Article 5.3 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires that:
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.
While this sets clear standards for governments, there is no equivalent for health and related organisations and those who work with them. The tobacco industry, now more than ever, seeks the credibility of association with reputable scientists and organisations, as part of a strategy to present itself as part of the solution to a problem it has created and continues to promote. At the same time, it opposes evidence-based action to reduce smoking and its harms. This paper proposes that it is time to establish a civil society equivalent of Article 5.3 to protect reputable organisations from associating with or lending support and credibility to the tobacco industry.
Article 5.3 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was adopted in 2003 and has been ratified by 181 countries.1 This followed a World Health Assembly resolution confirming that “the tobacco industry has operated for years with the express intention of subverting the role of governments and of WHO in implementing public health policies to combat the tobacco epidemic”2, and sets out the principle that “there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests”.3 The subsequent import of Article 5.3 WHO FCTC is that governments “should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products”, and that the industry and its representatives should be excluded from any role in health-related policy discussions and development.3
There is a vast literature demonstrating that tobacco has for decades been and remains not only the world’s most lethal industry, but also dishonest, devious and corrupt.4 While WHO reports that tobacco now kills some 8 million people each year5, the industry has become more strategic and aggressive, through approaches including lobbying, front organisations6, denigration of individuals whose views it dislikes7,8, and litigation and trade disputes to prevent or delay governmental action on smoking. In the words of a 2016 UK High Court judgement, the tobacco industry “facilitates and furthers, quite deliberately, a health epidemic. And moreover, a health epidemic which imposes vast negative health and other costs upon the state”.9
Tobacco company strategies include promoting limited and highly selective information about minimally described and downplayed harms caused by their products, presenting themselves as responsible corporate citizens seeking solutions, and claiming altruism and innocence by association. To this end they have sought to associate themselves with worthwhile causes and reputable organisations, and to fund research and researchers in ways that can be presented as evidence of their concern, from the earliest days of the notorious ‘Frank Statement’10 – a 1954 advertisement by American tobacco companies as part of a campaign aimed at creating doubt about studies showing cigarettes cause harm – to the Philip Morris–funded “Foundation for a Smoke-Free World”.11 They have also over time developed a vast range of either modified or new products claimed and promoted as reducing the harms of smoking.12-14 The low tar and filters frauds14 served the industry well for decades in discouraging smokers from quitting, misleading children, generating support from some scientists and distracting governments from effective policies, but there are many other examples, through to the ever-growing range of aggressively promoted novel products of the present day.15
The rationale for tobacco company efforts to ‘build relationships’, ‘form alliances’, ‘establish coalitions’ and simply to engage with health groups and researchers has been especially well documented in relation to the Philip Morris ‘Project Sunrise’ – with advantages ranging from weakening credibility of anti-tobacco groups and individuals to explicitly dividing and conquering the tobacco control movement.16
In recent years the major tobacco companies have placed a renewed emphasis on using science (and their scientists) as a means of circumventing Article 5.3.17 Now more than ever, the industry seeks the credibility of association with reputable scientists and organisations, so that it can present itself as part of the solution to a problem it has created and continues to promote, while fiercely opposing evidence-based action to reduce smoking and its harms.
At one time, scientists and others could have been forgiven for believing that there might be a case for trusting or working with tobacco companies. Decades ago some of us hoped that informal discussions with tobacco industry employees could enable us to learn something about the industry and its activities; that its scientists might have a genuine interest in open communication in the interests of benefiting health; or that quiet discussions with the industry might help to change their attitudes and approaches.
But we have learned over the years, not least from millions of once-confidential industry documents now accessible following the US 1998 Master Settlement Agreement18, as well as from further exposés, that they will only tell us exactly what they are allowed or instructed to tell us, on occasions maintaining operations that are secret even within companies19; that the industry is likely to learn and benefit even more from these interactions; that the companies suppress infinitely more information than they make available; that any information provided by tobacco companies not fully in the public arena and verifiable has no plausibility; and that the industry responds only to regulation, legislation, litigation, and public pressure. Seven decades after conclusive evidence that smoking is lethal, the companies themselves confirm that cigarettes remain their “core” product20 for the foreseeable future, and that low- and middle-income countries are a key growth target.21,22
Like much else in tobacco control, implementation of Article 5.3 is imperfect, particularly in countries where the industry remains powerful. Nonetheless, Article 5.3 sends out an important signal about the pariah status of Big Tobacco. It helps health departments to ensure that their work is supported across all arms of government23 and has played a critical role in promoting action to reduce both smoking and the influence of the tobacco industry.24
But Article 5.3, as part of the FCTC, applies only to governments, not to other organisations. Even though 181 countries have signed up to the FCTC, and hence Article 5.3, there is no similar convention to protect reputable organisations from associating with or lending support and credibility to the tobacco industry.
Many non-government groups have taken action that accords with the spirit of Article 5.3 – for example journals that do not accept tobacco industry–funded publications, universities and research institutions that do not accept tobacco-funded projects, funders that will not support applications from those with tobacco interests, conferences and other events that specifically exclude tobacco-industry participants, charities that do not accept tobacco-industry donations, investment portfolios that have disinvested from tobacco shares, and groups such as the Bloomberg-funded STOP Partnership25 that plays a valuable role in monitoring and exposing tobacco industry activities. Since 1990, World Conferences on Tobacco or Health have excluded “individuals who are supported or employed by any entity directly involved in the production, manufacture, distribution or sale of tobacco products”.26 Some conferences are even more thorough in ensuring that there can be no tobacco or related industry infiltration27 and explicit in “upholding a firm non-engagement policy with the tobacco industry”.28
It should be emphasised that these constraints and criticisms focus on tobacco companies and those who work with and are linked with the industry. They do not apply to genuinely independent researchers who are of course absolutely entitled to hold and promote their perspectives – whatever those might be. We all benefit from robust and respectful debate.
But it is a concern that 70 years after compelling evidence that smoking kills, the world’s most lethal industry not only maintains but now increases its efforts to influence the scientific and policy debate despite innumerable exposés, and directly counter to the ethos of Article 5.3.
Article 5.3 sets clear standards for governments, yet there is no equivalent for health and related organisations and those who work with them. Tobacco industry representatives and those funded by the industry are permitted to participate in some scientific conferences; papers from tobacco companies and their funded groups are accepted by some journals; and some reputable scientists participate in events organised by the industry or groups directly and indirectly funded by it, engage in conferences alongside industry representatives, and meet and associate with industry employees or industry-funded scientists. Surely all health organisations, including academic institutions and conferences, should be willing to adopt the ethical standards we require of governments. Such a stance would maintain an evil industry’s pariah status, deprive tobacco companies of the credibility that comes from acceptance and association and, in the words of McKee and Stuckler, “shape norms for healthy policy making”.29
It is time to establish a civil society equivalent of Article 5.3 – a declaration mirroring its intent and reflecting its wording.
Such a declaration, which could be developed by leading international health NGOs, in association with WHO, would stand well alongside the FCTC, providing a timely demonstration that health and academic organisations are willing to apply the same standards to themselves as those expected of governments. It would also play a valuable role in countering the continuing and even increasing efforts of tobacco companies to influence and weaken the work of those who seek to reduce smoking and its harms.
Externally peer reviewed, invited.
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