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Indonesia: Leveraging COVID compliance to catalyse tobacco control

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As Indonesia, like most countries, contends with rapidly rising COVID-19 cases—there were 6,033 new cases on 10 December, and the virus is now present in all 34 provinces—two Java cities are simultaneously tackling the virus and tobacco control violations by embedding smokefree monitoring into sanitation inspections. Spearheaded by The Union, this approach is operational in Yogyakarta, capital city of the special region of Yogyakarta, and Depok City on the western side of the island. Both cities have comprehensive smoke-free laws—Depok City first enacted its legislation in 2014 and made subsequent amendments in 2020; Yogyakarta was more recently, in 2017. The initiative is still in its early stages but enormously promising.

“Embedding tobacco control activities—particularly enforcement—in pandemic monitoring makes a great deal of sense,” said Dr Tara Singh Bam, Deputy Regional Director for The Union Asia Pacific Region. “We know that smoking increases the risk for ICU admission, need for mechanical ventilation or death during COVID-19. If inspectors are motivated to keep people safe—by making sure they are taking proper precautions outside of their homes—it’s smart to confirm they are also abstaining from tobacco. This is an absolute public health win and gain.”

The relationship between smoking and severe COVID-19 disease progression has emboldened Depok Mayor Muhammad Idris and Yogyakarta Mayor Haryadi to think strategically, leveraging COVID resources to support complimentary public health work.

On the ground, this translates to embedding rigorous adherence to smokefree and TAPS laws into COVID sanitation protocols. More specifically: checking to ensure that city residents are both complying with mask mandates and also abstaining from tobacco products. “When someone is smoking, there’s no way they are wearing a face mask in adherence with health guidance,” explained Diah Dewanti, The Union’s Indonesia Enforcement Consultant. “If they move their mask or touch it to accommodate a cigarette, the mask is being misused. You simply can’t smoke and be protected from the coronavirus at the same time.”

Both cities launched initiatives in August 2020. In collaboration with The Union and community partner NoTC, Depok City put boots on the ground, with civil police conducting smokefree and TAPS checks at the city and district level and the Head of Civil Police signaling her support for the program with radio announcements, promotions, and interviews. Fourteen inspections were conducted in November, and inspectors visited sub-district offices, restaurants, and retail areas, effectively folding smoke free and TAPS checks into COVID inspections. Additional inspections are slated for January.

In Yogyakarta, The Union has supported the Yogyakrta City government and local partner Muhammadiyah Tobacco Control Center (MTCC) on this initiative for the past six months. In August and September, meet and greet programs in sub-district communities highlighted the relationship between smoking and COVID-19. Weekend social marketing events along Malioboro, the main shopping and tourism street, educated civil society on the grim reality that COVID and smoking are deadly partners.  To compliment these efforts, the City Health Office installed a series of large billboards that read “Smoking Exacerbates COVID-19”; distributed over 1000 educational flyers; and hung and 500 posters highlighting that smoking has never been quite so dangerous. In November, the vice Mayor launched smoke-free Malioboro, installing five big billboards. In December there were random smokefree inspections as part of planned COVID-19 activities.  

There are high hopes for both cities.  “We are confident these initiatives will be game changers,” said Tara Singh Bam. “They—and similar models—could pave the path for less expensive, more sustainable tobacco control enforcement that also bolsters critical COVID-19 activities.”