Image source: eltpics/CC BY-NC 2.0

Key Points

• Viet Nam is a country located in South East Asia, part of the World Health Organization’s regional office for the Western Pacific (WPRO).
• It has a population of 98.2 million, with tobacco use prevalence of 24.9%.
• Viet Nam ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004. It has not joined the Protocol to Eliminate Illicit Trade in Tobacco Products.
• The Vietnam National Tobacco Corporation (Vinataba), a state-owned company, has the largest share of the national cigarette market, at nearly 58% in 2022.
• Of the transnational tobacco companies (TTCs), British American Tobacco (BAT) has by far the largest share of the market in Viet Nam, with Imperial Brands in second place. Philip Morris International (PMI), Japan Tobacco International (JTI) and others have smaller market shares.
• The tobacco industry has deployed a range of tactics to protect its interests in Viet Nam, including lobbying policy makers, use of third parties, complicity in the illicit trade in tobacco products, and spreading misleading information.

Although Viet Nam has made significant progress on tobacco control in recent years, it continues to face major challenges. Tobacco prevalence amongst men remains very high.¹ There is ongoing industry influence on policymaking, particularly on issues such as price and tax of tobacco products.² The state-owned company Vinataba enjoys special privileges from the Vietnamese state, and has long claimed a position as an affected stakeholder on matters of tobacco control.³⁴ There has also been interaction between the transnational tobacco companies (TTCs) and the Vietnamese state, including during the Conference of the Parties (COP) to the WHO FCTC.⁵

Tobacco Use in Viet Nam

In 2022, the population of Viet Nam was 98.2 million.⁶ According to a WHO age-standardised prevalence estimate, based on all national survey data between 1990 and 2019, overall prevalence of current tobacco use was just over 25%.¹ There is a major gender difference, with current male tobacco use at over 48%, compared to just over 2% for females.¹ Smoking has been an important aspect of social behaviour amongst Vietnamese men for many decades; offering cigarettes is considered to be a show of good manners.²

As of 2019, less than 3% of adolescents aged 13 to 17 were current tobacco users (i.e. they had either smoked cigarettes or used waterpipe on at least one day of the 30 days prior to the survey).⁷

In the Global Adult Tobacco Survey (GATS) 2015, overall prevalence for traditional bamboo waterpipe was 6.7%. This was higher for people aged between 45-64 (8.9%) and those living in rural areas (8.3%).⁸ Smoke from Vietnamese waterpipes tends to have very high nicotine content: the tobacco typically used is Nicotiana rustica, known locally as thuốc lào, which can contain up to 9% nicotine compared to 1-3% in standard tobacco leaves.⁹

There were an estimated 97,100 deaths attributable to smoking in 2019.¹⁰ This means that smoking accounted for over 15% of mortality in the country for that year.¹⁰ In 2011, the last year for which figures are available, the cost of tobacco use to the Vietnamese economy was estimated at nearly US$1.2 billion.¹¹ This was almost 1% of national GDP that year and around US$425 million more than the tax revenue the government received from the industry.¹¹

A 2022 study suggested that use and awareness of e-cigarettes in Viet Nam is relatively low.¹² However, the Vietnamese market for newer nicotine and tobacco products is expanding. According to market analysis by Statista, in 2022 the e-cigarette market was worth around US$22 million, up from US$7.7 million in 2014, and projected to reach US$24.7 million by 2027.¹³ Research conducted in June 2020 indicated that e-cigarettes were being sold mainly by speciality retailers and most of the brands available were Chinese imports. Brands popular in Western countries – such as BAT’s Vuse, Imperial Brands’ Blu and JUUL – were rare.¹⁴

According to Tobacco Control Laws – an archive of global tobacco control legislation maintained by the Campaign for Tobacco-Free Kids – as of May 2023, there were no restrictions on use; advertising, promotion and sponsorship; or packaging and labelling of e-cigarettes.¹³¹⁵ This lack of regulation, combined with Viet Nam’s relatively large population and high tobacco prevalence, make it an extremely attractive target for transnationals selling e-cigarettes and other newer nicotine and tobacco products.¹⁵¹⁴

