The 5th APCAT Asia Pacific Summit of Mayors was held on the 17 December under the theme “Mayors’ response to non-communicable diseases (NCDs), Lung Health and Tobacco Use during COVID-19”. Mayors and subnational leaders from Nepal, Philippines, Timor-Leste, India, Cambodia, Myanmar and Indonesia came together to share their insights and exchange experiences regarding the response to the COVID-19 crisis as well as Tobacco Control and NCDs Prevention. The packed summit was viewed by over 500 participants from 20 countries internationally. APCAT stand for Asia Pacific Cities Alliance for Tobacco Control and NCDs Prevention.
Renu Dahal, Mayor, Bharatpur Metropolitan, Chair of the 5th APCAT opened the session by sharing important successes in Bharatpur. “In 2020, several efforts have been made to advance tobacco control, clear signages are placed in all public places. Penalties are implemented for violations. Cessation services have also been set up in B.P Koirala Memorial Cancer Hospital. Bharatpur strengthened its health system by ensuring sufficient beds, selected free healthcare services and medicines as well as ensuring services such as delivering TB medicines has not been disrupted.”
Dr Guy Marks, President of The Union, said that this APCAT Summit’s importance is unlike any other ones in the previous years. Over 72 million cases of COVID-19 worldwide have occurred and over 1.6 million people have died. Millions more lives, families, and livelihoods upended. This is the heart-wrenching heavy price the world has had to pay for weak health systems, poor tobacco control, ineffective prevention of NCDs, and weak action on communicable diseases and other social and commercial determinants of health.
The Asia Pacific region accounts for 2.3 million of the 8 million deaths caused by tobacco worldwide each year, and has the highest smoking rates in the world, with two thirds of all men using tobacco. Tobacco use is also a significant risk factor for NCDs. Kelly Larson, Bloomberg Philanthropies said that “We know that people with underlying noncommunicable diseases are at greater risk of dying from COVID-19. It makes us realise that we need to double down on NCDs prevention. One way we can all help is by passing proven MPOWER policies”.
Dr Guy Fones, Head Secretariat of the Global Coordination Mechanism on NCDs, World Health Organisation, also added that addressing NCDs during and after COVID-19 is the way to build back a better world. “The deadly interplay between COVID-19 and NCDs has brought us to this critical juncture. COVID-19 has left many people living with NCDs, undiagnosed, untreated and unprotected. This will lead to a surge and pressure on the health system in the coming years”
“The vast majority of those that succumbed to COVID-19 in Bogor had underlying health conditions such as NCDs and Lung Diseases. Bogor City adopted 4 strategies, 1) Contact tracing, 2) Testing, 3) Education and 4) Health system preparedness to fight against COVID-19” said Dr Bima Arya Sugiarto, Mayor of Bogor City, Indonesia and co-chair of APCAT, speaking about how Bogor City has adapted its tobacco control, tuberculosis and NCDs programmes during the COVID-19 pandemic.
Francis A. Garcia, Mayor of Balanga City, Philippines & Co-chair of APCAT stated that Balanga City issued ordinances and Smokefree systems to ensure life could resume and adopt a new normal, saying “People in Balanga are used to a smokefree and regulated environment and this did not lapse during this year. We have issued ordinances to ensure safe distancing and allow for safe reopening of our city.”
“One of the tobacco control strategies in Indonesia is implementation of smokefree public areas,” said Dr Oscar Primadi, Secretary General of Ministry of Health, Indonesia, who spoke of the hope for Indonesia, “397 subnational regions in Indonesia have adopted these local policies. Our hope is that this will be expanded, efficiently implemented and adopted comprehensively in all jurisdictions.”
Keynote speaker for the summit was Prof. Dr. Muhajir Effendy, Coordinating Minister for Human Development and Cultural Affairs, Indonesia, who spoke about how they are tackling these challenges; “The government of Indonesia has conducted various strategies to limit the spread [of COVID-19]. This pandemic is a community health emergency and is therefore all our shared responsibility, national, subnational, community and individual to respond to overcome it. Moving forward, the vaccine will be made available for all Indonesian people.”
The summit presented the 5th APCAT declaration, which includes six points to accelerate progress towards eventually ending tobacco, as well as preventing the avoidable burden of COVID-19, NCDs, and communicable diseases and thereby averting untimely deaths. Presenting the declaration, Mayor Francis A. Garcia of Balanga City, Philippines and co-chair of APCAT said, “We commit to do everything in our power to ensure that COVID-19, tobacco control, NCDs prevention and TB control programs are effectively implemented and measured and the recovery from COVID is healthy equitable and sustainable.”
The summit also heard from a distinguished panel of subnational leaders and experts shared experiences during the Mayors Panel and experts panel. The following are highlights from each speaker:
- I Nyoman Suwirta, Regent of Klungkung, Indonesia: “Klungkung regency has succeeded to decrease smoking prevalence down to 13.5% and held the record as the lowest smoking prevalence in Bali Provinces. Klungkung has also banned tobacco outdoor and point of sale advertisements. The success story of Klungkung is due to the commitment and participation from city government and strong participation from the public in protecting people from harmful substances.”
- Dr. Myo Aung, Mayor of Nay Pyi Taw, Myanmar: “Nay Pyi Taw Development Committee (NPTDC) is committed to secure the health and wellbeing of our citizens by creating a smoke-free environment and integrating tobacco control activities in all aspects. Meetings, with local authority and other stakeholders, were found to be crucial and effective in strengthening tobacco control measures and increasing compliance. NPTDC has plans to strengthen tobacco control activities by creating more smokefree public places and work places, posing appropriate license fees for tobacco wholesale distributors and shops, imposing fines for any type of violations and initiating another round of compliance surveys.”
