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Worldwide news and comment
  1. Karen Evans-Reeves1,
  2. Ruth Canty2,
  3. Manuja Niranshi Perera3,4
  1. 1 Department for Health, University of Bath, Bath, UK
  2. 2 Global and Tropical Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia
  3. 3 Public Health, University of Kelaniya Sri Lanka, Ragama, Sri Lanka
  4. 4 Centre for Combating Tobacco Sri Lanka, Colombo, Sri Lanka
  1. Correspondence to Dr Karen Evans-Reeves, Department for Health, University of Bath, Bath, BA2 7AY, UK; k.a.evans-reeves{at}

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All articles written by Karen Evans-Reeves, Ruth Canty, Manuja Niranshi Perera unless otherwise attributed. Ideas and items for News Analysis should be sent to


Changing the business climate to protect the earth’s climate

United Nations bodies already offer the necessary tools to remove industry obstacles from the path of a liveable climate and improved public health. The global community must use them.

For decades, the vehicle industry produced vehicle fuel with lead additives. The decision by carmakers and refiners to use lead helped vehicles achieve greater power and was patented by its producers. It also poisoned human beings.

This was not a surprise. As early as the Roman era there were suspicions that lead damaged human health, and — more immediately — workers at the plants producing tetraethyl lead in the 1920s were reporting extreme medical maladies. Some died.

Yet, science is always playing catch-up, just as a lie sprints around the world while the truth is still lacing its shoes. Science, careful and meticulous, must find a way even when industry deploys its resources to hamper change and distort the truth. Although there was sufficient evidence to strongly suspect a link between lead exposure and ill-health, it took time to provide the scientific proof, meaning it was the 1970s before action really got underway. Only in 2021, following a 19-year campaign led by the UN Environment Programme (UNEP) and partners, was the United Nations finally able to help bring about a global ban on leaded petrol.

The story of leaded fuel helps explain the enormous barriers to banning harmful products, even when the evidence is incontrovertible, and when governments could reasonably apply the precautionary principle to justify legislation. This is why tobacco products remain on sale despite the irrefutable scientific knowledge that they kill as many as half their users — more than eight million a year, every year.

The tobacco industry is a stubborn foe. The world recognised this almost two decades ago, when in 2005 — after decades of trying to rein in the industry using other mechanisms — the WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force. Embedded in the Convention, as one of the international obligations reflecting the global resolve to address the tobacco epidemic, was Article 5.3, which acknowledged the need to protect public health policy from commercial and economic interests.

Article 5.3 is just 35 words long, but along with the Guidelines for its implementation adopted by the governing body of the WHO FCTC, it is central to the Convention: it recognises the damage done by an industry indifferent to public health goals, and eager to prioritise its profits over policies to reduce the demand for, and supply of, its harmful products. This provision has been critical in many countries to ensuring appropriate safeguards are in place to protect the integrity of public health policies from interference by industry and thus achieve effective implementation of the Convention.

The evidence gathered by the Secretariat of the WHO FCTC and its 182 Parties, as well as by tobacco control stakeholders around the world, is clear — the tobacco industry continues to interfere in almost every conceivable way in its efforts to confound the aims of the Convention and to sidestep Article 5.3.

This provision is not a cure-all; the industry is well-financed and willing to ruthlessly pursue its economic self-interest. But it is equally the case that, without Article 5.3, implementation of the global public health treaty would have been much less effective. If policy deliberations were subjected to the full might of the tobacco industry, it is likely that far fewer countries would have managed to advance life-saving tobacco control policies. The existence of Article 5.3 at the heart of the Convention provides a meaningful way for stakeholders to safeguard the creation of public health policy and to support Parties to the WHO FCTC to fulfil their commitments.

There are important lessons to apply from the Convention when addressing industry interference in climate policy. Indeed, the WHO FCTC Secretariat is open to sharing its experience, although of course, not all conventions should follow an identical path.

But there are certainly important parallels. The United Nations Framework Convention on Climate Change (UNFCCC) and the WHO FCTC both request their Parties to take actions to protect future generations, one protecting the climate system, the other by reducing continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.

