NEWS

Framework Convention on Tobacco Control Signed; Countries Consider Plan’s Implementation

Renee Twombly

A bold global attempt to tackle the single largest preventable cause of cancer deaths has moved from the World Health Organization in Geneva to the capitals of nations around the world.

In May, the World Health Organization’s (WHO) 192 member nations unanimously adopted the Framework Convention on Tobacco Control (FCTC), which requires that countries impose severe restrictions on tobacco advertising, sponsorship, and promotion. The agreement also establishes new labeling—such as a large warning that will cover 30% of cigarette packages—and imposes both new clean indoor air controls and legislation to clamp down on tobacco smuggling.



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The fifth round of negotiations for the World Health Organization’s Framework Convention on Tobacco Control met in October 2002 in Geneva. The final treaty was adopted in May of this year and was signed on June 16. (© WHO/P. Virot)

 
The international treaty is the first ever negotiated by the WHO, and was developed to head off predictions that the annual death toll from tobacco use will climb to 10 million people in 2020, double what it is now.

Few observers expected that the treaty would receive the unanimous endorsement that it did. Drafting it involved a contentious 4-year process that often pitted scores of poor nations, saddled with a growing tobacco use problem, against a handful of rich countries that have both declining consumption of cigarettes and strong multinational tobacco industries.

But, with the exception of the United States, nations all over the world are now engaged in a friendly competition to be among the first to take the next step and legally ratify the treaty, said Judith Wilkenfeld, Ph.D., director for international programs at the Campaign for Tobacco-Free Kids, one of more than 160 nongovernmental organizations from around the world that worked as treaty advocates.

"The European Union said they are going to be the first, even though Germany had long fought against the treaty and was one of the last nations to cave," she said. "Canada, New Zealand, and Australia have already begun the process. We are feeling better than good right now."

The treaty will go into effect in nations that ratify it as soon as 40 countries agree to sign on—a threshold that will surely be met, said Patti Lynn, an associate campaign director at Infact, a Boston-based corporate watchdog organization that also worked to make the treaty both tough and enforceable.

"We are very excited that the treaty was unanimously adopted," said Lynn, who attended the Geneva meeting. "It’s a major victory for public health and corporate accountability."

Although it seemed certain this spring that the United States would not endorse the treaty but would continue to play what many regarded as an obstructionist role, the situation changed at the last minute. After the U.S. delegation failed to win support for inserting a "reservations" clause that allowed nations to opt out of any aspect of the agreement it did not like, Secretary of Health and Human Services Tommy Thompson agreed to adopt the treaty. But he did not predict whether President George Bush would sign it, a necessary step toward treaty ratification in Congress.

Other U.S. Tobacco Control Efforts

Thompson may have been reacting to mounting pressure from inside and outside the United States to regulate the tobacco industry, observers have suggested. At the WHO meeting, "the U.S.’s constant pressure to reopen the talks and change the draft treaty was strongly and repeatedly rejected by countries around the world," Lynn said.

At the same time, in the United States, the American Society of Clinical Oncology (ASCO), the largest association of oncologists, called for immediate action to reduce tobacco use. Saying its goal was to produce a "tobacco-free world," ASCO representatives agreed at their annual meeting in May to push for measures that mirrored many in the treaty, such as increased taxes on cigarettes, and full disclosure of all ingredients in tobacco products.

Also in May, hearings to regulate the tobacco industry through the U.S. Food and Drug Administration got under way in two different committees of the House of Representatives. During one of the hearings, Surgeon General Richard Carmona, M.D., publicly pronounced his desire to ban tobacco, saying he sees "no need for any tobacco products in society."

Industry Support

The current willingness of politicians to consider FDA regulation of certain aspects of the tobacco industry, especially that of smokeless tobacco and "light" cigarettes, is controversial, especially because the world’s largest tobacco company, Philip Morris, is endorsing it. But observers say that, at last, the message is being heard in the United States that the toll of death and disease from tobacco use is no longer acceptable.

Said Tom Novonty, M.D., a former assistant surgeon general and former chair of the U.S. delegation to the treaty talks under former President Bill Clinton, "I’m skeptical about the intentions of Philip Morris in seeking regulation, and regarding the treaty, I have absolutely no expectation that the U.S. will sign it, but the whole negotiating process has raised the level of discussion of tobacco control in the U.S. and worldwide—and that is a very positive outcome."

Wilkenfeld, of the Campaign for Tobacco-Free Kids, predicted that the treaty will never reach the floor of Congress, and she said it "doesn’t matter" because the treaty can still have a tremendous impact throughout the world. "A lot of countries are taking their own steps to protect the world against multinationals," she said.

But U.S. Rep. Henry Waxman, a Democrat from California, vowed to push President Bush to support the treaty so that "we become not just a vote for it but one of the countries that will implement it."

Most surprising of all is that the Philip Morris company agrees with Waxman, saying that it supports U.S. ratification of the treaty as well as adoption of comprehensive FDA regulation of all tobacco products, both new and existing—a reversal of the company’s previous stance that its spokesman says reflects the changing world view of tobacco.

"Tobacco is the only thing that goes into a human body that is not regulated, and we think that should change," said Mark Berlind, a legislative counsel for Altria, the parent company for Philip Morris USA and Philip Morris International.

Adopting the WHO treaty in the United States would help curb illegal smuggling of cigarettes into America, a trend that is growing because of increasing taxes on tobacco products in this country, Berlind said. It also may result in larger warning labels, which Berlind said is acceptable, but he thinks it will not have much impact on tobacco advertising because of settlements already agreed to in the nationwide tobacco agreement.

Philip Morris further supports regulation of tobacco, both because it would be necessary if the treaty were passed by Congress, and because the company believes establishment of universal standards will help it effectively and "responsibly" compete for a share of the country’s dwindling appetite for tobacco.

"We want the FDA to have the authority to regulate all aspects of the tobacco product business, from design, manufacturing, and distribution as well as that it have enforcement powers over advertising," he said. "Setting and enforcing standards that all tobacco companies must follow just makes good business sense."

Lynn of Infact agreed that FDA regulation of the tobacco industry is desirable, but argued that it should be much stronger than what Philip Morris seems to be seeking, which focuses on the approval of so-called reduced risk tobacco products. "Our best chance is to stop the kind of regulation that benefits Philip Morris and is much more prohibitive," she said. "It is going to be a difficult battle in the current congressional climate, but we are working now to build support for tough FDA authority in a future Congress."



             
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