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Tobacco-control treaty language approved despite objections
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Tobacco-control treaty language approved despite objections
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It’s taken several years to get here but this treaty is a milestone in the history of public health China—with its stateowned monopoly—voiced procedural concerns. Japan—another renowned holdout because of the Finance Ministry’s majority stake in Japan Tobacco International—politely welcomed the draft text but likened the task of winning domestic acceptance to climbing a mountain. “The convention we have agreed on is a real milestone in the history of global public health”, said WHO DirectorGeneral Gro Harlem Brundtland who made tobacco control the cornerstone of her term in office and kick-started the negotiations in October, 1999. “Tobacco kills in every country of the world, and probably most of us know someone who has died”, she added. “Due to the actions that will follow from our shared commitments, millions and millions of lives will be saved”, said the former Norwegian prime minister, who stands down in July after 5 years. Seixas Correa, Brazil’s ambassador to the United Nations in Geneva, also voiced his satisfaction at pushing through a “powerful treaty” against a “common threat”. The Framework Convention Alliance, grouping some 180 campaigners such as the American Lung Association and the Campaign for
THE LANCET • Vol 361 • March 8, 2003 • www.thelancet.com
Tobacco Free Kids, hailed the outcome as historic. WHO estimates that 4·9 million people die every year of smokingrelated disease. It warns that this will swell to 10 million by 2030 as a result of the explosion in smoking in China and other developing nations. The draft convention is stronger than the text submitted to the 2week long negotiations by Seixas Correa. Incensed that the Brazilian diplomat’s Treaty is great news for the public document largely ignored the majority view at complete disarray. the previous talks in October, “We had hoped this could developing countries in Africa, have been concluded as a southeast Asia, and the consensus text”, said David Middle East effectively forced Hohman, the US health through a paragraph-byattache in Geneva. paragraph revision. “Unfortunately this is not Brundtland had thrown her possible.” The US negotiators weight behind Seixas Correa, were particularly upset about apparently hoping that Article 30 of the draft treaty, sceptics like the USA, which simply states that “no Germany, and Japan would be reservations may be made to able to agree to a less rigid this convention”. text, thus ensuring a smooth They argued in vain that it adoption by the WHA and the was vital for countries to have maximum possible number of the flexibility to opt out of ratifications. individual clauses that That is now open to violated the national question, especially because of constitution or were otherwise the US objections. The unacceptable. danger is that if the USA “We are disappointed that pushes for parts to be reservations are excluded renegotiated at the WHA, this which is a complication for may unravel the entire our legislative process”, text—and throw the WHA’s Hohman said, referring to the already packed agenda into fact that the US Senate may AP
fter tortuous negotiations, more than 170 governments agreed on the language of the proposed Framework Convention on Tobacco Control (FCTC) in the early hours of March 1, laying the groundwork for WHO’s first ever binding public-health treaty. The text, and in particular plans to ban or severely restrict tobacco advertising and introduce new labelling controls, was tougher than expected. It also contains provisions on environmental smoke, smuggling, manufacturer liability, education and cessation assistance, and taxation measures. Negotiating chairman Luis Felipe de Seixas Correa announced the agreement just after 0230 h. But the sense of exhausted euphoria was dampened by the US announcement that—although it wouldn’t block approval—it found parts of the draft treaty unacceptable and that it was examining its options for when the text is forwarded to the World Health Assembly in May. Ashen-faced German negotiators also voiced their objections to the advertising restrictions. Germany, which has long tried to frustrate European Union (EU) action against advertising and sponsorship, is likely to come under intense pressure from irate EU partners to fall into line before the WHA.
A
839
For personal use. Only reproduce with permission from The Lancet Publishing Group.