Tobacco in Viet Nam

Market share and leading brands

In 2022, market research company Euromonitor International estimated the Vietnamese tobacco industry to be worth VND₫104,094.9 billion – approximately US$4.4 billion.¹⁶ The state-owned Vietnam National Tobacco Corporation (Vinataba) has the largest market share, accounting for nearly 58% of the cigarette market in 2022.¹⁷ Vinataba’s range of brands includes Vinataba, Viet Nam’s most popular cigarette.¹⁸ Established in 1985, Vinataba has long enjoyed special privileges and recognition from the Vietnamese government.³ In addition, the government retains the right to appoint Vinataba’s chair and CEO.⁴

Transnational tobacco companies (TTCs) producing and distributing tobacco products in Viet Nam are required to establish joint ventures with Vinataba.⁴ Amongst the TTCs, British American Tobacco (BAT) has by far the largest market share, accounting for nearly 29% of the cigarette market in 2022.¹⁷ BAT has more than doubled its share of the market since 2001, and dominates the mid-range and premium market sectors with brands such as Craven A, White Horse and State Express 555.¹⁸¹⁹²⁰ Imperial Brands has a market share of 7% with one brand, Bastos. Similarly, Philip Morris International (PMI) has a share of 3% with one brand, Marlboro. The remaining companies account for another 3.5% of the market.¹⁷¹⁸

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

Tobacco farming and child labour

From 2000 to 2020, the area of land dedicated to growing tobacco in Viet Nam fell by nearly 49%.²¹ However, crop yield per hectare has more than doubled, meaning that in 2020 Viet Nam produced over 29,000 tonnes of tobacco leaf – around 200 tonnes more than in 2000.²¹ Nonetheless, this is a steep drop from 2010, when Viet Nam harvested 56,530 tonnes of tobacco from an area of 31,484 hectares.²¹

Viet Nam’s most recent National Child Labour Survey, conducted in 2018, identified more than a million children in a situation of child labour.²² Of these, more than half were working in the agriculture sector – though the report does not mention tobacco growing specifically.²² However, Vietnamese tobacco was one of the products identified in 2022 by the U.S. Department of Labor as having been produced by child labour, in violation of international standards.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

Viet Nam is a net importer of tobacco leaf. According to UN Comtrade, in 2021, it imported US$242 million in unmanufactured tobacco, compared to just over US$9 million in exports.²⁴²⁵ Comtrade data also states that Viet Nam is a net exporter of cigarettes: US$182 million in 2020, compared to just over US$63,000 in imports.²⁶²⁷

However, these figures differ significantly from customs declarations found on Datamyne, which suggest that Viet Nam is a net importer of cigarettes. According to Datamyne, the value of Vietnamese cigarette imports in 2020 was nearly US$537 million, compared to exports of nearly US$270 million.²⁸ The import and export figures for raw tobacco are also different: according to Datamyne, Viet Nam imported close to US$337 million in raw tobacco in 2021, compared to around US$17.6 million in exports.²⁸

Illicit trade

According to the Vietnamese government, 54.7 million packs of illicit cigarettes were seized between 2013 and 2018.²⁹ It estimates that the illicit tobacco trade accounts for 15% of the national market.²⁹ This is roughly consistent with research conducted in late 2017 by the Development and Policies Research Center, which concluded that illicit cigarettes accounted for nearly 14% of total cigarette consumption in Viet Nam.³⁰

By far the most popular illicitly traded cigarettes in Viet Nam are the brands Jet and Hero, which together account for around 85% of the illicit market. Both are manufactured by the Indonesian company Sumatra Tobacco Trading Company and then smuggled to Viet Nam.³¹² Both Jet and Hero sell for significantly higher prices – between 30% and 60% – than the average legal brand of cigarettes in Viet Nam.²

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

Roadmap to Tobacco Control

Viet Nam ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004.³² However, it has not yet joined the Protocol to Eliminate Illicit Trade in Tobacco Products.

The main tobacco control law in Viet Nam is the Law on Prevention and Control of Tobacco Harm, passed in 2012. It is the country’s first ever comprehensive tobacco control law and a major public health milestone.³³ It established smokefree spaces; increased the size of graphic health warnings on tobacco products; restricted tobacco advertising, promotion and sponsorship; and set up the Tobacco Control Fund, a sustainable source of funding for tobacco control initiatives paid for by a dedicated tax on tobacco.³³³⁴ More than ten subsequent decisions, decrees and joint circulars have built on this law and further strengthened tobacco control.³⁵ This includes the National Strategy on Tobacco Harm Prevention and Control, which set specific targets to reduce tobacco use prevalence from 2013 to 2020.³⁶

For more details, please see the following websites:

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

Tobacco Industry Interference in Viet Nam

Tobacco industry tactics used in Viet Nam include lobbying policy makers, use of third parties, complicity in the illicit trade in tobacco products, and spreading misleading information.

