictions which prevent access or increase barriers to tobacco harm reduction are now the biggest hurdle to achieving a society in which people do not die in millions per year from the harmful use of tobacco.
The GSTHR 2020 report said that globally, 36 nations currently ban low-risk alternatives, and most of them are LMICs in Latin America, the Middle East, Africa, and Asia.
Chowdhery said this is alarming because almost 80% of over a billion smokers worldwide live in developing nations where most of the 8 million annual deaths from smoking are recorded.
He said that in most countries where there is a ban on tobacco harm reduction products, the main argument is that it was done to “save the children.” He said this goal, in reality, is jeopardized as there is inadequate enforcement of the ban and a black market mushrooms, which is difficult to control.
“We have seen this in Brazil, Mexico, Thailand, and now in India. Recently, South Africa reversed its tobacco ban during the Covid outbreak over concerns that the resultant black markets would be difficult to shake off,” he said.
He said that ultimately, any move away from the concept of risk-differential taxation and increasing barriers to tobacco harm reduction ultimately serves to perpetuate smoking. “It hurts the health of the country, but also causes huge financial loss as tobacco-related mortality and morbidity costs, as well as the lost man-hours rise, and by decimating an industry which could create jobs and revenue while improving the health of tobacco users,” he said.
“This economic argument is stronger now than ever as countries struggle to cope during the pandemic—the answer isn’t in giving sops to the tobacco industry as Bhutan has done by ending its decades long tobacco ban, which was ineffective anyway; the answer is in allowing and promoting access to THR alternatives so while there is additional revenue, there isn’t additional death and disease,” said Chowdhery.
He said such restrictions also violate human rights principles by denying tobacco users a means to prevent disease and early death. “Personal liberty is built into almost all constitutions across the world, and especially when you take second-hand risk out of the equation, there remains absolutely no argument to prevent access without violating these basic principles. The failed war on drugs has led to introduction of harm reduction as among the core tenets of drug policy, and it’s time it caught on in tobacco control too,” he said.
Chowdhery said despite these adverse developments, there is a glimmer of hope as science is slowly but steadily winning over ideology. “Since the last edition of the GSTHR report in 2018, four countries have banned THR alternatives while 22 nations from various regions of the world have either reversed bans or put in place formal regulations allowing their use. The tide is turning, and I hope this trend continues in years to come,” he said.