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The Smoke Free Karachi initiative has launched in Pakistan as part of The Union’s Global Implementation Programme – a pilot programme funded by Bloomberg Philanthropies to support cities in Pakistan, Indonesia, China and India to effectively implement their tobacco control laws.

Smoke Free Karachi was launched on 9 March 2020 at an event held at the Office of the Commissioner of the Karachi Division, Pakistan, in collaboration with ‘Tobacco – Smoke Free Cities’, an initiative of the Tobacco Control Cell at the Ministry of National Health Services, Regulations and Coordination (NHSRC). ‘Tobacco – Smoke Free Cities’ is a Union funded grant under the Bloomberg Initiative to Reduce Tobacco Use (BI) Grants Program, through which The Union is currently supporting smokefree projects in five districts of Punjab and in Islamabad.

In the new Smoke Free Karachi initiative, The Union has committed to support two districts of Karachi, and the Commissioner of the Karachi Division, Mr Iftikhar Shalwani, has pledged to implement the programme in the remaining four districts of the city. The Union applauds the commitment shown by the Commissioner and the Karachi administration to ensuring that the city’s citizens are protected from the harms of second-hand smoke.

The launch event was chaired by the Commissioner and was attended by all Deputy Commissioners, Senior Police Officers, the Karachi Municipal Corporation, District Municipal Corporations, as well as representatives from other government departments. All senior government officials of Karachi assured the full cooperation of their offices to support the implementation of Smoke Free Karachi.

At the launch event, the Office of the Commissioner of the Karachi Division was declared a smokefree zone, and the ‘Smoke Free Pakistan’ mobile application was launched, which will allow mobile phone users anywhere in the country to report any violation of tobacco control laws by sending a notification to the respective district administration.

“Patience and determination, supported by the resources and technical support afforded by our dependable partner The Union, has brought in sight an otherwise uphill task of developing an effective model for implementing tobacco control laws in all six districts of Karachi,” said Dr Minhaj-us-Siraj, Deputy Director General of Health, Pakistan.

“I am proud to see the commitment of the Commissioner of the Karachi Division and his team who are leading this initiative, and joining hands to achieve the ultimate goal of protecting future generations from preventable diseases like cancer caused by tobacco and second-hand smoke.”

In 2002, the Government of Pakistan passed the ‘Prohibition of Smoking in Enclosed Places and Protection of Non-smokers Health Ordinance’, which bans smoking inside public places, and requires no-smoking signage be displayed.

However, in the November 2019 compliance survey undertaken by the Johns Hopkins University School of Public Health, a partner in the Global Implementation Programme, overall compliance across public places in the East and South districts of Karachi was only 57 percent. Smoke Free Karachi aims to increase this to over 85 percent compliance.

Karachi is the economic hub of Pakistan and one of the biggest cities in the world, with more than 16 million residents. Expanding support for the implementation of smokefree laws through Smoke Free Karachi under the Global Implementation Programme will protect millions of people from harmful second-hand smoke.

The Global Implementation Programme also launched in its first two cities, Yogyakarta and Depok City, Indonesia, last year.

 

The world is coming to terms with the reality of a pandemic of respiratory illness due to the novel coronavirus, COVID-19. Due, in part, to aggressive disease control measures in China, the early spread of the virus outside China was slow but it is now clear that there is sustained community transmission established in many countries. The entire world is in for a rough ride in the next few months with serious health, social and economic consequences for individuals, nations and the world.

As we steel ourselves as a global community to take on, and overcome, this new and significant challenge, we must look for areas of public health synergy wherever possible, including keeping the following facts about world lung health in mind: that more people die of tuberculosis (TB) every day than have died from COVID-19 to date; that every day on average about 1000 people die from influenza and 2000 children under the age of five years die from pneumonia.

The World Health Organization (WHO) is responsible for the international health-sector response to COVID-19 and, along with national public health agencies, is providing valuable technical advice. The Union, the world’s oldest global non-government organisation devoted to public health, strives to end suffering due to TB and lung disease by advancing better prevention and care. We are committed to achieving this by the generation, dissemination and implementation of knowledge into policy and practice. We aim to ensure that no-one is left behind and that resources and opportunities are fairly shared. With this mission in mind, we make the following calls and commitments:

1. The burden of this crisis must be borne fairly by the global community. Those who have little, have least capacity to bear additional costs. We must ensure that access to tests, medications and vaccines, when they are available, is equitable and not limited by capacity to pay. We need to ensure that those who are most vulnerable, both individuals and nations, are protected from severe economic consequences.

2. Control of transmission of the virus will require public health actions including isolation of infected, and potentially infected, individuals, social distancing and some changes in personal behaviour. It is likely that this will require some curtailment of individual liberties. It is important that these actions are implemented by authorities in a manner that is appropriate to the local epidemiological situation and is proportionate. Excessive and unnecessary restrictions should be avoided. At all times, authorities should seek to maximise both respect for the rights and needs of individuals and the protection of public health.