Influencing policy

For the Southeast Asia Tobacco Control Alliance (SEATCA), the Vietnamese state’s majority ownership of Vinataba clashes with its duty to regulate the tobacco industry.⁴ Vinataba has long claimed a position as an affected stakeholder on tobacco regulation, allowing it a seat at the table in discussions on issues such as taxation and illicit trade.⁴

There has also been some exchange of personnel between the government and Vinataba, with high-ranking executives at Vinataba appointed to powerful positions in government – particularly at the Ministry of Industry and Trade (MOIT) – and vice-versa. Several senior officials left government to subsequently assume roles in Vinataba.³⁷ Vinataba’s General Director (as of August 2023) was formerly deputy director of the Department of Light Industry, which is controlled by the MOIT.³⁸ Vinataba’s Secretary of the Party Committee and Chairman of the Member’s Council is a former vice director of the Industrial Policy and Strategy Institute, a government entity.³⁸

Vinataba’s influence is most obvious when it comes to price and tax. Cigarettes in Viet Nam are among the cheapest in the world: as of 2020, the price of a 20-pack – even of a premium brand – was less than one U.S. dollar.¹ In 2021, taxes accounted for under 39% of the retail price of the most popular brand of cigarettes – well short of the 75% recommended by the WHO.¹ Research by the World Bank has concluded that Viet Nam’s tobacco taxation policies have made cigarettes more affordable. Per capita income in Viet Nam has risen considerably in recent decades, outpacing the increase in the price of cigarettes, and increases in tobacco taxes have not been sufficient to close the gap.²

In 2017, the Ministry of Finance proposed switching to a mixed excise tax system, with a flat rate of VND₫1,000 – around four U.S. cents – imposed on top of the usual ad valorem tax on the factory price of tobacco products.² This would have made little difference to the affordability of cigarettes; health officials had argued for increase of between VND₫2,000 and VND₫5,000.² Vinataba, along with the Vietnam Tobacco Association, opposed the move, claiming it would lead to difficulties in tobacco production and business operations and increase the risk of smuggling.² At the time of writing, Viet Nam had yet to introduce the mixed tax regime.³⁹

The industry has also lobbied for the diversion of funding away from the Tobacco Control Fund – which is supposed to be used for public health purposes – and towards combatting illicit trade. Vinataba has made requests of this nature to various ministries and local governments.⁴ In 2017, the International Union Against Tuberculosis and Lung Disease (The Union) sent a letter to the U.S. Ambassador in Viet Nam, urging him to reconsider the Embassy’s facilitation of meetings between Philip Morris International (PMI) and Vietnamese government ministers, on the grounds that PMI would attempt to raise fears over illicit trade and seek diversion of funds away from the Tobacco Control Fund and towards anti-smuggling measures.⁴⁰ SEATCA reported the same year that the MOIT had endorsed a recommendation from the tobacco industry to divert half of the Tobacco Control Fund towards enforcement activities against illicit trade.⁴¹

The tobacco industry has also interacted with the Vietnamese delegation to the Conference of the Parties to the WHO FCTC.⁵ During COP6, held in Moscow in October 2014, PMI executives met with the Vietnamese delegation. Analysis of the delegation’s interventions by tobacco control groups observing the COP showed that they frequently mirrored positions held by PMI.⁵ For example, they argued that higher tobacco taxes would fuel the illicit trade and that the FCTC should be excluded from trade disputes, as well as opposing uniform parameters on legal liability for tobacco companies.⁵ Likewise, at COP7, held in Delhi in November 2016, PMI held meetings with members of the Vietnamese delegation away from the conference venue.⁵

Use of third parties

In June 2020 the R Street Institute, an American public policy thinktank, sent a letter to the Vietnamese prime minister and deputy prime minister urging them “to consider pragmatic regulations that allow Vietnamese citizens broad access to reduced-risk products.”⁴² It also argued that inserts in cigarette packets should be permitted in order to market such products to current smokers; that it should be possible to place “relative-risk labels” on these products; and that maximum nicotine levels should be high enough “to achieve nicotine delivery similar to combustible cigarettes”.⁴²

