- Email: [email protected]
Another step change for tobacco control in China?
development and deployment, we should not forget that the management of legal liabilities related to vaccines has been an important subject of discussion between national governments, international organisations, vaccine manufacturers, and other parties who have been engaged in the worldwide response to the Ebola outbreak during the past year. On the basis of previous experience with other vaccines,2 it is reasonable to expect that administration of Ebola vaccines (or similar medical countermeasures responding to other public health emergencies in the future) will almost certainly result in at least some adverse events that will give rise to legal liabilities, for which it is not clear what the legal and financial process for claims against manufacturers, distributors, or providers might be. Individuals experiencing such adverse events, manufacturers, governments receiving vaccines (eg, Guinea, Liberia, and Sierra Leone in the context of Ebola in west Africa), governments supporting vaccine distribution outside of their borders (eg, the USA, the UK, and France in the case of Ebola), and populations benefiting from widespread vaccination all have a shared interest in recognising, understanding, and managing potential liability as effectively as possible within the framework of a global public health response. Legal immunities for innovators and manufacturers of vaccines, such as the Public Readiness and Emergency Preparedness declaration made by Secretary Burwell, can be part of the solution. However, the cost of injuries attributable to vaccines should not simply fall on target populations. To allow such a result to occur risks feeding the same doubts that have thwarted some vaccination efforts in low-income and middle-income countries across the world. Several options are available to the global public health community to address potential legal liabilities in various public health emergency www.thelancet.com Vol 386 July 25, 2015
scenarios, including situations such as the Ebola outbreak. Unlike many contingencies associated with future pandemics or similar global public health crises that are difficult—if not impossible—to predict, creating an improved framework for management of legal liabilities is a preparation that all interested stakeholders can make before the next global health emergency occurs. We declare no competing interests.
John Monahan, *Sam Halabi [email protected] Georgetown University, Washington, DC, USA (JM); and The University of Tulsa, Tulsa, OK 74104, USA (SH) 1
2
US Department of Health and Human Services. Secretary Burwell issues declaration under PREP Act to support development of Ebola vaccines. http://www.hhs.gov/news/ press/2014pres/12/20141209a.html (accessed July 6, 2015). Dukes G, Mildred M, Swartz B. Responsibility for drug-induced injury: a reference book for lawyers, the health professions and manufacturers. Oxford: IOS Press, 1998, 451–67.
Another step change for tobacco control in China? In their Editorial about tobacco control in China (May 30, p 2122),1 the Editors of The Lancet discussed the steps that the Chinese Government is taking to control tobacco, which includes the adjustment of China’s consumption tax on the wholesale price of cigarettes. Is increasing tobacco taxation really another step change for tobacco control in China? China is the world’s largest tobacco producer and manufacturer, and is also home to more than 300 million smokers who consume over one-third of the world’s cigarettes and another 740 million people who are exposed to passive smoking. Tobacco use in China is causing a substantial rise in health hazards and economic burden, therefore comprehensive tobacco control is clearly needed. International experience and results of
studies consistently show that raising taxes on tobacco is one of the most cost-effective ways to reduce tobacco use.2 Hence, the WHO and relevant experts have repeatedly suggested that the Chinese Government should control tobacco use by sharply increasing tobacco taxes. However, for a long time, the government has been hesitating to use such strategies in its bid to reduce tobacco use for some well known reasons.3 The excise taxes on cigarettes in China have always been very low: in 2011, taxes levied on the retail price of cigarettes were still far from reaching the 70% suggested by WHO. A tobacco consumption tax was introduced in 1994, and the tax rate increased slightly in 1998, 2001, and 2009. Furthermore, every time the tobacco tax rate increased, China’s tobacco industry subsequently increased their subsidies to cigarette manufacturers to offset the negative effect. As a result, tobacco excise taxes could not be fully passed on to retail prices, and the retail prices barely changed. On May 7, 2015, the Chinese Ministry of Finance announced an increment in the consumption tax on wholesale cigarettes from 5% to 11% and each cigarette would also be taxed ¥0·005.4 The next day, the State Tobacco Monopoly Administration announced a 6% increase in wholesale cigarette prices and recommended a 10% increase in the retail price of each pack of cigarettes.5 Unlike previous tobacco tax adjustments, this increase in tobacco taxes is passed on to retail prices, which was considered impossible when taking into account the unique relation between the tobacco industry and the Chinese Government. After May 10, 2015, we observed that cigarette prices had increased by about 10% in many tobacco stores. Most people who care about tobacco control welcome tobacco tax adjustment and regard it as another step for tobacco control in China after the announcement of a
Associated Press
Correspondence
For the Global Adults Tobacco Survey China 2010 see http:// www.who.int/tobacco/ surveillance/survey/gats/en_ gats_china_report.pdf?ua=1
339
Correspondence
For the Beijing control smoking ordinance see http://210.75.193.155/rdzw/ information/exchange/Laws.do? method=showInfoForWeb& id=2014321
