Author: Franklin Apfel [including interview transcript from Derek Yach] January 26 2018 – This blog, one of four, is part of series in which Apfel analyses and McKee comments on Yach’s interview responses on the tobacco industry and his involvement in the Foundation for a Smoke-Free World. The series is intended to identify new ways in which the industry is attempting to (re)frame conversations on tobacco and health and tobacco industry behaviours as demonstrated by their adherence to or circumvention of article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC). Article 5.3 of the WHO Framework Convention on Tobacco Control states: "In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law."
A four part interview and commentary series
Interviewer: Franklin Apfel, World Health Communication Associates (WHCA)
Interviewee: Derek Yach, Founder and Director Phillip Morris International (PMI) Foundation for a Smoke- Free World
Commentary: Professor Martin McKee, London School of Hygiene and Tropical Medicine (LSHTM)
Stalled and ineffective FCTC frame
Apfel: This frame focuses on casting the FCTC process as stalled and ineffectual. Yach, while giving a nod to the role of the tobacco companies, blames governments and intergovernmental agencies and NGO charities for not doing enough and not giving enough money. The aim of this frame is clearly to shift attention off Big Tobacco’s role as the puppeteer here - pulling the strings of all these slow government responses through massive political contributions, anti-FCTC campaigns and supporting trade ministries to take control from health in the FCTC delegations.
Q. WHO and others have noted that the slow implementation of the framework convention is mainly due to the active interference of the tobacco industry, fierce opposition by Philip Morris International and others. What are your thoughts here?
DY. Yeah I would say that's part of the reason for slow progress-and in some countries an important one. But I think it also neglects other realit[ies] - that it's due to incompetence of governments…lack of funding for tobacco control …lack of priorities that governments give to tobacco control relative to many other areas. You only have to look at how [governments] [make] their budget allocations to see that many of the countries are [only] giving 1 to 11/2% of the GDP to health in the first place (starting with India for example) and of all that [only] a tiny fraction goes to NCD's [noncommunicable diseases] and within that a tinier fraction to tobacco. So, slow progress is not just due to tobacco companies. Governments could do more.
Q. WHO and others [provide strong evidence showing that Tobacco industry interference is a major factor in obstructing] the progress of the FCTC and [this consistent anti-health behavior is identified] as one of the key underlying explanations they offer in their letter recommending to governments and public health community not to cooperate with your new Foundation.
DY. WHO’s argument fails to consider the Foundation's independence. Once they do, they will see that we are a powerful ally for change alongside WHO and despite continued industry interference. Further, together we need to do more to increase funding for tobacco control. When I was at the WHO we spent a lot of time in Brussels trying to get the funding increased but there’s been virtually no significant increase in ODA [official development assistance] by a single major country in the world, not one. That's another reason why I think tobacco control remains in the doldrums.
Q. Some state that it's actually activities by the tobacco industry that is influencing the lack of government [and multi-lateral] action in this area. How do you feel about that?
DY. Well I think they’ve got to give the evidence. I think that suggests that there must be a massive collusion between tobacco companies ODA, the entire development agency world, including the World Bank. Frankly, if that exists, I would think we would have seen more solid documentary evidence of this by now.
Q. There is evidence on how tobacco companies have been influencing governments to appoint “tobacco sympathetic” trade representatives not only health advisors to the FCTC advisory groups. Would you consider that evidence of active collusion?
DY. I am not defending what tobacco companies do, and I don't have any detailed knowledge of what they're doing, but I would make one comment on that. I think in my Lancet article (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32602-8/fulltext)) the one thing I called for and suggested that the foundation would do is to actually take this question of “interference” to a much more sophisticated level. What struck me in having returned to tobacco control after one over decade of having been out of it full-time was how little had changed. The old arguments have remained, the same the documentation of interference had not moved along, and, in the meantime, the folks looking at pharmaceutical interference and questions related to patents and pricing have created the Access to Medicines Index, and the folks working on food and food policy have created the Access to Nutrition Index. In both cases, they provide very clear, specific criteria against which you can judge whether a company is coming out with good or bad behavior… When it comes to tobacco control, I still think we are almost a decade behind the level of sophistication needed. My hope is that we [the Foundation] would support an independent group to monitor all tobacco control activities around the world against the provisions of the framework convention so we would know:
a) was there a bribe to a government official (obviously that's against the law and it should be documented);
b) was there a handout of money (that's again a bribe);
c) was it a document produced recommending a policy direction - that I would say doesn't fall foul of any lobbying because that's what NGOs, everybody, civil societies have the right to do.