Endorsing the use of e-cigarettes and heated tobacco products (HTPs) as cessation tools, the letter refers specifically to IQOS – PMI’s flagship HTP brand (though PMI has also sold e-cigarettes under the IQOS brand).⁴² From 2014 until at least 2022, R Street received funding from Altria – the primary asset of which is Philip Morris USA, the largest tobacco company in the United States.^4344454647

In the same month, Factasia also sent a similar letter to the Vietnamese prime minister.³⁸ Factasia describes itself as “an independent, not-for-profit, consumer-oriented advocate for rational debate about – and sensible regulation of – the rights of adult citizens throughout the Asia-Pacific region to choose to use tobacco or other nicotine related products.”⁴⁸ It acknowledges receiving funding from PMI, as well as the Tobacco Vapor Electronic Cigarette Association (TVECA), an e-cigarette trade association. However, it denies acting as a mouthpiece for the tobacco industry.⁴⁹

Complicity in smuggling

There is evidence that the tobacco industry has smuggled its own products into Viet Nam. Internal British American Tobacco (BAT) documents from the 1990s show how BAT and its subsidiary smuggled State Express 555 (SE555) cigarettes manufactured in the UK into Viet Nam.⁵⁰⁵¹

BAT had been attempting to establish a presence in Viet Nam since the late 1980s, though with considerable difficulty. Negotiations on the terms of a joint venture with Vinataba were extremely slow, while a ban on foreign imports in 1990 meant that BAT would either have to license a Vietnamese company to manufacture its products locally or purchase equity in a local factory.¹⁹

Smuggling facilitated BAT’s entry into the Vietnamese market in two ways.¹⁹ Firstly, by circumventing the import ban, BAT managed to create brand awareness amongst Vietnamese smokers and obtain a competitive advantage prior to any opening of the market.¹⁹ Secondly, by highlighting loss of tax revenue due to illicit trade, BAT was able to use smuggling as leverage in its negotiations with Vinataba.¹⁹ An internal BAT document from 1993 states “We have the high ground [in negotiations with Vinataba] given the excellent quality of distribution, presence, and value of the GT [i.e. smuggled] product.”⁵²

The same BAT document states that “Both versions [i.e. licit and illicit cigarettes] will have a role to play in the further building of the brand and the ‘system’ profitability”.⁵²⁵³ Indeed, BAT continued to smuggle its own products into Viet Nam even after signing an agreement in 1994 which licensed Vinataba to manufacture SE555 locally.¹⁹ BAT carefully controlled the price of both the licit and illicit SE555, with the smuggled cigarettes fetching higher prices because they were perceived to be of higher quality.⁵⁰ BAT finally signed a US$40 million joint venture with Vinataba in 2001, for construction of a brand new leaf-processing plant in Dong Nai province.¹⁹⁵⁴ This was followed by a further agreement in 2006, under which 150 million packs per annum of Pall Mall and Viceroy would be manufactured for the domestic market, as well as another 50 million packs per annum for export.¹⁹ Even then, illicit BAT products did not disappear from the Vietnamese market. As recently as 2017, illicit SE555 were still selling at 169% of the value of the licit version.³⁰

Spreading misleading information

Most existing estimates of the illicit tobacco trade in Viet Nam are based on industry data and rely on methods which are opaque, undisclosed or difficult to replicate over time.² While the government estimated in 2020 that illicit trade accounted for 15% of the national market, and independent research from 2017 put that figure at 13.72%, tobacco industry estimates are significantly higher.²⁹³⁰ Japan Tobacco International Vietnam, for example, states that “the rate of smuggled cigarettes is quite high (more than 20%) on the market”.⁵⁵

Oxford Economics (OE) put the share of total illicit consumption at 23.4% in 2017.² An economic advisory agency with links to the tobacco industry going back to the early 2010s, OE produced yearly reports on the illicit trade in Asia between 2012 and 2017 which were funded by PMI and based on PMI-approved terms of reference.^565758596061

These reports have been criticised in the strongest terms by Dr Hana Ross of the University of Cape Town, writing for the Southeast Asia Tobacco Control Alliance (SEATCA):

“The common denominator to all pieces of this study is PMI and its TORs [terms of reference] with all of the multiple parties in the report’s chain of production. This is a way for PMI to control the final results—by controlling the input, the data analysis, as well as publication, distribution, and promotion.”⁶²