Another link is that during its entire life cycle from cultivation to consumer waste, tobacco has a negative impact on the environment. It uses and destroys soil that could be used for cultivating food crops, and it contributes to deforestation, desertification, and greenhouse emissions. Cigarette butts — which many people do not realise are made of plastic — are a major pollutant on coastlines and in seas, with more than 4.5 trillion butts estimated to be discarded annually.

The world faces multiple emergencies, something referred to as “a polycrisis” in the Financial Times recently, and the fossil fuel and tobacco industries – among others – are part of the problem. There is also a nexus between the environment, health policy and global human rights.

This point was highlighted by United Nations Secretary-General António Guterres at the opening of the General Assembly session in September 2022, when he described humanity’s “suicidal war against nature”.

He demanded that fossil fuel producers be held to account and pointed to their multi-billion-dollar business with its huge public relations machine.

“Just as they did for the tobacco industry decades before, lobbyists and spin doctors have spewed harmful misinformation,” he said, and added, “Polluters must pay.”

Genuine corporate liability is key to a better world, and it’s wholly reasonable to require businesses to behave ethically. They must not twist the science, distort the facts, misrepresent the risks or divert attention from their misbehaviour with “social responsibility” or “sustainability” schemes, a ‘new’ term that industry has appropriated.

All UN treaty organisations must be aware that while big business is often desperate for a place at the decision-making table, it is not there to help humanity, but to protect profits. If we want a cleaner and healthier world where humanity can thrive, special measures to protect the integrity of public policy are critical.

Dr Adriana Blanco Marquizo

Head of the Secretariat of the WHO Framework Convention on Tobacco Control.

Philip Morris International says it wants to be an ethical company

Philip Morris International (PMI) is reportedly aiming to become an Environmental, Social and Governance (ESG) stock to attract investors who have avoided the company due to its historically bad reputation and tobacco exclusion policies. There is currently no standard framework defining environmental, social and governance, yet many asset managers and pension funds sold off tobacco stocks precisely because they were not ethical stocks.

An ESG stock is a business that is implementing effective environmental, social and good governance policies within its organisation. PMI claims that it is shifting towards ‘less harmful’ vapour-based nicotine alternatives (including heated tobacco products) to replace cigarettes (although the company still promotes its combustible tobacco products around the world, opposes effective tobacco control policy measures, and is a market leader in many countries). PMI reported that about a third of revenues last year came from products other than cigarettes and these sales have, according to PMI’s CEO Jazek Olczak, placed the tobacco group’s new product line on the top for environmental, social, and governance impact.

PMI’s stated goal is to derive half of its revenues from reduced-risk products by 2025, driven by its IQOS heated tobacco stick. However, the long-term impacts of heated tobacco products are unknown.

The following Tweets highlight the paradox between being a tobacco company and becoming an ESG stock.

@mims: “Philip Morris says it’s charting a path to becoming an ESG stock. This is like saying you’re charting a path to becoming a unicorn by putting a horn on your head.”

@danariely: “Philip Morris claims it’s an ESG stock because it’s moving away from cigarettes and towards vaping. This is like saying you’re a good person because you’re moving away from murder and towards robbery.”

@davidfickling: “Philip Morris wants to be an ESG stock by shifting to vaping. That’s like saying you want to be an environmentalist by driving a Hummer instead of a tank.”

It is currently unclear whether PMI will achieve its ambition.


India: PMI yet again circumvents Indian laws, this time to promote banned electronic cigarettes and other nicotine and tobacco devices

On December 5, 2019, Indian lawmakers passed The Prohibition of Electronic Cigarettes Act, 2019 (PECA) - prohibiting the production, manufacture, import, export, transport, sale, distribution, storage and advertisement of all electronic cigarettes, heated tobacco products and e-Hookah. Violations of the Act could lead to a maximum of 1 year imprisonment or a fine of 100 000 Indian Rupees (about 1300 $USD), or both. According to the legislation, retailers need to hand over their remaining stocks for immediate disposal and cannot sell, distribute, transport, export or advertise them. However, shortly after the ban came into force, electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) were still available in stores in major cities and via online vendors.

Furthermore, tobacco companies who are heavily invested in these products have attempted to overturn and undermine the ban via direct and indirect channels. For example, via front groups such as the Association of Vapers India or the Voluntary Association of Trade Representatives of ENDS in India or the Association of Harm Reduction Education & Research, utilising media propaganda and litigation.

