Regional meeting on implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) in the Americas Bogota, Colombia, 3 6 September 2013 SUMMARY AND RECOMMENDATIONS Thirty-one countries from the Americas, including 26 Parties, five States non-parties and 11 intergovernmental and nongovernmental organizations that are observers to the Conference of the Parties (COP) met from 3 to 6 September in Bogota, Colombia. The meeting was organized by the Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC), in cooperation with the PAHO/WHO Regional Office, kindly supported and hosted by the Government of Colombia. Participants shared experiences in implementation of the WHO FCTC in the Region, associated challenges, and the role of development partners, and reviewed the Protocol to Eliminate Illicit Trade in Tobacco Products, which was adopted by the COP at its fifth session in November 2012. The aim was to further promote implementation of the Convention in the Region. The meeting was convened in line with the workplan adopted by the COP and was financially supported under the European Union grant to promote implementation of the Convention in developing countries. MAIN ISSUES DISCUSSED, OUTCOMES AND RECOMMENDATIONS A. General recommendations/suggestions from the Parties and updates on implementation experiences: achievements and challenges Implementation of the Convention in the Region of the Americas is currently in a very active stage, including recent adoption of new, treaty-compliant legislation in several countries. On the other hand, there are several Parties in which comprehensive tobacco control legislation has not been adopted yet, including non-compliance with the time-bound requirements of the Convention. The Parties adopting strong measures have faced or still face legal challenges, including litigation, initiated by the tobacco industry or other interest groups and are also facing misinformation promoted by the tobacco industry that WHO FCTC requirements are in conflict with countries obligations under WTO agreements. Given that trade aspects are given consideration in tobacco control and that several countries in the Americas are taking action to promote trade under bilateral and multilateral trade agreements, Parties express their concern at the possibility that those negotiations might include services, products and investments which are beneficial to the tobacco industry and might therefore potentially undermine the national measures or strategies on tobacco control. Parties request that this issue be discussed by the Bureau of the COP, as well as at the next COP to be held in October 2014 in the Russian Federation, in order to develop and adopt a relevant resolution. 1
Several countries shared the fact that enforcement of tobacco control laws is weak, especially at subnational levels, and this is primarily due to lack of capacities and resources. Less than half of the countries in the Region have adopted and implemented comprehensive multisectoral tobacco control strategies or have established national tobacco control focal points. Furthermore, multisectoral collaboration needs to be strengthened, including through the establishment of appropriate national coordination mechanisms for tobacco control. B. Protocol to Eliminate Illicit Trade in Tobacco Products Parties recognize that illicit trade in tobacco products affects all Parties. The Protocol will provide an important basis for international cooperation to fight illicit trade. It is not yet in force and efforts should be made to sign and ratify it. Parties pointed out that relevant studies would be important to further examine the extent of illicit trade in the Region of the Americas. The WCO is currently conducting a survey among its members, which should provide updated information. Several Parties requested support from the Secretariat in raising awareness of the Protocol, its provisions and the benefits of signing and ratifying it, by providing information documents, organizing bilateral webinars or by sending a letter to high-level officials of Parties to the WHO FCTC. Parties are invited to contact the Secretariat for such assistance by e-mail: protocolfctc@who.int. Some Parties recommended that a regional workshop, dedicated to the Protocol, and with the participation of representatives of relevant sectors, such as health, customs and law enforcement, be organized soon. The Secretariat indicated that it was ready to cooperate in such a meeting (which could also be at subregional level) if a Party was willing to host it. Parties also noted that existing intergovernmental subregional mechanisms can be utilized in establishing national or regional central points required under the global tracking and tracing regime and in other provisions of the Protocol, as relevant. C. Time-bound and other provisions of the WHO FCTC Overall: Parties recognize that enforcement of adopted legislation and regulations to implement the WHO FCTC and the implementation guidelines adopted by the COP remains a significant challenge. The strong lobbying and interference by the tobacco industry is also a challenge for most Parties in the Region. Article 5: In many instances, Parties lack the capacities required for implementation of Article 5 and they need assistance to meet their obligations, such as establishing a multisectoral coordinating mechanism or focal point; technical assistance to develop comprehensive, multisectoral national strategies and action plans; technical assistance 2