340
long-awaited draft national tobacco control guideline by the Legislation Office of the State Council, paving the way for strong action on tobacco control at the national level. The rise of the wholesale cigarette tax was expected to reduce cigarette consumption. However, according to a survey done by the Beijing Morning Post 6 most smokers ignored this price increase and expressed that they would not change the smoking habit. Why? One smoker commented that the price of cigarettes in China has barely changed much in the past 15 years, whereas personal incomes have been rising rapidly during this same period. Cigarettes are still quite affordable even after the adjustment. The increase of tobacco taxes is far from sufficient, and the effort to reduce smoking is muted because of the steady rise in personal incomes. Compared with the UK, China’s tobacco taxes are still moderate and, even after the latest increase, do not meet WHO recommendations. The government might be still reluctant to meet these recommendations, with fear of damaging the tobacco industry—a major economic pillar—thereby affecting the government revenue. Additionally, tax rates are simple to raise, and even the necessary approval procedures of the National People’s Congress can be exempted. So why is it so difficult to change? China has 300 million smokers and the largest tobacco industry in the world—making an increase in tobacco control crucial, but also making tobacco control a complicated task for the Chinese Government. To do so, China will face various obstacles, such as those from the State Tobacco Monopoly Administration. In terms of the extent of the tax hike this time, there is still a long way to go before smoking is curbed, but the campaign against tobacco in China has picked up in the past several months. Since June 1, 2015, the strictest smoking control law took effect in
Beijing. However, learning from the past, challenges remain. Will the smoking prohibition be enforced completely? Let us wait and see. We declare no competing interests.
*Yong Hu, Xiaoyang Sun, Zhenshan Yuan, Weixin Dong, Jiao Zhang [email protected] Department of Spinal Surgery, Ningbo NO. 6 Hospital, Ningbo 315000, China (YH, ZY, WD); and Medical College of Ningbo University, Ningbo, China (XS, JZ) 1
2
3 4
5
6
The Lancet. Will China make the great leap in tobacco control in 2015? Lancet 2015; 385: 2122. Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control 2012; 21: 172–80. Dan X, Yuankai S, Chen W. Tobacco in China. Lancet 2014; 383: 2045–46. The Ministry of Finance. Notice on the adjustment of cigarette consumption tax. http://www.gov.cn/xinwen/2015-05/08/ content_2859258.htm (accessed May 8, 2015). The Central People’s Government of the People’s Republic of China. The State Tobacco Monopoly Bureau issued a notice about domestic and imported cigarette cigarettes price adjustment. http://www.gov.cn/ xinwen/2015-05/11/content_2860059.htm (accessed May 11, 2011). Xiaofei Peng. Beijing Morning Post (Beijing). May 18, 2015. http://money.163. com/15/0518/06/APSJ0C6Q00253B0H.html (accessed May 18, 2015).
countries, such as Germany, where elaborate regulation6 impedes important investigations; this situation would be improved by easing access to a deceased person’s data. In the case of posthumous organ donation, people can choose to donate all their organs or specific ones. We think that the same should be true of data. All citizens should be encouraged to have a data donor card (and associated electronic record) that states whether their data can be used, and also which data can be used, for research after their death. We encourage governments to create, and all citizens to obtain, a data donor card and we would urge people to consent to donate data for open use after their death. Necessary details including data donation agreements and establishment of appropriate data donor banks and data donor registers on the basis of respective data donor laws pose no particular challenges. Overall, formalised data donation could prevent waste of crucial research information such as posthumous medical data, which is an extremely valuable legacy that should not be left untapped. We declare no competing interests.
Data donation after death
*David M Shaw, Julianne V Gross, Thomas C Erren
Sheila Bird (May 9, p 1830) recently pointed out how late registration of death in England and Wales seriously disabled statistical and epidemiological studies. Another serious obstacle to essential observational research is the accessibility of precious medical data after a person’s death. To prevent waste of medical research data, we suggest that all citizens should be encouraged to donate data after death just as people donate organs posthumously, as was previously suggested in relation to brain researchers’ personal data.2 It is clear that data should be protected, 3–5 but we equally need research protection. The present environment is challenging in some
Institute for Biomedical Ethics, University of Basel, CH-4056 Basel, Switzerland (DMS); and Institute and Policlinic for Occupational Medicine, University Hospital of Cologne, Cologne, Germany (JVG, TCE)
1
[email protected]
1 2 3 4 5
6
Bird SM. End late registration of fact-of-death in England and Wales. Lancet 2015; 385: 1830–31. Taylor KE. A data-donor scheme for brain researchers. Lancet 2000; 355: 849–50. Data protection in a digital age. Lancet 2009; 373: 518. McCall B. European Parliament supports data protection reforms. Lancet 2014; 383: 1115. Dove ES, Townend D, Knoppers BM. Data protection and consent to biomedical research: a step forward? Lancet 2014; 384: 855. German Federal Ministry of Justice and Consumer Protection. Federal Data Protection Act in the version promulgated on Jan 14, 2003 (Federal Law Gazette I p 66), as most recently amended by Article 1 of the Act of August 14, 2009 (Federal Law Gazette I p 2814). http://www.gesetze-im-internet.de/ englisch_bdsg/englisch_bdsg.html (accessed June 4, 2015).