One such effort against the law involved, once again, Philip Morris International (PMI’s) Chief Executive Officer, Jacek Olczak. On 18 February 2023, Olczak spoke at a plenary session on ‘ Sustainable economy for the greater good’ (figure 1) at The Economic Times Global Business Summit (17–18 February 2023) in the National Capital Territory of Delhi. Olczak claimed that “harm reduction” and “harm elimination” are not mutually exclusive, and promoted heated tobacco products as safer alternatives to cigarette smoking, questioning India’s ban. Olczak also promoted PMI’ s so-called transformation and used the opportunity to launch PMI’s ‘Unsmoke’ campaign. Given his role as CEO of one of the World’s biggest tobacco companies, Olczak’s participation in the discussion of sustainability was antithetical and contradicts Target 3 of Goal 3 of the United Nations Sustainable Developmental Goals (UNSDGs) that stipulate full implementation of WHO-FCTC.

Figure 1

Screenshot of the Global Business Summit 2023 website depicting PMI’s CEO addressing India on “Sustainable economy for greater good”. Source: Economic Times, Global Business Summit ( and @TheEconomicTimes (Youtube channel:

A few days prior to the Summit, the tobacco control community requested an immediate intervention from the Ministry of Health and Family Welfare, within the Government of India. The tobacco control community wanted the Ministry to ask the organisers of The Economic Times Global Business Summit to withdraw PMI’s participation (and that of any other tobacco industry linked entity). The global tobacco industry watchdog, STOP, amplified the tobacco control community’s requests on social media. However, PMI’s access to, and representation at, the Summit went ahead. The organisers could have followed the practice of the Future of Asia conference organisers that withdrew Philip Morris Japan (PMJ)’s participation following a global tobacco control intervention. Nevertheless, following the intervention of tobacco control advocates in India, the Ministry of Information and Broadcasting, Government of India, issued an advisory to all broadcasters, online and offline, (dated May 09, 2023) denouncing PMI’s promotion of e-cigarettes at the Summit and advising broadcasters to comply with PECA (figure 2).

Figure 2

Advisory to Print/Electronic and Digital Media entities for compliance of legal provisions of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Act, 2019 while organising conclaves. Source: Ministry of Information and Broadcasting, Government of India (

Having full knowledge of the law banning electronic cigarettes in India, the Foundation for a Smoke-Free World (FSFW), the PMI-funded organisation reached out to several Indian civil societies and public health institutions (via personal emails, social media posts, such as LinkedIn and its website), offering to fund research grants on e-cigarettes and harm reduction via two rounds of Request for Proposals in the months of February and May, 2023. (figure 3).

Figure 3

Screenshot of the FSFW’s Request For Proposals (February and May, 2023) via personal emails, LinkedIn and website. Source: Blinded Personal email communication, LinkedIn Post of Senior Vice President, FSFW ( and FSFW’s website (

This is nothing new for a low-middle income country (LMIC) like India, as PMI has aggressively attempted to subvert Indian tobacco control laws in the past, to advance its tobacco business in the country. This current behaviour reveals PMI’s continued disrespect for national tobacco control laws, regulations and polices.

Such occurrences are a gentle reminder to the global tobacco control community and advocates to remain watchful against the industry’s tactics. LMICs and other countries considering restrictions on electronic cigarettes should brace themselves for the tobacco industry and its front groups’ attempts to delay, dilute and derail these policies.

Shivam Kapoor

International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi

Amit Yadav

International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi

Sri Lanka: tobacco smoking below 10% but tobacco control cannot rest

Smoking prevalence has dropped beneath 10% in Sri Lanka, with 9.1 % of adults over the age of 15 currently smoking tobacco (daily and less than daily). Daily smoking prevalence is lower still, at 6.4%, with an overall mean consumption of four cigarettes per day. The official findings of the Global Adult Tobacco Survey (GATS) were published to coincide with World No Tobacco Day in May 2023.

While these findings are positive, these percentages are calculated on the total population and the population is growing. Absolute numbers show that Sri Lanka still has 1.5 million adults who smoke.

Research conducted in Sri Lanka suggested that to reach those who say they do not wish to quit, tobacco control interventions must target the informal employment sector, for example those who work as farmers, fishermen and transport drivers. Smoking in this sector is very high and current interventions (eg, printed media campaigns) are not succesful with this cohort. Sri Lanka does not currently run any mass media campaigns on tobacco use.

