Since the World Health Organization’s Framework Convention on Tobacco Control was adopted back in 2003, it’s been hailed by commentators as the most successful health treaty ever committed to paper. But now, recent studies published in the British Medical Journal (BMJ) say there’s no evidence that this landmark compact has had any effect on global smoking rates at all. In fact, they suggest, consumption has actually increased in the developing world since it was signed.
From these findings, it’s easy to extrapolate the conclusion that the FCTC is unfit for purpose. But criticizing the WHO and its flagship tobacco treaty misses the point; the problem isn’t the FCTC itself, but the way in which individual countries are implementing it, in the face of relentless pressure from the tobacco industry. Faced with declining consumption in the developed markets as a result of effective tobacco control, the tobacco industry has used its deep pockets and political influence to bully and cajole policymakers in the developing world. With its vast budgets and shady tactics, Big Tobacco presents a formidable opponent, and will only be beaten if the global community persists with the FCTC’s agenda.
That’s not to say we shouldn’t be worried by the BMJ reports. The WHO itself has said that the number of tobacco-related deaths will reach one billion this century, a ten-fold increase on its predecessor, and the FCTC has long been touted as a guardian against this looming crisis. Yet the researchers found that the treaty has had no discernible impact on the global decline in smoking rates, which began long before it was even introduced. Across the rather nebulous region which bundles the world’s low- and middle-income countries together with Asia, the studies showed that cigarette consumption has actually increased by over 500 cigarettes per adult.
However, as the researchers themselves went on to stress, this doesn’t mean the FCTC’s individual policies – which include higher taxes, advertising restrictions and the creation of smoke-free environments – are ineffective. This issue, they concluded, is that many of the treaties have yet to actually implement them.
Indeed, the WHO itself admits that progress is patchy. Its 2018 report notes that around 90% of the FCTC’s parties have banned smoking in public places and moved towards plain packaging, yet nearly a third have yet to impose a comprehensive advertising ban, and an even greater number have failed to take proper action on tobacco taxes.
But surely this only reinforces the view that the FCTC is a paper tiger? Well, it’s worth remembering that the treaty wasn’t designed to have particularly sharp teeth. As its name suggests, the treaty is a framework, a set of broad-brush policies and minimum requirements to facilitate future action. In the 30 years prior to its enactment, the WHO had lodged a series of resolutions against the tobacco industry, with little effect. The enacting of a global treaty was seen as an essential first step, a statement of intent which could be distilled into concrete policies at future conferences of its parties.
Thus, many of the treaty’s recommendations are rather vague or broad. Its article on taxes, for example, simply suggests that “measures… may include… implementing tax policies and, where appropriate, price policies, on tobacco products so as to contribute to the health objectives aimed at reducing tobacco consumption.” Although the treaty is legally binding upon its participants, only three of its key articles carry a specific time limit, and penalties for non-compliance are low.
What’s more, while the FCTC’s own guidance says it can help in “providing or strengthening the legal basis for a measure”, it doesn’t grant its signatories the power to steamroll the tobacco industry. And Big Tobacco, as it’s proven time and again, is an extremely tenacious opponent. In fact, industry interference was cited as the biggest single obstacle to progress in the 2018 FCTC report.
Much of this meddling centres on lower and middle-income countries, which often lack the resources to counter the tobacco industry’s expensive legal teams. In countries such as Thailand, Uganda and South Africa, the tobacco lawyers have attempted to block anti-smoking legislation designed to comply with the FCTC, arguing that the policies are unconstitutional – even though they’re commonplace in the West. In parallel with this legal filibustering, industry giants have engaged in blackmail and bribery during a tireless lobbying campaign, ingratiating themselves with FCTC delegations in the hope of blocking or diluting new regulations.
Despite the industry’s best efforts, the FCTC parties have taken a crucial step forward by ratifying the Illicit Trade Protocol, which came into force last year. The protocol obliges signatories to introduce new traceability systems against tobacco smuggling. Crucially it establishes that all such systems must be fully independent of industry. The Protocol is the first additional instrument adopted by the FCTC parties, after a decade long process; given that nearly a third of FCTC parties have still to impose measures to keep the manufacturers out of their regulatory bodies, the Protocol represents a sea-change, a statement of independence which can be extended to other anti-smoking measures.
However, even here, the industry is sinking its claws in. The EU inked its own track-and-trace policy back in 2014, four years before the Illicit Trade Protocol was even enacted, yet it’s faced industry pressure every step of the way. The manufacturers have frantically tried to foist their own traceability technology, Codentify, on European officials, using a variety of front groups and fake endorsements to press their case. Even though the EU’s system is now officially up and running, several member-states are still not ready, and there are fears that the industry could ultimately secure a stake.
A number of industry-friendly companies have managed to secure contracts to deliver key parts of the traceability system. Atos and sister company, Worldline are presently in charge of issuing unique identification codes for cigarette packs in many member states, as well as storing related data for the tobacco industry, even though the company is heavily involved in the development and promotion of Codentify.
A number of public health and civil society groups have called out the EU system’s non-compliance with the WHO Protocol. If the FCTC’s parties want to clamp down on such cynical tactics, they need to work together and put some robust policies in place – just as the treaty originally intended. As the BMJ authors state, it’s not enough for the treaty’s parties to simply say they’re going to adopt its core principles. Now, they all need to start matching their words with actions.