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The Foundation launched its Strategic Plan 2019-2021 at the end of 2018, its first full year of operation. Having reached the midpoint of this strategic period, the Foundation now assesses its: (1) progress by strategic pillar, (2) mission alignment, and (3) cohesiveness related to how its activities work together toward achieving its mission. Over the past 18 months, the Foundation has made substantial progress toward its goals, and it is on track to achieve even greater impact over the next 18 months. The Strategic Plan 2019-2021 is organized around three pillars: Health, Science, and Technology (HST), Agriculture and Livelihoods (AGL), and Industry Transformation (IT).
The Foundation’s “Purpose” includes the entirety of Article Third of the Foundation’s Certificate of Incorporation and Article IX, Par. A of the Foundation’s Bylaws. Article Third of the Foundation’s Certificate of Incorporation specifies use of assets or income toward seven sets of activities (smoke-free purposes (i) to (vii)). The Foundation is demonstrating progress in six of the seven smoke-free purposes. Specifically, the HST work addresses smoke-free purposes (i), (ii), (iii), and (vii). The AGL work addresses smoke-free purpose (v). The IT work addresses smoke-free purpose (iv). Smoke-free purpose (vi) will be addressed in a future strategic plan.
i.) make grants and other distributions to academic, health-related, research and science centers and institutions and other collaborating centers and institutions, and to scientists and health-related experts, to support research and projects regarding alternatives to cigarettes and other combustible tobacco products and how to best achieve a smoke-free world and advance the field of tobacco harm reduction;
ii.) fund global research initiatives and publish reports regarding, among other things, the attitudes and opinions of the general public towards tobacco harm reduction;
iii.) fund scientific verification studies to assess the impact of smoke-free and reduced risk products on public health outcomes and how such products affect the general population;
iv.) scrutinize, comment on, and inform the general public regarding the activities of the tobacco industry, other commercial entities and other stakeholders which may have an impact, either positive or negative, on achieving a smoke-free world and advancing the field of tobacco harm reduction;
v.) research the effect of the reduced demand for leaf tobacco on farmers and other stakeholders and explore and promote sustainable agricultural and nutritional alternatives for tobacco farmers, tobacco land and other stakeholders;
vi.) research sustainability issues and solutions related to management of smoke-free and reduced risk products-related waste and materials;
vii.) conduct global conferences, forums, panels and similar programs to focus on the evolving science regarding alternatives to cigarettes and other combustible tobacco products and how to best realize a smoke-free world.
Table 1 maps the Foundation’s grants to the smoke-free purposes, as well as to the Strategic Plan Objectives (defined below). Certain grants address multiple smoke-free purposes and strategic plan objectives.
Table 1 Mapping of Foundation Grants to Purposes and Strategic Plan
Strategic Plan Objectives
The Foundation’s theory of change for ending smoking involves transforming the nicotine ecosystem, which includes taking account of nicotine users, cigarette and related product manufacturers, tobacco farmers, investors, and the health professional community.
The Foundation’s work is informed by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). We recognize that coordinated action on both demand and supply sides needs to happen, and we go beyond the FCTC by also seeking to engage industry to accelerate the reduction of harm caused by tobacco use. Our support for the Morven Dialogues is one example of how we have approached the need for multi-stakeholder engagement.
The Context for Strategic Plan 2019-2021 provides greater detail regarding the context of our work and the determinants of our strategic framework. The Foundation’s role is to identify and fill gaps in the implementation of the FCTC and other elements of ecosystem-wide transformation. These gaps relate to smoking, tobacco farming, and industry. The gaps are succinctly outlined in a recent article, “Accelerating an end to smoking: a call to action on the eve of the FCTC’s COP9” (Yach, 2020).
The Foundation’s Strategic Plan 2019-2021 objectives by pillar are listed as follows:
Health, Science, and Technology
A. Multi-year research programs underway, with output published and being used to inform policy and regulations
B. Research centers established in priority countries, strengthening local research capability and attracting new talent
C. Investment vehicles operational, and funds deployed for innovating cessation tools, and improving access to cessation and reduced-risk products
D. First issues of country-level tobacco & nicotine atlases, used by policymakers, researchers, and other stakeholders
Agriculture and Livelihoods
A. Viable models ready to be scaled, based on pilots and new investment mechanisms
B. Center for Agricultural Transformation created with active researchers
C. Grants awarded, with new tobacco-specialized and local scientists joining
D. Some policy reforms in action, with legislation drafted
E. First improved nutritional outcomes, improving national food security indicators
A. First issues of the Tobacco Transformation Index ™ live, with top 15-25 global companies surveyed
B. Engagements with Institutional Investors, first drafts of engagement strategies and oversight measurement objectives
C. Reviews of indexing outputs with investors/policymakers and industry
D. First structured investors’ engagements with tobacco industry, communicating through right platforms
E. Initial counter-marketing campaigns underway, based on Index data
Progress and Mission/Purpose Alignment
The Foundation has awarded grants to a number of world-renowned researchers who are spearheading innovative smoking cessation and harm reduction projects. The related grant payments are anticipated to be made through 2024. Many research partners also have published research reports and contributed to peer-reviewed articles. A summary of the grants related to the Health, Science, and Technology (HST) pillar can be accessed here – HST Grants. Table 1 above demonstrates the manner in which these grants relate directly to Foundation Purpose (in particular, to each smoke-free purpose) and to the Strategic Plan 2019-2021 Objectives.