www.thelancet.com Vol 386 July 25, 2015
scenarios, including situations such as the Ebola outbreak. Unlike many contingencies associated with future pandemics or similar global public health crises that are difficult—if not impossible—to predict, creating an improved framework for management of legal liabilities is a preparation that all interested stakeholders can make before the next global health emergency occurs. We declare no competing interests.
John Monahan, *Sam Halabi [email protected] Georgetown University, Washington, DC, USA (JM); and The University of Tulsa, Tulsa, OK 74104, USA (SH) 1
2
US Department of Health and Human Services. Secretary Burwell issues declaration under PREP Act to support development of Ebola vaccines. http://www.hhs.gov/news/ press/2014pres/12/20141209a.html (accessed July 6, 2015). Dukes G, Mildred M, Swartz B. Responsibility for drug-induced injury: a reference book for lawyers, the health professions and manufacturers. Oxford: IOS Press, 1998, 451–67.
Another step change for tobacco control in China? In their Editorial about tobacco control in China (May 30, p 2122),1 the Editors of The Lancet discussed the steps that the Chinese Government is taking to control tobacco, which includes the adjustment of China’s consumption tax on the wholesale price of cigarettes. Is increasing tobacco taxation really another step change for tobacco control in China? China is the world’s largest tobacco producer and manufacturer, and is also home to more than 300 million smokers who consume over one-third of the world’s cigarettes and another 740 million people who are exposed to passive smoking. Tobacco use in China is causing a substantial rise in health hazards and economic burden, therefore comprehensive tobacco control is clearly needed. International experience and results of
studies consistently show that raising taxes on tobacco is one of the most cost-effective ways to reduce tobacco use.2 Hence, the WHO and relevant experts have repeatedly suggested that the Chinese Government should control tobacco use by sharply increasing tobacco taxes. However, for a long time, the government has been hesitating to use such strategies in its bid to reduce tobacco use for some well known reasons.3 The excise taxes on cigarettes in China have always been very low: in 2011, taxes levied on the retail price of cigarettes were still far from reaching the 70% suggested by WHO. A tobacco consumption tax was introduced in 1994, and the tax rate increased slightly in 1998, 2001, and 2009. Furthermore, every time the tobacco tax rate increased, China’s tobacco industry subsequently increased their subsidies to cigarette manufacturers to offset the negative effect. As a result, tobacco excise taxes could not be fully passed on to retail prices, and the retail prices barely changed. On May 7, 2015, the Chinese Ministry of Finance announced an increment in the consumption tax on wholesale cigarettes from 5% to 11% and each cigarette would also be taxed ¥0·005.4 The next day, the State Tobacco Monopoly Administration announced a 6% increase in wholesale cigarette prices and recommended a 10% increase in the retail price of each pack of cigarettes.5 Unlike previous tobacco tax adjustments, this increase in tobacco taxes is passed on to retail prices, which was considered impossible when taking into account the unique relation between the tobacco industry and the Chinese Government. After May 10, 2015, we observed that cigarette prices had increased by about 10% in many tobacco stores. Most people who care about tobacco control welcome tobacco tax adjustment and regard it as another step for tobacco control in China after the announcement of a
Associated Press
Correspondence
For the Global Adults Tobacco Survey China 2010 see http:// www.who.int/tobacco/ surveillance/survey/gats/en_ gats_china_report.pdf?ua=1
339
Correspondence
For the Beijing control smoking ordinance see http://210.75.193.155/rdzw/ information/exchange/Laws.do? method=showInfoForWeb& id=2014321
340
long-awaited draft national tobacco control guideline by the Legislation Office of the State Council, paving the way for strong action on tobacco control at the national level. The rise of the wholesale cigarette tax was expected to reduce cigarette consumption. However, according to a survey done by the Beijing Morning Post 6 most smokers ignored this price increase and expressed that they would not change the smoking habit. Why? One smoker commented that the price of cigarettes in China has barely changed much in the past 15 years, whereas personal incomes have been rising rapidly during this same period. Cigarettes are still quite affordable even after the adjustment. The increase of tobacco taxes is far from sufficient, and the effort to reduce smoking is muted because of the steady rise in personal incomes. Compared with the UK, China’s tobacco taxes are still moderate and, even after the latest increase, do not meet WHO recommendations. The government might be still reluctant to meet these recommendations, with fear of damaging the tobacco industry—a major economic pillar—thereby affecting the government revenue. Additionally, tax rates are simple to raise, and even the necessary approval procedures of the National People’s Congress can be exempted. So why is it so difficult to change? China has 300 million smokers and the largest tobacco industry in the world—making an increase in tobacco control crucial, but also making tobacco control a complicated task for the Chinese Government. To do so, China will face various obstacles, such as those from the State Tobacco Monopoly Administration. In terms of the extent of the tax hike this time, there is still a long way to go before smoking is curbed, but the campaign against tobacco in China has picked up in the past several months. Since June 1, 2015, the strictest smoking control law took effect in
Beijing. However, learning from the past, challenges remain. Will the smoking prohibition be enforced completely? Let us wait and see. We declare no competing interests.
