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s2smodern

Harry Shapiro Director DrugWise

Since attending the 2016 GFN Conference in Warsaw, I have heard all sorts of dark tales about the Framework Convention on Tobacco Control (FCTC), the Framework Convention Alliance (FCA) and the Conference of the Parties (COP). The FCTC adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003 came into force in 2005 and seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”. The FCA is an international civil society consortium of around 500 organisations, mainly NGOs who act to support the maintenance and development of the FCTC. The COP is an annual gathering of FCTC signatories, the FCA and other observers.

My impression has been of a monolithic body of anti-tobacco fanatics who wrap ENDS (the WHO term for e-cigarettes and other similar technologies) in the same fog of evil that envelops the issue of cigarette smoking. So I thought I would try to those actually involved in the smoke and mirrors of tobacco control. I spoke to two people from the FCA who will remain anonymous, but whose comments I have conflated under the pseudonym of Mr A. My conversation also coincided with the publication of a Reuters investigation into how Philip Morris International (PMI) attempts to influence the COP meetings throwing in a leaked PowerPoint presentation of PMI Corporate Affairs strategy and some internal emails for good measure.

http://www.reuters.com/investigates/special-report/pmi-who-fctc/

It became clear early on in my interviews that the FCA is far from being the implacable face of tobacco control; in relation to ENDS, it contains within its ranks the whole spectrum of opinions from harm reductionists to staunch prohibitionists and all shades in between. For his part, Mr A (along with other FCA members) question that although nicotine is mentioned in the treaty, whether ENDS are even within the scope of the FCTC. There is talk of a legal opinion on this as the whole thrust of the Convention is control of tobacco not nicotine. Mr A says that if nicotine per se is within the scope of the Convention then it follows that NRT should be as well. He gets frustrated that the COP meetings spend so much time on ENDS when they are “not economically viable in most parts of the world; in developing countries, they will just sell to city-dwelling rich people. We should just focus on the combustibles”. Apparently at COP 7, the Canadians arrived and said from the get-go, this is what we are going to agree to on ENDS, but it took two days to get to the same point.

Mr A reckons the majority of FCA members actually believe that ENDS represent a safer alternative to cigarettes, so what is stopping a firm policy statement on the issue, given that the FCA is the most powerful NGO body attending the COP and could be very influential? The problem is (as it is with the COP and all UN treaty bodies) that policy positions are arrived at by consensus. And on such a controversial issue trying to get a consensus is currently impossible. As it stands, the FCA policy position simply restates the arguments on both sides without coming to any firm resolutions.

http://www.fctc.org/images/stories/FCA_policy_brief_ENDS.pdf 

What’s the problem? On this subject, Mr A says the FCA operates on the precautionary principle; members are “nervous and concerned” on some key points. The preamble to the FCTC states that the Parties are “Determined to promote measures of tobacco control based on current and relevant scientific, technical and economic considerations” that are also fully independent and from non-commercial sources. The UK reports from Public Health England the Royal College of Physicians absolutely fit that criteria. But says Mr A, “then you read some conflicting report from somewhere else and it is very confusing for policy makers. And some of them will look at the same research paper and come to completely different conclusions depending on how you interpret the data”.

Clearly there is deep suspicion of the involvement of Big Tobacco. There is a fear that ENDS are just part of a strategy to renormalize smoking, trying to reinvigorate the tobacco market, or if not maybe just extending the market for nicotine. “The harm from nicotine is very, very low. But I would still have an ethical issue here: I would want all the smokers in my country to switch to e-cigarettes, but that might be an opportunity for the industry to increase the market for nicotine beyond ex-smokers.” Would it have made a difference if the whole industry was in the hands of legions of small entrepreneurs? Apparently not; the argument goes that regulators would then be faced by a huge range of products that would be very difficult to control and tax.

From the point of view of the tobacco control bureaucrat working in a developing country with a tiny budget to work with, “e-cigarettes look like a threat simply because you have to think about it and put in some regulatory energy. So the knee jerk reaction is ‘I don’t want to deal with this, let’s just ban it”. But even if you do give some thought to it, as Mr A said, few smokers are going to be able to buy them, you have little if any capacity for enforcing regulations so why bother?? And once you ban ENDS, wherever this takes place in the world, like with illegal drugs, it is very hard to turn back.

The main focus of the rather over-heated Reuters article was that PMI were leading the charge to try and influence the COP by encouraging Parties not just to send their public health officials, but also have a mix of officials from other ministries with an interest in tax, trade and revenue. And Mr A agreed that he had witnessed such changes although the article failed to present any direct evidence of how PMI might have engineered this. Nor was there any evidence from the leaked PMI internal emails that while final proposals included changes to industry advantage, these changes were pushed through by industry ‘stooges’.

In fact, I put it to Mr A that maybe the changes in delegate composition and in final proposals had come about because those Parties with substantial tobacco industries might be thinking that the FCTC has gone too far. He thought the public health delegates were acting in the spirit of the FCTC, but that other ministerial departments represented at the COP may have other priorities and “don’t necessarily view the industry as evil corporations”. So there are those around the COP table not wedded to the first principle of Article 5.3 of the FCTC. He mentioned China as a country that while waking up to the medical costs of tobacco-related diseases, was also looking to become a cigarette exporter.

The COP go to some lengths to try and ensure that there is no Big Tobacco presence or influence, although the process at the COP meetings themselves appear strange. Pretty much anybody will gain admittance at the start of the five-day meeting. But at the end of Day One, a naming and shaming exercise takes place, resulting in the whole meeting being cleared of general public and media for the rest of the conference. Restrictions also apply to those allowed to observe. Interpol were banned because they took industry money to help the fight against tobacco smuggling. WiFi is also apparently disabled, suggesting an acknowledgement that Big Tobacco proxies are in the room. Overall, however, Mr A is not convinced that the industry has been that successful in influencing the COP and cites the example from a recent COP where finance-oriented delegates had a side meeting with the industry leading the other COP delegates to think that if the industry is that concerned about taxation, this is something to focus on.

However, regarding ENDS, Mr A did notice that at COP 7 in India, just as they were moving to a statement they could agree on, one delegate in particular kept trying to prolong the debate, bringing up procedural points and using very industry-sounding language.

Finally. If the FCA does entertain tobacco harm reduction support, what about the prospect of vaping organisations being able to join the FCA? The short answer seems to be; don’t hold your breath. The original fear of the FCA was that smokers’ groups like FOREST would want join. But that ban been extended to the blanket exclusion of any pro-harm reduction vaping NGO. Even if the organisation could satisfy the Board and then the general membership that it was an international charity/NGO and entirely free from industry influence, it would hit the buffers on one Catch-22 point. If you are an organisation wholly dedicated to tobacco harm reduction (as opposed to a tobacco control advocate who happens to think there is some merit in the idea) you must by definition, be in the pocket of Big Tobacco.