Ep 16: How does Big Tobacco target different countries?

From the Tobacco Control Research Group at the University of Bath hosted by me, Louis Lawrence.

“We are an international research group that investigates the tactics used by Big Tobacco to”

maximise its profits at the expense of public health. The evidence we produce helps society to hold this deadly industry to account. If you enjoy listening, then please subscribe, leave us a review and share this podcast. Big Tobacco is a global industry and one that reinvents itself to drive sales and maximise profits from its deadly products.

In this episode, we're digging into how the industry tailors its strategies across different regions of the world and how it uses the Tobacco Control efforts of different countries as promotional material.

We'll hear how companies take credit for reducing national smoking rates by claiming that

industry products are responsible. In today's episode, we'll hear from in-country experts about how the industry is co-opting their success. I'm also joined remotely in the studio by Dr. Gangewan, Senior Vice President of Tobacco Control at vital strategies to help us unpack how these localized stories are being used

by the industry on the global stage to argue against regulation of its products. Welcome, Dr. Gangewan. Thank you for having me, Louis.

To start off maybe as a bit of an introduction, you could possibly tell us about your experience

is in tobacco control, the work of vital strategies in challenging the global tobacco industry. Right. At Western Strategies, we're going to back control in over 50 countries around the world and we help governments with tobacco control policies and implementation. As you know, during the policy adoption process, tobacco industry interference is something

we have to deal with all the time.

“So, one key area of the work for us is countering tobacco industry interference in almost”

every country we're working. I have to say we are very familiar with the traditional sort of tactics of tobacco industry lobbying the government and over the past 10 years or so, we started to observe this new tactic or strategies from the tobacco industry, which is they are really taking the opportunity of the emergence of easy grants and heated tobacco products to promote their

so-called harm reduction and industry transformation narratives. They're really using these tactics to whitewash their image and gain a seed at the policy making table at the government, which is very concerning. But also this strategy is very destructive for the government who should be focusing on tackling the issue of cigarettes smoking.

So, it's obviously a real challenge for governments around the world. Maybe you could tell us a bit more about exactly how, well, firstly, what is vital strategies as an organisation and how exactly do you support governments when they're dealing with that kind of interference? Yeah, other strategies we our primary mission is to help governments around the world to build

“a big health systems and as part of the public health systems, policy is a very important part”

of it and once you have passed the policies, then implementation of the policy is also a very important issue because if you only have the policy on paper without implementation and the enforcement, you won't see live saved as a result of the tobacco control policies. So, in many countries, especially the lower middle income countries around the world, we vital strategies work very closely with governments.

We provide both technical and financial support to these governments, helping them adopt tobacco control policies, share the international best practices with these governments, by trainings, capacity building trainings, to the government staff, and also when it comes to countering tobacco interference, we also help these governments as FCTC article 5.3 policies. So, and we also work with NGOs, empowering these NGOs with the skills to

investigate and expose the tactics of tobacco industry in their country, doing investigations

of government staff in terms of why they should stay away from tobacco industry, why they should

“attack, publicly held the policy making from interference of the tobacco industry.”

So, one of these kind of interference tactics, as you mentioned briefly before, is using the case of these newer products as a way to argue against other more traditional forms of tobacco control and tobacco regulation. We've seen how the industry uses, we're going to hear a bit more in these case studies about how the industry uses success stories in specific countries to support

its own narrative, things like the use of snooze and Sweden vaping in the UK and heat tobacco

products in Japan. In your view, how much of this messaging, the sort of narratives that the industry uses is a coordinated global effort, how much is it kind of a more optimistic response

“to local events? I think it's absolutely very much strategically coordinated globally from the”

tobacco industry. We should look no further than the foundation for smoke-free world, which is no organisation launched with funding from the Morris International with the amount of

around the pledge funding of amount of $1 billion in 2017. Of course, the foundation for smoke-free

world has pretty much failed and hasn't really achieved the desired purpose of PMI and their investment has reduced dramatically. But if you look at the core strategies of the foundation for smoke-free world when it was established, it was pretty much to promote the harm reduction narrative harm reduction products and the associated industry transformation narrative from the Morris

“and similarly for British American tobacco and Japan tobacco international as well.”

