Tobacco control

In just over a decade, the global community has made significant tobacco control progress, with some 4.7 billion people—63% of the world’s population—now covered by at least one comprehensive policy measure, a quadrupling since 2007 when only 1 billion people (15% of the world’s population) were covered.1 Despite this success, there is much to be done, particularly in the areas of policy implementation and enforcement. According to the World Health Organization (WHO), more than one-fifth of the Parties to the Framework Convention on Tobacco Control (FCTC) consider better enforcement of FCTC measures absolutely imperative.2 Achieving this ambitious goal is dependent on several related factors: precise regulations, effective communication and engagement, coordinated monitoring and enforcement actions, and awareness of—and ability to counter— disruptive tobacco industry interference.

Tobacco Vendor Licensing (TVL) reduces tobacco product availability and accessibility, particularly to vulnerable youth. A key tobacco control measure, TVL can limit tobacco retailer density around schools, parks, and hospitals; this is critically important because vendor abundance normalizes tobacco use, increases exposure to tobacco advertisements, and thwarts quit efforts. TVL can also restrict the types of products sold alongside tobacco and ensures inspectors know where products are sold, allowing for more effective enforcement of all point-of-sale tobacco laws.

After more than a decade of pressure from increasing government tobacco controls, a growing illicit cigarette economy and changing consumer attitudes towards smoking, South Africa's Tobacco industry was subjected to a twenty-week prohibition on the sale of all raw tobacco leaf, processed tobacco and all manufactured tobacco products under lockdown measures. This led to the industry losing significant market share to illicit cigarette sales. The industry also faced an 8% increase in excise duties and announcements of renewed government efforts to finalise further tobacco controls.

Introduction: Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law.

Aims and Methods: Policy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM).

Results: The TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition.

Conclusions: Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it.

Implications: The PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.