Pushing on to strengthen our stand against nicotine addiction

Malaysia did poorly in two indexes measuring tobacco industry interference in health policy in 2023, showcasing our vulnerability to undue influence from industry on our government officials. — Filepic

Nicotine addiction from tobacco use is harmful.

The numerous harms, which have been known for decades, include increased risk of cardiovascular, respiratory and gastrointestinal diseases; ill effects on reproductive health; and various cancers, as well as resistance to chemo- and radiotherapeutic agents.

The debate on the Control of Smoking Products for Public Health Bill in the Dewan Rakyat last Nov 29 (2023) was fractious, with members from both sides of the political divide raising the issue of the influence of the tobacco and vaping industry on health policy.

According to the World Health Organization (WHO): “The tobacco industry’s ongoing tactics to win influence and interfere with health policies include:

• “Claiming a public health role while killing over eight million people every year.
• “Saying they are ‘sustainable’ while their products pollute our planet.
• “Funding scientists or third parties to produce biased research.
• “Financing front groups to lobby against tobacco control policies.
• “Paying for social media influencers and event sponsorships.
• “Hiring legal teams to litigate, challenge and delay tobacco regulations.
• “Financially supporting activist groups to rally against tobacco policies.”

The urgency of passing the Bill was attributed to the delisting of nicotine from the Poisons List last April 1 (2023).

This had opened the floodgates to allow the advertising, promotion and sales of nicotine products; entry of tobacco companies to the vaping market; and most importantly, legalised sales to everyone, including minors below 18 years of age.

Until the Bill is enforced, there will be no closing of these floodgates.

The silence of the health authorities to a minister’s statement that there is no link between smoking and cancer, is deafening.

This column provides some background on the issue of tobacco and health policy.

Industry influence

On May 21, 2003, the World Health Assembly of WHO adopted the WHO Framework Convention on Tobacco Control (FCTC), which entered into force on Feb 27, 2005.

It was one of the most rapidly-endorsed treaties in United Nations’ history.

The FCTC resulted from the globalisation of the tobacco epidemic.

It is an evidence-based treaty that reaffirms the right of every human being to the highest standard of health, and provides new legal dimensions for international health cooperation.

Malaysia, which has been a party to the FCTC since Dec 15, 2005, is bound by its commitments.

The Global Tobacco Industry Interference Index (Global Tobacco Index) is a worldwide survey on how governments are responding to tobacco industry interference and protection of their public health policies from commercial and vested interests, i.e. it measures the indicators in the FCTC.

These indicators are:

• Level of participation in policy development
• Tobacco industry’s corporate social responsibility activities
• Benefits to the tobacco industry
• Unnecessary interaction between government and industry
• Measures for transparency
• Preventing conflicts of interest, and
• Measures that prevent industry influence.

The lower a country is ranked based on the Index, the better the implementation of the FCTC, i.e. the country ranked first has the best implementation, while the one ranked last has the worst implementation.

Last year (2023), Malaysia ranked 78th out of 90 countries.

Malaysia also deteriorated to 17th position out of 19 Asian countries in the Asian Tobacco Industry Interference Index.

Similar to the Global Tobacco Index, the lower the rank in this index, the more the tobacco industry interference.

The Asian Tobacco Industry Interference Index is compiled by the South-East Asia Tobacco Control Alliance (Seatca), which is a multisectoral non-governmental alliance whose objective is to accelerate and effectively implement the control measures in the FCTC.

For Malaysia, Seatca noted the delisting of nicotine from the Poisons List without any existing policy to regulate these products.

It also noted that last April (2023), the Deputy Health Minister met with representatives of the vape industry, with no record of the meeting on the Health Ministry’s website nor the purpose of the meeting.

The US-Asean Business Council’s annual Business Mission last March also connected representatives from American multinational tobacco company Philip Morris, among other corporations, to some ministers and high-level government officials.

Transparency required

In November 2008, the WHO adopted guidelines for implementation of Article 5.3 of the FCTC on the protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry.

The guidelines emphasise the importance of adopting transparency measures in both government interactions with the tobacco industry and within the industry.

The Article 5.3 guidelines were to:

• Raise awareness about the addictive and harmful nature of tobacco products, and about tobacco industry interference with the signatory parties’ tobacco control policies.
• Establish measures to limit interactions with the tobacco industry and ensure the transparency of those interactions that occur.
• Reject partnerships and non-binding or non-enforceable agreements with the tobacco industry.
• Avoid conflicts of interest for government officials and employees.
• Require that information provided by the tobacco industry be transparent and accurate.
• Denormalise, and to the extent possible, regulate activities described as “socially responsible” by the tobacco industry, including, but not limited to, activities described as “corporate social responsibility”.
• Not give preferential treatment to the tobacco industry, and
• Treat state-owned tobacco industries in the same way as any other tobacco industry.

The WHO also launched the “Stop the Lies” campaign last Nov 13 (2023).

This is an initiative to protect the young from tobacco products by calling for an end to the tobacco industry’s interference with health policy.

The objectives of the campaign are to:

• Counter the tobacco industry’s infodemic and show policymakers how the industry continues to target children and youth.
• Protect future generations by asking governments to safeguard health policymaking from tobacco industry interference.
• Spread awareness about the various tactics the tobacco industry uses to influence public opinions and policy, and
• Amplify calls from youth to protect them from the tobacco industry.

Work to do

On Dec 1 (2023), Seatca, in commenting on the Control of Smoking Products for Public Health Bill stated: “Now that a tobacco-free generation is no longer an immediate course of action, Malaysia must play catch-up with international best practices and its obligations under the WHO FCTC, including introducing standardised tobacco packaging, enforcing 100% smoke-free environments in all indoor public and work places, prohibiting flavoured tobacco products, and enforcing its ban on tobacco sponsorships to include the fake corporate social responsibility activities of the tobacco industry...

“While the new law requires registration of retailers, there is a need to speed up its full and strict implementation.

“The registration of Malaysia’s 50,000 cigarettes retailers, which began some time ago, is still incomplete, and regulators will have to race to similarly register vape traders.

“They will also need to work closely with the non-health sector to curb online sales and promotion of tobacco.”

It is moot to question whether what occurred with the Bill last year was in consonance with strategy 2 of the Health Ministry’s National Strategic Plan for the Control of Tobacco and Smoking Products 2021-2030, i.e. Strengthening the Law & Enforcement on the Control of Tobacco and Smoking Products.

It is also moot to assess the Health Ministry’s response to WHO’s “Stop the Lies” campaign, bearing in mind that Malaysia is still a vice-president of the World Health Assembly (until May 2024), the governing body of the WHO.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.