By: Jayna Kothari & Aparna Ravi

Public health activists were eagerly awaiting the implementation of new health warnings on cigarette packs that were to come into force from yesterday, April 1. Instead, on the eve of their implementation, the Union government announced that the amendments to the Cigarettes and Other Tobacco Products (Packaging and Labelling) Rules, 2008, which sought to increase the size of health warnings from the current 40% to 85% of the packets’ surface area would be kept “in abeyance”. The reason given was that there was no Indian study to confirm that the use of tobacco products leads to cancer and that this was in the interests of bidi workers in the tobacco industry.

The enhanced labelling requirements have been adopted by a number of countries such as Nepal (where the ‘warning coverage’ is of 90% of the display area on packs), Thailand (85%) and Australia (82.5%). These amendments were passed following the recommendations from an expert group constituted by the Union ministry of health and family welfare and were based on evidence that larger warnings, with a mixture of pictures and words, served as a stronger deterrent to tobacco use.

Even more shocking is the claim that there is no Indian study to suggest that tobacco use causes cancer. There are, indeed, numerous studies including those commissioned by the government of India’s health ministry that show a link between tobacco use and various diseases, including cancer of the lungs and mouth. After the new rules were passed in October 2014, the health ministry received several thousands of representations from tobacco industry groups. Numerous petitions challenging the constitutionality of the new pack warnings were filed in courts by tobacco companies and industry lobbyists.

The tobacco industry’s influence on scientific research as well as government regulation and policy is an important part of the tobacco story. In a compelling piece in the American Journal of Public Health, the Harvard historian of medicine, Allan Brandt, describes how in the face of scientific evidence of the harms of smoking, the tobacco industry has, from the 1950s, been using sophisticated public relations to undermine and distort emerging science.

Unconvincing Science

The modern problem of conflict of interest with the tobacco industry began several decades ago. We can see how it is manifesting in India. One of the tobacco industry’s old strategies has been to claim uncertainty to scientific facts, to claim that the health dangers of tobacco were “not proven”, to create doubt over scientific studies and use this tactic to fight regulatory measures.

The interests of tobacco companies are naturally to maximise shareholder returns. Governmental policies such as the recent amendments increasing the size of health warnings would reduce cigarette sales and are, therefore, antithetical to the industry’s interests. Hence, it is crucial that the tobacco industry has no role to play in the shaping of public health regulations. This distance has, unfortunately, not been maintained.

Recognising the “fundamental and irreconcilable” conflict of interest between the tobacco industry and governments’ public health goals, the World Health Organization’s Framework Convention for Tobacco Control (FCTC), signed and ratified by India in 2005, specifically states in Article 5.3 that “parties in setting and implementing their public health policies with respect to tobacco control, shall act to protect these policies from commercial and vested interests of the tobacco industry”.

The FCTC further provides guidelines to assist governments in ensuring that they do not fall prey to the tobacco industry’s tactics when framing tobacco control legislation. These guidelines include limiting interactions with the tobacco industry, ensuring that any interactions that do occur are transparent, and establishing policies to keep a check on pecuniary or other interests that public officials and government employees may have in the tobacco industry.

Despite being one of the earliest signatories to the FCTC, India has done little in the way of addressing conflict of interest and implementing Article 5.3. Ties between the government and the tobacco industry that would amount to a serious conflict of interest continue to exist. First, the Tobacco Board that was established under the Tobacco Board Act, 1975, whose mandate is to promote the interests of tobacco growers and the development of the tobacco industry, has not been dismantled. Second, public sector corporations such as the Life Insurance Corporation have made huge investments in tobacco companies. Third, representatives of the tobacco industry have easy access to bureaucrats and ministers without their interactions being made public or transparent.

Going Up in Smoke

Not addressing these serious conflicts of interest has resulted in the industry winning over and succeeding in having the new health warnings kept in abeyance.

We need new policies to mitigate the increasingly powerful influence of the tobacco industry on the government as they seriously affect the public interest. Such policies should put in place checks and safeguards for the government against possible conflicts of interest. If such measures to guard against industry influence are not put in place, the very purpose that any new public health regulation seeks to achieve risks being impaired and taken over by industry groups with a completely different set of goals and interests.

The recent pack warnings debacle is a stark example of the vested interests of the tobacco industry coming in the way of the government’s public health goals.

(The writers are with the Centre for Law and Policy Research, Bengaluru)