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).² These countries are important sources of new customers for tobacco companies as markets in higher income countries where consumption is generally falling.³⁴⁵

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.¹⁶⁷

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”.⁸ 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.⁸  The guidelines also recommend parties treat state-owned tobacco companies in the same way as any other tobacco company, including avoiding any “preferential treatment”.⁸

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”.⁸

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.”⁹ Another decision required governments to “take into account their public health objectives in their negotiation of trade and investment agreements”.¹⁰

Nevertheless, diplomats continue to lobby for tobacco companies around the world.¹

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,¹¹ 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),¹² the guidelines were revised in 2013.¹³ 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”.¹³

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,¹⁴¹⁵ Hungary,¹⁶ and Pakistan.^1217181920

UK officials have also disclosed contact with tobacco companies in Panama and Venezuela,²¹²² Laos,²³ Cuba,²⁴ and Burundi.²⁵

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.²⁶

• 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)”.¹³

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.^1272829

In 2020, staff from the UK high commission in Pakistan attended a promotional event for a BAT product in Pakistan.³⁰

• 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.³¹  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).²¹  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,¹⁴¹⁶ It may simply be described as relating to ‘doing business’ in the country.²²

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.¹³ One of the activities used to justify interaction by UK diplomats is “resolving business problems that are potentially discriminatory”.^1214163233 This has been criticised as running counter to the WHO FCTC guidelines.¹³⁴

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”.³⁵³⁶³⁷  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.¹²⁹

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.³⁸

• 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.³⁹ Japanese diplomats have also toured tobacco farms and JTI factories in Tanzania and Zambia.⁴⁰⁴¹

Japan Tobacco International is the overseas subsidiary of Japan Tobacco (JT), which is one third-owned by the Japanese government.⁴²

Germany

In May 2022, the German ambassador to Beirut visited the offices of Regie, the Lebanese Tobacco and Tobacco Inventory Administration.¹⁴³

Denmark

The Imani Centre for Policy and Education, a Ghana-based think tank,  received money from the Danish embassy while lobbying against tobacco control.³¹⁴⁴

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.⁴⁵⁴⁶⁴⁷  The proposed legislation included significant tax increases on heated tobacco products, in which PMI has invested.⁴⁵⁴⁸

The same year, PMI helped fund an inaugural event for the new Swiss Embassy in Moscow.⁴⁹⁵⁰

• 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.^51525354 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.⁵¹  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.⁵¹⁵⁵

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.¹

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.¹

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”.⁵⁶

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.

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”.⁶¹ Some countries have developed their own definition of waterpipe tobacco smoking (WTS).⁶²

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.⁶³⁶⁴

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.^61646566In this way waterpipe has spread beyond the Middle East and become integrated into the global tobacco market.⁶⁷ 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).⁶⁵⁶⁶⁶¹

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.⁶⁸

This was the case until  2012, when Japan Tobacco International (JTI) acquired Egyptian company Al Nakhla.⁶⁹ At the time Al Nakhla was globally the largest company manufacturing waterpipe tobacco products.⁷⁰ However, even this was perceived as a strategy to enhance the sale of cigarettes.⁶⁸

In 2019, Philip Morris International (PMI) filed a patent ‘Shisha device for heating a substrate without combustion.’⁶⁸  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)⁷¹⁷²

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.⁶⁵

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.⁶¹

• 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.⁶⁵⁶⁶⁶¹

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.⁷³. 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.⁷⁴  A study among , adults in Lebanon indicated that the introduction of novel tobacco flavours contributed to people initiating WTS and increased its use.⁷⁵ 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’.⁷⁶

• 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.⁷⁷

As with cigarettes and rolling tobacco the smoke of waterpipe is toxic and carcinogenic. One study identified 27 known or suspected carcinogens. ⁷⁸As a waterpipe is often shared, it is also a mode of transmission for communicable diseases, a particular concern during the COVID-19 pandemic.⁷⁹ 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.^61808182

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.⁶⁵⁶⁶⁶¹ 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.”⁸³