balk at ratification. Hohman said that the general definition on advertising and sponsorship was too broad but—amid considerable surprise—he said that Washington could generally live with the sweeping advertising restrictions. But Hohman said the USA had serious concerns about the plan to force manufacturers to put a health warning on at least 30%, and preferably 50%, of a cigarette pack. The tobacco industry claims this is in breach of its trademark rights. A provision that would ban free distribution of cigarettes was also, he continued,
unacceptable because it ignored US federal rules that provide for the regulation of commercially sold products but not giveaways. In one of the more bizarre twists to a public health treaty, the USA also objected to language in the preamble voicing concern about high smoking rates among indigenous “peoples” rather than “people” as is the norm in UN conventions. Washington fears such language may set a dangerous precedent and imply some sort of notion of sovereignty for native American Indians. Although the USA has strict tobacco-control legislation compared with
most countries, it was the object of suspicion throughout the negotiations. Antismoking campaigners charged that the Bush administration is more interested in protecting the profits of Philip Morris—the world’s biggest exporter—than the health of the poor. “We didn’t expect the United States to ratify anyway”, said Clive Bates, director of ASH UK, in reference to the US objections. “They haven’t ratified treaties like this for years. Their presence here is academic.” Clare Kapp
Key points of the draft tobacco convention Price and tax measures: Governments shall implement tax policies, and where appropriate, price policies “so as to contribute to the health objectives aimed at reducing tobacco consumption”, and prohibit or restrict duty-free sales to international travellers. Exposure to tobacco smoke: Governments shall take measures “providing protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public planes, and, as appropriate, other public places”. Packaging and labelling: Within 3 years of entry into force of the convention, signatories shall adopt national measures to ensure that product packaging and labelling “do not promote a tobacco product by any means that are false, misleading, deceptive” or give the impression that a particular product is less harmful than others. “These may include terms such as ‘low-tar, ‘light’, ‘ultra-light’, or ‘mild,”—although there is no total ban on such terms. Each pack must carry health warnings which should
ideally be 50%—but no less than 30%—of the principal display and may include pictures or pictograms. Advertising, promotion, and sponsorship: “Each party shall, in accordance with its constitution or constitutional principles, undertake a comprehensive ban of all tobacco advertising, promotion, and sponsorship”. This should be within 5 years and include sponsorship of international events and—subject to technical constraints—crossborder advertising. Radio, television, print media, and—as appropriate—other media such as the internet—should be covered. Countries unable to impose a ban for constitutional reasons (including the USA) shall apply restrictions. Demand reduction: Signatories shall increase public awareness and education activities and develop effective cessation and counselling programmes. Illicit trade: Governments shall implement measures to ensure that all unit packets
and outside packaging are marked to help determine the origin of the product and carry wording such as “sales only allowed in xx country”. There should be more international exchange of information between tax and customs authorities and cooperation between enforcement agencies. Sales to minors: Signatories shall prohibit the sale of cigarettes to minors by requiring vendors to place prominent signs and ask for proof of age; banning sales from accessible store shelves; and restricting the sale of individual or small quantities of cigarettes. Liability: “For the purpose of tobacco control, the Parties shall consider taking legislative action or promoting their existing laws, where necessary, to deal with criminal and civil liability, including compensation where appropriate.” This is the first time an international treaty has introduced the concept of manufacturer liability, although the provisions are deliberately vague. Clare Kapp
History of the treaty May, 1999: WHA resolution formally endorses plans for a global tobacco control treaty. October, 1999: WHO holds first working group meeting, which agrees on basic elements of planned FCTC. August, 2000: WHO report says that Big Tobacco systematically tried to infiltrate the organisation and undermine its antismoking strategies. October, 2000: WHO hosts unprecedented public hearings on tobacco. First formal Intergovernmental Negotiating Body (INB) meets, bringing in representatives of finance and agriculture ministries for the first time. April, 2001: INB2 discusses text by then chairman Celso Amorim of Brazil, which would ban advertising and sponsorship aimed at under-18s. November, 2001: INB3 discusses text filled with brackets with competing options. March, 2002: Luis Felipe de Seixas Correa takes over as chairman at INB4 after heading off a challenge from South Africa, one of the strongest proponents of strict tobacco control. July, 2002: Seixas Correa publishes draft of treaty, proposing that countries “reduce, with a view to gradually eliminating” advertising, promotion, and sponsorship. October, 2002: Momentum grows at INB5 in favour of much stronger restrictions on advertising and sponsorship. January, 2003: Seixas Correa produces a watered-down text, which is endorsed by Bruntdland. But antismoking groups and African nations denounce it as too feeble. Feb 17, 2003: INB6 opens with Brundtland appealing to countries to agree to a draft treaty which can command broad support. March 1: Negotiators from around 170 countries approve the language of the draft FCTC and agree that it should be forwarded to WHA for adoption. Clare Kapp
