Key Points

• Bangladesh is a country in South Asia, part of the World Health Organization’s South-East Asia Region.
• It has a population of 171.2 million, with tobacco use prevalence of 43.7%.
• Smoking prevalence is high, at 23.5%. However, smokeless tobacco (SLT) use prevalence is even higher, at 27.5%.
• Bangladesh ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2004. It has not ratified the Protocol to Eliminate Illicit Trade in Tobacco Products.
• The Bangladeshi cigarette market is dominated by British American Tobacco Bangladesh, followed by Japan Tobacco International’s local subsidiary United Dhaka Tobacco Company Limited. There are also local cigarette, bidi and SLT producers.
• Recent tobacco industry tactics in Bangladesh include direct lobbying of civil servants, which successfully obtained an exemption to lockdown restrictions during the COVID-19 pandemic; using diplomats to lobby in its interests; and the mobilisation of third-party organisations against tobacco control.

In 2016, Prime Minister Sheikh Hasina declared her intention to make Bangladesh tobacco free by 2040.¹ Bangladesh has in recent years increased its compliance with the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), created a dedicated tobacco control cell and introduced a health surcharge on all tobacco products.¹² However, according to a study published in 2022, no measures have been adopted to implement Article 5.3 of the WHO FCTC.³ Industry interference in public policy – particularly by British American Tobacco Bangladesh (BATB), in which the state holds a share of over 9% – is an ongoing challenge.³⁴ The study’s authors argue that progress in minimising such interference is essential if the commitment to a creating a tobacco-free Bangladesh by 2040 is to be met.³

Tobacco Use in Bangladesh

In 2022, the population of Bangladesh was 171.2 million.⁵ Among adults aged from 18 to 69, overall tobacco use prevalence was nearly 44% as of 2018 (almost 60% of men and over 28% of women).⁶

As of 2018, 23.5% of Bangladeshi adults smoked.⁶ Cigarettes were the most popular product: amongst current tobacco smokers, over 99% reported using cigarettes, compared to 32.5% who reported smoking bidis (cigarettes rolled by hand in a dried leaf of the tendu tree).⁶ There was a major gender difference, with nearly 47% of men reporting current smoking at the time of the survey, compared to 1% of women.⁶

At 27.5%, smokeless tobacco (SLT) use is even more common than smoked tobacco.⁶ This is due in part to the high prevalence of SLT use amongst Bangladeshi women. Over 28% of Bangladeshi women used SLT, compared to nearly 27% of men.⁶Most female tobacco users in low- and middle-income countries are SLT users in India and Bangladesh.⁷ Popular SLT products include betel quid with zarda, betel quid with sadapata, pan masala with tobacco and gul.⁶

Amongst adolescents aged from 13 to 17, nearly 10% used tobacco in some form as of 2014, with almost 14% of boys using tobacco compared to 2% of girls.⁸ The rate for cigarette smoking was nearly 8%, with 11% of boys smoking compared to 1.5% of girls.⁸

There were an estimated 106,000 deaths attributable to smoking in 2019, accounting for over 12% of all mortality in Bangladesh that year.⁹ The total annual cost of tobacco use in Bangladesh was estimated at BDT৳305.6 billion (US$3.6 billion) in 2018, which was equivalent to 1.4% of GDP in 2017-18.¹⁰ Direct healthcare costs accounted for BDT৳83.9 billion, of which 24% was covered by public health expenditure. This is a significant outlay, representing 8.9% of the healthcare budget in 2018-19.¹⁰ However, most of the costs attributable to tobacco use – both direct and indirect – are borne by tobacco users and their families.¹⁰ While the economic contribution of the tobacco industry to Bangladeshi GDP was estimated at BDT৳229.11 billion ($US2.7 billion) in 2018, this was still BDT৳76.54 billion (US$911 million) less than the annual costs attributable to tobacco use. Tobacco therefore results in a net loss to the Bangladeshi economy.¹⁰¹¹

Tobacco in Bangladesh

Market share and leading brands

In 2022, market research company Euromonitor International estimated the Bangladeshi tobacco market to be worth nearly BDT৳420 billion – over US$4.5 billion.¹²¹³

British American Tobacco Bangladesh (BATB) dominates the Bangladeshi tobacco market, with a market share of over 84.5% in 2022.¹⁴ Its portfolio includes the three bestselling brands of cigarette in the country: Royal, Derby and Hollywood.¹⁵ The Bangladeshi state holds a stake of more than 9% in BATB, both directly, and through two state-owned assets.⁴

BATB’s closest competitor is Japan Tobacco International (JTI), which has a market share of over 9% following its 2018 acquisition of the United Dhaka Tobacco Company Limited (UDTCL), the tobacco business of the Akij Group conglomerate.¹⁴¹⁶¹⁷ Its leading brands are Sheikh and Navy.¹⁵

Smaller domestic companies include Abul Khair Tobacco Company, Alpha Tobacco Manufacturing Company and Nasir Tobacco Industries Ltd.¹⁸

• For more information on the tobacco industry in Bangladesh, please see the Tobacco Supply Chain Database.

Smokeless tobacco and bidis

Accurate, up-to-date information on the SLT industry in Bangladesh is scarce. SLT producers are mostly home based and work informally, which makes for a fragmented market.¹⁹²⁰ However, larger companies include Kaus Chemical Works, which sells Hakimpuri Zarda, one of the most popular zarda products (made of dried and boiled tobacco leaves, lime, areca nut, additives, tannins and spices) in the country; and Baba Al-Tajer Dhaka.¹⁹²¹²²

Similarly, reliable and up-to-date information about bidi production is not available. However, a 2012 investigation found 117 bidi factories spread throughout the country.²³ The leading bidi company in Bangladesh is the Akiz Bidi Company; others include Aziz Bidi, Maya Bidi and Bangla Bidi.²⁴

Tobacco farming

Large-scale tobacco agriculture began in Bangladesh following independence in 1971, when BATB began growing in the greater Rangpur area.²⁵ Today, tobacco is grown throughout the country, with significant tobacco-growing regions including Lalmonirhat, Nilphamari, Kushtia, Manikganj, Tangail, Bandarban and Cox’s Bazar.²⁵

Bangladeshi tobacco production was steady at around 40,000 tonnes annually from the late 1970s until 2009, at which point it began to increase rapidly, peaking at just under 130,000 tonnes in 2019.²⁶ In 2020 Bangladesh declared nearly 86,000 tonnes, making it the 12^th largest tobacco producer in the world.²⁶²⁷

Child labour

Human rights organisations have documented child labour in tobacco fields in Bangladesh.²⁸ In 2020, a video report published by Unfairtobacco and Bangladeshi NGO UBINIG showed children missing school in order to help their families with the tobacco harvest.²⁹ Another video report documented the impacts of tobacco farming on Bangladeshi women, including the challenge of combining long hours working on the harvest with domestic tasks; negative health effects, including respiratory problems, fevers, and loss of appetite; as well as poor economic returns.³⁰

In 2016, the Swedish NGO Swedwatch published a report based on research in three leaf cultivation areas which supply BATB.³¹ It documented widespread child labour and negative impacts on the health and wellbeing of farm labourers, both children and adults.³¹ It also showed how the use of flawed contracts and uncertain promises contributed to over-indebtedness and trapped many farmers in poverty.³¹ In response, BAT conducted an internal review which, according to the company, “did not raise any significant concerns and indicated that the report as a whole is not representative of the reality on the ground.”³² A subsequent investigation BAT commissioned to consulting firm DNV GL supported its internal review.³³

Bangladeshi bidis feature on the U.S. Department of Labor’s 2022 List of Goods Produced by Child Labor or Forced Labor.³⁴ It is estimated that at least half of the workforce in the Bangladeshi bidi industry is aged between 4 and 14; average wages are between US$0.77 and US$1.57 per day.²⁴ A 2012 investigation found that most bidi workers were women and children.²³ According to several workers, managers and people in communities around the bidi factories surveyed, this is because their labour is much cheaper and they are less capable of organising for higher wages or better working conditions.²³

• For information on tobacco industry responses to accusations of complicity in child labour, please see the pages on CSR: Child Labour and the Eliminating Child Labour in Tobacco-Growing Foundation (ECLT).