In addition, a list of Foundation-sponsored publications can be accessed here – HST Reports and Publications. These outputs include: reports that are publicly available; publications that are in press or nearly final, or presentations that have not been disseminated; and a summation of deliverables expected from partners in the next 12 months. Note that publications have appeared in leading academic journals, including British Medical Journal, Lancet, and American Journal of Public Health, as well as in leading textbooks (e.g., Social Justice in Health).
The Foundation’s grantees and research partners include highly cited grantees, such as Jed Rose, Rose Research Center; Riccardo Polosa, University of Catania; and Steven Shoptaw, University of California. The list includes emerging researchers from the private sector, such as Adam Hill and Karen Nelson, as well as organizations such as Cambridge Design Partnership, EY-Parthenon, Etheim Biotics, BOTEC, and Signals Analytics. All these partners have deep expertise not available in traditional tobacco control programs. The Foundation is actively drawing upon cutting-edge scientists from outside of the narrow confines of tobacco control to bring new energy and creativity to this area. By recruiting new researchers, the Foundation aims to tackle novel issues related to THR, particularly the use of innovative technologies to catalyze cessation and harm reduction. Finally, the Foundation is building new research capacity in developing countries.
Early on, the Foundation recognized the research capacity gaps in low- and middle-income countries (LMICs), and it included capacity strengthening in its Strategic Plan and HST workstream. The size of the gap was recently documented.
Connection map – electronic cigarette researchers
NOTE: Author data is analyzed using Visone social networking data visualization methodology to identify ‘top authors’ by connections; results include authors with 3 or more publications (N = 859); Search term – electronic cigarette, includes all publications from 2007 to 2017
To address research gaps, the Foundation has issued grants devoted to efforts in LMICs. These efforts include:
The Agriculture and Livelihoods strategy addresses smoke-free purpose (v) and the summary of grants can be accessed here – AGL Grants. The Centre for Agricultural Transformation (CAT) in Lilongwe, Malawi, announced in 2019, is a science, technology, and business incubation project. The CAT aims to strategically commercialize and disseminate innovations that support smallholder Malawian farmers in making economically viable, data-driven decisions for diversifying incomes. Lead grantees include Land O’Lakes / Venture37, Stellenbosch University, the Malawi University of Science and Technology, and Lilongwe University of Agriculture and Natural Resources (LUANAR). Malawi’s Policy Agenda for the Transformation of Agriculture (MwAPATA) established an independent policy institute in Malawi that offers research support to government policymakers. The lead grantee for this initiative is Michigan State University. Related reports and papers include: Malawi Country Overview, Global Trends in Tobacco Production and Trade, and The Past, Present and Future of Land Use in Malawi: A Background Review (to be published in July 2020).
The Industry Transformation strategy addresses smoke-free purpose (iv). The first Tobacco Transformation Index ™ is scheduled to launch September 2020. This tool draws upon extensive stakeholder dialogues which were completed in 2019 and included 8 sessions, 7 countries, and over 150 participants. Index design review is open to stakeholders, expert reviewers, and companies. Voluntary industry consultation feedback and response cycles have occurred with multiple parties. Lead grantees, as documented by Tobacco Transformation Index Management & Governance, include SustainAbility and Euromonitor International. The Foundation laid the groundwork for the Index through its Global Trends in Nicotine reports.
The Foundation Board of Directors has a clear understanding of the Foundation’s Purpose (and each of the smoke-free purposes) and the Strategic Plan Objectives. The Board has a deep level of engagement, receives detailed information from management, approves grants, is familiar with grantee activity and direct charitable activities, and carefully oversees the Foundation’s operations (including financial operations and expenditures).
Cohesiveness – Achieving the Purpose/Mission
The Foundation, at the midpoint of its Strategic Plan 2019-2021, is achieving material progress via grants and research reports in support of its Purpose. Further, the Foundation is developing relationships with innovative researchers across the globe. As a result, the Foundation’s initial Strategic Plan is on target at its midpoint, with more to come in the second half and beyond. Approaching the back end of the first Strategic Plan period, the Foundation is aligning resources to address COP9 in November 2021. The Foundation’s plan is to amplify research, advance debate, and educate about Tobacco Harm Reduction. Yach, 2020 includes a model showing how many lives could be saved in the future if THR and better cessation programs were to be deployed.
The Foundation’s work addresses a key lever of change identified in the Foundation’s Strategic Plan: smokers need a “correct understanding of the health benefits of quitting or switching to reduced-risk nicotine alternatives.” This force for change is consistent with smoke-free purposes (ii), (iv), and (vii). It also aligns with Gap 5 in the Context for FSFW 2019-21 Strategic Plan, “improving public awareness of the drivers of smoking harm and of the availability of alternatives.” Over the past 18 months, the Foundation’s activities and grantmaking in this area have expanded to include: staff participation in external events; strengthening consumer networks; disseminating evidence-based publications, videos, podcasts, and blogs; and strengthening local capacity for the same.
Figure 2. Adoption of HRPs projected to drastically reduce tobacco deaths by 2060
To prepare for COP9, the Foundation has developed a strategy to apprise country delegates and national stakeholders to share and utilize research evidence on Tobacco Harm Reduction. Grants have been issued to coordinate work in WHO defined regions (SEARO, EMRO, Latin America, and Europe, with one for Asia Pacific under development). The International Network for Nicotine Consumer Organizations (INNCO) now has funding from the Foundation to focus specifically on Europe, where COP9 will be held. INNCO and Knowledge Action Change also are playing an important role in debates around the European Tobacco Products Directive.
At the midpoint of the Strategic Plan 2019-2021 period, the Foundation is in position to advance the smoke-free purposes and strategic plan objectives through the remainder of the period and into the next plan. This conclusion is based on the Foundation’s completed, current, and planned work.