840
THE LANCET • Vol 361 • March 8, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
EU improves rules for handling human cells and tissue HIV/AIDS lowers UN’s global population estimates South Africa stalls again on access to HIV drugs Religious leaders back Croatia’s first no-smoking day News in brief New internet brings medicine up to speed Swiss financial capital attracts suicide tourists
Tobacco-control treaty language approved despite objections
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
It’s taken several years to get here but this treaty is a milestone in the history of public health China—with its stateowned monopoly—voiced procedural concerns. Japan—another renowned holdout because of the Finance Ministry’s majority stake in Japan Tobacco International—politely welcomed the draft text but likened the task of winning domestic acceptance to climbing a mountain. “The convention we have agreed on is a real milestone in the history of global public health”, said WHO DirectorGeneral Gro Harlem Brundtland who made tobacco control the cornerstone of her term in office and kick-started the negotiations in October, 1999. “Tobacco kills in every country of the world, and probably most of us know someone who has died”, she added. “Due to the actions that will follow from our shared commitments, millions and millions of lives will be saved”, said the former Norwegian prime minister, who stands down in July after 5 years. Seixas Correa, Brazil’s ambassador to the United Nations in Geneva, also voiced his satisfaction at pushing through a “powerful treaty” against a “common threat”. The Framework Convention Alliance, grouping some 180 campaigners such as the American Lung Association and the Campaign for
THE LANCET • Vol 361 • March 8, 2003 • www.thelancet.com
Tobacco Free Kids, hailed the outcome as historic. WHO estimates that 4·9 million people die every year of smokingrelated disease. It warns that this will swell to 10 million by 2030 as a result of the explosion in smoking in China and other developing nations. The draft convention is stronger than the text submitted to the 2week long negotiations by Seixas Correa. Incensed that the Brazilian diplomat’s Treaty is great news for the public document largely ignored the majority view at complete disarray. the previous talks in October, “We had hoped this could developing countries in Africa, have been concluded as a southeast Asia, and the consensus text”, said David Middle East effectively forced Hohman, the US health through a paragraph-byattache in Geneva. paragraph revision. “Unfortunately this is not Brundtland had thrown her possible.” The US negotiators weight behind Seixas Correa, were particularly upset about apparently hoping that Article 30 of the draft treaty, sceptics like the USA, which simply states that “no Germany, and Japan would be reservations may be made to able to agree to a less rigid this convention”. text, thus ensuring a smooth They argued in vain that it adoption by the WHA and the was vital for countries to have maximum possible number of the flexibility to opt out of ratifications. individual clauses that That is now open to violated the national question, especially because of constitution or were otherwise the US objections. The unacceptable. danger is that if the USA “We are disappointed that pushes for parts to be reservations are excluded renegotiated at the WHA, this which is a complication for may unravel the entire our legislative process”, text—and throw the WHA’s Hohman said, referring to the already packed agenda into fact that the US Senate may AP
fter tortuous negotiations, more than 170 governments agreed on the language of the proposed Framework Convention on Tobacco Control (FCTC) in the early hours of March 1, laying the groundwork for WHO’s first ever binding public-health treaty. The text, and in particular plans to ban or severely restrict tobacco advertising and introduce new labelling controls, was tougher than expected. It also contains provisions on environmental smoke, smuggling, manufacturer liability, education and cessation assistance, and taxation measures. Negotiating chairman Luis Felipe de Seixas Correa announced the agreement just after 0230 h. But the sense of exhausted euphoria was dampened by the US announcement that—although it wouldn’t block approval—it found parts of the draft treaty unacceptable and that it was examining its options for when the text is forwarded to the World Health Assembly in May. Ashen-faced German negotiators also voiced their objections to the advertising restrictions. Germany, which has long tried to frustrate European Union (EU) action against advertising and sponsorship, is likely to come under intense pressure from irate EU partners to fall into line before the WHA.
A
839
For personal use. Only reproduce with permission from The Lancet Publishing Group.
