A man lights a cigarette along a road in Mumbai, India. Photo: Reuters/Danish Siddiqui
A man lights a cigarette along a road in Mumbai. Photo: Reuters / Danish Siddiqui

The Conference of the Parties to the World Health Organization Framework Convention for Tobacco Control (WHO FCTC) held its ninth session from November 8-13. 

The COP9 meeting was supposed to strengthen and expand the support to address tobacco-control issues.

The question is whether COP9 was able to achieve its core objective of fighting the tobacco epidemic.   

In this context, Asia Times spoke with Dr Ehsan Latif, a tobacco-control expert and vice-president for grant management and health and science strategy at the Foundation for a Smoke Free World. 

Previously, Latif (right) served as senior adviser for non-communicable diseases and was director of tobacco control at the International Union Against Tuberculosis and Lung Disease, managing global teams in India, China, Singapore, Mexico, Bangladesh, the Philippines, Vietnam, Pakistan, Brazil and Chad.

Latif has served on the boards of several public-health entities, including the Framework Convention Alliance, the Non-Communicable Disease Alliance, and the Global Smoke Free Partnership.

He is also a member of various international groups working on lung-health and tobacco-control setups under the Framework Convention on Tobacco Control secretariat and the World Health Organization. 

Latif holds a doctorate in medicine from Punjab Medical College and a master’s degree in public health from the London School of Hygiene and Tropical Medicine.

Sachi Satapathy: The WHO FCTC is peculiar among multilateral treaties as it has little to do with international relations, and primarily covers matters pertaining to domestic law. Virtually every provision of the treaty could be enacted into law by willing countries, even in the treaty’s absence. Do you still think that the FCTC’s claim of being able to control the tobacco menace in a global form is feasible, or can it best be dealt with at the national level?

Ehsan Latif: To save people from the harms of tobacco use, concerted efforts are needed both at a global and national level. The FCTC provides that opportunity for national governments, UN organizations and international philanthropies and funders of tobacco control to work together, share the experiences on what works but, more importantly, where to allocate resources for maximum impact to end smoking and other forms of tobacco use.  

The FCTC has put the need to decrease the harms of tobacco use on a global level with intersections [among] political, economic, social, and environmental discourses.

The FCTC allows national governments to use FCTC articles as guidelines for enacting their national laws, but all of us need to remember that for the FCTC to be successful and have an impact on the death and disease caused by tobacco use, it must be implemented in the spirit it was negotiated in. All the articles of the FCTC on both the demand and supply sides should be translated into national law as applicable to [each] country’s legal and statutory environment. 

SS: At the last several COPs, FCTC policymaking has become increasingly non-transparent. The public has been shut out. The media have been shut out. Organizations and individuals even remotely associated with tobacco interests have been banned. Many believe that at the international level, transparency and openness should be restored to the work of the COP, with full confidence that sound policies with a solid evidentiary basis will prevail in an open exchange of ideas.

EL: The FCTC Secretariat established after the coming into force of the FCTC serves the parties who have ratified the FCTC and should consider the opinions and recommendations of these parties, who are in fact all member states served by the WHO.

In my opinion, national governments should take the lead for making COPs as transparent as possible. They should weigh the recommendations provided by the WHO and the FCTC Secretariat for all matters including these exclusions and assess independently the options and take decisions reminding themselves of the openness and transparency they strive for in their own countries for all walks of life. 

The FCTC text was drafted and negotiated with the best possible evidence available at that time. We have come a long way since then and the technological revolution we have seen in the last decade or so is remarkable. These technological advances are all coming from the private sector, including the manufacturers of vaping devices, “heat not burn” technologies and cigarette producers. 

The US FDA [Food and Drug Administration] recently gave Modified Risk Tobacco Product (MRTP) authorization to three products for sale in the US after considering all the evidence submitted by the manufacturers. Moreover, countries like the UK [and] Japan have been able to apply harm-reduction principles to reduce the use of combustibles in their countries helping smokers to either quit or switch to safer nicotine delivery systems.

We should harness these advancements in technologies to improve public health and not shun these based on incomplete or biased information…. The text of the FCTC is not the issue, it’s the biased interpretation of these articles which will lead to further exclusions from the COPs. 

SS: The increasing move toward non-transparency and exclusion at the FCTC COPs is a stark departure from the norm for international negotiations and is entirely irreconcilable with the transparency principles that the WHO and the Convention Secretariat themselves espouse as an essential means to build consensus globally. As a global expert in the field for the last two and half decades, what would be your suggestion to COP to bring changes so that all stakeholders can contribute to this process?  

EL: Transparency, openness, and inclusivity are values everyone involved in health programs strives for. Though the information is limited, we did hear that some accredited journalists were allowed to observe the proceedings at COP9. This is not enough.

COPs should revert to the same principles under which the FCTC was negotiated where even the representatives of the cigarette manufacturers were allowed as observers, journalists would report on the proceedings and experts provided their inputs independently. That openness, transparent and inclusive process led to the FCTC text properly negotiated and the treaty accepted globally.

It’s the responsibility of national governments to lead the effort to make the COP events as open as possible and take on board the expert opinions from all sides of the debate for tobacco harm reduction as a solution to smokers to quit or switch from combustibles. 

SS: Do you think that the last COP9 meeting achieved anything concrete, and what would be your recommendation for future COP meetings?

EL: Due to the limitations imposed by the Covid pandemic and the virtual mode of COP9, substantial technical discussions were postponed till COP10, to be held in Panama in 2023. This gives the parties of the convention ample time to assess the evidence base for tobacco harm reduction, which continues to grow, conduct national research to find nationally acceptable solutions and share experiences for both success and challenges faced.

Countries like the UK, Japan [and South] Korea can provide valuable inputs based on their success. The countries should also consider the US FDA announcements and the evidence they considered. 

The national and regional meetings for health [that will] happen between now and 2023 are extremely important to discuss tobacco use and for countries to assess the approaches which would work for them. The FCTC Secretariat and WHO should review their reports as submitted by their experts and ensure that these reflect the latest evidence base from all sections of the debate and then open these up for comments from all stakeholders.

SS: COP9 closed with an agreement to embark on a multimillion-dollar financial plan to strengthen global tobacco-control measures. When a country needs resources to implement its domestic tobacco law at the field level, what is the logic of generating such huge resources, which many think does not seem to make any headway in actual tobacco control implementation?

EL: Sustainability for public health endeavors comes from allocation from national resources backed by political will. All public health programs should be incorporated into the national health infrastructure based on strategies developed by national stakeholders.

Efforts to decrease tobacco use have seen philanthropic support but these are not a replacement or a substitute for national budgetary allocations for health. The role of the WHO and the FCTC Secretariat is to develop and offer advice to countries and for countries to adapt these to their national legal and regulatory environment.

Given the urgency of the death and disease caused by tobacco use, we need to move away from these time-limited efforts, which can fund pilot programs but cannot provide financial support for a whole country’s efforts to decrease tobacco use even if it is for implementation of certain tobacco demand-reduction articles of the FCTC.

In the absence of details, I hope that this fund does not turn into or is limited to a support mechanism for the FCTC Secretariat’s budgetary and spending requirements. 

Sachi Satapathy

Sachi Satapathy is an international development practitioner who has worked on large-scale projects. His interests are in public policy, poverty alleviation and public-private partnerships for development in middle-income and developing countries.