This exaggeration of the scale of illicit trade is a well-documented means of fighting tobacco control measures such as graphic health warnings, plain packaging and increased tobacco taxes. However, there is no evidence to show that tax increases have led to an increase in the illicit trade in Viet Nam; on the contrary, the illicit trade declined even after a 5% increase in the ad valorem tax rate in January 2016.³⁰

• For more information see Illicit Tobacco Trade

Relevant Links

• Global Adult Tobacco Survey (GATS) Viet Nam 2015, GATS Viet Nam Working Group
• Vietnam 2023 Tobacco Industry Interference Index, Global Center for Good Governance in Tobacco Control
• Vietnam 2021 Tobacco Industry Interference Index, Global Center for Good Governance in Tobacco Control
• Asian State-Owned Tobacco Enterprises: Challenges & Opportunities in Implementing WHO FCTC Article 5.3, Southeast Asia Tobacco Control Alliance (SEATCA)
• Vietnam: Overview of tobacco control legislation, use and taxation, World Bank Group
• Evidence Matrix: Vietnam, Tobacconomics
• Inside Philip Morris’ campaign to subvert the global anti-smoking treaty, A. Kalra, P. Bansal, D. Wilson, T. Lasseter, The Philip Morris Files, Reuters

Tobacco Tactics Resources

• Western Pacific Region
• Waterpipe
• Price and Tax
• Tobacco Smuggling
• Oxford Economics
• R Street Institute
• Factasia

TCRG Research

• 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.
• Gaining access to Vietnam’s cigarette market: British American Tobacco’s strategy to enter ‘a huge market which will become enormous’, K. Lee, H.V. Kinh, R. Mackenzie, A.B. Gilmore, N.T. Minh & J. Collin, 2008, In: Global Public Health. 3, 1, p. 1-25.

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 Viet Nam 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).⁶⁴ These countries are important sources of new customers for tobacco companies as markets in higher income countries where consumption is generally falling.⁶⁵⁶⁶⁶⁷

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.⁶³⁶⁸⁶⁹

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”.⁷⁰ 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.⁷⁰  The guidelines also recommend parties treat state-owned tobacco companies in the same way as any other tobacco company, including avoiding any “preferential treatment”.⁷⁰

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”.⁷⁰

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.”⁷¹ Another decision required governments to “take into account their public health objectives in their negotiation of trade and investment agreements”.⁷²

Nevertheless, diplomats continue to lobby for tobacco companies around the world.⁶³

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,⁷³ 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),⁷⁴ the guidelines were revised in 2013.⁷⁵ 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”.⁷⁵

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,⁷⁶⁷⁷ Hungary,⁷⁸ and Pakistan.^7479808182

UK officials have also disclosed contact with tobacco companies in Panama and Venezuela,⁸³⁸⁴ Laos,⁸⁵ Cuba,⁸⁶ and Burundi.⁸⁷

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.⁸⁸

• 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)”.⁷⁵

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.^63899091

In 2020, staff from the UK high commission in Pakistan attended a promotional event for a BAT product in Pakistan.⁹²

• 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.⁹³  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).⁸³  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,⁷⁶⁷⁸ It may simply be described as relating to ‘doing business’ in the country.⁸⁴

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.⁷⁵ One of the activities used to justify interaction by UK diplomats is “resolving business problems that are potentially discriminatory”.^7476789495 This has been criticised as running counter to the WHO FCTC guidelines.⁶³⁹⁶

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”.⁹⁷⁹⁸⁹⁹  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.⁶³⁹¹

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.¹⁰⁰

• 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.¹⁰¹ Japanese diplomats have also toured tobacco farms and JTI factories in Tanzania and Zambia.¹⁰²¹⁰³

Japan Tobacco International is the overseas subsidiary of Japan Tobacco (JT), which is one third-owned by the Japanese government.¹⁰⁴

Germany

In May 2022, the German ambassador to Beirut visited the offices of Regie, the Lebanese Tobacco and Tobacco Inventory Administration.⁶³¹⁰⁵

Denmark

The Imani Centre for Policy and Education, a Ghana-based think tank,  received money from the Danish embassy while lobbying against tobacco control.⁹³¹⁰⁶

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.^107108109  The proposed legislation included significant tax increases on heated tobacco products, in which PMI has invested.¹⁰⁷¹¹⁰

The same year, PMI helped fund an inaugural event for the new Swiss Embassy in Moscow.¹¹¹¹¹²