*Yong Hu, Xiaoyang Sun, Zhenshan Yuan, Weixin Dong, Jiao Zhang [email protected] Department of Spinal Surgery, Ningbo NO. 6 Hospital, Ningbo 315000, China (YH, ZY, WD); and Medical College of Ningbo University, Ningbo, China (XS, JZ) 1
2
3 4
5
6
The Lancet. Will China make the great leap in tobacco control in 2015? Lancet 2015; 385: 2122. Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control 2012; 21: 172–80. Dan X, Yuankai S, Chen W. Tobacco in China. Lancet 2014; 383: 2045–46. The Ministry of Finance. Notice on the adjustment of cigarette consumption tax. http://www.gov.cn/xinwen/2015-05/08/ content_2859258.htm (accessed May 8, 2015). The Central People’s Government of the People’s Republic of China. The State Tobacco Monopoly Bureau issued a notice about domestic and imported cigarette cigarettes price adjustment. http://www.gov.cn/ xinwen/2015-05/11/content_2860059.htm (accessed May 11, 2011). Xiaofei Peng. Beijing Morning Post (Beijing). May 18, 2015. http://money.163. com/15/0518/06/APSJ0C6Q00253B0H.html (accessed May 18, 2015).
countries, such as Germany, where elaborate regulation6 impedes important investigations; this situation would be improved by easing access to a deceased person’s data. In the case of posthumous organ donation, people can choose to donate all their organs or specific ones. We think that the same should be true of data. All citizens should be encouraged to have a data donor card (and associated electronic record) that states whether their data can be used, and also which data can be used, for research after their death. We encourage governments to create, and all citizens to obtain, a data donor card and we would urge people to consent to donate data for open use after their death. Necessary details including data donation agreements and establishment of appropriate data donor banks and data donor registers on the basis of respective data donor laws pose no particular challenges. Overall, formalised data donation could prevent waste of crucial research information such as posthumous medical data, which is an extremely valuable legacy that should not be left untapped. We declare no competing interests.
Data donation after death
*David M Shaw, Julianne V Gross, Thomas C Erren
Sheila Bird (May 9, p 1830) recently pointed out how late registration of death in England and Wales seriously disabled statistical and epidemiological studies. Another serious obstacle to essential observational research is the accessibility of precious medical data after a person’s death. To prevent waste of medical research data, we suggest that all citizens should be encouraged to donate data after death just as people donate organs posthumously, as was previously suggested in relation to brain researchers’ personal data.2 It is clear that data should be protected, 3–5 but we equally need research protection. The present environment is challenging in some
Institute for Biomedical Ethics, University of Basel, CH-4056 Basel, Switzerland (DMS); and Institute and Policlinic for Occupational Medicine, University Hospital of Cologne, Cologne, Germany (JVG, TCE)
1
[email protected]
1 2 3 4 5
6
Bird SM. End late registration of fact-of-death in England and Wales. Lancet 2015; 385: 1830–31. Taylor KE. A data-donor scheme for brain researchers. Lancet 2000; 355: 849–50. Data protection in a digital age. Lancet 2009; 373: 518. McCall B. European Parliament supports data protection reforms. Lancet 2014; 383: 1115. Dove ES, Townend D, Knoppers BM. Data protection and consent to biomedical research: a step forward? Lancet 2014; 384: 855. German Federal Ministry of Justice and Consumer Protection. Federal Data Protection Act in the version promulgated on Jan 14, 2003 (Federal Law Gazette I p 66), as most recently amended by Article 1 of the Act of August 14, 2009 (Federal Law Gazette I p 2814). http://www.gesetze-im-internet.de/ englisch_bdsg/englisch_bdsg.html (accessed June 4, 2015).
www.thelancet.com Vol 386 July 25, 2015