Nevertheless, more than half of all those who smoke in Sri Lanka (51.6%) report that they would like to make a quit attempt in the next year. Over a third of these reported making a quit attempt during the past year. Nearly half (47%) of those who smoke had been advised to stop by a healthcare professional. Thus, there is scope for healthcare professionals to support a greater number of those who smoke, to stop.

Currently, there is a national level quitline that offers cessation counselling. There is also the helpline of the professional association of the mental health specialists, whom also provide addiction management support. The legal age to buy or sell tobacco products is 21, there is a ban on tobacco advertisements, promotion and sponsorship, a ban on smoking in public places, a prohibition of tobacco vending machines, and pictorial health warnings covering 75% of the cigarette packs are required. However, single stick sales are still allowed and it is not common practice to ask for age verification when selling tobacco products. During the pandemic, online cigarette sales were also initiated and there are no specific laws currently addressing these.

Two prominent challenges that Sri Lanka may face with reducing tobacco smoking rates are the increasing use of e-cigarettes and/or cannabis. The Sri Lankan legal framework only prohibits e-cigarettes that contain tobacco under its Prohibited Tobacco Products Regulations 2016. This legislation omits all other nicotine delivering devices that do not contain tobacco. Currently, e-cigarette use is low, possibly because of their relatively high price currently.

Cannabis popularisation may also present a long-term threat to smoking cessation. Wealthy investors from tobacco, alcohol and the food industry have been pressing for legalisation of cannabis for non-medicinal use and wider availability of the drug to its potential users worldwide. The Sri Lankan Government has presented a favourable attitude towards cannabis cultivation. Sri Lanka legalised medicinal use of cannabis via its Ayurveda Act decades ago and permits Ayurvedic medical practitioners to use it in their treatments. However, cannabis is still identified as a “dangerous drug” and any other use is illegal. Social media groups and some other individuals and organisations are increasingly campaigning to make cannabis more available in Sri Lanka and the current government publicly maintains a favourable attitude towards those parties. Canada, which has legalised the use of Cannabis, has shown through its annual cannabis survey results, that youth prevalence of cannabis use estimated to be at least 50%.

While Sri Lanka appears to be on a positive path towards tobacco smoking reduction, challenges remain ahead, which require lateral thinking and strategizing.

Australia and England take very different approaches to regulating e-cigarettes

In recent months big announcements concerning the regulation of electronic nicotine delivery devices have been made in both the UK and Australia. In April 2023, the UK government announced that one million people who smoke in England would be offered a free “vape starter kit” along with behavioural support to quit cigarette smoking, to meet their target of less than 5% smoking prevalence by 2030. It was also announced that the government would close a loophole that allows businesses to give out free samples to those under 18. The UK government maintains that vaping can help reduce the health burden caused by smoking cigarettes by supporting people who smoke who are trying to quit. Dubbed “swap to stop”, the policy would see vaping starter kits given to almost one in five people who smoke in England.

Shortly after, in May 2023, the Australian government announced a ban on all non-prescription sales of electronic nicotine and tobacco delivery devices as well as a ban on single use disposable vapes, a ban on flavours and the introduction of plain packaging for these products. The Australian model will allow all General Practitioners to prescribe e-cigarettes rather than only authorised prescribers under the current system. There is some evidence to suggest that previous efforts to regulate the e-cigarette market in Australia have resulted in a thriving black market, and there are concerns that this will be exacerbated by further restrictions, with some highlighting the need for accompanying restrictions on the sale of combustible tobacco products such as retail licensing and caps on numbers of retailers.

Hotly contested debates continue between those advocating e-cigarettes as a form of harm reduction, and those urging caution against over-reliance and under-regulation of relatively unstudied products. In Australia, daily vaping prevalence among 15–24 year-olds is estimated at around 15%. Figures from the CDC (Centres for Disease Control) in the USA estimate that 4.34% of high school students are vaping daily. Research from the UK has found that 4% of 11–18 year-olds are using e-cigarettes regularly. Reviews have examined the evidence around use of e-cigarettes and health outcomes and efficacy in smoking cessation. One review found evidence suggesting that their use can result in smoking uptake in non-smokers, showed limited evidence of their efficacy in smoking cessation, and an absence of evidence regarding health outcomes. However, others have found that nicotine vaping products can be effective in aiding in smoking cessation and a survey of US high school students found no evidence to suggest a surge in nicotine dependence among young people, possibly due to changing product use profiles.

