Indonesia is unduly burdened by tobacco: it has a has a 63% male smoking prevalence, and smoking causes approximately 235,000 deaths each year. There is also significant evidence that smokers are at greater risk of more advanced COVID-19. The infectious disease—it had claimed more than 38,000 Indonesian lives by March 2021—and smoking must be tackled concurrently. To reiterate the connection between the two, The Union, Ministry of Health, Ministry of Home Affairs, Association of all Indonesia Health Offices (ADINKES), and the Asia Pacific Cities Alliance for Health and Development (APCAT) conducted a 16 March webinar entitled “Our shared responsibility: Ending Epidemics – Smoking and COVID-19 in Indonesia.”
In his key note speech, Honourable Minister of Health, Budi Gunadi Sadikin said, “Smokers are considered a vulnerable group for COVID-19 transmission and morbidity. Despite this, smoking prevalence has actually increased by 1% during this pandemic. Additionally, smoking is also a risk factor for Tuberculosis (TB) and a range noncommunicable diseases (NCDs), which have high mortality rates in Indonesia.”
The Honourable Health Minister appealed to everyone to follow all health protocols and avoid COVID-19 transmission, including abstaining from tobacco. He noted that controlling tobacco will also help control TB. Governments have promised to end TB globally by 2030. The WHO has clearly stated that tobacco smoking substantially increases the risk of TB by more than two-and-a-half times and also increases the risk of death from TB. More than 20% of global TB incidence may be attributable to smoking.
In discussing the Ministry of Health’s plans, the Honourable Health Minister said, “Several strategies are being pursued by MOH, including revising the government regulation PP 109/2012 to accommodate stricter tobacco control regulation, including increasing the pictorial health warning on tobacco products to 90%; prohibiting the sale of single sticks; regulating electronic cigarettes & heated tobacco products; and prohibiting online tobacco advertising and in outdoor mediums. In addition, MOH is also increasing education to the public through social media; involving multi-stakeholders to accelerate Smokefree Area (SFA) at the regional level and support the increment of cigarette excise tax by as much as possible and introducing provision of national consultation for smoking cessation services.”
Dr. Dante Harbuwono, Vice Minister of Health reiterated the Minister’s message and noted, “A revision of the national regulation PP109/2012 is a top priority for the Ministry of Health aside from COVID-19 vaccination roll out. MOH is committed to include a 90% pictorial health warning on tobacco packs, banning outdoor and online tobacco advertising, and prohibiting tobacco product displays at the point-of-sale and other provisions. The increase in youth smoking shows that attention to tobacco control policies needs to be more aggressive.”
Dr. Bima Arya, Mayor of Bogor City and Co-Chair of APCAT said that despite interference from the industry and its front groups, Bogor City has promoted and the adoption of tobacco control policies, such as Smokefree environments, advertising bans and tobacco product display bans at the point-of-sale. “It is not only about law enforcement, but we must also promote healthy lifestyles,” he said. “Preventive measures are most effective—having safe spaces for cycling, jogging or other physical activities are important if we want people to choose healthier lifestyles.”
Also present at the event was Dr Nancy Anggaraini, Deputy Assistant for Disease Control from the Coordinating Ministry for Human Development and Culture. She said, “A vital approach to curb smoking prevalence is to have strong national policies. The Coordinating Ministry urges all stakeholders to support the amendments of PP109/2012 so that Indonesia can achieve its health goals.”
Director of Public Health and Nutrition from the Ministry of National Development and Planning, Mr Pungkas Bah Bahjuri Ali said, “A package of fiscal and non-fiscal policies are critical to curb the tobacco epidemic. One such fiscal policy would be the simplification of the tobacco tax system and continual increase of tobacco tax in order to make cigarettes less affordable. At the same time, it is also important to mitigate the impact on tobacco industry workers and farmers. These strategies would require the support of various national and subnational stakeholders”
Mr Febri Ardian Pangestu, Policy Analyst, Ministry of Finance said, “The price of cigarettes in Indonesia remains one of the lowest in the world, which contributes significantly to the high smoking rate. Making cigarettes less affordable is effective to reduce tobacco use. Higher tax will also generate revenue for governments which can be used as a source of funding for Universal Health Care, Health systems and Health programs, all of which are being strained due to COVID-19.”
Budiono Subambang, Director General, Ministry of Home Affairs, lent his support and commitments to his fellow speakers, “MOHA provides technical and strategic support to all subnational governments to adopt and implement smokefree local policies. The goal is to have all local jurisdictions adopt and enforce comprehensive policies and achieve a high compliance rate. Regional governments should develop yearly targets and mid-term targets to control tobacco use. MOHA is responsible to ensure that national goals are implemented at the local level.”
Echoing these statements, Muhammad Subuh, Head of ADINKES said, “ADINKES is always open to collaborate with all parties to end the smoking epidemic in Indonesia by working together with national and subnational governments, civil societies and the community. ADINKES supports local governments to adopting and implementing strategies such as smokefree areas, ban tobacco advertising and promotion and many other evidence-based policies. At national level, it coordinates with MOH and MOHA to improve government’s regulation such as PP109. Subnational movements can move policy decisions for tobacco control and make tobacco control a priority. Tobacco control is the key to control noncommunicable and communicable diseases”
Kelly Larson from Bloomberg Philanthropies praised the Indonesian government's remarkable progress in tobacco control since 2007. “Leadership and political will are critical to the success of tobacco control. In Indonesia, we are grateful to see the commitments of Minster of Health and other high-level officials from various Ministries. Strong tobacco control programs are critical to the fight against tobacco use and saving lives. Very strong subnational policies have been seen in cities such as Bogor, where Mayor Bima is leading the way. We will continue to support evidence-based policies such as higher tax, TAPS ban, smokefree, and larger graphic health warnings.”
Tara Singh Bam, Director, The Union Asia Pacific, said, “Covid-19 has highlighted the importance of health and that health security is critical not just to individuals but for economies. The clock is ticking: commitments must be translated into actions, and government accountability is essential. The Union is committed to continuing the support for the government of Indonesia in advancing tobacco control, the fight against TB, and NCDs.”
Read the full webinar report here.