Tobacco and the economy

Bangladesh is a net exporter of tobacco. In 2015, the last year for which data is currently available from UN Comtrade (as of September 2023), Bangladesh exported US$43.5 million in raw tobacco, compared to just over US$8 million in imports.³⁵³⁶ However, it is a net importer of factory-made cigarettes. The same year, it imported over US$3 million in cigarettes, compared to just over US$354,000 in exports.³⁷³⁸

Illicit trade

A World Bank report published in 2019 found that Bangladesh had a low estimated incidence of illicit trade in cigarettes (2%), compared to estimated global rates of 10-12%.³⁹ According to the report, annual revenue losses from the illicit cigarette trade are about US$100 million, around 4% of total tobacco revenues.³⁹ Bangladesh has strong legal and institutional structures to combat illicit trade, including a cigarette stamp and banderol system to ensure compliance with taxation, robust law enforcement and stiff penalties for smuggling.³⁹

Though the illicit bidi trade is likely to be larger than that for cigarettes, revenue loss has so far been low given that bidis were barely taxed at all until recently.³⁹ The illicit trade in smokeless tobacco is also likely to be significant, though in the absence of any track and trace system or even tax stamps on SLT products, it is impossible to estimate the illicit share of the SLT market accurately.¹⁹ A 2022 study found that “Almost all ST [smokeless tobacco] products bought in Bangladesh (…) were non-compliant with the local packaging requirements and hence potentially illicit”.¹⁹

Tobacco and the environment

A 2020 study found various forms of contamination due to tobacco growing in Bangladesh, both in the soil and in nearby water sources. The most important parameter found to be significantly higher in tobacco-growing land was the pesticide aldicarb.²⁷ Classified as “extremely hazardous” by the WHO, this chemical is banned in 125 countries, though its use remains widespread.⁴⁰ The same study calculated the environmental cost of tobacco curing (due to carbon emissions) at US$310 per acre used for tobacco cultivation.²⁷

Another report stated that contamination of water and soil by tobacco farming is endangering the livelihoods of nearly 800,000 people in the Bandarban and Cox’s Bazar districts who depend on the Matamuhuri river for fishing and cultivation of food crops.⁴¹ Swedwatch also documented deforestation and forest degradation linked to farms in Bandarban and Chakoria which supply BATB.³¹ It alleged that BATB has contributed to these problems by failing to prevent sourcing of fuel wood from natural forests and by supporting the construction of kilns in forest areas.³¹

• For more information on the tobacco industry in Bangladesh, please see the Tobacco Supply Chain Database.

Roadmap to Tobacco Control

Bangladesh was the first country to sign the WHO FCTC on 16 June 2003.⁴² It ratified the treaty a year later.⁴³ However, it has not signed the Protocol to Eliminate Illicit Trade in Tobacco Products.⁴⁴

The Smoking and Tobacco Products Usage (Control) Act (2005) is the principal law governing tobacco control in Bangladesh. The Act is comprehensive and covers smokefree spaces; tobacco advertising; the sale of tobacco to and by minors; and the packaging and labelling of tobacco products, among other areas.⁴⁵ However, the law had some major limitations. For example, it mandated only textual health warnings on smoked tobacco products, which is problematic in Bangladesh given the popularity of smokeless tobacco.⁴⁶ Similarly, although it banned advertising of tobacco products, it did not comprehensively cover sponsorship.⁴⁶

The Act was amended in 2013 and implementation rules were introduced in 2015, increasing compliance with the WHO FCTC. However, the industry was given a 12-month transition period to fully comply.⁴⁶ Even then, industry interference – principally by British American Tobacco Bangladesh (BATB) – has succeeded in delaying full implementation of the Amendment.⁴⁶ For example, though the Amendment mandated graphic health warnings (GHWs) on the upper half of all tobacco packaging, as of May 2022 – over seven years since the implementation rules were first published in the country’s official gazette – GHWs were still printed on the lower half of tobacco products.⁴⁶ Though this is considered a complete measure by the WHO, it means that the GHWs may be less visible to many Bangladeshi consumers. This is because tobacco products are often sold by mobile sellers out of steel trays which cover the lower half of the products.⁴⁶

Other major loopholes remain. Designated smoking areas are still permitted in certain public places; there are no restrictions on the sale of individual cigarettes (single sticks), small packets of cigarettes, or tobacco products via the internet; and there are no restrictions on use, advertising, promotion and sponsorship, or packaging and labelling of e-cigarettes.⁴⁵

However, as of June 2022, the Ministry of Health and Family Welfare (MoHFW) was preparing a new amendment to the Smoking and Tobacco Products Usage (Control) Act, which contains a number of global best practices.⁴⁷ If passed, it would eliminate designated smoking areas; ban corporate social responsibility (CSR) by tobacco companies; ban the sale of single sticks; ban the display of tobacco products at points of sale; and increase the size of graphic health warnings (GHWs) on tobacco products from 50% to 90%.⁴⁷ It also aims to ban the sale of e-cigarettes.⁴⁷

In 2015, the Bangladeshi government began to levy a 1% Health Development Surcharge (HDS) on all tobacco products, which brings in around US$71 million a year, designed to support key government health initiatives including tobacco control.⁴⁸ However, this funding has not always been easily accessible to the MoHFW. As of March 2021, the National Tobacco Control Cell (NTCC), which sits within the MoHFW, was working on a long-term tobacco control programme which would have smoother access to HDS funding.⁴⁸

For more details, please see the following websites:

• Legislation by country – Bangladesh, Tobacco Control Laws, Campaign for Tobacco Free Kids
• Bangladesh, WHO FCTC Implementation Database, WHO FCTC Secretariat
• Country profile – Bangladesh, World Health Organization, WHO report on the global tobacco epidemic 2021

Tobacco Industry Interference in Bangladesh

Recent tobacco industry tactics in Bangladesh include direct lobbying of civil servants, which successfully obtained an exemption to lockdown restrictions during the COVID-19 pandemic; using diplomats to lobby in its interests; and the mobilisation of third-party organisations against tobacco control.

Influencing policy: conflicts of interest

According to a study published in 2022, no measures have been adopted to implement Article 5.3 of the WHO FCTC in Bangladesh.³ The tobacco industry continues to influence policymaking, particularly BATB, in which the government holds a share of over 9%.³⁴

This incident also demonstrates how much the tobacco industry (particularly BATB) is connected with government in Bangladesh.³ The Secretary at the MoI, who granted the lockdown exemptions to BATB and UDTCL, simultaneously had a seat on the BATB board as a non-executive director.³ This arrangement between the MoI and BATB appears to date back to at least 2010.⁵⁴

Several other senior civil servants also sit as independent or non-executive members on the BATB board, including a secretary at the Prime Minister’s Office.^55565754

A study published in 2022 stressed that the presence of senior government officials on the BATB board leads both to individual and institutional conflicts of interest.³ However, a former Secretary at the MoI has denied this, stating that tobacco control is not discussed at BATB board meetings.⁵⁸

• For more on tobacco industry activity during the pandemic, please see the COVID-19 Tobacco Tactics page and the COVID-19 monitoring database.

Influencing policy: lobbying by diplomats

There have also been cases of lobbying of Bangladeshi authorities by foreign diplomats on behalf of the two main transnational tobacco companies operating in the country. In 2017, the British High Commissioner in Bangladesh intervened on behalf of BATB in a tax dispute between BATB and the NBR. Similarly, in 2021, the Japanese Ambassador sent a letter to the Bangladeshi Finance Minister criticising tax reforms which had impacted JTI, as well as restrictions on the marketing and sale of certain JTI products. The letter also complained of “anti-competitive” behaviour, alluding to BATB’s domination of the Bangladeshi tobacco market.

• For more information, please see the pages on UK Diplomats Lobbying for BAT: Bangladesh and Japanese Diplomats Lobbying for JTI.

Use of third parties

In June 2022, the Ministry of Health and Family Welfare (MoHFW) published another draft amendment to the Smoking and Tobacco Products Usage (Control) Act (2005) – Bangladesh’s main tobacco control law – and asked for input from relevant stakeholders (see section Roadmap to Tobacco Control).⁵⁹

In response, the MoHFW received letters criticising the amendment from various trade associations, including the Federation of Bangladesh Chamber of Commerce and Industries (FBCCI) and the Foreign Investors’ Chamber of Commerce and Industry (FICCI), both of which have tobacco industry links.⁶⁰⁶¹

In July 2022, a “policy dialogue” event – widely reported in the press – was held at a five-star hotel in Dhaka by the Intellectual Property Association of Bangladesh (IPAB). Speakers argued the amendment would reduce tax revenue, increase illicit trade and threaten livelihoods, reportedly describing it as “unrealistic”, “unimplementable” and “counterproductive”.⁶² On its website, IPAB lists BATB among its corporate members, from which it acknowledges receiving “extensive support”, and two members of IPAB’s executive committee also hold senior positions at BATB.^63646566

Another participant at the event was the executive director of FICCI, which lists BATB, Philip Morris Bangladesh and United Dhaka Tobacco Company Ltd (UDTCL) as member organisations.^62676869 FICCI also includes tobacco industry executives on its board of directors, including the managing director of UDTCL, author of the letter to the Ministry of Industries requesting an exemption from COVID-19 restrictions in 2020 (see Influencing policy: conflicts of interest).⁵¹⁷⁰

A 2018 investigation by the public health NGO PROGGA concluded that BATB’s infiltration of influential business and trade organisations constituted a major barrier to greater tobacco control in Bangladesh.⁷¹

• For more information on business organisations in Bangladesh and neighbouring countries see Trade Associations.

