How Thailand successful fought tobacco industry efforts to overturn its ENDS ban

Here in the USA and many other countries there are debates on the health effects of e-cigarettes and heated tobacco products and whether they are, as the tobacco companies claim, reducing harm, some countries have decided to just prohibit their sale entirely. In doing so they have avoided skyrocketing youth use and can sit on the sidelines while places like the US and UK allow e-cigarette and heated tobacco product companies to experiment on their populations to define what the real health effects are.

In order to understand industry efforts where electronic nicotine delivery systems (ENDS, which includes e-cigs and heated tobacco products) are not legal, Roengrudee (“Kade”) Patanavanich and I just published “Successful countering of tobacco industry efforts to overturn Thailand’s ENDS ban” in Tobacco Control. This paper details how the government, with active support from tobacco control advocates, has fought off efforts orchestrated by Philip Morris International to open the market to its IQOS heated tobacco product and other electronic nicotine delivery systems.

While pro-tobacco forces represent the battle as one of local harm reduction advocates, we found that the pro-ENDS Thai efforts were tied into in international network that PMI has built with its Foundation for a Smokefree World as a key facilitating agent (see infographic above).

Here is the bottom line of the research:

Lessons learnt from the tobacco industry tactics on manipulating regulatory frameworks to enhance ENDS markets in Thailand can inform public health efforts in other countries to defend current policies that make ENDS illegal, particularly by illuminating how the tobacco companies use third parties, often tied to the FSFW, to mobilise public pressure to open the market to ENDS. Understanding these networks has become even more important since April 2019, when the US Food and Drug Administration (FDA) misapplied the public health standard in the US law and authorised PM to market IQOS in the USA.117 PMI then started using FDA’s marketing authorisation, including quoting FDA’s Centre for Tobacco Products, director Mitch Zeller, to advertise that FDA had determined that IQOS was ‘appropriate for the protection of the public health’.117 This situation was aggravated in July 2020, when the FDA authorised PM to advertise that IQOS reduces exposure to some toxic chemicals compared with cigarettes.118 (Significantly, FDA specifically refused to authorise PM to make its requested reduced health risk claims. Nevertheless, PMI is already using the FDA authorisation to claim that IQOS reduces risk.) The Thai experience highlights the importance of public health advocates and health ministries being proactive in anticipating and heading off these claims, including by stressing that the US law governing FDA decisions does not apply in other countries and that the USA is not a party to the FCTC.

The Thai experience also provides practical lessons for implementing the union’s recommendation to ban e-cigarettes and HTPs in LMICs119 in part because ‘LMICs lack both the resources and the enforcement mechanisms required to fully support comprehensive e-cigarette and HTP regulations’5 similar to what the FDA is trying to implement in the USA.

The Thai experience also reinforces the importance of the public and policy-makers being alert to tobacco industry activities in other alternative markets such as marijuana, a common product used with ENDS, and tobacco industry-created nicotine replacement therapy, which many smokers use in combination with cigarettes.120 (The cigarette companies were considering entering the marijuana business as far back as the 1970s.121) Tobacco product innovation, alternatives and market locations may change over time, but the tobacco industry tactics and strategies remain unchanged. A whole-of-government approach should be applied in tobacco control and the government should fully comply with FCTC Article 5.3 to prevent tobacco industry interference in public health policies.

Here is the abstract from the paper:

Background After Thailand enacted laws to ban the import and sale of all types of electronic nicotine delivery systems (ENDS, including e-cigarettes and heated tobacco products (HTPs)) in 2015, pro-ENDS advocacy groups pressured the government to lift the ban, particularly after Philip Morris International (PMI) started promoting its HTP IQOS in 2017.

Methods We reviewed information related to ENDS in Thailand between 2014 and 2019 from Thai newspaper articles, meeting minutes and letters submitted to government agencies, websites and social media platforms of pro-ENDS networks and Thai tobacco control organisations.

Results The tobacco industry and the pro-ENDS groups used five tactics to try to reverse the Thai ban on ENDS: creating front groups, lobbying decision-makers, running public relations campaigns, seeking to discredit tobacco control advocates and funding pro-tobacco harm reduction research. ENDS Cigarette Smoking Thailand (ECST), a pro-ENDS group in Thailand, worked in parallel with Philip Morris Thailand Limited (PMTL) to oppose the ban. The group connected with international coalitions that promote harm reduction through the PMI-funded Foundation for a Smoke-Free World.

Conclusion Although ECST and PMTL continuously worked to revoke the ban since 2017, the government still kept ENDS illegal as of October 2020. This decision resulted from the strong commitment and collaboration among Thai tobacco control organisations and their shared vision to protect the public’s health from harmful tobacco products. The linkages between the pro-ENDS movement in Thailand and the tobacco companies could inform health advocates and policy-makers in other low and middle income countries facing pressure to market ENDS.

The full citation is

Patanavanich R, Glantz S Successful countering of tobacco industry efforts to overturn Thailand’s ENDS ban Tobacco Control Published Online First: 23 November 2020. doi: 10.1136/tobaccocontrol-2020-056058. It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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