Wanted: A Watchdog to STOP Big Tobacco in Its Tracks

Students hold up no smoking signs to support World No Tobacco Day at a primary school in northern China's Hebei province, on May 30, 2016. STR/AFP/Getty Images
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Students hold up no smoking signs to support World No Tobacco Day at a primary school in northern China's Hebei province, on May 30, 2016. STR/AFP/Getty Images

Big Tobacco, beware: A new global watchdog will soon be on your tail.

The search is on for a lead organization for Stopping Tobacco Organizations and Products (STOP) that will aggressively track and monitor tobacco industry practices that undermine public health.

With an initial $20 million investment from Bloomberg Philanthropies, STOP will support the creation of a vigorous global monitoring system to call out the tobacco industry’s deceptive tactics—like aggressively marketing to children and teenagers in low- and middle-income countries, targeting countries weak on enforcement and rife with corruption, and pushing alternative products such as cessation devices while the evidence remains inconclusive. NGOs and academic institutions have until June 1, 2018 to submit their best and boldest ideas. To learn more about what STOP plans to achieve, GHN turned to Kelly Henning, a medical doctor and epidemiologist who leads the public health program at Bloomberg Philanthropies.

What do you hope STOP will achieve?
What we’re looking for is a global tobacco industry watchdog. Michael R. Bloomberg announced this new initiative to answer the need for new organizations dedicated to pushing back against the tobacco industry. The idea is that STOP will monitor the tobacco industry, go out and collect new data, organize existing data, and give the public the truth about how the industry is diverting attention away from effective tobacco control.

We see STOP as an important next step in our fight against tobacco—to shine a light on industry activity that is illegal, or crosses the line somewhat, or holds countries back from making progress on protecting their citizens from tobacco. The idea is to expose these acts so that other countries can see what is going on and prepare to do more on tobacco control.

What inspired the idea for a global watchdog?
We really know what works for tobacco control—it’s one of the good things about working on this issue. Between the WHO MPOWER policies and the WHO Framework Convention on Tobacco Control, the roadmap is very clear for what countries and governments can do to improve the health of their citizens. But what we face over and over again is this ceaseless pushback by the very well-funded tobacco industry against our work. Most recently, Philip Morris’s newly funded Foundation for a Smoke-Free World, announced not too many months ago, demonstrated how the tobacco industry uses every imaginable tactic to push back. That announcement made us stop and think that maybe there is more we should be doing to try to counter the tobacco industry’s interference with tobacco control. That was really what led Bloomberg Philanthropies to launch this effort.

You’ve called tobacco use a problem with a solution. Which tobacco control strategies have proven most effective, and how will STOP support those strategies?
Bloomberg Philanthropies is very supportive of the WHO’s MPOWER policies, which include posts in public places, advertising bans, warning the public about the dangers of tobacco through pack warnings, and other forms of public education. But tobacco taxation is probably the single most effective strategy among the MPOWER strategies. Raising the price of tobacco products has been shown to be highly effective in reducing tobacco use, particularly among young people and those with lesser available income, and that’s an area of tobacco control that Bloomberg Philanthropies focuses on a lot. We know that the tobacco industry does a lot to undermine progress on tobacco taxation, so certainly that will be one of the elements that we imagine organizations that apply for the STOP award will focus on. We envision that those organizations will collect information about interference by the tobacco companies, and on the ways that the tobacco industry is pushing back against government policy.

But the organization chosen to lead STOP will collect information on a global scale, correct?
STOP is meant to be a global effort. There will be examples undoubtedly that STOP will collect from particular countries on tobacco industry behavior and interference, and the idea is that information will inform public reports that will go out at least annually—hopefully more often—and that the information will be made publicly available so that governments can learn from what is happening in other countries and localities.

How will STOP be able to collect data and work in countries that have been friendly to the tobacco industry?
It’s definitely correct to say that in many countries the tobacco industry does fairly directly interfere with the law-making process to put in place policies that are favorable to tobacco control. And certainly STOP is going to want to look very carefully at examples of places and situations where the tobacco industry is interfering with strong tobacco control, either laws or regulations. We have examples of countries that will very clearly say, for example, that their tobacco taxation roadmaps—the information on how much tax they’re going to raise on tobacco in the coming 5-10 years—are actually made and created by the tobacco industry. That’s a difficult problem, and that’s the kind of thing that will be looked at by the STOP team. The watchdog will provide more granular information about what’s happening in such settings, and how countries might be able to resist that type of interference.

Would STOP also track countries that have strong laws or regulation in place, but where enforcement is weak?
It certainly could. In fact, in a place where the industry is preventing countries from moving ahead with enforcement, yes.