Relevant Links

• Live: Tobacco Industry Interference on Amendment of Tobacco Control Law 2022, Center for Research and Advocacy to Fight Tobacco
• National STEPS Survey for Non-communicable Diseases Risk Factors in Bangladesh 2018, National Institute of Preventive and Social Medicine (NIPSOM)
• The economic cost of tobacco use in Bangladesh: A health cost approach, Bangladesh Cancer Society

Tobacco Tactics Resources

• South East Asian Region
• Trade Associations
• Greenwashing

TCRG Research

• Tobacco industry interference to undermine the development and implementation of graphic health warnings in Bangladesh, M.H. Shahriar, M.M. Hasan, M.S. Alam, B.K. Matthes, A.B. Gilmore, A.B.M. Zubair, Tobacco Control, 2023, doi: 10.1136/tc-2022-057538
• Achieving a tobacco-free Bangladesh by 2040: a qualitative analysis of the tobacco advertising environment and prohibitions in Bangladesh, A. Tselengidis, S. Adams, B. Freeman, S.M. Alam, P.A.S. Astuti, J. Cranwell, BMJ Open 2023;13:e069620, doi: 10.1136/bmjopen-2022-069620
• Advancing whole-of-government approaches to tobacco control: Article 5.3 and the challenge of policy coordination in Bangladesh, Ethiopia, India and Uganda, R. Barry, S.M. Abdullah, A. Chugh, S. Hirpa, P. Kumar, D. Male, R. Ralston, T. Wagner-Rizvi, J. Collin, Tobacco Control, 2022;31:s46-s52
• Developing more detailed taxonomies of tobacco industry political activity in low-income and middle-income countries: qualitative evidence from eight countries, B.K. Matthes, K. Lauber, M. Zatoński, L. Robertson, A.B. Gilmore, BMJ Global Health 2021;6:e004096.
• Estimating the magnitude of illicit cigarette trade in Bangladesh: protocol for a mixed-methods study, S. Abjullah, R. Huque, L. Bauld, H. Ross, A. Gilmore, R.M. John, K. Siddiqi, Int. J. Environ. Res. Public Health 2020, 17(13), 4791

For a comprehensive list of all TCRG publications, including research that evaluates the impact of public health policy, go to TCRG publications.

References

The post Bangladesh Country Profile appeared first on TobaccoTactics.

There have been multiple instances of lobbying by ambassadors and other diplomats from the UK, as well as Japan and Switzerland. Much of this lobbying activity has taken place in low and middle-income countries (LMICs).⁷³ These countries are important sources of new customers for tobacco companies as markets in higher income countries where consumption is generally falling.⁷⁴⁷⁵⁷⁶

Diplomats are also involved in activities which help promote the tobacco industry via local media, such as visiting tobacco farms or factories. Other engagement supports tobacco companies’ product promotions, or corporate social responsibility strategy. These activities help to raise the profile of tobacco companies, enhance their reputations, and support the ‘normalisation’ of the industry.⁷²⁷⁷⁷⁸

Background

Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) have an obligation to protect public health policies from the “commercial and vested interests of the tobacco industry” and any contact with tobacco industry representatives, or others seeking to further their interests, must be “limited” and “transparent”.⁷⁹ The implementation guidelines to Article 5.3 of the WHO FCTC recommend that Parties limit interactions with the tobacco industry to those that are absolutely necessary to regulating the industry, and ensure the transparency of those interactions that do occur.⁷⁹  The guidelines also recommend parties treat state-owned tobacco companies in the same way as any other tobacco company, including avoiding any “preferential treatment”.⁷⁹

In addition, the guidelines state that “… Whenever possible, interactions should be conducted in public, for example through public hearings, public notice of interactions, disclosure of records of such interactions to the public”.⁷⁹

However even in countries with a high level of compliance with the WHO FCTC requirements, diplomatic missions rarely achieve this level of transparency. Information on tobacco industry engagement has largely been found through media investigations and Freedom of Information requests (FOIs).

In October 2014, the 6^th Conference of the Parties (COP) decided to urge parties: “to raise awareness and adopt measures to implement Article 5.3 and its implementing Guidelines among all parts of government including diplomatic missions.”⁸⁰ Another decision required governments to “take into account their public health objectives in their negotiation of trade and investment agreements”.⁸¹

Nevertheless, diplomats continue to lobby for tobacco companies around the world.⁷²

Countries whose diplomatic representatives have lobbied on behalf of tobacco companies overseas  include the UK, Germany and Japan, who are all Parties to the WHO FCTC,⁸² as well as the United States and Switzerland. BAT, PMI and Japan Tobacco all have offices in Geneva, Switzerland, the location of the World Health Organization and other key international bodies.

UK

There are specific guidelines covering the engagement of British (UK) officials working overseas designed to limit contact with tobacco companies, and support compliance with Article 5.3. After the UK Ambassador to Panama lobbied on behalf of British American Tobacco (BAT),⁸³ the guidelines were revised in 2013.⁸⁴ These guidelines state that “Posts must not…Engage with local foreign governments on behalf of the tobacco industry, except in cases where local policies could be considered protectionist or discriminatory”.⁸⁴

Engagement and lobbying

Despite having guidelines in place to support compliance with the WHO FCTC, FOI requests and media investigations have revealed that British diplomats continue to interact with the tobacco industry more than is necessary. UK diplomats have lobbied for BAT in Bangladesh,⁸⁵⁸⁶ Hungary,⁸⁷ and Pakistan.^8388899091

UK officials have also disclosed contact with tobacco companies in Panama and Venezuela,⁹²⁹³ Laos,⁹⁴ Cuba,⁹⁵ and Burundi.⁹⁶

In 2018, UK advocacy organisation Action on Smoking & Health (ASH) called this a “global pattern of engagement” by British officials to defend BAT’s interests.⁹⁷

• For more details see UK Diplomats Lobbying on Behalf of BAT.

Tobacco industry events

UK government guidelines state that staff must not:

“Attend or otherwise support receptions or high-profile events, especially those where a tobacco company is the sole or main sponsor and/or which are overtly to promote tobacco products or the tobacco industry (such as the official opening of a UK tobacco factory overseas)”.⁸⁴

However, UK staff have attended such events, generating considerable local media coverage.

For example, in 2019 the British ambassador to Yemen opened a cigarette factory in a free trade zone in Jordan, celebrating the expansion of the tobacco company Kamaran which is part-owned by BAT.^729899100

In 2020, staff from the UK high commission in Pakistan attended a promotional event for a BAT product in Pakistan.¹⁰¹

• See UK Diplomats Lobbying for BAT for details.

Engaging with industry allies

The links between diplomatic missions and tobacco companies can be more indirect, via funding third party allies of the industry. The UK guidelines state that diplomats should not “endorse projects which are funded directly or indirectly by the tobacco industry”.  However, a 2019 investigation by The Guardian found that the British high commission in Malaysia had given funding to a Kuala Lumpur based think tank (IDEAS) for several years. At the same time the think tank was also receiving money from tobacco companies and was lobbying against plain packaging regulation and tobacco taxes.¹⁰²  While the UK had already implemented plain packaging regulations, tobacco control was being undermined overseas.

Attending meetings with the tobacco industry

Tobacco companies attend meetings and events organised directly by UK government departments, such as the FCO (now FCDO) or the DIT (now Department for Business and Trade).⁹²  They also attend those held by regional, national or local business organisations such as chambers of commerce.

Responses to FOI requests show that when the attendance of UK government officials at such events is disclosed, there is little detail about the specific purpose or content of these meetings,⁸⁵⁸⁷ It may simply be described as relating to ‘doing business’ in the country.⁹³

Business vs public health interests?

The UK guidelines for overseas staff (last updated in 2013) allow for the communication of “basic trade, investment and political information”, although this is not defined.⁸⁴ One of the activities used to justify interaction by UK diplomats is “resolving business problems that are potentially discriminatory”.^838587103104 This has been criticised as running counter to the WHO FCTC guidelines.⁷²¹⁰⁵

While transparency is required for tobacco industry interactions in 2018, the UK government told Parliament that it “does not catalogue the representations it makes on behalf of companies”.^106107108  Research by the Tobacco Control Research Group (TCRG) concluded that the stated WHO FCTC goal of “maximum transparency” is not being achieved in the UK.⁷²¹⁰⁰

Japan

In 2021, the Ambassador of Japan to Bangladesh lobbied the government of Bangladesh on behalf of Japan Tobacco International (JTI).  In a letter to the Bangladesh Finance Minister the Ambassador criticised 2019 taxation changes for their impact on JTI. It also complained about the activities of competitors, and licensing demands.¹⁰⁹

• For details, including the lobbying letter, see Japanese Diplomats Lobbying for JTI

The Japanese Ambassador to Ethiopia was present at the signing of a deal between the Ethiopian government and JTI in 2016,  when the Ministry of Public Enterprise sold 40% of its National Tobacco Enterprise to the Japanese company.¹¹⁰ Japanese diplomats have also toured tobacco farms and JTI factories in Tanzania and Zambia.¹¹¹¹¹²

Japan Tobacco International is the overseas subsidiary of Japan Tobacco (JT), which is one third-owned by the Japanese government.¹¹³

Germany

In May 2022, the German ambassador to Beirut visited the offices of Regie, the Lebanese Tobacco and Tobacco Inventory Administration.⁷²¹¹⁴

Denmark

The Imani Centre for Policy and Education, a Ghana-based think tank,  received money from the Danish embassy while lobbying against tobacco control.¹⁰²¹¹⁵

Switzerland

Switzerland is not Party to the WHO FCTC.

