Introduction

At present, IQOS, Philip Morris’s (PM’s) heated tobacco product, is being test-marketed in 30 countries worldwide.1 Similarly to electronic cigarettes,2 regulation varies widely by country. In the USA, for example, sales and marketing of IQOS are currently prohibited by the Food and Drug Administration’s (FDA’s) premarket approval structure, pending a decision by the FDA.3 Canada allows marketing, and has been termed a ‘dark market’ due to its strong tobacco advertising ban in combination with its categorisation of IQOS as a tobacco product.4 Italy, by contrast, has exempted IQOS from its comprehensive ban on cigarette advertising and also from the graphic warnings which are required on cigarettes.5

This paper describes the entry of IQOS into Israel, and its marketing campaign (see Figure 1). In 2016, when the IQOS campaign began, the adult smoking prevalence was 21.6%.6 Israel was a signatory to the Framework Convention on Tobacco Control (FCTC), had a governmentally approved tobacco control plan, national legislation for smoke-free public indoor and outdoor places and high levels of taxation.7 A partial advertising ban was in place which prohibited advertisement of tobacco products on television and radio, and in print press publications directed at youth.7 No premarket regulatory mechanism existed for any tobacco or nicotine product, and Israel did not have any distinct category for emerging tobacco and nicotine products.

During the first half of 2016, PM communicated directly with officials from the Ministries of Health and Finance via high-level meetings and letters prior to marketing of IQOS to the public.6 This is consistent with PM’s global strategy.8 Following these meetings, the Ministry of Health (MOH) sent a letter to the Tax Authority defining IQOS as a new product which did not fall under existing tobacco regulation.9 PM …