Producers of electronic nicotine and tobacco products, including tobacco companies such as Philip Morris International and British American Tobacco have worked to create and exacerbate the fracture in the tobacco control community and have been quick to modernise their cigarette marketing and advertising playbooks. ‘New’ strategies see them target children and young people through social media platforms such as TikTok, luring them with colourful packaging, appealing flavours and sponsorship of influencers. They also continue to lobby governments and other stakeholders such as retailers under the guise of initiatives such as Responsible Vaping Australia.

Although the UK and Australian policies seem at odds with each other, both governments offer a similar rationale and justification for their plans. Both governments maintain that vaping can be a support for people who smoke but are trying to quit and both agree that addressing vaping among young people is of critical importance. One final point for consideration is the significant environmental impact of these products. These products cannot be recycled and the devices themselves as well as the packaging and battery waste are, at best, ending up in landfill. Australia’s ban of disposable devices goes some way to addressing this issue and should be considered elsewhere. Policy solutions are required.

North America

Canada: health warnings to be printed on every cigarette

On 31 May 2023, Canada announced world precedent setting final regulations to require a health warning directly on every cigarette.

As depicted in figure 4, the warnings will appear on the tipping paper (the paper that overwraps the filter), in black text on a white background, in capital letters, and in English and in French. There will be 2 sets of 6 warnings. The first set will be required to be printed on “king size” cigarettes (83–85 mm, the standard length internationally) as of April 30, 2024, at the manufacturer level and July 31, 2024, at the retail level. For “regular size” cigarettes (70–73 mm), the implementation deadline at retail is April 30, 2025. The implementation deadline for the second set of 6 warnings is August 1, 2026, for all cigarettes, regardless of length. King size cigarettes represented 69% of cigarette sales in Canada in 2021. The warning requirement directly on the product will also apply to little cigars with tipping paper, and to filtered tubes sold without tobacco.

Figure 4

Canadian Department of Health mockup of English version of first set of 6 warnings to appear on cigarettes in Canada.

Draft regulations had been announced for consultation on 10 June 2022, with an initial consultation launched in October 2018, a Health Minister announcement on 31 May 2018 of an intention to require the measure, and regulatory authority established through legislative amendments adopted 23 May 2018.

In one improvement to the draft regulations, in the future, the content of the warnings on cigarettes can be changed by government administrative decision without the need for a regulatory amendment. The new Canadian regulations also include the country’s third round of picture health warnings for the package exterior, the third round of health messages for the package interior (the second round with pictures), and a new set of toxicity information messages for a package lateral side.

The Canadian announcement received extensive media coverage both in Canada and internationally, including through Associated Press and Agence France Press wire stories.

In the United Kingdom, Lord Young of Cookham congratulated Canada. Previously, on 18 March 2022, Lord Young’s private member’ s bill to require warnings on cigarettes was adopted by the House of Lords, but would not be adopted by the House of Commons. In the 1970s, as a health minister in the Conservative government of Prime Minister Margaret Thatcher, the then Sir George Young had proposed warnings on cigarettes.

International momentum for warnings on cigarettes is expanding. On 30 November 2022, the Australian government announced a series of new tobacco control measures including that it “will look to make individual cigarettes dissuasive with unattractive colours or printed warnings like ‘smoking kills’ ”. On 31 May 2023, the Australian government released draft legislation for consultation that included regulatory authority to require warnings on cigarettes. On 31 March 2023, the Norwegian government sent to Parliament a recommended national health strategy with intended new tobacco control measures to include warnings on cigarettes.

Health warnings on every cigarette bring tobacco health warnings to a new level, prompt discussion, render the product less appealing and discourage smoking, provide a further means to increase awareness of health effects, and highlight the uniquely harmful nature of the product. Such warnings have reach with every cigarette and every puff, and in every community. Government health departments determine message content and tobacco companies pay the cost. Given the compelling rationale, it is inevitable that many countries will follow the Canadian precedent.

Rob Cunningham

Senior Policy Analyst

Canadian Cancer Society

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