COVID-19 and Smoking Publications
In May 2020, the Tobacco Control team published the first of eleven scientific briefs on COVID-19 and smoking. The briefs, which were disseminated to Union staff, posted on our website, and shared with tobacco control and non-communicable disease (NCD) colleagues, examined and summarised the rapidly growing body of research demonstrating smokers’ increased risk for advanced COVD-19 disease progression. We noted key study findings, pointed out important limitations and flaws, and examined how conclusions supported or contradicted other research.
The first brief, which became a living, frequently updated document, answers key questions about COVID-19 and smoking. Perhaps most importantly, it delineates three critical stages along the COVID-19 disease spectrum (infection with SARS-CoV-2; symptomatic infection that requires an outpatient visit or hospitalisation; and advanced disease progression that requires ICU admission, mechanical ventilation, or results in death) and explains where evidence stands at various points on the spectrum. Subsequent briefs — these were initially published every two weeks — explored other issues, including whether nicotine upregulates or downregulates ACE2, the receptor through which SARS-CoV-2 enters cells. We also explored — and debunked — the attention-grabbing thesis of three French studies suggesting that nicotine might have a protective effect against infection with SARS-CoV-2. In total, the team read nearly 1,000 epidemiological and biochemical studies and found that there was clear and sufficient evidence that smokers are vulnerable to the most extreme disease outcomes.
In addition to the scientific briefs, the Tobacco Control Department also published “Smoking in COVID-19 times” and “COVID-19 information sheet.”
Novel Product Paper “Where Bans Are Best” and New Policy in Mexico
Just prior to World No Tobacco Day, the Tobacco Control team published its fourth paper on e-cigarettes and HTPs, “Where Bans Are Best: Why LMICs’ Must Prohibit E-cigarette and HTP Sales to Truly Tackle Tobacco”. We felt it was imperative to contribute to the discourse on this contentious subject with a particular lens on low- and middle- income countries, which have been largely ignored as discussions often pit the United Kingdom’s approach to these products against the way in which they are regulated in the United States. The context in these countries — relatively early-stage tobacco epidemics, weak enforcement, lax regulations, significant tobacco industry interference, and extreme youth targeting — creates a perfect storm for e-cigarettes and heated tobacco products (HTPs) to wreak tremendous destruction and significantly impede or roll back tobacco control progress.
Unlike The Union papers published in 2013, 2015, and 2018, “Where Bans Are Best” examines e-cigarettes and HTPs together, rather than in separate documents. This was done deliberately and reflects the recent popularity of HTPs, which may be considered part of an ever-expanding group of rapidly emerging novel products. The 2020 paper lays out 10 distinct but related arguments explaining why The Union recommends that LMICs ban these products before they inflict significant havoc and remain vigilant to industry interference to thwart protective policies.
The Department also contributed to and catalysed important policies that will save lives. In Mexico, where The Union has provided technical assistance to further tobacco control policies since 2006, the Government issued a February decree prohibiting the import of e-cigarettes and HTPs. The decree sends a clear message that public health should be protected at the highest level, above the commercial interests of the tobacco industry.
Global Implementation Hub
At the end of 2020, The Union launched an important new resource to help provide governments and public health practitioners with the tools they need to effectively implement tobacco control laws.
The Tobacco Control Implementation Hub aims to improve implementation of tobacco control laws, increase compliance, and ultimately protect people from the harms of tobacco. The Hub responds to the fact that while countries have made excellent progress in passing tobacco control laws, governments face many barriers in implementing and enforcing them. When laws are not well implemented, they do not protect people, creating massive distrust of the government.
Building on its network of leading experts in tobacco control, The Union’s Implementation Hub empowers city officials and the tobacco control community.
The Hub is frequently updated with the latest practical tools, technical resources, guidance, evidence, and case studies, acting as a library and technical guide.
The Hub has five areas: a fully searchable resource library, a breakdown of key policy areas and elements of implementation, country hubs with guidance in local languages, and a directory of global experts. It includes signposting to key resources from trusted partners such as the World Health Organization, the Pan American Health Organization, the Centers for Disease Control and Prevention, Vital Strategies, Johns Hopkins University, Campaign for Tobacco Free Kids and more. The Hub was developed by The Union with support from Bloomberg Philanthropies as part of The Union’s Global Implementation Programme.
Pakistan Comprehensive Ban on TAPS
At the end of January, Pakistan passed legislation banning tobacco displays at point-of-sale and immediately put the law into effect. Pakistan has one of the world’s highest tobacco-related disease burdens and tobacco use accounts for 110,000 deaths each year, according to the Tobacco Atlas. Still, around 1.4 million adults and 125,000 children in the country continue to use tobacco every day.
The tobacco industry often markets its products by displaying them at point-of-sale. The tactic works: it increases smokers’ consumption and encourage non-smokers and children to purchase products. The World Health Organization Framework Convention on Tobacco Control strongly recommends comprehensive bans on tobacco advertising as a proven method to reduce tobacco use.
While Pakistan has made progress in strengthening legislation against tobacco advertising, promotion, and sponsorship in recent years, tobacco displays at point-of-sale persisted until this groundbreaking legislation. The Union supports Pakistan’s tobacco control cell, which developed and passed this legislation. The Union will continue to support the government to effectively implement the ban now that legislation has passed.
Indonesia Tobacco Tax Increase
In Indonesia, the Ministry of Finance released a decree with a provision for increasing tobacco taxes. This provision generates government revenue, which can be used to fund universal health care, health systems and health programmes, all of which are strained from COVID-19 and the inordinately high burden of tobacco-related diseases.
The provision to raise tobacco taxes is part of an implementation strategy for the National Mid-Term Development Plan 2020-2024 (decree No. 77), which was issued on 30 June 2020. In addition to tobacco taxes, the decree also includes taxes on foods containing large amounts of sugar, salt, and fat, which are also non-communicable disease (NCD) risk factors.
Indonesia has one of the world’s lowest cigarette prices, which significantly contributes to the country’s high smoking rate. Making cigarettes less affordable through increased tobacco taxation is an evidence-based policy set out in the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) that is proven to reduce tobacco use. This ‘win-win’ measure uses tobacco taxation revenue to strengthen health systems that are strained from high smoking rates.
Implementing measures that reduce tobacco use are especially important during the COVID-19 pandemic. Tobacco is one of the leading risk factors for NCDs, and tobacco users and people with NCDs are at significantly greater risk for experiencing the virus’ worst outcomes, including death.
The Union worked closely with Indonesia’s Ministry of Health and the Ministry of Finance to increase policy awareness for the benefits of tobacco taxation and tax tier simplification. In partnership with our grantees through the Bloomberg Initiative to Reduce Tobacco Use Grants Program, The Union is also involved in providing technical and strategic guidance for the National Mid-Term Development Plan 2020-2024.