If you look at the tobacco companies themselves, for instance, for PMI, we know PMI's acquisition of several pharmaceutical companies, such as a vectoral, fwritten and autotopic in the past few years. These acquisitions are very much in line with this so-called transformation strategy, which is really to brand the tobacco industry themselves as a new entity so that they can claim to be the solution for this tobacco epidemic and they can gain a seed at the tobacco

control policy-making table inside the government. When it comes to the lower middle-income countries, such messaging has been delivered by a lesion of front groups and many of them are supported by the foundation for smoke-free world. They're active in many of countries. We work in especially Philippines, Vietnam, Indonesia, India, and so on and so forth. And very often, they're not only promoting this industry transformation in harm reduction

and narratives and they're also attacking tobacco control advocates who do not share the same position with them who do not embrace the industry's transformation harm reduction tactics. And many of the tobacco control NGOs who work in these countries, including vital strategies, have been the target of these attacks by the front groups of the tobacco industry as well. You mentioned the foundation for smoke-free world. It's an organization we've heard quite a lot

about in this and the last series of the deadly industry podcast. Now, of course, free-named to global action to end smoking. We also heard about how Philip Morris had pulled funding to some extent, but are you still seeing them as a kind of active threat in these areas in particular countries? Still, they are very, very much active in many of the countries. We, we working, even though their funding has been slashed by PMI as you just mentioned,

quite significantly, but over the past almost ten years, they have really cultivated a group of harm reduction advocates who are very much well coordinated across the country

the smoking reduction needs Sweden is due to snooze use and the success story of vaping in the

UK and also the popularity of heated tobacco products in Japan and really tried to push many of the lower middle-income countries to follow the success stories of these countries.

“You know, I think there's a lot we can talk about the products per se. There's, you know,”

for instance, when it comes to easy threats, there is some evidence of the utility of easy threats to help smokers crystal-looking, but only in clinical settings. And we know it's not the interest

of the tobacco industry or the easy-grade companies to produce easy threats as cessation hates.

Their main intention is to produce these products or promote these products as consumer products. Where the situation gets a lot a lot more complicated as we have observed. There's a lot of dual use amongst smokers and smokers who used to have the intention to quit smoking entirely, but now come back to use these products and become dual users and a lot of nicting addiction

“among the youth. And I think one thing I really want to emphasize in the lower middle-income”

country setting is the very or regulatory infrastructure. The marketing of these products is especially

easy threats. It puts a lot of burden onto the government's regulatory body. And in every country, as we, you know, as we talk about thousands of different flavors and variations of the products, and we have seen how the FDA and the U.S. struggled with enforcement. And we have seen how the regulatory agencies in many, a lot of my sees failed big time. So these advocates, these from reduction advocates or front groups by the tobacco industry really

choose not to see the regulatory inefficiencies of the LMI sees and try to sell the so-called success stories of some of the high-income countries. And I think the result is inevitably what is going to be called a dual epidemic of both smoking and some of the use of some of the new products. You mentioned there the kind of selling of these success stories from high-income countries to low- and mid-income countries by the industry on international scale. We're going to

hear from a moment, a short case study interview from Swedish to our control expert, Lisa Lennard's daughter Irman from the research group, Cancer Fondon, who talked to us earlier on about what's known as the Swedish experience. And she talks quite a lot in this case study about it's news. Maybe we could give us a quick intro to what news actually is. News is not a product you can smoke. It's made of tobacco leaves and it's a pouch and you can insert between between your gum and insider mouth and the

nicotine from these products will be absorbed through the blood vessels inside the mouth into the

“blood system and finally into the brain. And that's how you get the nicotine, the kick,”

the high from nicotine consumption. Thanks for that, Lisa Lennard. So the narrative that is promoted by tobacco industry advocates is that the Swedish experience have been using news as a way of decreasing, smoking tobacco, which is not true. Swedish politicians have been aiming at decreasing all tobacco use between 2003 and 2024. So the goal for the government in Sweden have been to reduce all tobacco use including sniffs. But that is something that is promoted as the Swedish way

that we use the news which we haven't done. And so that's one one thing. And the other is statistics on how successful Sweden have been to tobacco industry advocates would a lot of times say we have

born citizens. So it's a true number, but it's used in a misleading way. So it's Swedish born

“citizen, not all citizens, which I think is a bizarre way of presenting statistics. So if you want”

to know how many people or how big the percentage is of tobacco users in Sweden, that is 11% and that's a difference between 4.5% and 11%. So that is also using real statistics, but in a misleading way, a lot of times they put our Swedish born citizen number of 4.5% next to current use number, meaning totally use from another country. And those numbers can't be compared. And that is also

very misleading. So to promote the Swedish experience or the Swedish model, they use statistics

to make Sweden look even more successful than we actually have been. I mean, Sweden have been successful and there are reasons to look at Sweden for what we've done, but that will be looking at

