Accelerating an End to Smoking
As published in the Cape Times [Cape Town, South Africa]
Fifteen years ago, this month, the final negotiating meeting for the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) ended in Geneva. WHO used its treaty making right for the first time to tackle a major global health threat. Four million people died that year (2003) from tobacco-related diseases.
As with all complex negotiations, each country had to make some compromises. But with this treaty, Dr. Brundtland (the Director General of WHO during the negotiations) not only placed smoking onto the global health agenda-but along with it, all other leading noncommunicable diseases and their associated risks. Global health would never again only be synonymous with infectious diseases, maternal and child health, a view that had been dominant since WHO’s creation in 1946.
Progress led by WHO and in recent years funded by US philanthropies has been substantial. Many countries have increased taxes on tobacco products, banned tobacco advertising and put in place comprehensive monitoring systems. And prevalence has gone down in many countries as is documented in WHO’s 2017 report on the global tobacco epidemic.
The size of the challenge though remains immense. There are a billion smokers in the world. Over 7 million smokers die annually mainly from combusted cigarettes. We are on target to record a billion deaths this century. These numbingly high figures dwarf those from AIDS, malaria and tuberculosis combined and hide the personal, family and economic burdens they impose.
The work of the FCTC remains the bedrock upon which progress depends. However, exceptional additional means and new players are needed to complement what is underway if we are to accelerate an end to smoking.
Smoking causes many diseases of which lung and many cancers, heart and lung diseases are most common. These only become evident after decades of smoking. Because of this long lag, we know that even as smoking rates decline, death and disease rates for many conditions will continue to climb. If no children were to start smoking today, the impact on the death and disease rates would only become evident beyond 2050.
We need more effective ways to rapidly reduce smoking and its harmful impacts in today’s billion smokers. The 2017 WHO Report concedes that “little progress has been made to address smoking cessation since 2007.” The innovation pipeline for new interventions for cessation has been virtually empty for decades. At the same time, a range of harm reduction products that separate nicotine from the killing aspects of cigarettes has rapidly emerged. Millions of smokers are switching to such products.
Public Health England and the US FDA have recently highlighted the need for better cessation and harm reduction interventions. Their calls are igniting excitement to invest and innovate in these areas among cutting-edge scientists, entrepreneurs and large companies. In the few months since we have launched the Foundation we have witnessed this first hand. This reality offers us a chance to go faster. I offer our early ideas about what might support progress.
Facilitate and fund research aimed at developing more effective cessation and safer harm reduction products priced and designed to meet the needs of smokers in low and middle-income countries. And link this to large scale research to assess the benefits and any downsides of products. We have seen how private-public alliances have led to global progress on HIV/AIDS and malaria drugs, vaccines and micronutrients. Now we need such scaled support to tackle smoking. And we must learn from HIV/AIDS and engage smokers and nicotine users early and often in product development.
Support development of regulatory policies that would support wide adoption of effective products. Tax differentials on leaded versus unleaded gasoline supported widespread adoption of unleaded gasoline. Well-designed tax incentives for research and for consumers is leading to higher levels of solar energy use. In both cases, pricing policies have been backed by government led informational campaigns about the benefits of switching for health and the environment. We should apply similar approaches in ways that help smokers quit or switch.
Fund initiatives to objectively shine a spotlight on continued tobacco industry behaviors that impede or block attainment of the FCTC and those that contribute to lowering population risk. We need to understand the structure and motivations of the tobacco industry if we were to make progress. At WHO we drew an analogy of the tobacco industry being the equivalent to malaria’s mosquito as the true vector of disease. Work on the mosquito has transformed malaria control. Work on what it will take to truly transform the entire tobacco sector requires clarity and vision of what is possible.
We will build upon the experiences of two other sectors engaged in sector-wide transformation-pharmaecuticals and food. For both, initiatives led by independent teams, have been underway for several years. They document industry progress and regression. An annual integrated report is prepared using country specific metrics on company performance. The report ranks the overall performance of all major companies in the sector in terms of their positive and negative impacts. Companies and investors use these reports in their decision making while NGOs and governments consider these reports for their use.
Build institutions and invest in the next generation of scientists and policy makers able to drive change especially in low and middle-income countries. In doing so, we are aware that 85-90 percent of all tobacco control and research resources are concentrated in US and UK who account for 5 percent of the world’s smokers. Decades of experience in global health shows that more and better scientists in countries leads to innovation and knowledge; better policies and wider public support for areas of neglect.
A billion smokers. A billion deaths this century. Both are unacceptable. Both require renewed urgency and actions. The Foundation seeks to work with others committed to progress.
Brief note about the Foundation
The Foundation for a Smoke-Free World, Inc. is an independent foundation formed and operated free from the control or influence of any third party. Philip Morris International, S.A. has provided the initial funding to the Foundation. The Foundation makes grants and supports medical, agricultural and scientific research to end smoking and its health effects, and to address the impact of reduced world-wide demand for tobacco