• 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.^113114115116 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.¹¹³  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.¹¹³¹¹⁷

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.⁶³

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.⁶³

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”.¹¹⁸

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”.¹²³ Some countries have developed their own definition of waterpipe tobacco smoking (WTS).¹²⁴

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.¹²⁵¹²⁶

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.^123126127128In this way waterpipe has spread beyond the Middle East and become integrated into the global tobacco market.¹²⁹ 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).^127128123

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.¹³⁰

This was the case until  2012, when Japan Tobacco International (JTI) acquired Egyptian company Al Nakhla.¹³¹ At the time Al Nakhla was globally the largest company manufacturing waterpipe tobacco products.¹³² However, even this was perceived as a strategy to enhance the sale of cigarettes.¹³⁰

In 2019, Philip Morris International (PMI) filed a patent ‘Shisha device for heating a substrate without combustion.’¹³⁰  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)¹³³¹³⁴

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.¹²⁷

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.¹²³

• 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.^127128123

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.¹³⁵. 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.¹³⁶  A study among , adults in Lebanon indicated that the introduction of novel tobacco flavours contributed to people initiating WTS and increased its use.¹³⁷ 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’.¹³⁸

• 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.¹³⁹

As with cigarettes and rolling tobacco the smoke of waterpipe is toxic and carcinogenic. One study identified 27 known or suspected carcinogens. ¹⁴⁰As a waterpipe is often shared, it is also a mode of transmission for communicable diseases, a particular concern during the COVID-19 pandemic.¹⁴¹ 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.^123142143144

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.^127128123 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.”¹⁴⁵

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.¹⁴⁰¹⁴⁶

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.¹⁴⁷

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 ¹²⁸ 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.¹⁴⁸

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.¹⁴⁹ A study in Western Cape from 2013, reported higher figures: 40% current use, and 70% ever use.¹⁵⁰ 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.¹⁵¹

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.¹⁵² In Canada, although cigarette smoking among young people had significantly decreased, waterpipe use increased by 2.6% among young people between 2006 and 2010.¹⁵³

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.¹⁵⁴ It also increased in multiple countries, with prevalence ranging from 9% to 15%.¹⁵⁵

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.¹⁵⁶ In England, data from 2013 indicated that for people aged 16-18 the level of waterpipe smoking was low, at 3%.¹⁵⁷

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.¹⁵⁸.

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.¹⁵⁹¹⁶⁰ 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.¹⁵⁹

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.^127128123126

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”.¹⁶¹ 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.¹⁶²
• 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.¹⁶³
• At COP7 in 2016, more detailed instructions were given to Parties, including to ban the use of flavourings in waterpipe tobacco products.¹⁶⁴
• 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.¹⁶⁵

The full list of articles covering waterpipe are listed in the Fact sheet: Waterpipe tobacco smoking & health.¹²³

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. ¹⁶⁶

In 2018, the WTS knowledge hub submitted a report to the WHO FCTC COP8 that summarized Parties’ regulations concerning waterpipe.¹⁶⁷ This report was updated in 2022, and found that, of the 90 countries reviewed, over half (47) had policies relating to waterpipe.¹²⁴ The majority of policies, nearly 45%, were in Europe and around 21% in EMR.¹²⁴

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.¹⁴¹ In EMR alone, 17 countries banned waterpipe tobacco use in public places.¹⁶⁸

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.¹⁶⁹¹⁷⁰ 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.¹⁷¹

The WTS market is still concentrated in the Middle East and Africa, followed by  Europe.¹⁷² Market analysis company Valuates estimated that as of 2022 the global WTS market was worth over US$ 800 million, forecast to nearly double by 2029.¹⁷²

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.¹⁷³

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.¹⁷⁴ 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).¹⁷¹ Products are promoted online by users via social media, rather than WT companies.¹⁷¹  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.¹⁷⁵

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.¹⁷¹¹⁷⁶

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.¹⁷¹  WTS charcoal companies in particular published misleading information about charcoal being ‘100% natural’ and ‘free of chemicals’.¹⁷¹

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.¹⁷⁷

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.¹⁷⁸

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.¹⁷¹¹²³.

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.¹⁷⁹ The illicit products are from both unauthorized domestic production, and increasingly tobacco smuggled from other countries, reported to taste better than locally manufactured products.¹⁸⁰

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.¹⁸¹

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. ¹⁸²

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.¹⁸³

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.