“classical tobacco control measures, because that is what Sweden has. We really don't, to reduce”

tobacco use. Thanks to Lisa there, it's interesting, you know, case in Sweden, Gangewell. One thing that stood out was this issue of the misuse of statistics, kind of unfair comparisons between Sweden and other countries, depending on the population that the industry chooses to compare. Is that quite a common strategy that kind of statistical misdirection? Um absolutely, we know from history, the spark industry really has a long record of

but manipulating science and you know dating back, I would say dating back to the 1960s, you know,

70s, especially when we realized how second-hand smoke could harm your health in how second-hand

smoke could cause a long cancer. The industry is really a spend a lot of money, supported a lot of research and employed many researchers to produce junk science to confuse the public about the issue of second-hand smoke. So, really very, very long

“history of manipulating science and that's why within the tobacco control community,”

we ask researchers not to work with tobacco industry and second-of-all not to receive funding from the tobacco industry because we know from the inside documents from the tobacco industry, they do have a history of manipulating science and manipulating any research. That brings us on to our next case study actually, which is in the Asian context. For this one, we're joined by Dr. Ulysses Dorotheo, Executive Director at the

Southeast Asia, Tobacco Control Alliance, and he shared of us what kind of tactics the industry is using in his region. Siyatka, the Southeast Asia Tobacco Control Alliance, works throughout the ASEAN region, which covers 10 countries, the Association of Southeast Asian Nations. So, that would be Brunei, Cambodia, Indonesia, Lao, PDR, Myanmar, Malaysia, Philippines, Singapore, Thailand, and Vietnam, and obviously the industries in all these countries, to varying extents.

Maybe we'll focus a bit more on my country, the Philippines, because I know that best and also, in the region, the Philippines, Indonesia, Vietnam, and Thailand have the highest smoking populations. We also have the largest populations in the region overall. So, that's where the industry's focused to try to expand its market, not just for cigarettes, but also for its newer products, have chronic smoking devices, particularly heated tobacco products.

But they conflate the two, heated tobacco and electronic cigarettes, and they will try, and they have been trying to get both products into the market wherever the opportunity exists. So, very recently, there was a technovations expo where Philip Morris said, "Oh, you should follow

nicotine alternatives into the market, and they're doing quite well, and so other countries should follow.

“And I can tell you, we're not doing well, we have a huge surge in”

esigrate use among our youth. Over time, we've been able to reduce our smoking prevalence among adults from about 33% now it's down to 19 as of 2021, and this is primarily because of our higher tax rates on cigarettes. And at the same time, smoking prevalence among the young have also reduced, but in the past, I'd say, five years, we've seen an upsurge in esigrate use, and now our

youth vaping rate is around 14% as opposed to our smoking prevalence among youth, which is 10%.

And given that we know there will be a, the way esigrates are a gateway to smoking later on,

“there's a very high risk of that happening. We're seeing in the future, possibly a reversal”

of the downtrend of the decline in smoking in our country. And in the industry, also uses other countries as examples for our country to follow. And they still do this, even though esigrates and he, the HTPs are in our country already, they still point to Japan, you know, as a good example where

HTPs were introduced in 2014, and smoking rates have declined, supposedly because of HTPs.

If we look at the evidence, obviously, we're not seeing a further decline in smoking prevalence compared to before the entry of HTPs. It was already on the decline, and the rate of the decline has remained constant, even in the UK, which they cite also quite often, as being a model for the Philippines, you know, when we were still debating our vape law, they said, the UK introduced these products into the market, and they've seen a decline in smoking prevalence. And we don't

see a further decline in smoking prevalence, despite the use of esigrates, the trend has been pretty much the same. So, Gandran, in the case study, we just heard, we had Dr. Dorotheo mentioned how esigrate policy in the UK is being used in the Philippines and Sophie Stasia, as one of these narratives of, by the tobacco industry, to promote its business. The UK actually has a long, strong history of tobacco control, regulation of tobacco products, but in recent years,

it has been praised by some quarters from bracing esigarettes as part of its smoking cessation strategies. To your mind, what complications arise when some of these products are then,

“you know, as we saw a Sweden as well, promoted by the tobacco industry in other parts of the world?”

