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s2smodern

1. Keep faith in a strategy that is failing millions

The primary concern of tobacco control should be to tackle the extent of the current adult smoking epidemic. This means tackling the projected toll from death and disease which will worsen as populations grow in those lower and middle income countries (LMIC) which already have the highest numbers of smokers.

But by the WHO’s own admission, overall, the impact of its MPOWER tobacco control strategy in actually getting smoking under control has been limited. Simply having laws in place is not enough.


Moreover, a BMJ article suggested that the 2005 Framework Convention on Tobacco Control (FCTC) has done little to accelerate declines in smoking in those countries which had been seeing declines well before FCTC was enacted.

https://www.who.int/tobacco/global_report/en/

https://www.bmj.com/content/365/bmj.l2287

That bit of MPOWER demonstrating the least impact is O – Offering help (to quit smoking). Why? Because that needs a robust and accessible health infrastructure in place - which many LMIC do not have.

2. Ignore the role of governments in making things worse

The blame is put entirely on Big Tobacco interference, without any public acknowledgement that countries like China and India not only have the most smokers and the world’s largest tobacco industries, but that those tobacco industries are state run. This creates obvious internal tensions between business and health where politically, health will invariably be weaker. Moreover, many LMIC will have higher health priorities than reducing smoking – mainly infectious disease control.

3. Exploit the moral panic when faced with new solutions

The advent of safer nicotine products has been manna from heaven for the more fundamentalist elements within tobacco control. It has allowed attention to be drawn away from failing control policies, to focus on the Big Tobacco conspiracy tropes to hook the next generation on nicotine. And that, despite no evidence of increasing regular teen vaping nor gateway effects to smoking in the world’s largest vaping markets.

As ever, there appears little concern about smokers themselves – they can either quit or die. Much more politically sexy (and to swerve around the embarrassment of the failure to make an appreciable dent in cigarette sales) is to focus on the kids as a way of trying to bring down the whole safer product industry. This explains the impetus to ban flavours – and Bloomberg’s $160m war chest for US campaigners. The over-arching public message? That Big Tobacco malfeasance and tobacco harm reduction are one and the same thing.

4. Draw funds from philanthropists with strong opinions

None of the international public misinformation campaigns against safer products would be possible without cash from Big Philanthropy – mainly Bloomberg (backed up by Gates) - who is able to drive a moral agenda through the international funding of a large and very compliant network of NGOs and the WHO Tobacco Free Initiative.

The Campaign for Tobacco Free Kids (CTFK) and The Union are using their generous Bloomberg handouts and neo-colonial ambitions to push LMIC into going further than richer countries with outright bans on safer products.  This is on the basis of no evidence whatsoever, because these groups don’t actually have any evidence to counter against tobacco harm reduction. They simply parrot conspiracy and the ‘inconclusive evidence’ they are instrumental in perpetuating. 

5. Draw (yet more) funds from pharmaceutical companies with a stake in the status quo

Meanwhile a crab-wise step away from reality is on to get cheaper nicotine replacement therapy (NRT) products into LMIC, where they are currently either unavailable or too expensive. This idea appears in the new job description of a Union appointee tasked with making it happen. 

I haven’t seen much mention of this before in tobacco control documents (but then again, I do have a life).  So here is a bit of speculation on my part.

Big Pharma, through the Robert Wood Johnson Foundation, set up the CTFK in the mid-90s. Other companies with an equally huge investment in NRT like Pfizer, funded international tobacco conferences, among other things. Then they backed off as other anti-tobacco players arrived – Big Philanthropy.

Modern day international business-based philanthropy has one eye on producing more health and wealth in poorer countries. Why? So they will then be able to buy more stuff. Gates was quoted saying as much in a 2008 article in The Economist. Since when Bloomberg has pumped over $1bn into international tobacco control efforts. Bloomberg and Gates are businessmen, they love quick wins (like banning things). But they also expect a return on investment. Despite the Bloomberg booty, tobacco control people think it is not nearly enough. And maybe they need Big Pharma back on board, in case Big Mike puts his cash elsewhere. 

Except of course, all the actual evidence shows NRT products are much less effective without allied support and counselling (so who pays for that in LMIC?) - and significantly less effective when matched against e-cigarettes. This partly explains why in the UK, with a pragmatic response to tobacco harm reduction, stop smoking services have been losing clients.

But no matter – the WHO have specifically said that while medical nicotine is acceptable, recreational use is not. So that’s OK then. 

Will we see renewed Big Pharma philanthropy in exchange for the financial benefits of a strategic move towards NRT, while the global attack on tobacco harm reduction is played out?

Back to the future?

The tragic irony of course is that if prohibition does strangle the global safer product  industry, many small businesses around the world will fold. 

Meanwhile, Big Tobacco will shrug its shoulders and walk away, safe in the knowledge the cash will still roll in from cigarette sales. Lots of high fives at the self-licking ice cream cone which is the biennial FCTC Conference of the Parties, while outside, more people die.