In 2019, Swiss diplomats approached the government of the Republic of Moldova on behalf of Philip Morris International (PMI) seeking an opportunity to discuss new tobacco legislation.^116117118  The proposed legislation included significant tax increases on heated tobacco products, in which PMI has invested.¹¹⁶¹¹⁹

The same year, PMI helped fund an inaugural event for the new Swiss Embassy in Moscow.¹²⁰¹²¹

• For more details see Swiss Diplomats Lobbying for PMI

USA

Although the US is not Party to the WHO FCTC, it has specific laws and guidance that prohibit its diplomats from promoting the sale or export of tobacco, or influencing non-discriminatory restrictions on tobacco marketing.^122123124125 However, US diplomats have enabled meetings between tobacco companies and government representatives.

The US ASEAN Business Council organises delegations of US businesses, including Philip Morris International (PMI), which meet high level officials in the ASEAN region.¹²²  PMI was at the time a vice chair of its Customs & Trade Facilitation Committee and used this opportunity to meet with government officials from the Ministry of Industry and Trade of Vietnam.¹²²¹²⁶

Why it matters

The examples above illustrate contraventions of the WHO FCTC, an international treaty, and in many cases breaches of national guidelines. As TCRG research points out, all of these activities also undermine the spirit of these laws, by apparently serving the commercial interests of transnational tobacco companies and helping to ‘normalise’ the industry in the eyes of policy makers and the public.⁷²

The implementation guidelines of Article 5.3 urge Parties to exclude the tobacco industry completely from the public health policy arena.  The guidelines also urge them not to participate in corporate social responsibility (CSR) activities which are used by the tobacco industry and as an alternative means to access policy makers, as well as for public relations and product promotion.⁷²

In August 2019, in direct response to the exposure of lobbying by Swiss diplomats, the WHO released a statement urging governments to comply with Article 5.3 and to “proactively aspire to reduce the number of people starting and continuing smoking, to promote health and preserve future generations”.¹²⁷

TobaccoTactics Resources

• UK Diplomats Lobbying for BAT
• UK Diplomats Lobbying for BAT: Bangladesh
• UK Diplomats Lobbying for Tobacco: Burundi
• Swiss Diplomats Lobbying for PMI
• Japanese Diplomats Lobbying for JTI
• Third Party Techniques

TCRG Research

A “willingness to be orchestrated”: Why are UK diplomats working with tobacco companies?, R. Alebshehy, K. Silver, P. Chamberlain, Frontiers in Public Health, 17 March 2023, Sec. Public Health Policy, Volume 11 – 2023, doi: 10.3389/fpubh.2023.977713

For a comprehensive list of all TCRG publications, including TCRG research that evaluates the impact of public health policy, go to the Bath TCRG’s list of publications.

References

The post Diplomats Lobbying for Tobacco Companies appeared first on TobaccoTactics.

In January 2021, the Ambassador of Japan to Bangladesh lobbied the government of Bangladesh on behalf of Japan Tobacco International (JTI).  See below for details.

Background

Japan ratified the WHO FCTC in 2004. The Japanese government owns a 31% share in Japan Tobacco International.¹³⁵

The 2020 Global Tobacco Industry Interference Index gave Japan the worst overall score of all countries included, with extensive policy interference and conflicts of interest.¹³⁵ The index reported that Japan is one of the countries that persists in seeing the tobacco industry as economically crucial. It also allows the tobacco industry to have a say in the development of tobacco control measures.¹³⁵

Japanese Ambassador Lobbying for JTI in Bangladesh

In January 2021, the Ambassador of Japan, Ito Naoki, sent a letter to the Bangladesh Finance Minister with the subject line:

“Re: Japan International’s (JTI) Landmark Investment in Bangladesh and Repeated Challenges Posed Due to Policy Shifts and Anti-Competitive Activities”¹⁰⁹

The three-page letter criticised taxation changes in 2019 which “significantly hit JTI” and restrictions on the importation and selling of certain JTI products. It also complained of anti-competitive activities by competitors and “undue” demands by a licensing authority. In the last case the ambassador said: “When respected Cabinet Secretary  became aware if the issue, he stepped in and solved the issue in rapid speed”.¹⁰⁹

The letter ended with the ambassador telling the Finance Minister:

“I believe that Japanese investors are carefully watching the action of the government as JTI Bangladesh is a single largest flagship investment from Japan. Success of JTI is an important factor for decision making of potential investors in Japan.”¹⁰⁹

The letter can be read in full here

The Japan Society for Tobacco Control criticised the lobbying in a letter to Foreign Minister Toshimitsu Motegi, saying: “…it is legally impossible for him to work with or to otherwise act in the interest of the tobacco industry.”¹³⁶¹³⁷

TobaccoTactics Resources

Influencing foreign tobacco legislation via diplomats is a known tobacco industry tactic.

For more background and examples see Diplomats Lobbying for Tobacco Companies

Also see:

• Third Party Techniques
• Japan Tobacco International
• Newer Nicotine and Tobacco Products: Japan Tobacco International

TCRG Research

A “willingness to be orchestrated”: Why are UK diplomats working with tobacco companies?, R. Alebshehy, K. Silver, P. Chamberlain, Frontiers in Public Health, 17 March 2023, Sec. Public Health Policy, Volume 11 – 2023, doi: 10.3389/fpubh.2023.977713

References

The post Japanese Diplomats Lobbying for JTI appeared first on TobaccoTactics.

Background

According to the CHRE website, the company is based in Hampshire, UK, at the University of Southampton Science Park.^147148149 It was registered as a private limited company with UK Companies House in August 2018, with the registered business address in Chandlers Ford, Hampshire.¹⁴³¹⁵⁰

In 2020, CHRE’s website stated its goal as “preventing Cancer through research and evidence based policy and practice interventions” and it identifies its priorities as smoking cessation and obesity prevention. The cessation resources on its website recommend Nicotine Replacement Therapies (NRT) and e-cigarettes.¹⁵¹

As of 2020, its website stated that “CHRE does not receive any funds from tobacco, pharmaceutical or e-cigarette companies”.¹⁵²

It also stated that:

“If there are research and evidence gaps regarding “unhealthy” behaviours, those gaps need to be plugged by all the stakeholder groups that have a vested interest in improving public health in the context of those behaviours. We are committed in advocating for and enabling such research, shaping policy, and help bridge the divide between policy and practice.”
[original text in bold]¹⁵³

The CHRE website was updated in 2021.¹⁵⁴

Relationship with the tobacco industry

According to his LinkedIn profile, CHRE Medical Director Dr. Sudhanshu Patwardhan worked for British American Tobacco (BAT) from 2005 until February 2019, and became one of the two directors of CHRE in February 2019.¹⁵⁵ According to UK Companies House records he was appointed Director of CHRE in August 2018 (see below for more details).¹⁵⁶ A conflict of interest statement on a 2021 journal paper about nicotine pouches highlighted S. Patwardhan’s prior work with BAT subsidiary Nicoventures and also that co-author Karl Fagerström “currently receives consulting fees from Swedish Match [a manufacturer of nicotine pouches] and has received fees in the past from tobacco companies to assist their development of less-risky tobacco products.”¹⁵⁷

CHRE received project funding from the Foundation for a Smoke-Free World in 2019, 2020, 2021 and 2022 (see below).^143144145146

Activities

On the centre’s “Projects” webpage it states that it is “working with local partners in South Asia to build capacity among healthcare professionals in tobacco de-addicton [sic] and national health programmes for TB, cancer prevention and Maternal and Child Health.”¹⁵⁸ Other CHRE material states that they have projects in India and Bangladesh.¹⁵⁹

The Projects webpage includes a logo for a “Tobacco Research and Cessation Network” (TRC-NET) but there is no further information on CHRE’s website about this network.¹⁵⁸ The logo is also included on web pages and materials for CHRE’s summits on cessation and mental health (see below). FSFW’s July 2020 country report on India featured an expert endorsement from Dr. Gaurav Kale, stating that he represented the “Maharashtra Secretariat” of TRC-Net.¹⁶⁰ The report was also endorsed by Sudhanshu Patwardhan and Dr. Pooja Patwardhan.¹⁶⁰

In 2020, it appeared that CHRE was exploring the feasibility of establishing a network for tobacco research and cessation in India, with funding from FSFW (see below). An article by director Sudhanshu Patwardhan, published in July 2020, states that “ the authors are involved in preparing a systematic training programme for HCPs [Healthcare Professionals] to upskill them using global best practice applied to locally available cessation treatments.”¹⁶¹ It goes on to say that this work will involve the creation of “nationally relevant cessation protocols and guidelines, including those for smokeless tobacco products” (defined elsewhere in the paper as oral tobacco).¹⁶¹ After piloting and validation, the intention is for the programme to be rolled out across India, and shared with neighbouring countries in South Asia.¹⁶¹ The article refers to findings from the authors’ research in India, and they note that this is not yet published.