Yeah, I think starting from the UK and also the US, as well as other high-income countries, when these products are introduced into the market, the government will be facing enormous challenges when it comes to enforcing the policies and enforcing the regulations when it comes to the sales of these products. Simply due to the nature of these products, and there are many variations of each type of product. So, great challenge for the government, and when it comes to some of the

lower-medal income countries that we are talking about here, especially in Southeast Asia, such as the Philippines, Indonesia, Vietnam, we know the enforcement capacity of the government in this part of the world is usually not optimal. And when the sort of the very relaxed policy is being pushed and by the tobacco industry and passed by the government, for instance, in the case in the Philippines, then what's going to happen is the enforcement agency,

such as the FDA in the Philippines, will be overwhelmed by the marketing and by the simply

in these countries. And because of the popularity of these products, we are seeing problems

“among youth to be skyrocketing in the past few years. And, you know, we also have pretty solid evidence”

that when youth starts to use these products, especially Egypt, then there's a very high chance that they will transition later in their lives to become cigarette smokers. So, that's really the underlying strategy of the tobacco industry to add a new generation of east to graduate users with nicotine and then continue to let them use, you know, a

platform of products produced by the tobacco industry, be it cigarettes, e-sigarettes, or heated

tobacco products. So, that's exactly what's going to happen in these countries. So, kind of rather than acting as an off-wrap from cigarettes, these new products are actually in some cases, more and on ramp to smoking, especially amongst youth. Exactly, exactly. And at the same time, you know, I think we shouldn't forget that the tobacco industry is claiming they are transitioning away from producing cigarettes. But, if you go to any

of the countries in this region, or, you know, Latin America, Eastern Europe, or even Africa,

the tobacco industry is really trying everything they can to stop any meaningful tobacco control policies from being passed. And these policies are really trying to address

“the issue of cigarette smoking. So, that's here. That's why we're saying the tobacco industry”

is not wholeheartedly claiming that they are transitioning away from producing cigarettes. You mentioned, hopefully, Latin America can context there, and our final case study, we, you know, really international episode today, we're going over to Latin America. We were joined by Daniel Dorado Torres, director of policy organizing and tobacco campaign for Latin America at corporate accountability. And he told us a bit more about

what was happening in that region and what kind of strategies the industry was using. So, overall, the tobacco industry is positioning its discourse or narrative around

“reduced risk products and alternatives for those consumers that want to have other options.”

Primarily, I am going to provide some examples of fielded Maurice International. Well, we have noticed that particularly this corporation, when they announced the launch or the of the Hitovaco products, Icos in Colombia, South America, back in 2017, well, they came with all this narrative that was positioned it globally, but primarily also with its launching Japan, when they were also back in 2014, they were announcing

that there were where's coming this new alternative for adults, smokers who want to have different options and also that these were our reduced risk products. But what calls our attention at corporate accountability was that the launch of this product in Colombia was made in one of the largest Latin American music festivals. The name of this music festival is a stereo picnic. And as you can imagine, it's not only a festival that is target for adults, even though

well, they're the festival itself promoting itself as only people that is over 18 years old cool at hand, but the ways they promote the festival, they use youth influencers to promote the festival of course, well, young adults, not only adults that are over the 30 years, you can imagine adults around 18 years, 19 years, 20 years attend in this type of festival. No, so well, here are those type of messages, why you are launching a product like this in a music festival

that convinced not only Colombian people, no, many, many people for all over Latin America came to this

documented in a report that corporate accountability launched back in 2024 and show how,

“particularly Philip Morris International at some stages of this festival was one of the sponsors”

of the festival as the festival editions keep evolving. They start to hide its participation. We imagine that it was because of the civil society exposure, but they came with this strong public relation message in that they were offering an annual alternative, but what another thing that captures our attention was that they were promoting advertising traditional products. At the same festival, so they keep promoting malborosigarits. Malboros is the top brand

selling of cigarettes of Philip Morris International. They promote this in the first editions of

the festival inside the festival, but at later editions, they were promoting the products outside the festival where young audience is able to walk through the venue and through other locations. So yeah, it is these contradictions between what, how you are positioning a product that sinks or that you position as something that is solely addressed to adults. And then you see that you are promoting, you keep promoting other products because when they came with with icons,

for example, they say that they will stop selling cigarettes and this has not been the case for

“Columbia, and I think has not been the case for any other country in the world. Second, that they”

are not target youth audiences and where the festival illustrates a contradiction. Up to date has not been demonstrated that they are doing anything to reduce the deaths that their products are causing. So again, during we heard that from Daniela Bay, this use of music festivals kind of cultural events as ways of targeting markets. I mean,

this is in some ways of familiar strategy of the tobacco industry that they've always been

interested in. It's kind of marketing through cultural sponsorship, that kind of thing. But this is about new products. What's your response to this strategy? This strategy with this strategy to ours is that tobacco industry is very much eyeing on the new generation that's their potential customers in the future. We know these cultural events such as music festivals are usually attended by the youth, by the young generation.