- Han Kosal, Vice Governor of Kampong Cham Province, Cambodia: “Kampong Cham Province plans to seek more partners to work on NCDs, Tobacco use and NCDs, develop more innovative programmes for health promotion and design tools to identify the whole spectrum of health issues, including tobacco use and lungs disease. Kampong also plans to develop an experience exchange manual that connects tobacco use, lungs disease and COVID-19, which can be shared with other regions across Cambodia as we believe that together, we will be able to get out of this daunting time of COVID-19.”
- Haryadi Suyuti, Mayor of Yogyakarta City, Indonesia: “Yogyakarta city is committed to implementing a smokefree areas with strict enforcement. Even during the COVID-19 pandemic, the city launched Malioboro street, (one of the main tourist sites in Yogyakarta) as a completely non-smoking area. The city also integrated tobacco control policy with COVID-19 response by conducting a campaign called “4M + 1TM” which refers to: Wear A Mask Properly, Wash Hands with Soap, Avoid Crowds, and No Smoking.”
- Dr M. Subuh, Advisor to the Minister of Health, Indonesia and Head of Indonesia’s Health Office Association: “The government of Indonesia aims to reduce TB cases by 90% and end TB by 2050. Multisectoral efforts, evaluating of existing strategies and building accountability are vital methods to achieving our targets. Despite the COVID-19 pandemic the president of Indonesia has stated that Indonesia will continue to carry out the priority health programmes without disruption. One of the most vital strategies we are using is to strengthen the capacity of city leaders to respond to TB and other health policies”.
- Jose Martinho Dos Santos Soares, Mayor of Ermera Municipality, Timor-Leste: “We have deployed teams in the borders and throughout the city to inform travellers and the community about COVID-19 and how to avoid transmission. Similarly campaigns against tobacco use and alcohol have been sustained. Ermera collaborates will all relevant stakeholders and Ministries for a multisectoral approach. Throughout these several years of our efforts, the rate of tobacco use has reduced in Ermera. For NCDs, we have built outdoor gyms to encourage physical activity.”
- Mr Manjunath Prasad, IAS Commissioner; Bruhat Bengaluru; Karnataka, India: “Bengaluru has had quite a large outbreak of COVID-19. Thankfully in the last few months, the number of cases and fatalities has greatly reduced. This was made possible by the increased capacity for testing, public education and contact tracing. We have also increased testing in certain groups such as those with NCDs and other known co-morbidities which has greatly impacted their rate of survival. Increased number of beds have also been made available for COVID-19 patients. To support the efforts, sale of chewing tobacco (to prevent spitting) and public smoking has been banned.”
- Gaspar Soares, Mayor of Dili, Timor-Leste: “When the first COVID-19 case was confirmed in Dili, a COVID-19 prevention commission was established. The commission increased awareness on the prevention of the transmission of COVID-19. The commission is also in charge of infrastructure such as building of more handwashing stations, prevention of imported cases, conducting surveillance and contact tracing. Dili has three main activities to be implemented in 2021; 1) Declare a village a free tobacco village, 2) Make several areas in the Municipality smokefree and 3) Launch a tobacco free Generation.”
- Dr. K. H. Mohammad Idris, Mayor of Depok, Indonesia: “Depok city adopted its smokefree regulation 8 years ago and implementation is getting better each year. During COVID-19, smokefree enforcement was adapted with the health protocols in mind. We continue to conduct random inspections and remove violations several times a month. Implementing a smokefree area is not easy, but it is possible to make it happen.”
- Gazi Kamrul Huda Selim, Mayor of Manikganj City, Bangladesh: “Manikganj City has been working intensely for the last four years to prioritise Tobacco control and NCD prevention. Sellers of tobacco products are now needed to apply a special license. This controls unwarranted shops and allows for better regulations. Sale has also been banned within 100 yards of hospitals and schools. Penalties are also issued to those who break the laws. All government offices in the municipal area has been declared as smokefree areas. Use of Tobacco products are banned in public places and public transports. We also have implemented compulsory masks wearing at all times. To implement and enforce all these measures the government works with all relevant stakeholders and also engages civil societies for a whole community approach.”
- Gan Quan, Director of Tobacco Control, The Union: “In the last 10 years, much progress has been made in tobacco control policies in the region, in particular many countries have been able to adopt large pictorial health warning on tobacco packages. Progress has also been made in banning tobacco advertising, for example, in the subnational in Indonesia. In comparison, little progress has been made in raising tax and price of tobacco products. Smoking doubles the risk of COVID-19 disease progression, it also increases transmission due to the hand-to-mouth action and sharing of waterpipes and spitting. The tobacco industry has jumped at the opportunity to polish its image by conducting many cooperate social responsibility activities such as donation of PPE and other essential items, and not forgetting their involvement in vaccine development.”
At the closing of the 5th APCAT summit, Dr Tara Singh Bam, Deputy Regional Director of The Union Asia Pacific, highlighted the role of The Union Asia Pacific (UAP), permanent Secretariat of APCAT. As APCAT secretariat, UAP measures the impact of APCAT by assessing programme interventions, identifying local solutions and development of action plans with resources. The UAP works to support the sharing of best practices by organising webinars, media conference and producing publications; providing technical assistance in designing and providing evidence for tobacco control, NCDs prevention, TB control and COVID-19 response programmes. UAP believes that fostering partnerships between parliament, government, media, national organisations, international organisations and civil society is the key to achieving all the goals of APCAT.
The summit was jointly organised by The Union; Bharatpur Metropolitan, Nepal; Bogor City, Indonesia; Balanga City, Philippines; Ministry of Health and Sports, Myanmar; Ministry of Health, Indonesia; APCAT Parliamentarians, APCAT Media and World Health Organization Civil Society Working Group for NCDs. The Union Asia Pacific is the permanent Secretariat of APCAT.