The five campaign elements

1. PM’s ‘Smoke-free Israel Vision’ embodied the main concept of the entire campaign and was part of PM’s global campaign for a Smoke-Free World.14 It framed the emerging tobacco and nicotine products as being fundamentally different from the combusted cigarette and promoted the idea that PM was taking a global leadership role in pursuing a world without smoke (figure 2A).

2. The harm-reduction element focused on transitioning smokers from combustible to non-combustible products. The claim that non-combustible products were risk-reduced compared with cigarettes appeared as part of this element. PM referred to the harmful chemicals in cigarette smoke as the main cause of tobacco-attributable illness, proposed alternatives and quoted from the FDA and the WHO (figure 2B). The advertisements did not state that the original WHO and FDA statements did not endorse any particular product, type of product or company in their original statements.

3. IQOS status: PM proposed that non-combustible products should enjoy a different status for the purpose of regulation due to the harm reduction (figure 2C).

4. Taxation policy: The content of messages regarding taxation policy were specific to Israel policy, though not specific to IQOS (figure 2C).

5. The classic product element was aimed at the public, and was similar to IQOS marketing elsewhere. Messages included: ‘IQOS: This changes everything’ (in English), TRUE (tobacco taste), REAL (tobacco experience), ‘No fire/No smoke/No ash/Less smell/Unlike cigarettes/CLEAN’ (figure 2D,E,F).

The two campaigns

We observed two distinct campaigns.

The Policy Makers Campaign began with contacts between PM and governmental officials prior to advertisement or sales of IQOS to the Israeli public, and continued postmarketing. On 5 March 2017, these actions were complimented by a letter sent by PM to the MOH regarding their ‘Smoke-Free World Vision’ and IQOS.15 Advertisements in the print press were a key element of the campaign: these were publicised in the weekend editions of papers over many weeks, often in full or half-page advertisements. The earliest advertisements featured the Smoke-Free Israel Vision (figure 2A), often with text only, without pictures and without any mention of IQOS at all. In the Smoke-Free Vision ads, the PM logo was present, but not prominently. At the bottom of the advertisements were black boxed warnings. The warnings provided at the time of IQOS’s launch in Israel were placed voluntarily by PM, with messages such as ‘Medical researches suggest that cigarettes cause addiction’ (figure 2A,D). These advertisements used the identical style and font as governmentally required tobacco product warnings, but did not use the governmentally approved set of warnings and did not attribute them to the MOH. After IQOS’s status had changed to that of a tobacco product, the black boxes included MOH-approved warnings for cigarettes and were attributed to the MOH.

Further actions in the campaign for decision-makers were reactive to the Supreme Court petitions and decisions. In March 2017, following the two first petitions by Dubek and the Israel Association for Progressive Democracy, PM placed large advertisements in the printed press demanding that the MOH ‘review our science’ and ‘inform Israeli adult smokers about the findings in an objective and transparent manner’ (figure 2B). Once IQOS was defined as a tobacco product, the battle for preferential taxation, on the basis of PM’s risk-reduction argument, ensued. PM sent world-famous economist Arthur Laffer to meet with officials in the Ministry of Finance regarding taxation.16 PM further addressed the issue in well-funded print press campaigns, made possible, even after definition of IQOS as a tobacco product, by the lack of a tobacco advertising ban in the print press. The ‘Don’t burn the chance to reduce the harm of smoking’ advertisement, which appeared as full page ads, argued in favour of lower taxation. As the battle intensified, PM presented data in the advertisements about taxation policies in other countries, suggesting that if Israel did move to equalise taxation, it would be the only country in the world with equal taxation (figure 2C).

The Public Campaign, which began with the IQOS launch, started with a widely disseminated digital marketing campaign17 which included photos of the product and short text messages. The word IQOS and the phrase ‘This changes everything’ appeared, in English only, on many advertisements. This differed from the other terms which were in Hebrew (except in advertisements in the English press, some of which are presented here). Pop-ups appeared regularly on internet sites and as people opened their smartphones or popular news websites. This was later complemented by print press advertising with similar types of messages. Other components of the campaign included a unique Facebook page under the slogan ’Smoke Free Israel' and cars with advertising messages. Package inserts advertising IQOS appeared in cigarette packages. Journalists were flown to Switzerland by PM. As an example of coverage, the report in a local English paper by a reporter flown by PM to Switzerland mentioned the words ‘harm reduced’ or ‘less harm’ 12 times in a single article, described reduced exposure to toxicants and quoted PM executives extensively.18 IQOS was also distributed to celebrities.19 20 A flagship IQOS store, closely resembling Apple iPhone stores, was opened in Tel Aviv on October 2017.