Pakistan’s tobacco control dilemma

Pakistan’s struggle with tobacco control reveals how industry interference and policymaker susceptibility can undermine public health efforts. Recently, Pakistan has been operating without a WHO Framework Convention on Tobacco Control (WHO FCTC) technical focal point.

This position is crucial as it serves as the country’s liaison with the Convention Secretariat, ensuring compliance with tobacco control measures and protecting citizens, especially youth, from tobacco exposure. However, the recent removal of the technical focal point in Pakistan highlights deeper, systemic issues with public health policy, particularly around tobacco industry interference.

The vacant position resulted from a series of controversial events that exposed the influence wielded by tobacco companies. The tobacco industry in Sudan signed a lucrative $20.5 million deal with Pakistan to produce and export “kiddie packs,” which contain only ten cigarettes per pack.

This deal clashed directly with Pakistan’s domestic laws, specifically an SRO that mandates a minimum pack size of 20 cigarettes to limit youth access to tobacco. The “kiddie pack” size is known to attract underage smokers due to its affordability and accessibility, raising questions about Pakistan’s adherence to global tobacco control commitments, particularly Article 16 of the WHO FCTC, which mandates restrictions on youth-targeted packaging and marketing.

In response to the proposed amendment to Pakistan’s SRO, more than 60 health experts across Africa, where tobacco usage remains a pressing public health concern, wrote to Pakistan’s Prime Minister. They expressed concerns that allowing kiddie packs for export would set a dangerous precedent and could compromise global health efforts to curb tobacco use among youth.

Their concerns reflected an understanding that Pakistan’s actions would not just impact domestic youth but also contribute to an increase in underage smoking in Sudan. Delays in amending the SRO ultimately led Sudan to source these kiddie packs from Bangladesh, an FCTC signatory as well, resulting in a substantial $20.5 million profit for Bangladesh, and (as claimed by the tobacco industry) a loss to the ailing Pakistani economy.

In Pakistan, the tobacco industry’s influence is enormous. After the deal with Sudan fell through, the technical focal point tasked with coordinating Pakistan’s tobacco control efforts with the WHO was abruptly dismissed, reportedly under direct orders from the Prime Minister’s office.

This move effectively left Pakistan without a critical figure in tobacco control for nearly two months, compromising its obligations under the WHO FCTC. As news media notes, such actions undermine the credibility of Pakistan’s health policies and the government’s commitment to protecting youth from the harms of tobacco. This incident starkly illustrates how industry influence can disrupt the work of public health officials, even resulting in the removal of individuals essential to advancing Pakistan’s position.

The role of a WHO FCTC technical focal point is not a mere bureaucratic position; it represents Pakistan’s commitment to international health standards and coordination. The focal point facilitates knowledge exchange, oversees implementation, and is integral to reporting on compliance.

Without this key figure, Pakistan risks falling behind on essential tobacco control measures, such as implementing graphic health warnings, advancing taxation policies to reduce consumption, and enforcing bans on youth-targeted advertising and packaging. Further, delay in appointing a new focal point risks isolating Pakistan from international tobacco control communities and diminishes its standing in global health forums.

Pakistan’s lack of a technical focal point and the influence of the tobacco industry set a troubling precedent. While the government may have deemed the focal point expendable, the role’s absence could have lasting repercussions on the country’s ability to control tobacco use.

This incident calls for a stronger firewall between public health policy and tobacco industry interests, especially given the vulnerability of policymaking processes to industry interference. The importance of tobacco control efforts cannot be overstated, given the country’s high rates of tobacco-related illnesses and premature deaths.

Pakistan must take decisive steps to fill the focal point role with a qualified and impartial candidate dedicated to public health, free from industry influence. Moreover, a transparent review of the processes that led to the focal point’s dismissal should be conducted to reinforce the autonomy of health policies from corporate interference. Pakistan’s commitment to the WHO FCTC and the health of its population requires that the government stand firm against industry pressure.

A comprehensive approach to tobacco control in Pakistan will require aligning with international best practices, including maintaining strong leadership roles like the FCTC focal point, enforcing pack size regulations, and strengthening restrictions on underage smoking.

By restoring this critical position and ensuring its independence, Pakistan can reinforce its dedication to public health, both for its citizens and in line with its global obligations.

Copyright Business Recorder, 2024