The planned programme does not appear to be restricted to using standard Nicotine Replacement Therapy (NRT) but mentions the use of other newer nicotine and tobacco products including e-cigarettes (also known as electronic nicotine delivery systems, or ENDS) and nicotine pouches, stating that:

“Regarding alternative nicotine products, manufacturers need to work with policymakers to create and comply with regulatory frameworks that ensure consumer safety and quality assurance and prevent youth uptake. This is particularly true in the case of e-cigarettes and nicotine pouches, both product categories with a promising role in smoking cessation due to their harm reduction potential.”¹⁶¹

A law was passed in India in 2019 banning the manufacture, sale and promotion of e-cigarettes.¹⁶²

In December 2023 The Times newspaper published an article that described how CHRE helped promote e-cigarettes in the UK.¹⁶³

See below for details of publications and other outputs.

Funded by the Foundation for a Smoke-Free World

CHRE received project funding from the Foundation for a Smoke-Free World in 2019 and 2020.¹⁴³¹⁴⁴ Information published on the FSFW website, stated that the project aim was the “Development of insights on UK’s remaining smokers and their healthcare advisers’ needs and wants to help achieve smoking cessation; identification of priority interventions needed to achieve maximal and broadest impact of smoking cessation in the UK.”¹⁶⁴ (Note that in 2020, the FSFW website stated that the aims were  to “Synthesize and formulate lessons learned from countries with ANDS availability which have seen drastic drops in number of smokers” [ANDS, not defined here: Alternative Nicotine Delivery Systems]; and the “identification of observable smoker characteristics that are linked to cessation success”.¹⁶⁵ However, as of 2021 this text appeared in the entry for Ernst and Young.¹⁶⁴)

According to the FSFW’s 2020 tax return, CHRE was awarded a total of US$3,449,956 between 2019 and 2021.¹⁴⁴¹⁴⁵ As of 27 May 2021, there was no information about FSFW funding on the CHRE website. In 2022 CHRE was awarded US$3,584,019 by FSFW, the majority of which was for its work in India (see below).¹⁴⁶

In November 2019, CHRE was awarded a grant of US$450,115 (GB£348,570) to fund a “Smoke-free UK landscaping project – reaching the ‘hardcore’ of smokers and supporting quitting”, according to the FSFW’s 2019 tax return.¹⁴³ The tax return also stated that the aim of the funding was to “Achieve and sustain smokefree at UK’s Priory Group Mental Health Hospitals”.¹⁴³

The Priory Group is a private healthcare company that provides services to the UK National Health Service (NHS) and was listed as a co-sponsor of CHRE’s 2019 and 2020 mental health summits (see below).¹⁶⁶ A Director of Priory Group gave a presentation on smoking cessation and mental health at CHRE’s summit in September 2019.¹⁶⁷ Searches of the Priory Group website in May 2020 for mentions of CHRE produced no results until a blog post was published on 31 May, on World No Tobacco Day.¹⁶⁸ This stated that “At Priory Group, we have been working with experts from Centre for Health Research and Education (CHRE) to upskill and empower our staff to provide support to patients for quitting smoking successfully.”¹⁶⁸ It quoted Dr. Rick Driscoll, Visiting Consultant at Priory Hospital Bristol and Expert Adviser to the CHRE, and said that Priory had been working with CHRE since 2019 “to support all willing smoker patients in their quitting journey”.¹⁶⁸

CHRE declared the FSFW grant on an event listing for its 2020 “Smoke-Free Mental Health Summit”.¹⁶⁹  The text, in small type at the bottom of the page (see Figure 1), stated that “FSFW has no role in determining the agenda, content or programme of the project including the Summits.” ¹⁶⁹ The event was listed as a “report or publication” sponsored by FSFW.¹⁷⁰ It was postponed due to the Covid-19 pandemic; as of July 2020, it was not clear whether or when the event

Figure 1: Screenshot of CHRE event web page with reference to the FSFW grant.¹⁶⁹

Although it was not clear if he was due to speak at the 2020 summit, Sudhanshu Patwardhan, Medical Director of CHRE, spoke at the 2019 event (see below).

Funded for research in India

In July 2020, information on grants uploaded to the FSFW website showed that CHRE was also awarded a grant in January 2020 for “Evaluating the feasibility and establishment of a multi-center network for tobacco research and cessation in India”. This included scoping work and “Development of a coherent and bold vision” by July 2020.¹⁷¹ The 2021 FSFW tax return indicated that CHRE had been paid US$1,527,783 that year for “Capacity building to reduce tobacco related death and disease in India”.¹⁴⁵ and in 2022 CHRE received an additional US$1,196,504 from FSFW to “Build and strengthen tobacco harm reduction and cessation knowledge and capacity in India”, as well as a further US$2,037,044 for the capacity building project.¹⁴⁶

Since the grants were awarded, the directors of CHRE have discussed cessation in India in various articles and webcasts (see below for details). The two directors of CHRE are also listed as directors of a private company registered in Pune, India. (see below)

Key staff

CHRE’s website did not have a page listing staff, as of July 2020. According to Companies House, its two directors and sole shareholders are Sudhanshu Ramesh Patwardhan and Pooja Sudhanshu Patwardhan.¹⁷²¹⁷³

Sudhanshu Patwardhan is named as Medical Director.¹⁵⁵ His role has been described as including responsibility for Policy.¹⁷⁴ According to his LinkedIn profile, he worked for British American Tobacco (BAT) for nearly 14 years. From 2005 to 2008, he held scientific roles. From 2008 to 2013, he was responsible for “Corporate and Regulatory Affairs” where he “Strategically led the business to make the first global acquisition by a FTSE 10 company in the electronic cigarettes category, to bring scale and global availability of reduced risk alternatives for smokers who would not or could not quit smoking”.¹⁵⁵ BAT’s first e-cigarette acquisition was Vype in 2012. In 2013, he then went on to work in BAT’s newer nicotine products company Nicoventures, on the “global nicotine KOL ecosystem to facilitate smoking cessation and serve public health”¹⁵⁵ (The term KOL stands for “Key Opinion Leaders”). During this time, his job title was Senior International Engagement Manager.¹⁷⁵¹⁷⁶

On a BAT webpage, in connection to its 2008 Sustainability Report, Sudhanshu Patwardhan described his role as BAT’s “interface with the medical and public health communities” and stated that:¹⁷⁷

“One of the biggest challenges we face is our limited freedom to finance external research because of restrictions on third parties receiving funds from the tobacco industry. It’s frustrating that, unlike other multinational companies, we are unable to collaborate freely with academic centres of excellence to drive science and innovation. We are actively seeking constructive solutions to overcome this challenge”.¹⁷⁷

He left BAT in February 2019.¹⁵⁵

Sudhanshu Patwardhan is listed as a mentor for the Tobacco Harm Reduction Scholarship programme run by Knowledge Action Change (KAC), which is also funded by FSFW.¹⁴³¹⁷⁸

He was listed as a speaker at the Global Forum on Nicotine (organised by K-A-C) in 2016,¹⁷⁹ and in 2018.¹⁸⁰¹⁸¹ He has also attended the tobacco industry event the Global Tobacco and Nicotine Forum (GTNF), previously called the Global Tobacco and Networking Forum.

In September 2020, he was listed as key speaker and co-organiser at an event funded by FSFW called “15 Years of Framework Convention on Tobacco Control”, which ended on 1^st October 2020.¹⁸² See Events below for further details. Sudhanshu Patwardhan was described as “guest editor” of the associated special edition of journal Drugs and Alcohol Today.¹⁸³¹⁸⁴

Pooja Patwardhan’s role is Clinical Director of CHRE.¹⁶⁹ As of June 2020, her LinkedIn profile states that she is a “Medical Doctor: Self-employed” but contains no further information.¹⁸⁵ She has been registered as a General Practitioner (GP) with the UK General Medical Council (GMC) since 2011, is licensed to practice in the UK, and is on the GP register (a requirement to be employed as a GP in the UK).¹⁸⁶

Sudhanshu Patwardhan has been registered as a (GP) with the GMC since 2013, and is licensed to practice in the UK. As of June 2020 he is not listed on the GP register.¹⁸⁷

Sudhanshu Patwardhan and Pooja Patwardhan are named as two of the three directors of a private company registered in Pune, India in August 2019, called the Paarth Centre for Healthy Futures, whose registered address is Utkarsha Hospital in Solapur in the state of Maharashtra.¹⁸⁸ The third director is listed as Vikas Vinayak Kirpekar, who is also a director of Utkarsha Hospital Private Ltd.¹⁸⁸¹⁸⁹

Outputs

Webinars, Podcasts & Radio Interviews

On 29 April 2020, Pooja Patwardhan took part in a podcast on ‘global health perspectives’ hosted by Derek Yach, President of FSFW.¹⁹⁰¹⁹¹ The FSFW website states that she has “upskilled and empowered 100s of influencers in UK as well as in India, as part of the mission of creating local champions, to support tobacco users in their quitting journey”.¹⁹⁰ It also states that she has been “at the forefront of creating and disseminating “Quit During Covid” message using innovative ways”.¹⁹⁰ It is not clear what the term “influencer” here refers to as no further details are given on the website.