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.⁷⁸⁸⁴

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.⁸⁵

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 ⁶⁶ 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.⁸⁶

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.⁸⁷ A study in Western Cape from 2013, reported higher figures: 40% current use, and 70% ever use.⁸⁸ 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.⁸⁹

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.⁹⁰ In Canada, although cigarette smoking among young people had significantly decreased, waterpipe use increased by 2.6% among young people between 2006 and 2010.⁹¹

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.⁹² It also increased in multiple countries, with prevalence ranging from 9% to 15%.⁹³

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.⁹⁴ In England, data from 2013 indicated that for people aged 16-18 the level of waterpipe smoking was low, at 3%.⁹⁵

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.⁹⁶.

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.⁹⁷⁹⁸ 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.⁹⁷

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.^65666164

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”.⁹⁹ 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.¹⁰⁰
• 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.¹⁰¹
• At COP7 in 2016, more detailed instructions were given to Parties, including to ban the use of flavourings in waterpipe tobacco products.¹⁰²
• 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.¹⁰³

The full list of articles covering waterpipe are listed in the Fact sheet: Waterpipe tobacco smoking & health.⁶¹

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. ¹⁰⁴

In 2018, the WTS knowledge hub submitted a report to the WHO FCTC COP8 that summarized Parties’ regulations concerning waterpipe.¹⁰⁵ This report was updated in 2022, and found that, of the 90 countries reviewed, over half (47) had policies relating to waterpipe.⁶² The majority of policies, nearly 45%, were in Europe and around 21% in EMR.⁶²

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.⁷⁹ In EMR alone, 17 countries banned waterpipe tobacco use in public places.¹⁰⁶

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.¹⁰⁷¹⁰⁸ 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.¹⁰⁹

The WTS market is still concentrated in the Middle East and Africa, followed by  Europe.¹¹⁰ Market analysis company Valuates estimated that as of 2022 the global WTS market was worth over US$ 800 million, forecast to nearly double by 2029.¹¹⁰

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.¹¹¹

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.¹¹² 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).¹⁰⁹ Products are promoted online by users via social media, rather than WT companies.¹⁰⁹  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.¹¹³

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.¹⁰⁹¹¹⁴

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.¹⁰⁹  WTS charcoal companies in particular published misleading information about charcoal being ‘100% natural’ and ‘free of chemicals’.¹⁰⁹

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.¹¹⁵

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.¹¹⁶

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.¹⁰⁹⁶¹.

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.¹¹⁷ The illicit products are from both unauthorized domestic production, and increasingly tobacco smuggled from other countries, reported to taste better than locally manufactured products.¹¹⁸

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.¹¹⁹

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. ¹²⁰

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.¹²¹

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

The post Waterpipe appeared first on TobaccoTactics.

This is one of six geographic regions of the World Health Organization (WHO). This region includes 22 countries, with a total population of nearly 679 million people.¹²⁶

Smoking in the Eastern Mediterranean Region

The latest WHO tobacco trends report, 2019, projects a smoking rate (properly called tobacco prevalence) of 18.6% in the EMR in 2020. The report expects a tobacco prevalence decrease in the region from the estimated 20.5% in 2015 to 17% in 2025. This decrease will however mean an increase in numbers of tobacco users from the estimated 90 million in 2015 to 94 million in 2025 because of population growth.¹²⁷

The report also shows a huge difference in tobacco prevalence according to gender with 33.3% tobacco prevalence among males but just 3.9% among females. Another remarkable difference is the tobacco prevalence across different countries in the region. It starts at 9.6% in Oman and reaches 42.6% in Lebanon.¹²⁷
The EMR has the highest waterpipe use as compared to any other region. Waterpipes are a particular method of consuming tobacco with it heated and drawn through water in inhaled via a pipe., It is estimated that schoolchildren aged 13–15 use waterpipes more frequently than cigarettes.¹²⁸ Studies indicate mean prevalence estimate of ever use of waterpipe of 31.9% among adults in the EMR.¹²⁹

Tobacco in the Eastern Mediterranean Region

Out of the 22 countries of this region, at least 14 countries grow tobacco and at least seven countries manufacture it. The following table shows a summary of agriculture and production of tobacco in the EMR (table 1). This table is based on fact sheets prepared jointly by WHO and the United Nations Conference on Trade and Development in 2015. However it is believed that both agriculture and production are much higher now.¹³⁰

Table on agriculture and production of tobacco in the EMR

Who dominates the market?