balk at ratification. Hohman said that the general definition on advertising and sponsorship was too broad but—amid considerable surprise—he said that Washington could generally live with the sweeping advertising restrictions. But Hohman said the USA had serious concerns about the plan to force manufacturers to put a health warning on at least 30%, and preferably 50%, of a cigarette pack. The tobacco industry claims this is in breach of its trademark rights. A provision that would ban free distribution of cigarettes was also, he continued,
unacceptable because it ignored US federal rules that provide for the regulation of commercially sold products but not giveaways. In one of the more bizarre twists to a public health treaty, the USA also objected to language in the preamble voicing concern about high smoking rates among indigenous “peoples” rather than “people” as is the norm in UN conventions. Washington fears such language may set a dangerous precedent and imply some sort of notion of sovereignty for native American Indians. Although the USA has strict tobacco-control legislation compared with
most countries, it was the object of suspicion throughout the negotiations. Antismoking campaigners charged that the Bush administration is more interested in protecting the profits of Philip Morris—the world’s biggest exporter—than the health of the poor. “We didn’t expect the United States to ratify anyway”, said Clive Bates, director of ASH UK, in reference to the US objections. “They haven’t ratified treaties like this for years. Their presence here is academic.” Clare Kapp
Key points of the draft tobacco convention Price and tax measures: Governments shall implement tax policies, and where appropriate, price policies “so as to contribute to the health objectives aimed at reducing tobacco consumption”, and prohibit or restrict duty-free sales to international travellers. Exposure to tobacco smoke: Governments shall take measures “providing protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public planes, and, as appropriate, other public places”. Packaging and labelling: Within 3 years of entry into force of the convention, signatories shall adopt national measures to ensure that product packaging and labelling “do not promote a tobacco product by any means that are false, misleading, deceptive” or give the impression that a particular product is less harmful than others. “These may include terms such as ‘low-tar, ‘light’, ‘ultra-light’, or ‘mild,”—although there is no total ban on such terms. Each pack must carry health warnings which should
ideally be 50%—but no less than 30%—of the principal display and may include pictures or pictograms. Advertising, promotion, and sponsorship: “Each party shall, in accordance with its constitution or constitutional principles, undertake a comprehensive ban of all tobacco advertising, promotion, and sponsorship”. This should be within 5 years and include sponsorship of international events and—subject to technical constraints—crossborder advertising. Radio, television, print media, and—as appropriate—other media such as the internet—should be covered. Countries unable to impose a ban for constitutional reasons (including the USA) shall apply restrictions. Demand reduction: Signatories shall increase public awareness and education activities and develop effective cessation and counselling programmes. Illicit trade: Governments shall implement measures to ensure that all unit packets
and outside packaging are marked to help determine the origin of the product and carry wording such as “sales only allowed in xx country”. There should be more international exchange of information between tax and customs authorities and cooperation between enforcement agencies. Sales to minors: Signatories shall prohibit the sale of cigarettes to minors by requiring vendors to place prominent signs and ask for proof of age; banning sales from accessible store shelves; and restricting the sale of individual or small quantities of cigarettes. Liability: “For the purpose of tobacco control, the Parties shall consider taking legislative action or promoting their existing laws, where necessary, to deal with criminal and civil liability, including compensation where appropriate.” This is the first time an international treaty has introduced the concept of manufacturer liability, although the provisions are deliberately vague. Clare Kapp
History of the treaty May, 1999: WHA resolution formally endorses plans for a global tobacco control treaty. October, 1999: WHO holds first working group meeting, which agrees on basic elements of planned FCTC. August, 2000: WHO report says that Big Tobacco systematically tried to infiltrate the organisation and undermine its antismoking strategies. October, 2000: WHO hosts unprecedented public hearings on tobacco. First formal Intergovernmental Negotiating Body (INB) meets, bringing in representatives of finance and agriculture ministries for the first time. April, 2001: INB2 discusses text by then chairman Celso Amorim of Brazil, which would ban advertising and sponsorship aimed at under-18s. November, 2001: INB3 discusses text filled with brackets with competing options. March, 2002: Luis Felipe de Seixas Correa takes over as chairman at INB4 after heading off a challenge from South Africa, one of the strongest proponents of strict tobacco control. July, 2002: Seixas Correa publishes draft of treaty, proposing that countries “reduce, with a view to gradually eliminating” advertising, promotion, and sponsorship. October, 2002: Momentum grows at INB5 in favour of much stronger restrictions on advertising and sponsorship. January, 2003: Seixas Correa produces a watered-down text, which is endorsed by Bruntdland. But antismoking groups and African nations denounce it as too feeble. Feb 17, 2003: INB6 opens with Brundtland appealing to countries to agree to a draft treaty which can command broad support. March 1: Negotiators from around 170 countries approve the language of the draft FCTC and agree that it should be forwarded to WHA for adoption. Clare Kapp
840
THE LANCET • Vol 361 • March 8, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.