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May 31, 2019

Tobacco control: a reality check

While the world is observing ‘No Tobacco Day’ today by highlighting the hazardous impact of smoking on lung health, the tobacco industry has hurled another challenge to health regulations by launching a range of nicotine delivery products calling them ‘relatively safe’ than cigarettes.

The tobacco industry has activated ‘harm reduction’ within the ambit of the WHO’s 2004 FCTC (Framework Convention on Tobacco Control) which defines “tobacco control” as a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.

The tobacco industry has been claiming that, although nicotine is not risk-free, it is not the primary cause of smoking-related diseases. The majority of the harmful effects caused by cigarette smoking are caused by the chemicals formed when tobacco is burned.

Therefore, considering cigarette only as a nicotine-delivery product, it has come up with a range of heat-not-burn products that are safer. The term used for these products is Reduced-Risk Products (RRPs) which pose less risk or harm to smokers.

The industry is trying to create its niche in the quit smoking area, where a smoker finding it difficult to quit altogether can opt for safer products with reduced health harms. The alternative nicotine delivery systems, known more commonly as ANDS consist of products such as snus, vapes and Electronic Nicotine Delivery Systems (ENDS) such as e-cigarettes, are creating inroads speedily into tobacco products in many developed countries such as the UK, US and Japan.

In Pakistan too ANDS and ENDS are readily available in shops and online. Although tobacco companies have yet to officially launch these products in Pakistan, vaping clouds have already started hovering in posh localities among higher income groups where the youth are rapidly taking up ANDS.

This emerging scenario requires Pakistan to reposition itself by bringing in smart health regulators with vibrant laws and policies based on scientific research and evidence. Instead of short-term ‘cut and paste’ interventions on tobacco control, the country needs to develop proactive multi-sectoral policy within the ambit of the FCTC.

The multi-sectoral policy must have ownership of the commerce ministry which regulates tobacco production, the finance ministry which deals with tobacco taxes, the Ministry of Science and Technology which manages standards and testing labs, the food security ministry to provide farmers with alternative crops, and the Ministry of Climate Change to address the hazardous environmental impacts of farming.

In the existing constitutional framework, this policy followed by strategy should be approved by the Council of Common Interests to have buy-in from all four provinces and other regions. In addition, instead of reinventing the wheel, a review of existing laws should be conducted to investigate how these can be used to pursue tobacco control, which is a cross-sectoral mechanism. The policy will give direction to these laws.

Otherwise, in the post 18th Amendment era, which re-endorsed health as a provincial subject, except in drug regulation, executing international treaties and managing and legislating only for Islamabad, the NHSRC (Ministry of National Health Services Regulations and Coordination) is struggling to establish its presence.

Pakistan direly needs to jack up its health regulations to remain abreast with the ongoing global debate and research around safer levels of nicotine.

Nicotine is addictive. Hence there is a consensus that the youth should be barred from using nicotine products. Given the youth bulge in Pakistan, the tobacco buying age should be raised from 18 to 21. This will help protect children from tobacco use.

Pakistan has a mixed result in cigarette control. In 2005, it comfortably went into the ratification of the FCTC with a bag containing three laws – the Prohibition of Smoking and Protection of Non-smokers Health Ordinance 2002; the Cigarettes (Printing of Warning) Ordinance, 1979; and the West Pakistan Tobacco Vend Ordinance 1958.

The vend law which provides for the regulation of retail and sale of manufactured tobacco in urban areas has been repealed by the West Pakistan Repealing Ordinance, 1970 and since then has been a provincial law in each province. However, this law is so far adopted by Punjab and Islamabad.

There is another parallel law in the country, the Pakistan Tobacco Board Ordinance 1968 under the federal Ministry of Commerce, whose aim is to promote and regulate tobacco cultivation.

Given the fact that around a quarter of Pakistan’s population are tobacco users and half are smokers, the existing tobacco control laws only cover around 11 percent of Pakistani smoking population. Of the FCTC’s nine articles related to demand reduction, Pakistani laws that are poorly enforced and only cover four articles related to smoking at public places, higher tax, warning against smoking and a partial ban on advertisement.

However, Pakistan has failed to provide any smoking cession facilities to its smoking population. Similarly, Pakistani regulations do not require tobacco manufacturers and importers to report the levels of harmful and potentially harmful constituents (HPHCs) found in their tobacco products and tobacco smoke.

Pakistan also does not have any tobacco testing laboratory facilities.

On demand reduction, Pakistan has only covered one article regarding banning underage sale of cigarettes, while other two articles that remain unaddressed relate to illicit trade and provision of support for economically viable alternative activities to tobacco farmers.

Pakistan has recently signed a supplementary FCTC Protocol to Eliminate Illicit Trade in Tobacco Products. However, efforts are already on by the Federal Board of Revenue (FBR) to curb the illicit trade of cigarettes and bring them under the tax net.

According to the Pakistan Tobacco Board’s (PTB) statistics, around 36.55 million kg is being produced outside its regulation. Interestingly, it is roughly the same quantity that is procured by two multinational companies in Pakistan to produce cigarettes. Of the total 86.22 million kg tobacco produced annually, the PTB only regulates 49.67 million kg. This the PTB does by collecting the tobacco requirement of 53 companies, including two multinationals, and publishing it after fixing the per kg rate and asking farmers to enter into contract with respective company. The rate is set based on different quality grades. Hybrid seed imported from Brazil grows the best.

Last year, the FBR further boosted its efforts to control duty non-paid cigarettes and has started monitoring Green Leaf Threshers (GLTs) Units, where raw tobacco from farms is taken for further processing.

Another issue is budgetary allocation for tobacco control. Unlike the TCC (Tobacco Control Cell) under NHSRC which has no budgetary support, the PTB’s functions are financially supported by a special tobacco cess.

Expression of strong political will is another area which is so far missing. The PTI has considerable stakes both in fighting cancer (the Shaukat Khanum Hospital says that 30 percent of cancers are caused by cigarette smoking) and growing tobacco (the PTI has a strong political base in tobacco growing areas).

The PTI government needs to bring all the official stakeholders on one table and evolve a tobacco control policy.

The writer is a freelancecontributor.

Email: [email protected]