In June 2020, around the time of World No Tobacco Day, Pooja Patwardhan was interviewed by several local radio stations in the UK, including two local BBC stations. According to the FSFW website, she talked about quitting tobacco and “national and regional results of the COVID-19 poll”.¹⁹² This refers to a poll commissioned by FSFW and conducted by market research company Nielsen, in the UK, Italy, South Africa, India, and the US.¹⁹³

In August 2020, Sudhanshu Patwardhan was listed as the only guest speaker at a webinar hosted by the Lee Kuan Yew School of Public Policy, Singapore, and chaired by Professor Tikki Pangestu, Visiting Professor at the Lin School of Medicine, National University of Singapore.¹⁹⁴ The webinar was titled “FCTC- the policy and practice gap” and aimed to “propose a set of approaches and solutions for realising the public health potential of FCTC”.¹⁹⁴ Invitations to the seminar were sent to public health advocates, but by 21 August the event had been cancelled, with no explanation given on the event web page.¹⁹⁴ Tikki Pangestu was former Director of Research Policy & Cooperation at the World Health Organization, for over a decade, until he left in 2012.¹⁹⁵¹⁹⁶ He also took part in a FSFW podcast, in May 2020. ¹⁹⁰¹⁹⁷

Articles

On 7 April 2020, Pooja Patwardhan (PP) published an article in BJGP Open, the journal of the British College of General Practitioners, discussing the risks for smoking rates rising during the COVID-pandemic.¹⁹⁸ According to the author’s disclosure: “PP or CHRE have not received any funding from pharmaceutical, electronic cigarette, or tobacco industries.”¹⁹⁸ The article was not peer reviewed.¹⁹⁸ In July 2020, this paper was listed as an FSFW sponsored publication.¹⁷⁰ A correction to the ‘competing interests’ section of this article was subsequently issued by BJGP Open on 19 January 2021. The correction removed the statement “PP or CHRE have not received any funding from pharmaceutical, electronic cigarette, or tobacco industries”, instead saying “CHRE has received grants from Foundation for a Smoke-free World, Inc (FSFW)… FSFW describes itself as a non-profit, independent organisation which is funded by Philip Morris International Global Services, Inc.” and that “PP did not receive specific funding and it has been written in a personal capacity,”.¹⁹⁹ Pooja Patwardhan says that the paper was removed from the FSFW website at the author’s request in August 2020.²⁰⁰ It is no longer listed on the site.²⁰¹

Sudhanhsu Patwardhan published a related blog article on the Royal Society for Public Health (RSPH) website.²⁰² The conflict of interest statement said that “SP or CHRE do not receive any funding from pharmaceutical, electronic cigarette or tobacco industries.”²⁰² Pooja Patwardhan also contributed a news item on the RSPH website where she talks further about the role of GPs and smoking cessation during the Covid-19 pandemic and the material the CHRE has produced for GPs.²⁰³ There is no mention of who funds the CHRE in the article or on the infographics produced.

On 26 May 2020, Pooja Patwardhan published a blog post on the same topic in Nicotine Science and Policy, which is produced by Knowledge Action Change.²⁰⁴²⁰⁵. In the blog, Pooja Patwardhan said:

“As a practising GP and a firm believer in preventive medicine, I have been involved in upskilling GPs and other clinicians on smoking cessation around the world. I have seen that when accurate information reaches them in a practice-friendly way from another clinician, they are very receptive and supportive of helping their patients quit smoking and manage cravings using the harm reduction principle.”²⁰⁵

Nicotine Science and Policy offers readers “daily news, research, comment and policy analysis on nicotine containing products, electronic cigarettes and other novel nicotine delivery systems.”²⁰⁶

A short communication paper written by Sudhanshu Patwardhan and Ira Banerjee was published in the Journal of Addiction Science on 8 May 2020 on “Nicotine Withdrawal, the Role of NRT in Hospitalised Smoker Patients and its Implications for Covid-19”.²⁰⁷ The paper stated that Ira Banerjee was Communications Manager at CHRE, and that neither the authors nor the centre received funding from tobacco companies.

On 4 June a paper about cessation in mental health settings written by Pooja Patwardhan and Richard Driscoll (Visiting Consultant at Bristol Priory Hospital and CHRE) was published on the e-journal website ecancer medical science.²⁰⁸ The conflict of interest statement said that “PP or CHRE have not received any funding from pharmaceutical, electronic cigarette or tobacco industries”. The funding statement said that “CHRE has received a grant for a project in Smokefree Mental Health from The Foundation for Smokefree World”. This paper was listed as an FSFW sponsored publication.¹⁷⁰

On 1 July 2020, Pooja Patwardhan published an article with Marewa Glover, on smoking among minority groups including those with mental health conditions.²⁰⁹ This paper was also listed as an FSFW publication and jointly credited to CHRE and COREISS.¹⁷⁰
CHRE’s FSFW funding was not disclosed in the article until February 2021, seven months after publication. When the funding was declared an “Expression of Concern” statement was also added by the publisher, emerald insight, “to inform readers that credible concerns have been raised regarding the editorial process for this article”.²¹⁰ In correspondence with TobaccoTactics, Pooja Patwardhan has said that “This funding statement was omitted by the publishers during the publication process”.²¹¹

Glover is the director of COREISS, a private registered company based in New Zealand established with funding from FSFW. For more information see our page on COREISS.

On 17 July 2020 Sudhanshu Patwardhan published a paper with Jed E. Rose on “Overcoming barriers to disseminate effective smoking cessation treatments globally” (see above).¹⁶¹ The conflict of interest statement declared CHRE’s funding from FSFW for “work in smoking cessation” and stated that it did not receive funding from tobacco companies.¹⁶¹ Co-author Jed Rose (President and CEO of the Rose Research Center) declared funding from tobacco companies and Juul Labs.¹⁶¹ For more information see our page on Jed E. Rose. The authors acknowledged the input of FSFW President (at the time), Derek Yach. (Both July papers were to be presented by the authors at the 2020 FCTC-themed online event funded by FSFW.¹⁸² See below for more details.)

Before this, in May 2020, an article by Sudhanshu Patwardhan on the cost of nicotine replacement therapy in India was published on The Economic Times healthworld.com website, co-authored by Professor Amir Ullah Khan from the Indian School of Public Policy.²¹²

In July 2021, CHRE published a report on its website titled: “Reclaiming Stolen Years: A survey report on barriers and opportunities to reduce tobacco related harms in the UK among the two million people with mental health conditions who smoke”.²¹³²¹⁴ It stated that part of this project was supported by a grant from FSFW and was supported by Ogilvy Consulting.²¹³²¹⁴ (See Ogilvy Group for more on the company and its relationship to the tobacco industry and FSFW)

In May 2022, Sudhanshu Patwardhan and Karl Fagerstrom co-authored a paper on the harm reduction potential of nicotine pouches.²¹⁵ The authors stated that they had not received any external funding for the article.²¹⁵ The declaration of interests stated that CHRE had received grants from FSFW for “some of its smoking cessation projects”, that Patwardhan had previously worked for BAT’s Nicoventures, and that he had no financial interest in nicotine pouches. It stated that Fagerstrom set up Niconovum (now owned by Reynolds/BAT) and was in receipt of consulting fees from Swedish Match.²¹⁵²¹⁶ (Swedish Match sells nicotine pouches as well as snus. PMI announced its bid to buy the Swedish company in April 2022. See Philip Morris International for details).

Presentations

Prior to the FSFW grant being awarded, Sudhanshu Patwardhan gave a presentation at CHRE’s smoking cessation summit on 30 September 2019, titled “Smoking Cessation and Mental Health What does the future hold for us?”.²¹⁷ One presentation slide included an image of Nordic Spirit, a snus-type nicotine pouch made by Japan Tobacco International (JTI).²¹⁷ It is not known if the product was discussed as a cessation tool at the conference. The same slide contained a graphic representing the Voke nicotine inhaler, a product licensed by the British Medicines & Healthcare products Regulatory Agency (MHRA) as a medicine since 2014.²¹⁸ Until 2017, BAT had a commercial agreement with Kind Consumer Ltd to commercialise this device, but the product was never marketed directly by the tobacco company. In 2017, the licence was handed back to Kind Consumer, which began selling Voke in 2019.  Sudhanshu Patwardhan was working for Nicoventures during the period Voke was licenced to BAT.¹⁵⁵

Partnerships

Sudhanshu Patwardhan stated in his 2019 CHRE summit presentation slide that “CHRE is working with technology and healthcare partners to rapidly test and roll out innovation in smoking cessation”. Its partners were not specified.²¹⁷

His speaker profile at the 2016 GFN stated that he worked with the British Standards Institute (BSI) steering group “to create the world’s first quality and safety specifications for vapour products” and that he was a “Co-convenor at the European CEN working group on definitions and terminology related to vapour products”.¹⁷⁹ He was working for BAT during this period.¹⁵⁵

Events

In September 2019, CHRE organised a conference on smoking cessation and mental health in partnership with Priory Health Group.²¹⁹ Its 2020 Smoke Free Mental Health Summit, funded by FSFW, was postponed due to the Covid-19 pandemic.¹⁶⁹

On 5 May 2020, Sudhanshu Patwardhan was hosted for a Twitter chat by the pan-African Centre for Harm Reduction Alternatives (CASA).²²⁰ Based in Kenya, CASA’s Chair is Joseph Magero, who has received scholarship funding from the FSFW-funded organisation Knowledge Action Change.²²¹

In September 2020, an event called “15 Years of Framework Convention on Tobacco Control”, hosted by the journal Drugs and Alcohol Today, featured Sudhanshu Patwardhan and Pooja Patwardhan as speakers. The event appeared to be jointly presented by Sudhanshu Patwardhan and journal editor Axel Klein.¹⁸²  The event website stated that “The 15 Years Conference is supported by the Foundation for a Smoke-Free World. The Foundation played no part in determining the planning or execution of the event.”¹⁸² For more information see The Foundation for a Smoke-Free World.