The tobacco products that destroy so many people’s lives are the result of the activities of a number of companies around the world. The Tobacco Supply Chain Database enables tobacco control researchers and advocates to understand what the supply chain is, where it is located and who is involved. For more information, access the database here.

The cigarette market in the EMRO region is dominated by international and multinational companies, with their brands being the most sold cigarette in at least 12 countries. Locally produced cigarette brands are still the highest sellers in at least four countries. The waterpipe market shows a growing presence from multinational companies.¹³¹¹³²

Table showing countries with most sold cigarette brand owned by international and multinational companies

Table showing the countries with most sold cigarette brand owned by local companies

Table giving examples of the dominant brands of waterpipe in the region

Links to governments

The industry aims to make sure it is well-represented

The industry has an established strategy in the region to lobby political figures and governments to serve its benefits. This strategy indicates links between tobacco industry and senior officials in the region trying to influence their decision making process.¹⁴⁴
It is reported that the tobacco industry used corporate social responsibility activities as a strategy to access officials in Egypt, Jordan, Lebanon, Morocco, Pakistan, Tunisia and the United Arab Emirates. An example of the industry lobbying in the EMR is in trying to influence the countries’ selection of their representatives to the Conference of Parties (COP) of the WHO Framework Convention on Tobacco Control (WHO FCTC). Tobacco industries have pushed countries to send representatives from non-health sectors, who may see tobacco as a business rather than a health hazard.¹⁴⁵

There are state-owned and state-supported companies in number of EMR countries such as the Eastern Company in Egypt, Iran Tobacco Company in Iran, National Tobacco and Matches Corporation in Tunisia, Regie Libanaise des Tabacs et Tombacs in Lebanon, Régie des Tabacs in Morocco, and Kamaran Industry and Investment in Yemen. Most of these companies are a monopoly in charge of production, importing, and exporting tobacco products.¹⁴⁶

Examples of good practice

Iran, one of the leading tobacco control countries in the region, is reported to be a successful country in resisting tobacco industry interferences by adherence to the WHO FCTC Article 5.3 guidelines. Iran bans corporate social responsibility activities by the tobacco industry and does not accept any support from or presence of the representatives of the Iranian Tobacco Company, a state monopoly, in its tobacco control policy making process.¹⁴⁷

Saudi Arabia, another leading tobacco control country in the region, has issued a policy to regulate communication and interaction, if required, between the government officials and tobacco industry. The policy reflects the principles and recommendations of Article 5.3 of the WHO FCTC. ¹⁴⁸

Roadmap to tobacco control

Most countries of the EMR are parties to WHO FCTC with 19 out of 22 countries have ratified joining the treaty.¹⁴⁹ Additionally, six countries of the region are parties to the Protocol to Eliminate Illicit Trade in Tobacco Products.¹⁵⁰ Most countries of the EMR have tobacco control laws.¹⁵¹ However, the strength of such laws varies dramatically from a country to another.¹⁵²

The WHO Report on Global Tobacco Epidemic 2019 shows that out of the 22 EMR countries there are six countries that have recent, representative and periodic data on tobacco prevalence for both adults and youth; seven countries that have legislation banning smoking in all public places; three countries that have national quit line and both nicotine replacement therapy and some cessation services cost-covered; five countries that have large pictorial warnings on tobacco packages; four countries that have conducted national tobacco control campaign aired on television and/or radio; ten countries that have legislation banning all forms of direct and indirect advertising; and three countries that have a tax on retail price on the most popular brand of cigarettes higher than 75%.¹⁵³