3. We have learned from our experience with TB of the effects of stigma on people with or at risk of disease and the importance of the language we use when describing the illness. We have seen the similar use of stigmatising language by the media and others when discussing people who have COVID-19. It is important that we adhere to the language guidance issued by WHO, which mirrors many of the lessons we have learned in TB to minimise stigma experienced by people affected by COVID-19.

4. Both transparency and truth are important values at these challenging times. It is important that authorities are open about the impact of the epidemic and the actions required to control it.

5. There are many unanswered questions about how best to deal with this novel problem. It is important that rigorous scientific methods are applied, with adequate resourcing, to ensure that the best tools, policies and procedures for mitigating the problems caused by COVID-19 are rapidly identified, validated, implemented and scaled up. This involves basic and laboratory science, epidemiological, operational and clinical research methods. The knowledge gained in these endeavours should be public and openly disseminated.

6. It is likely that COVID-19 has arisen from an as-yet-unidentified animal source, as have other recent outbreaks such as SARS, MERS and Ebola. A One Health approach to disease control should be embraced, as it recognises the importance of the intersection of humans, other animals and the environment.

7. The Union undertakes to use its resources, including its membership network, its conferences, webinars and publications, its communications team and its technical team to support the global response to the challenge of COVID-19.

José Luis Castro, Executive Director

Dr Keren Middelkoop, Chair, Coordinating Committee for Scientific Activities

Prof Guy B Marks, President

On behalf of the International Union Against Tuberculosis and Lung Disease (The Union)

 

The city of Bogor, Indonesia, won a court case upholding its ban on the display of tobacco products at point-of-sale on 24 February. In 2017, Bogor became the first Indonesian city to implement a point-of-sale tobacco display ban as part of its smokefree law.

The case against the ban was raised by three retailers, who claimed that it was unreasonable because cigarettes are legal, and contribute to excise taxes and to the success of local businesses.

Overwhelming support was expressed by Bogor residents and civil society members across Indonesia in favour of maintaining Bogor’s tobacco control policies, which serve to protect people from the harms of tobacco and to prevent young people from starting smoking. The Union’s grantee, the Muhammadiyah Student Association, rallied young people in Bogor to send 1000 letters in support of the city’s smokefree law to the Mayor.

Technical and legal support to contest the lawsuit was provided by The Union and other organisations including RAYA Indonesia, No Tobacco Community (NOTC) and the Ministry of Health.

Mayor Bima Arya of Bogor welcomed the Supreme Court’s decision to uphold the ban on the display of tobacco products at point-of-sale. He said: “Data shows that smoking is a major contributor to stunting in children and undernourishment, as families are spending more money on cigarettes than on nutritious food. Bogor City’s smokefree policies help our community.”

“Displaying tobacco products at point-of-sale is one of the primary channels for tobacco companies to market their products, especially to children and young people,” said Dr Tara Singh Bam, Deputy Regional Director for Asia Pacific at The Union. “The Supreme Court verdict to uphold the ban is a huge public health win for tobacco control, as it will give confidence to all subnational leaders across the Asia Pacific region to implement lifesaving policies like this without fear of being targeted by similar lawsuits.”

 

STOP, a global tobacco industry watchdog of which The Union is a partner, published an in-depth analysis revealing the scale of Philip Morris International (PMI)’s current campaign to deceive the public, infiltrate health policy and profit from an epidemic.

The report, Addiction at Any Cost: Philip Morris International Uncovered, presents evidence that PMI is addicting new users to its IQOS product (which heats tobacco as opposed to burning it) because its cigarette business is under threat – rather than solely because it wants smokers to quit as the company claims.

PMI has spent millions of dollars telling the public that it wants to achieve a “smoke-free world” – yet the new STOP report highlights evidence that PMI continues to invest in cigarettes, a deadly business that kills eight million people every year.

In 2019, the same year that it launched its “Unsmoke” campaign, PMI made more than 700 billion cigarettes, launched a new brand of cigarettes in Indonesia and announced a deal with a local company in Uzbekistan to start producing Marlboro cigarettes.

Since its publication on 20 February, STOP’s report has gained significant media attention globally and has been featured in Global Health Now, Politico Pulse, Telegraph (India) and BioSpectrum, among others. The Bureau of Investigative Journalism also used the research in its recent exposé on PMI in Dispatches (UK).

“Attempting to improve its public image is a tactic we have seen used by the industry before when its profits come under threat,” said Dr Gan Quan, Director of Tobacco Control at The Union. “STOP’s report will play an important part in making sure that the public is informed about the true motives behind PMI’s ’smoke-free world’.”

Read the full report here.

Visit STOP’s website at exposetobacco.org to access tools and resources including the latest analyses, reports, and information on the industry’s tactics.

