I know there are some readers of this blog who are unfamiliar with the happy-go-lucky world of international tobacco control. Here is a snippet of back story. Derek Yach was formerly an important figure in WHO tobacco control circles until he recently became head of the Foundation for a Smoke Free World (FSFW) funded in a very transparent way by Philip Morris International.
Not surprisingly, this sparked howls of outrage from many in the tobacco control community. OK. Fair enough – be outraged and move on. OR maybe take a more grown up approach. If you think this is just a Big Stunt from Big Tobacco (BT), engage in some open dialogue and discussion, encourage journals to publish its research - stress test the whole venture. Maybe, as Canadian lawyer and long-time adversary of BT David Sweanor suggests, try and understand what is driving the industry’s interest and investment in safer nicotine products.
But no, presumably for fear of passive inhalation from somebody who has been in the same room as industry people, the organisers of the World Conference On Tobacco Health (WCOTH) actually banned Mr Yach from attending their recent event in South Africa. This is even worse that the iniquitous ‘No Platform’ and ‘Safe Space’ nonsense currently infecting some centres of so-called higher learning in the UK as Derek Yach was not even due to speak. But it does resemble the ‘snowflake’ response, almost as if the delicate flowers of the tobacco community constitute some massive victim support group in need of protection. The conference even devoted a whole session to the Foundation.
Moreover, a new body has been established specifically to monitor its work. As the title suggests - STOP (Stopping Tobacco Organisations and Products) – has no interest in engagement and instead is just the latest investment by Bloomberg Philanthropies who along with the Bill Gates Foundation are now major tobacco control and anti-harm reduction funders since the days of Big Pharma (BP) as primary sponsors of tobacco control conferences like the WCOTH (in support of BP interest in killing off the e-cigarettes threatening their NRT business) appears to be over.
One is tempted to think that at least some of the anti-BT rhetoric stems from a need to deflect from what must be the hugely uncomfortable presence of China around the tobacco control tables. The Chinese government oversees the biggest tobacco company in the world, serving a eye-watering 2.5 trillion cigarettes a year to the world’s largest population of smokers. And if the WCTOH delegates regard e-cigarettes as the other half of the twin axis of evil, well, step right up China again, home to the e-cig equivalent of ‘silicon valley’ in the city of Shenzen where the world’s most popular e-cig battery was developed and whose manufacturers dominate the global independent device and e-liquid market. But no ban for China at any major tobacco event, no eviction from COP meetings and no invocation of Article 5.3 – nor should there be. But if the concern really is about public health and not just a self-congratulatory hug fest on the iniquities of the cigarette business, the question has to be asked - what is the difference between any state-run tobacco enterprise whose government officials are publicly gung-ho anti-BT and anti-harm reduction - and a privately owned global tobacco company? Unless of course, you take the view that any country has the sovereign right to poison its population especially if like China, they are also responsible for massive infrastructure projects across the developing world – and which poor country would want to mess with that for the sake of reducing cigarette deaths?
What to do about this? If you can’t beat them, join them, I am announcing the formation of the World Tobacco Forum aka WTF to monitor the activities of STOP while they monitor the activities of FSFW. After all, Quis custodiet ipsos custodes? (go on, Google it). In an ideal world, the WTF would hold an annual conference which would be an open platform for all aspects of harm reduction public health policy and science. Everybody would be able to come from any standpoint of tobacco control be they officials from the WHO, members of the Framework Convention Alliance and FCTC delegates, representatives from the tobacco industry and vaping advocates and nobody would be barred. Oh, hang on, that already exists; its called the Global Forum on Nicotine which does just this. But guess who won’t accept an invitation?
If that’s not enough, click here for more thoughts on Billy Graham-style evangelism meets lynch mob hysteria
Judy Gibson from the International Network of Nicotine Consumer Organisations (INNCO) alerted me to this article by INNCO member Samrat Chowdhery who leads the Indian Vaping Group. His article on the plight of Indian vapers is instructive as to what lies beneath the rush to vaping control in a country with such a staggering death toll from smoking. This is an edited version. The full article is here:
Samrat first set the context, “The country is the second largest consumer of tobacco in the world: India spends $22bn a year on tobacco-related illnesses, 120 million Indians smoke, and 900,000 die from tobacco use each year”. But instead of embracing harm reduction options, “Five Indian states have banned vaping, some others are leaning towards [while] the government is considering a national ban”. Why?