Although the number of countries having such powerful tobacco control measures is not high, most of the EMR countries have at least some tobacco control measures. Most have implemented measures that puts them in the middle of their way to meet the comprehensive and recommended measures of tobacco control by the WHO FCTC. The report also shows that despite the existence of tobacco control laws, the compliance to such laws is challenging. For example, the report puts only one country in high compliance category out of the seven countries that have legislation banning smoking in all public places, and puts only five countries in high compliance category out of the ten countries that have legislation banning all forms of direct and indirect advertising. This compliance assessment highlights a huge gap in enforcement of existing legislation.¹⁵²

Stakeholders of tobacco control in the EMR includes governments, international intergovernmental organizations, non-governmental organizations, and academic institutes. Most countries of the EMR have a tobacco control unit within their ministries of health. Most international intergovernmental organizations that are accredited as observers to the COP are present in the EMR including the Arab League that 19 of the EMR countries are included in its members.¹⁵⁴ However the presence of non-governmental organizations accredited as observers to the COP is less noted in the EMR.¹⁵⁵¹⁵⁶

Some academics in the region work in the field of tobacco control research with an example of the American University in Beirut hosting the Knowledge hub of FCTC on waterpipe.¹⁵⁷ The WHO is present in the region through the Tobacco Free Initiative Unit in their office for the EMR, in addition to tobacco control focal point in the organization’s country offices.¹⁵⁸

Industry interference

Published literature shows that the EMR has been suffering from tobacco industry interferences for many decades. Such interferences undermine efforts of tobacco control in the region leading to continuous high prevalence of tobacco use. ¹⁵⁹ The following are themes and examples of tobacco interferences in the EMR.

Illicit trade

The tobacco industry claims to combat illicit trade but that contradicts their overproduction in some markets and oversupplying to others and in the knowledge that excess tobacco will end up on the illicit market. In the region, the tobacco industry continued to supply the contraband trade despite appeals by the government to cease undermining its revenues.¹⁶⁰ The magnitude of illicit trade in both cigarettes and waterpipes is huge within the EMR with studies referring to the tobacco industry involvement either through the producers or the distributers of tobacco, using various routes to, from and across the region. ^{161162163164165166}

Hijacking public health policies

The industry aims to undermine tobacco control efforts through their links to governments in the EMR.¹⁴⁴ For example the tobacco industry manoeuvrings to hijack the track and tracing systems of tobacco products in the EMR. Although, as discussed earlier, the links between the tobacco industry and illicit trade are studied and observed, there is still an ongoing process of signing memorandums of understanding between them and the governments in many of the EMR allowing the industry to have links with customs and giving them the opportunity to influence the new track and tracing systems.¹⁶⁷

Influencing taxation policies

Internal documents of the tobacco industry show their efforts in delaying the establishment of unified tax increases across the Gulf Cooperation Council’s countries that consists of six of the EMR countries; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates.¹⁶⁸ An internal Philip Morris memo showed how they work strategically to influence the tobacco taxing system in Egypt through range of interferences including lobbying at all levels of the authorities.¹⁶⁹ In Pakistan, the tobacco industry did changes in cigarette prices at their advantage by shifting some of their most sold brands to the lowest tax slab allowing itself to manipulate the market by price setting.¹⁷⁰

Expanding of multinational companies

The expansion of multinational companies in the region as part of the industry’s strategy to shift from developed markets, where tobacco control policies are strong and smoking prevalence is declining, to emerging markets where demand for tobacco is higher and tobacco control legislations are weaker. Additionally, local companies such as Eastern Company in Egypt are expanding as well.¹⁷¹ A prominent example for the expansion of multinational companies in the EMR is the increasing investments of Japan Tobacco International in the region. The company bought two major tobacco manufactures in the EMR: the Egyptian waterpipe company Nakhla and the Sudanese cigarette manufacturer Haggar, which gives Japan Tobacco access to export its products to 85 countries, mainly in the EMR and Africa.¹⁷²¹⁷³