And that's where the tobacco industry is pouring their marketing and advertising dollars into promoting their products. And besides the examples shared by Daniela, we know recently in the Philippines that Steve Alke was collaborating with the Morrison National to promote their products' eye course in one of his concerts, which was to be held in the Philippines. And just another perfect example of how the tobacco industry work with celebrities

in trying to market their products targeting the youth. And thanks to the wireless and successful advocacy efforts from the tobacco control community of this particular concert in the Philippines was cancelled. So yeah, the tobacco industry is very much aware that the markets do die from smoking-related diseases. And many of them die younger. So they do need younger generations to continue to profit from this smoking epidemic.

I mean, it's an incredible amount of pressure that all countries are under, but particularly

as you mentioned, low and middle income countries or countries of weaker regulatory tobacco

“control laws in place. They're really vulnerable to some of these strategies aren't they?”

They've got these narratives about new products used in high income countries. They've also got sponsorship pressure on the young people of these countries to take up these new products. What can countries do when they're in this kind of bind? And how do you guys support some of these countries in challenging this immense amount of pressure they're under? I think when it comes to these new products, what we tell the countries

Well, a result in net public health benefit or not. They need to carefully assess the situation

“and start up to a cost-benefit analysis of this. And what we realized in these countries and”

in our working with the governments in these countries is that the introduction of these products will not switch smokers from away from smoking as the industry claim. But rather, it will just perpetuate the smoking epidemic among smokers. And also,

probably much more concerning is the younger generation that the younger generation will be

hook up with nicotine addiction and eventually become customers of the tobacco industry. So it's really up to the government to decide what kind of policies they want to adopt. And there's a lot of factors they need to take into consideration in whether they should ban or regulate these products. But we do know that many countries, for instance, when it comes to estigrats, about 42 countries around the world have banned the sale of estigrats. And we know many of the

countries we work in the Southeast Asian region, including Latin American region, have also banned the sale of these products mainly from the consideration that introduction of these products into the market will not bring net public health benefits to the country. And we know countries are that have banned the use of estigrats, for instance. They have lower problems of use among youth than countries who regulate the estigrats. So that's just another perspective

that when you ban these products, you are really doing a better job than regulating these products

to protect the health of your population. And finally, just zooming out to the kind of global

perspective again, what do you think can be done as a kind of global public health community

“to challenge these industry narratives and the way that the industry is adapting to tobacco control?”

Yeah, um, if we look back, let's say 20 years when the FCTC was first came into force, then the tobacco control community had a very strong consensus when it comes to their position against the tobacco industry. There was no question, you know, everybody was on the same page about the tobacco industry is a bad player and they should be shouldn't be engaged in tobacco control policy discussions, so on and so forth. There was no question

about that, but because of the emergence of these products and because of the industry's effort to sell the harm reduction and industry transformation narratives, we began to see a division within the tobacco control, even a monetary tobacco control community, starting, I was say about 10 years ago, in terms of the utility of the new products, such as especially the e-sigrats, and even their position to all the tobacco industry, whether they should be a player,

whether it should be a stakeholder in tobacco control or not. This is quite unfortunate.

“To see that tobacco control community is no longer as united as in the past, so I think part of that”

is due to the fact that the evidence on these products have not been conclusive because they are new to the market and the research studies on these products, many of them are still ongoing,

the tobacco control advocates can really have a clear understanding of these products and can be united

again against the tobacco industry, so because only if we can be a united force against the

tobacco industry, can we generate the power that we need to fight against the tobacco industry

“and to protect the tobacco control policies from the interference from the industry?”

I think that's an excellent point to end our conversation on, so all it's left to say is, thank you very much Dr. Gangewand for joining me today in the studio. Thank you.

“Also thanks to Lisa Leonard's daughter, Eman, you deceased Dorothy and Daniel Dorado Torres”

for also contributing their specialist knowledge to this episode, as always the sources for today's

discussion can be found in the episode show notes. This was the final episode of the second season

“of deadly industry challenging a big tobacco. We hope to be back with more episodes in the future”

where we'll continue to challenge deadly industries, but for now, thank you for listening. From the tobacco control research group you've been listening to season two of deadly industry challenging Big Tobacco hosted by Louis Lawrence produced by Kate White and edited by Sasha Goodwin. The production manager is Jacqueline Oliver. You can email us at [email protected] or find us on LinkedIn, Blue Sky and X. This is a University of Bath Production.