Relevant Links

The Centre for Health Research and Education (CHRE) website

TobaccoTactics Resources

• Foundation for a Smoke-Free World Grantees
• Harm Reduction
• COREISS
• Jed E. Rose
• E-cigarettes: British American Tobacco
• Nicoventures

References

The post Centre for Health Research and Education (CHRE) appeared first on TobaccoTactics.

What is waterpipe?

Waterpipe has different names in different countries such as narghileh, shisha, hookah, hubble-bubble, or goza.

The World Health Organization (WHO) defines waterpipe tobacco smoking (WTS) as “a form of tobacco consumption that utilizes a single or multi-stemmed instrument to smoke flavoured or non-flavoured tobacco, where smoke is designed to pass through water or other liquid before reaching the smoker”.²²⁶ Some countries have developed their own definition of waterpipe tobacco smoking (WTS).²²⁷

The origin of WTS is somewhat unclear. In the late 19th century, it was popular among older men in the Middle East but with the introduction of sweetened and flavoured tobacco in the early 1990’s, waterpipe use surged among youth, and expanded globally, through universities and schools.²²⁸²²⁹

Social acceptability of waterpipe use has increased, due to the growth of ‘café culture’ in the Middle East and globally, becoming the focus of social gatherings of young people, as a waterpipe can be shared by a group of friends over an extended time, with a slow puff rate. Tourists have taken the waterpipe habit back to their countries, and expatriates from the Middle East have opened waterpipe cafés and restaurants around the world.^226229230231In this way waterpipe has spread beyond the Middle East and become integrated into the global tobacco market.²³² While there are restrictions on tobacco advertising in other regions, products have been promoted throughout the Middle East via satellite television, internet and social media. As these media are largely unregulated the industry is able to circumvent most advertising bans (see below for more on product regulation).^230231226

Transnational tobacco company interests

Historically, transnational tobacco companies had little interest in waterpipe tobacco smoking. A review of tobacco industry documents showed no focus on waterpipe tobacco or its accessories, except for some ‘waterpipe-inspired’ products that did not become mainstream in the market.²³³

This was the case until  2012, when Japan Tobacco International (JTI) acquired Egyptian company Al Nakhla.²³⁴ At the time Al Nakhla was globally the largest company manufacturing waterpipe tobacco products.²³⁵ However, even this was perceived as a strategy to enhance the sale of cigarettes.²³³

In 2019, Philip Morris International (PMI) filed a patent ‘Shisha device for heating a substrate without combustion.’²³³  However, as of 2023, this product had not yet appeared on the market.

• See Waterpipe market below for details on companies, brands and market shares

Use

Image 1: Waterpipe device (Source: Waterpipe Briefing, National Centre for Smoking Cessation and Training/Jawad et al 2013)²³⁶²³⁷

Waterpipe tobacco is smoked using a device like that in image 1. As the smoker draws from the mouthpiece, a piece of lit charcoal heats the waterpipe tobacco leaf within the head of the apparatus. This heat generates smoke that travels through the device’s body and enters the water-filled bowl. By inhaling through the hose attached to the top of the bowl, the smoker pulls the smoke through the water, resulting in bubbles, before finally inhaling the smoke via the mouthpiece. Typically, the head is filled with flavoured and sweetened, and it is separated from the charcoal by a perforated aluminium foil. While the specific design and characteristics may vary across different regions, the fundamental principle remains consistent: the smoke is filtered through water.²³⁰

E-hookahs or e-shisha or hookah pens are not waterpipe devices as they do not involve burning charcoal. These are classified as electronic nicotine devices, similar to e-cigarettes, where a sweetened liquid is electrically heated creating an aerosol to be inhaled.²²⁶

• For more information on e-cigarettes and other product types see Tobacco Industry Product Terminology

The role of flavour

The traditional type of waterpipe tobacco smoking (WTS) uses unflavoured types of leaf (Ajami, Tumbak, or Jurak). However, since the 1990s flavoured tobacco has become more popular.^230231226

The most common type is Maasel (or Mo’assel), or ‘honeyed’ tobacco, which consists of one-third tobacco and two-thirds honey and fruit flavours, usually a combination of tobacco, molasses, glycerine and fruit flavours.²³⁸. A review looking at waterpipe use in the USA, Canada and the UK has shown that young adults use waterpipe mainly for its appealing flavours, always preferring it over other tobacco products.²³⁹  A study among , adults in Lebanon indicated that the introduction of novel tobacco flavours contributed to people initiating WTS and increased its use.²⁴⁰ Similarly, a study from Iran indicated that the wide variety of flavours has as well contributors to the increase in prevalence of smoking among youth and women. The different flavours were considered ‘tempting’.²⁴¹

• For information on the appeal of flavoured tobacco products see Flavoured and Menthol Tobacco

Health effects

Evidence shows that waterpipe, like other tobacco and nicotine products, is addictive.²⁴²

As with cigarettes and rolling tobacco the smoke of waterpipe is toxic and carcinogenic. One study identified 27 known or suspected carcinogens. ²⁴³As a waterpipe is often shared, it is also a mode of transmission for communicable diseases, a particular concern during the COVID-19 pandemic.²⁴⁴ Consequently, waterpipe has both  short-term and long-term harmful health impacts on people who use it, and additional harms for those exposed to second-hand smoke.^226245246247

Among many groups of users there is a belief that the smoke of waterpipe is filtered in water, making it less harmful than cigarette smoking. This perception has contributed to a growing popularity and acceptance.^230231226 For example research from the UK found that:

“[w]aterpipe was perceived to be safer than cigarette smoking due to the pleasant odour, fruity flavours, and belief that water filtered the toxins.”²⁴⁸

However, waterpipe contains similar or greater levels of toxic substances, leading to the same cellular effects as conventional products, leading to pulmonary and arterial diseases.²⁴³²⁴⁹

Prevalence

A 2018 systematic review, which included 129 studies from 68 countries, found that use of waterpipe was highest among adults in the Eastern Mediterranean region (EMR). However, among youth, prevalence was similar in Europe and EMR. Comparing WTS between adults and youth, globally the study reveals that smoking is higher among youth.²⁵⁰

A WHO advisory note about waterpipe, published in 2015, indicated that although waterpipe smoking was traditionally associated with the Eastern Mediterranean region, Southeast Asia and Northern Africa, its use is growing globally among youth and adults of both genders. Use is particularly increasing among schoolchildren and university students. Research reported in the WHO advisory note ²³¹ and a study from Lebanon indicates that the shape, colour and size of the apparatus contributed to the popularity of WTS product mainly among women.²⁵¹

Africa

Research in South Africa from 2012, shows that 20% of poor high-school students reported using waterpipe daily, and 60% reported ever having used one.²⁵² A study in Western Cape from 2013, reported higher figures: 40% current use, and 70% ever use.²⁵³ Even among medical students, use may be relatively high; a study in Pretoria in 2010 found that nearly 20% of participants had used a waterpipe at some time.²⁵⁴

The Americas

Although there is limited research on waterpipe in Latin America, some has been conducted in the United States (US) and Canada. In US a national study of 104,434 university students, published in 2014, shows that after cigarette smoking, waterpipe smoking was the most frequent form of tobacco use (8.4%, compared to 29.7% for cigarettes), and over 30% reported using waterpipe at some time.²⁵⁵ In Canada, although cigarette smoking among young people had significantly decreased, waterpipe use increased by 2.6% among young people between 2006 and 2010.²⁵⁶

Eastern Mediterranean

This region has the highest prevalence of waterpipe use. Studies (1999 – 2008) suggest that waterpipe use was more frequent than cigarette smoking among children aged 13–15 in most countries of the region.²⁵⁷ It also increased in multiple countries, with prevalence ranging from 9% to 15%.²⁵⁸

Europe

Evidence compiled in 2012 showed that, among people aged 15 years or over, 16% had tried waterpipe at least once. Studies suggest waterpipe prevalence ranging from 35-40% in Latvia, Estonia, and Lithuania, but below 10% in Malta, Spain, Portugal, and Ireland. Use was growing sharply in Austria, the Czech Republic and Luxembourg.²⁵⁹ In England, data from 2013 indicated that for people aged 16-18 the level of waterpipe smoking was low, at 3%.²⁶⁰

However, a study looking at adult smoking in England using a nationally representative cross-sectional survey found that since then pipe, cigar or waterpipe smoking increased five times – from around 150, 000in 2013 to over 770, 000 in 2023. Cigars was the most used of the three product types, closely followed by waterpipe, and the increase was higher among young adults.²⁶¹.