Promoting Next Generation Products

The tobacco industry is aggressively promoting electronic nicotine/ non-nicotine delivery systems and heated tobacco products in the region and has already launched them in number of countries such as Kuwait.¹⁷⁴ It is also expected that an international “vaping expo”, first of its kind, will be held in the United Arab Emirates in 2020 to frame the future of such products connecting manufacturers, distributors, and users of the products.¹⁷⁵ Although these products are being promoted globally by the industry, the case in the EMR is unique as electronic cigarettes were already banned in 11 out of the 22 countries of the region in 2017.¹⁷⁶ However, the situation is dramatically changing with Saudi Arabia, one of the leading tobacco control countries in the region, reverting its legislation and allowing electronic cigarettes, raising fears that a domino effect will take place allowing the product in the rest of EMR.¹⁷⁷ The industry is using number of interferences to promote these products such as lobbying policy makers and targeting youth with false information and by adding favourable flavours to its products.¹⁷⁸

Corporate social responsibility activities

Tobacco industry maneuvers to manipulate public opinion to gain the appearance of respectability happen across the countries in the EMR. For example, funding the education of women from Afghanistan in western universities by British American Tobacco;¹⁷⁹ donating to cancer screening and treatment hospital in Egypt by Eastern Company for Tobacco;¹⁸⁰ and funding projects for education in Pakistan, Jordan, Lebanon, Morocco, and Palestine by Philip Morris International.¹⁸¹ Additionally, the industry sponsor popular sports such as the Egyptian Eastern Company for Tobacco sponsoring a football team carrying its name and playing in the Egyptian football league.¹⁸²Multinational companies also sponsor sport teams to brand their products such as British American Tobacco branding their electronic cigarette on McLaren cars (motorsports team) in the Bahrain Grand Prix, and Philip Morris International using Ducati (motorcycle team) for branding at the Qatar MotoGP.¹⁸³

Use of influencers and allies

A clear example of this well-practiced tactic is the visit of prominent doctors from number of Egyptian medical schools to a Philip Morris International factory in Switzerland, and then posting on social media about the visit claiming that it was supported by the WHO to check a new product of the company that has no side effects. The WHO issued a press release to condemn the incident and to deny any support to such tobacco industry maneuvers. The doctors removed the post from social media after the WHO press release.¹⁸⁴The industry is also active in approaching universities to keep its presence among youth and to recruit best qualified graduates in the region to keep growing. For example, British American Tobacco is listed as partner to the American University in Cairo in conducting employment fairs, After conducting such meetings, BAT publish news about it, which gives the impression that they are linked somehow to this prestigious university.¹⁸⁵¹³²

Generating industry-funded science

The tobacco industry use of research and policy forums is a well-known strategy to influence policy-making processes. In the EMR there is an example of funding research institute in Pakistan with thousands of dollars to conduct studies in the field of tobacco. This fund from the Foundation for a Smoke-Free World, which is a Philip Morris International funded organization. There are also examples of think tanks in the EMR that are allied with the tobacco industry which are the Egyptian Center for Public Policy Studies and the Pakistani Policy Research Institute of Market Economy. Both think tanks opposed plain packaging of tobacco products despite the fact that it is an evidence based public health tobacco control intervention.¹⁸⁶

Benefiting from emergencies and political instability

Tobacco industries look to use political instability as an opportunity to increase illicit trade and shape tobacco control policies in their favour. A number of countries in the region requested that tobacco control in protracted complex emergency situations should be an item for discussion during the COP of the WHO FCTC.¹⁸⁷ As a result of such discussion, the COP made a specific decision in this regard aiming to providing technical and financial assistance to countries in protracted complex emergency situations, and requesting countries to pay special attention to Article 5.3 of the WHO FCTC and related Guideline.¹⁸⁸

Tobacco Tactics resources

• JTI Involvement in Smuggling
• Gallaher Versus its Cypriot Distributor
• CSR Strategy
• Motorsport Sponsorship
• Foundation for a Smoke-Free World
• Think Tanks

References

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