What kind of organizations do you envision applying? What strengths should they posses?
Applicant organizations can either come in alone, or in a group of 2 or 3—but at least one of those organizations must be from a low- or middle-income country. Eligible institutions include educational institutions or nonprofits or some combination. And I think what we’re really looking for is high quality work that is creative and feasible, and that really focuses on industry monitoring and data collection as well as making sure that whatever is collected is publicly accessible, easy to use, and presented in an understandable fashion. And then, we also envision that we will collaborate with other Bloomberg Philanthropies partners and our subgrant program so that information can be put to use quickly by those who work on the ground. Last but not least, we want to make sure that all of this information is highly visible.

What advice could you share with potential applicants?
I think clarity of mission and description is very important for us, as this is a fairly complex area, and there are a lot of moving pieces. The request for proposals online provides a fairly detailed account of what we’re requesting from applicants, and of course reviewing that will be very important for anyone that is applying.

Right now there is a lot of information out there about tobacco industry behavior, but it is scattered. Applyicants should demonstrate how they pull that together and make it understandable and usable. That’s what we’re really looking for.

 

Ed. Note: Michael R. Bloomberg is a benefactor of the Johns Hopkins Bloomberg School of Public Health, which publishes Global Health NOW. This interview has been edited lightly for clarity and length.

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Comments +

1 comment

Bill Godshall
May 3, 2018

If Bloomberg Philanthropies, WHO and the Hopkins School of Public Health truly desire to reduce the worldwide diseases and death toll caused by tobacco use, they must first acknowledge that cigarette smoking causes >95% of worldwide tobacco attributable morbidity, disability, mortality and healthcare costs (including 99% in North America, Europe, South America, Pacific Island nations, and most Asian and African countries).

In sharp contrast, the combined use of all other tobacco/nicotine products (i.e. smokeless tobacco, cigars, pipe tobacco, dissolvables, gums, lozenges, patches, inhalers, vapor & heat-not-burn products) are attributable for <5% of worldwide tobacco attributable morbidity, disability, mortality and healthcare costs (and just 1% in 95% of the world's nations).

Public health benefits every time a cigarette smoker switches to an exponentially lower risk smokefree tobacco/nicotine alternative (i.e. smokeless tobacco, vapor, heat-not-burn, gums, lozenges, patches, inhalers),
and at least 10 million smokers worldwide have switched from cigarettes to these low risk alternatives in the past decade.

While cigarette smoking remains the world's deadliest drug addiction, tobacco and nicotine use are NOT public health problems. Conflating the very low risks of smokefree products with the deadly risks of cigarette smoking unethically deceives the public about the vastly different risk/benefit profiles of different tobacco/nicotine products, and discourages cigarette smokers from switching to lower risk alternatives.

Instead of attacking and criticizing tobacco companies for marketing new low risk tobacco/nicotine products to addicted cigarette smokers, WHO, Bloomberg Philanthropies, and Hopkins School of Public Health should inform smokers that these alternatives are far less harmful, encourage smokers to switch, and advocate policies to keep all lower risk alternatives legally available and affordable for addicted smokers (just as public health advocates support harm reduction alternatives for opioid addicts).

Abstinence only moralism, laws and programs that oppose ALL tobacco products, users and companies poses a far greater threat to public health (by preventing hundreds of millions of smokers from switching to exponentially less harmful alternatives) than do tobacco companies.

But of course, tobacco companies cannot be trusted to protect public health.

Since 2011, Altria, BAT/Reynolds and Lorillard joined forces with THR prohibitionists to lobby FDA (via Deeming Regulation) to ban the sale of vapor products sold by 10,000 small vape shops in the US to protect their cigarette from market competition, and to ensure that FDA will give their cigalike e-cig products monopoly or cartel protection (as only the large tobacco companies have $100+ Million and scientific, engineering and regulatory staff needed to submit PMTA and MRTP applications that FDA will actually consider).

But while THR advocates criticized tobacco companies for lobbying FDA to protect their cigarettes and new e-cig products from market competition by the 10,000 small vapor companies, THR opponents (including Bloomberg) lobbied FDA to impose the Deeming Regulation (that protected the tobacco industry's cigarettes and created a tobacco vapor monopoly/cartel controlled by tobacco companies).

In the US and elsewhere, since 2014 tobacco companies have been lobbying government officials to tax e-liquid by the milliliter (instead of ad valorem percent of price) because the 40-60mg nicotine vapor products marketed by tobacco companies contain 1ml or less of e-liquid, while vape shop customers who vape 0-6mg nicotine vapor products typically consume 35-140 ml of e-liquid per week. And yet, the vast majority of smokers who quit smoking by switching use vape shop products, while the vast majority of smokers who use cigalike e-cigs sold by tobacco companies continue to smoke cigarettes.

Regardless, harm reduction alternatives and truthful risk/benefit communication are just as essential for reducing the cigarette addiction epidemic and they are for reducing the opioid addiction epidemic.

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