South-East Asia

Studies (2008 – 2011) suggest that waterpipe prevalence among men was just over 1% in Bangladesh, and in India, and much lower in in Indonesia and in Thailand (0.3%). Fewer than 1% of women use waterpipe in India Bangladesh,  Indonesia, and Thailand.²⁶²²⁶³ However, waterpipe “hookah” bars and restaurants are becoming increasingly common and are most often frequented by young people.

Western Pacific

Waterpipe is called “bong” and is different in design from the popular Middle Eastern waterpipe, and therefore is often not included in waterpipe studies. It can be made of bamboo, metal or glass and is used in China, the Lao People’s Democratic Republic, Myanmar, and Vietnam. In 2010 in Vietnam around 13% of males aged or over 15 used bong.²⁶²

Regulation

In many higher income countries, waterpipe products are exempted from tobacco control policies. In many lower income countries, even if there is a policy, enforcement is very weak. Although flavouring is a major factor in the appeal to young people, flavour bans often do not cover waterpipe tobacco products. Consequently, the use of waterpipe has increased globally, largely unchecked.^230231226229

The WHO Framework Convention on Tobacco Control (WHO FCTC) identifies tobacco products as “products entirely or partly made of the leaf tobacco as raw material which are manufactured to be used for smoking, sucking, chewing or snuffing”.²⁶⁴ This definition covers waterpipe tobacco products. WHO FCTC issued COP decisions specifically for waterpipe tobacco control:

• At COP3 in 2008, Parties were invited to consider introducing health warnings and messages on tobacco packages, including waterpipe, and to use innovative measures requiring health warnings and messages to be printed on instruments used for waterpipe smoking.²⁶⁵
• At COP6 in 2014, Parties were invited to strengthen the implementation of WHO FCTC on waterpipe, including conducting surveillance of its use and research on its market. This decision also invited the Secretariat of the Convention to work with the WHO to support countries in waterpipe control.²⁶⁶
• At COP7 in 2016, more detailed instructions were given to Parties, including to ban the use of flavourings in waterpipe tobacco products.²⁶⁷
• At COP8 in 2018, there is a decision on the implementation of Articles 9 and 10 of the WHO FCTC (Regulation of contents and disclosure of tobacco products, including waterpipe, smokeless tobacco and heated tobacco products), including the establishment of an expert group to examine the reasons for low implementation of Articles 9 and 10 of the Convention.²⁶⁸

The full list of articles covering waterpipe are listed in the Fact sheet: Waterpipe tobacco smoking & health.²²⁶

In January 2016, the Secretariat of the WHO FCTC signed a Memorandum of Understanding with The American University of Beirut making it the global knowledge hub for WTS, in particular with respect to education, research, and the dissemination of information that contributes to the implementation of the Convention. ²⁶⁹

In 2018, the WTS knowledge hub submitted a report to the WHO FCTC COP8 that summarized Parties’ regulations concerning waterpipe.²⁷⁰ This report was updated in 2022, and found that, of the 90 countries reviewed, over half (47) had policies relating to waterpipe.²²⁷ The majority of policies, nearly 45%, were in Europe and around 21% in EMR.²²⁷

For up-to-date information on tobacco regulation, see the Tobacco Control Laws website, published by the Campaign for Tobacco Free Kids (CTFK).
Information on progress by parties can be found in the FCTC Implementation database.

During the COVID-19 pandemic in 2020, many countries temporarily banned the use of waterpipe as part of their efforts to stop the spread of the infection.²⁴⁴ In EMR alone, 17 countries banned waterpipe tobacco use in public places.²⁷¹

Waterpipe, along with heated tobacco products, had been exempted from the EU flavour ban, stipulated by the 2014 European Tobacco Products Directive (TPD) and implemented in 2020. A new directive was issued in 2022 and came into force in 2023. This removed the exemption, bringing regulation of these products in line with cigarettes and hand rolled tobacco.²⁷²²⁷³ This means that waterpipe tobacco with a “characterising flavour” can no longer be sold legally in the EU. For more information see Menthol Cigarettes: Industry Interference in the EU and UK.

Waterpipe market

According to advocacy group It’s Still Tobacco, the region with the largest global market share of WTS is the Middle East and Africa (MENA), a range estimate for the two years2016-2017 to be 54% to 69% in.²⁷⁴

The WTS market is still concentrated in the Middle East and Africa, followed by  Europe.²⁷⁵ Market analysis company Valuates estimated that as of 2022 the global WTS market was worth over US$ 800 million, forecast to nearly double by 2029.²⁷⁵

Market research company Euromonitor International publishes data on waterpipe, as part of the broader pipe tobacco category. It is therefore hard to estimate global market shares specifically for waterpipe tobacco. However, it is possible to identify specific waterpipe brands in the data. In 2022, JTI held the largest share with Al Nakhla, making up nearly 13% of the entire pipe tobacco market, followed by Al Fakher and Eastern brands (including Moassel) at around 12% and 8% respectively.²⁷⁶

Tobacco industry interference

The waterpipe industry is multidimensional, composed of both tobacco and non-tobacco actors, including third parties. Interference can therefore be less obvious, making it difficult to develop effective WTS policy.²⁷⁷ However, there is some evidence of the tactics used by the industry and its allies.

Tobacco industry tactics used to interfere with and undermine regulation relating to waterpipe include:

Use of third parties

The third-party technique includes creating, funding and empowering allies and front groups.

The public representation of the WT industry primarily revolves around the hospitality sector (waterpipe cafes, bars, and restaurants).²⁷⁴ Products are promoted online by users via social media, rather than WT companies.²⁷⁴  A study from Lebanon indicates that, following the passage of the tobacco control law, enforcement of a ban on indoor smoking came to a halt due to the lobbying of policy makers by establishments where waterpipe was available.²⁷⁸

In 2012, the hospitality sector in Lebanon commissioned Ernst & Young (now EY) to evaluate the effects of the smoke-free law on their financial revenue and impact on employment.²⁷⁴²⁷⁹

Spreading misleading information

Waterpipe companies have published misleading information, including on the risks of tobacco products.

A study of 16 company websites indicated that most (n=12) published misleading marketing information This was mostly prominent among non-MENA companies (n=8) compared to MENA companies’ websites (n=4).   Several companies in Jordan (Al-Rayan, Al-Tawareg, Al-Waha, and Mazaya) were found to have disseminated misleading information on the quality and safety of WTS.²⁷⁴  WTS charcoal companies in particular published misleading information about charcoal being ‘100% natural’ and ‘free of chemicals’.²⁷⁴

Another study looking at marketing materials at a European trade fair,  and from the MENA region, found the prevailing message was that waterpipe is less risky compared to cigarettes.²⁸⁰

Industry science

Al Fakher Tobacco Trading LLC, the second largest WT company, has a ‘shisha science’ section on its website and publishes its own research. A poster of a study published on its page indicates that the paper was presented at the CORESTA Smoke Technology Conference, in 2019. The study argues that a comparisons of Total Particulate Matter (TPM) yields between waterpipe and cigarettes do not provide meaningful information to inform an assessment of relative risk of its products.²⁸¹

For information on science websites of transnational tobacco companies, see:

• Industry Approaches to Science on Newer Products

Illicit trade

Although cigarettes form most of the illicit tobacco trade, there is some evidence of illicit trade relating to waterpipe, specifically in the Eastern Mediterranean and South-East Asian regions.²⁷⁴²²⁶.

Research from Turkey indicates that the majority (up to 99%) of waterpipe tobacco is illicitly traded, reflecting the significance of the informal economy in the waterpipe tobacco market.²⁸² The illicit products are from both unauthorized domestic production, and increasingly tobacco smuggled from other countries, reported to taste better than locally manufactured products.²⁸³

OLAF, the European anti-fraud office, has identified suspicious shipments of waterpipe tobacco heading into Europe. In 2022, OLAF detected a truck carrying 20,000 kg of waterpipe tobacco as it was leaving Türkiye on its way to Denmark.²⁸⁴

Tax evasion

There have been some documented cases of the under reporting of imports and exports of waterpipe tobacco, in order to evade tax.

In 2022, New Zealand changed its taxation law related to WTS to base it on product weight rather than the content declared by importers, as the customs authority suspected that some importers had been under-declaring tobacco content in order to avoid paying tax. ²⁸⁵

In 2023, the Mozambique the tax authority seized two containers of waterpipe tobacco, reporting the lack of a proper declaration for taxes and other customs fees.²⁸⁶

Relevant Links

• WHO FCTC Knowledge Hub for Waterpipe Tobacco Smoking
• Virginia Commonwealth University Center for the Study of Tobacco Products video Addressing the Myths of Hookah

TobaccoTactics Resources

• Eastern Mediterranean Region
• Industry product terminology
• Japan Tobacco International

TCRG Research

Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations,  H. Alaouie, R.S. Krishnamurthy, M. Tleis, L. El Kadi, R.A. Afifi, R. Nakkash, Tobacco Control, 2022, 31(2):187-197. doi: 10.1136/tobaccocontrol-2021-056550

References

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