About STOP (Stopping Tobacco Organizations and Products)

STOP (Stopping Tobacco Organizations and Products) is a global tobacco industry watchdog whose mission is to expose tobacco industry strategies and tactics to undermine public health. STOP is funded by Bloomberg Philanthropies and comprised of a partnership between the International Union Against Tuberculosis and Lung Disease (The Union), The Tobacco Control Research Group at the University of Bath, The Global Center for Good Governance in Tobacco Control and Vital Strategies.

 

The Union lauds the Armenian Parliament which voted, on 11 February, in favor of a comprehensive tobacco control law. Among its most important measures, the law enacts a ban on indoor smoking in all public places (cafes and restaurants), workplaces, and public transport; it also places a total ban on tobacco product advertisements, sponsorship and promotion; and mandates plain packaging. Perhaps most critically, the law imposes strict fines for violations.

Armenia has been an unfortunate anomaly in the South Caucasus region, failing to garner significant political support for and enforcement of tobacco control, even when neighbouring countries were effective in both.  A law in 2005, for example, banned tobacco in hospitals, schools, and cultural institutions but it—along with additional restrictions in 2006—proved ineffectual in the absence of specific legal sanctions for compliance violations. The government also tried to regulate tobacco in 2017 but the law never went into force.

“This new law is critically important,” said Dr Gan Quan, Director of Tobacco Control at The Union. “We have long been deeply concerned about Armenia’s tobacco epidemic and believe this new legislation can help create a much-needed sea change.”

Over 50 percent of Armenian men presently smoke regularly, and the country has the second highest number of male smokers in the World Health Organization European region. Not surprisingly, Armenia has a high incidence of lung cancer and has, according to Health Minister Arsen Torosyan, been not inaccurately referred to as an “ashtray.”

Torosyan, who became Health Minister in 2018, spearheaded the law, bravely criticising those who failed to endorse it. It passed the National Assembly in December 2019, with a vote of 83 to 15. At the February parliamentary debates, Torosyan’s deputy, Dr. Lena Nanushyan, reiterated the law’s urgency, noting, “Cigarette smoking is responsible for 10 percent of annual deaths in Armenia and this is a significant number.”

The indoor smoking ban will take effect in March 2022. Violations will incur fines ranging from 50,000 drams (US $105) to 200,000 drams (US $418).

During the period leading to implementation, The Union will continue to support the Ministry of Health and other partners who will undoubtedly experience significant opposition and pushback from the tobacco industry.

“History has shown us that there is no time to be complacent,” cautioned Dr. Gan Quan. “Armenia has taken an important step, but tobacco control advocates must remain vigilant, monitoring corporate interference that could derail progress.”

 

Myanmar’s capital city, Nay Pyi Taw, has issued a decree extending the requirements specified by the country’s national tobacco control law and making smokefree legislation more comprehensive in the Nay Pyi Taw region. Smoking is now prohibited in hospitals, clinics, workplaces, children’s playgrounds, education facilities and commercial accommodation.

Under Myanmar’s national Control of Smoking and Consumption of Tobacco Products law, restaurants are required to have designated smoking areas, but other public places, such as tea shops and establishments known as “cold drinks shops”, aren't mentioned at all in the law.

This city level decree, issued by the Nay Pyi Taw Development Committee (NPTDC), is the first of its kind in Myanmar, and is intended to close gaps like these in the national law. Under the decree, all air-conditioned restaurants, tea shops and cold drinks shops must be smokefree, and non-air-conditioned (partially open air) restaurants, tea shops and cold drinks shops can have designated smoking areas, but these must be outside.

Myanmar has a high overall smoking rate of 26.1 percent, with 43.8 percent of adult men and 8.4 percent of adult women who smoke. The Mayor of Nay Pyi Taw said that he hopes that this new decree will protect the city’s one million citizens from tobacco smoke, and will increase public awareness of the dangers of smoking.

An event was held to promote the decree, which was attended by 550 participants including high-level national and subnational government officials, academics and representatives from civil society and the media. At the event, the Minister of Health and Sports praised Nay Pyi Taw’s commitment to curbing the tobacco epidemic: “Tobacco use causes chronic diseases which not only burden the patient but also the family, community and country.” He urged other cities in Myanmar to follow the example set by Nay Pyi Taw.

It is hoped that the collaboration between NPTDC and the Ministry of Health and Sports will lead to stronger enforcement of tobacco control laws in the region. “The Union congratulates Nay Pyi Taw for its commitment to tobacco control,” said Dr Tara Sing Bam, Deputy Director for the Asia Pacific region at The Union. “Subnational leadership plays a key role to fulfil the implementation gaps in tobacco control, and can make each sector accountable to identify local solutions to the local problems.”

The Union provides technical assistance to the Ministry of Health and Sports and Nay Pyi Taw government for tobacco control. Nay Pyi Taw is a member of the Asia Pacific Cities Alliance for Tobacco Control and Non-Communicable Diseases Prevention (APCAT), and representatives from Nay Pyi Taw declared their commitment to advance tobacco control in their city at the 4th APCAT Summit in 2019.

 

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