Q. Some are calling you a “turn-coat” and others see you as the poster boy of the tobacco industry now. What are your thoughts on that?
DY. Luckily I am kind of comfortable in what I am. I remain a tobacco control advocate. I remain perhaps true to my very early roots. Before I even started running a campaign in the university in medical school in the late 1970s, I knew that it wasn't good enough to talk about the tobacco industry being the vector of the disease, which is what we always used to say. I wanted to know for myself what they were doing. During those very first years, I spoke to tobacco industry people, visited their laboratories, visited their factories and continued to do that all the way through my WHO years. In fact, I invited tobacco industry scientists into the WHO building to talk about it because I have always felt there were two areas of tobacco control where there would be common ground with public health even though those in public health may not believe it. One was illicit trade and secondly harm reduction to fundamentally change the nature of the product.
And if it's a turncoat to continue talking and listening to scientists and see that we are at a point to know when actually the products can lower risk materially and how we could be doing a lot better in reducing illicit trade in many parts of the world. If that's what a turncoat is, fair enough. To me it's actually doing my job honestly as a tobacco control advocate and being aware of the advances in science and technology and innovation and bringing to the table insights I have learnt from other areas of corporate transformation that many in tobacco control are either stuck in the mud about. Frankly if we look at the tobacco control research world, not much has changed for 25-30 years. Look at the major critics who'd been upset about [this Foundation concept]. The most vocal critics are people who are saying the same thing now they were saying about 25 years ago with regards to previous research efforts by industry. Well, this effort bears no resemblance to previous efforts and arguments from 25 years ago no longer apply.
Commentary by Professor Martin McKee -
Derek Yach talks of how, having spent a decade away from tobacco control, working with the manufacturers of sugar sweetened beverages and alcohol, he was disappointed at how little had changed. But has it? He ignores the achievements of those researching the drivers of the tobacco epidemic, shedding light on the tactics adopted by corporations like Philip Morris. We now know much more about how Big Tobacco modifies the production of its cigarettes to increase their attractiveness to children and addictive potential, how it markets its products to a new generation of smokers, and the dubious tactics it engages in, including in poorer countries where it is pushing its products most aggressively. Indeed after more than a decade of litigation by the US Government, the major tobacco companies in the US will shortly have to run corrective advertising telling the truth about their products, and their record of inentionally designing cigarettes to make them more addictive.
This information has transformed the tobacco control landscape, with ever more countries working together, sharing experiences on issues such as plain packaging. The recent European Union Tobacco Products Directive exemplifies how governments can work together to tackle industry tactics. Combined with measures to make cigarettes increasingly expensive, these policies have been extremely successful in reducing smoking and, crucially, initiation by children, as shown by Australia, where adolescent smoking rates are now under 7%. Yet Big Tobacco has fought these measures tooth and nail with misleading evidence, lobbying on a massive scale, and litigation ....
Yach places much of the blame on governments for failing to prioritise tobacco control. Yet he seems reluctant to find out why this is the case. Challenged on how Big Tobacco has sought to obstruct effective policies he replies “Well I think they’ve got to give the evidence”. Even allowing for his absence from the field of tobacco control research in recent years, surely he cannot have missed the vast body of evidence that has been presented not only in the academic literature but as major features by news agencies such as Reuters and in leading newspapers, such as The Guardian. Yet maybe he has missed it, given his comment that “I don't have any detailed knowledge of what they're doing”. If this is really so, and we must take his word for it, then it seems that he should have taken more care with his “due diligence”, questioning the exceptionally high degree of reputational risk in engaging with an initiative such as this....
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