“A key reason” he argues “is economic”. According to the latest Global Adult Tobacco Survey, “although 29 percent of Indians use tobacco in some form, only four percent of them smoke cigarettes, comprising barely 11 percent of the total tobacco consumption. The other 89 percent is made up of a large portfolio of smokeless products, along with a hand-rolled cigarette known as ‘bidi’. This is unlike most parts of the world where cigarettes account for over 90 percent of tobacco consumption”.
But the tax burden for smokers is nowhere near evenly distributed, “smokers, who make up such a tiny portion of total tobacco users, pay [nearly 90%] of the $5.3 billion annual tobacco tax, making cigarettes in India among the costliest in the world. As a percentage of per capita GDP, cigarette taxes in India are almost 14 times higher than in the USA, nine times higher than Japan and almost seven times more than China. Cigarette smokers are thus India’s cash cow despite being proportionately small in number, and anything that risks upsetting this apple cart invites resistance”
“Then there is the issue of livelihoods. Farmers form the core of India’s still largely agrarian economy, and India is the second largest producer of tobacco in the world. The industry sustains 45 million livelihoods and the tobacco crop yields among the richest dividends. No surprise then that Karnataka, the state which produces the most flue-cured tobacco, the variety used in cigarettes, was the first to impose an outright ban on vaping.”
“None of this, however, is an excuse to continue letting millions die. It is unconscionable, and also bad economics. Instead of relying on cigarette smokers to subsidise the habit for other tobacco users and denying them access to safer products, the state should be looking at spreading out the tax burden so the benefits of prohibitionary pricing (if it works) are felt by all, exploring harm reduction avenues for all the categories, snus included, and figuring out ways to transition tobacco farmers and the industry to other sources of income”.
“But this requires political will and recognising that options exist. Which is where the World Health Organisation (WHO) crash lands onto the scene with a planeload of ‘the evidence is not clear’ mistruths and ‘Big Tobacco is evil’ agenda, cheered on by public health officials who rely on the WHO for funds and validation, and a government reluctant to let go of its golden goose”
“The WHO owns health policy in this part of the world by paying for a whole lot of welfare programmes, while remaining curiously unmindful of the elephants in the room – state-owned tobacco companies (the Indian government owns a 32 percent stake in the country’s largest tobacco firm, ITC). India holds the chair at the WHO’s Framework Convention for Tobacco Control (FCTC), whose notorious “countries that have not yet banned ENDS” prodding at its last Conference of the Parties (COP7) held in New Delhi in 2016 has sent the harm reduction ship hurtling towards the precipice”.
“Parroting this misguided sentiment, the Indian Medical Association pronounced electronic cigarettes are like any other tobacco product and just as harmful, while the anti-tobacco lobby, a section of which was caught red-handed accepting illegal funds from Bloomberg Charities, got into the act by clamouring for vape bans.
Media has played a role too, publishing anti-vaping propaganda and jumping on every half-baked study they can find, driven by a moralistic urge to oppose Big Tobacco while wholly discounting the fact that vaping is still largely a people-led, grassroots movement.
The effect of this squeezing from all sides has been that vaping is yet to really take off in India, with not more than 200,000 vapers at present. These are not a cohesive lot either, most purchasing gear and e-liquids from sites abroad or from street side tobacconists who sell juices of dubious quality. Organizing a resistance in this environment has thus been an uphill task. But organize we did, and some serious work has taken place in this regard.
In June 2016 after the Karnataka ban, a few vapers got together to form an advocacy platform, Association of Vapers India (AVI), to fight back against the bans and create awareness about this safer alternative. We have since mounted a legal challenge to the vape bans in Karnataka and Jammu & Kashmir states, and are planning to intervene in a case on vaping filed in New Delhi which involves the central government. The hope is to make lawmakers aware through the judiciary that limiting choices — safer choices — impinges on the rights of citizens, especially when they are faced with dire consequences in their absence”.