Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) mentions that warning labels on tobacco product packaging and labelling should be 50 per cent or more, but no less than 30 per cent of the principal display areas.

Such warnings, especially the graphic pictorial ones, may deter people from taking up smoking and inform them, including the smokers, about the hazards involved in an effective way. There is also a perception among the proponents of this measure that the bigger the warning size, the bigger is the impact.

As per the fact sheet shared by the US based Campaign for Tobacco Free Kids (TFK), as of July 18, 2016 112 countries and jurisdictions require Graphic Warning Labels (GWLs) with a size of at least 30 per cent of the principal display areas. In total, 91 of these countries require GWLs of at least 50 per cent and 11 countries require GWLs of at least 75 per cent. Though these countries have approved these sizes, not all of them have necessarily implemented the warning labels.

Pakistan is among the countries with the highest approved GWL size bracket. It announced in February 2015 to increase the pictorial warning size to 85 per cent. Nepal with 90 per cent, Vanuatu 90 per cent, India 85 per cent, Thailand 85 per cent, Australia 82.5 per cent, Sri Lanka 80 per cent, Uruguay 80 per cent, Brunei Darussalam 75 per cent, Canada 75 per cent and Myanmar 75 per cent are the other countries in this list.

The issue is that despite passage of more than one and a half years there is no implementation yet. Besides, several extensions have been given to the tobacco industry that the civil society and the anti-tobacco campaigners allege has been done due to the lobbying of the tobacco industry and its patrons.

Representatives of tobacco industry claim that the government of Pakistan, failing on achievement of other public health targets, has tried to impress WHO by announcing to increase warning size on cigarette packs.

Nadeem Iqbal, executive director at The Network for Consumer Protection -- an Islamabad based non-profit organisation working for consumer rights, tells TNS they have filed a writ petition in the Lahore High Court (LHC) against non-implementation of this decision. He says that it is criminal on the part of the government to delay implementation of such an important decision.

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He points out that a diplomat from a Western country also tried to influence the Ministry of National Health Services, Regulations and Coordination (MNHSRC) in this regard and this news was made public by the concerned minister of the state.

A source in Tobacco Control Cell (TCC) at MNHSRC says Pakistan introduced Pictorial Health Warning (PHW) on cigarette packets and outers in 2010 and this warning was supposed to be rotated on a yearly basis. In order to rotate current PHW, TCC notified new pictorial health warning on January 29, 2015 and enhanced the size from 40 per cent to 85 per cent of cigarette pack on both sides.

The source adds that this PHW was to be implemented from March 30, 2015 but later on the implementation date was extended and an Inter-Ministerial Committee (IMC) was constituted to review the impact of pictorial health warning on revenue & smuggling and to consult with stakeholders regarding implementation issues.

It has been learnt that this committee deliberated on the issue and recommended to adopt phased approach, i.e., PHW to be increased by 10 per cent from June 1, 2016 and further be increased by 10 per cent on June 1, 2017 or 5 per cent on June 1, 2017 and another 5 per cent on June 1, 2018. It was also decided that in the third year of the decision, a survey to assess the impact of pictorial health warning on revenue and smuggling will be conducted.

After reviewing the result of the survey, further decision will be made on the enhancement of PHW sign or adoption of current international trends, i.e., plain packaging.

The source adds the IMC recommendations had been sent to the minister for finance for approval but there is an impasse as two petitions were filed in Islamabad High Court against the constitution and decision of the committee. "This ministry is party in the case and is waiting for the decision of the court in order to work out is action plan," the source says.