in planning and preparation of tools for accessing assistance from development partners. In the meantime, Parties recognize that strong implementation of Article 5 will have an overarching impact on implementation of the Convention. Parties feel that engaging key policy-makers and government departments other than health is necessary, to strengthen sensitization of all government sectors, ensure understanding of the intersectoral nature of the treaty, and fully involve them in implementation of the Convention. The tobacco industry in most cases fiercely opposes introduction of strong measures, especially in the areas of tobacco advertising, promotion and sponsorship; smoke-free environments; product regulation; and packaging and labelling. Governments must protect tobacco control policies from undue influence by the tobacco industry in compliance with Article 5.3. To exchange views and share expertise in this area, Parties would support the organization of a workshop on implementation of Article 5.3 in the Americas, which could build upon the training programmes already provided by PAHO/WHO in some countries of the Region. Article 6: Parties recognize the importance of conducting studies of the economic and social costs of tobacco use (direct and indirect) and using the outcome and observations of such studies as strong and effective advocacy tools with political actors and policymakers. Parties also recognize the need to take into account the set of guiding principles and recommendations for implementation of Article 6 of the Convention adopted by the COP at its fifth session and to foster implementation of price and taxation policies to reduce tobacco consumption, and call for support from agencies such as the World Bank and PAHO/WHO. Article 8: Recent developments and the increase of the number of countries in the Region implementing 100% smoke-free areas in their national settings are encouraging. Examples of well-documented practices concerning enforcement of smoke-free measures also exist in the Region, specifically in Panama and Uruguay (at national level) and Chile (at subnational levels). The most successfully implemented legislation resulting in high levels of compliance were those complemented with targeted communication campaigns. Such examples of best practices need to be promoted for the mutual benefit of the Parties across the Region and beyond. Articles 9 and 10: There is a need to strengthen implementation of the Convention in the areas of product regulation and disclosure of information on the contents and emissions of tobacco products to governmental authorities and the public. Implementation of Articles 9 and 10 has gained momentum in the Region. A workshop organized by PAHO/WHO in Panama in early 2013 aimed at promoting policies on packaging (Article 11 of the Convention), product regulation and disclosure of information to the public. 3
Good country practices from Brazil and Canada are available for adaptation in other Parties within and outside the Region, through strengthened international cooperation. In the Americas, Parties recommended promotion of these measures via subregional and inter-subregional mechanisms. Standardized forms and instruments requiring the submission of information on the contents and emissions of tobacco products by tobacco companies and importers should be shared among the Parties in order to obtain and ensure compliance by the industry. Parties consider that requiring disclosure of information on the content of tobacco products and market data need to be strengthened, and can be a first step in implementing Articles 9 and 10 of the Convention for the Parties who are yet to take comprehensive measures to implement these Articles. Parties discussed testing and measuring the contents and emissions of tobacco products, and the laboratories to be used for these purposes. Parties discussed the alternatives to establishing a national laboratory, which is costly to establish and run. Use of laboratories may be needed in cases where compliance with the product standards (e.g. for banned additives) has to be monitored and Parties with such facilities are encouraged to offer these facilities to other Parties in the Region in need. Article 11: The Region performs well in the adoption of large health warnings containing pictures. There are also recent strong achievements in the Region in this area, including an increase in the size of pictorial warnings in Uruguay and Ecuador (to 80% and 60% of both main sides of cigarette packages, respectively) and the adoption of CARICOM standards on tobacco packaging (also containing the pictures proposed for inclusion in the combined textual and pictorial warnings). Several Parties implementing strong measures under Article 11 face tobacco industry lawsuits nationally and internationally. Under the coordination of PAHO/WHO and the Convention Secretariat Parties should examine the establishment of a regional task force to coordinate activities and assist countries facing legal challenges, including sharing information, resources and legal expertise in line with the requirements of Article 22.1(b) of the Convention. Due to the fact that the development and pre-testing of the pictorial warnings is a time-consuming and costly process, Parties could consider using, by adaptation, existing databases containing images already in use in other Parties, such as: 1. the WHO FCTC Health Warnings Database (http://www.who.int/tobacco/healthwarningsdatabase/); 2. the Mercosur image-bank (http://www.cictmercosur.org); 3. the Physicians for a smoke-free Canada database (http://www.smoke-free.ca/warnings/research.htm). Article 13: There are recent strong achievements in regard to this Article, including new comprehensive bans on all forms of tobacco advertising, promotion and sponsorship in Brazil, Chile, Costa Rica and Suriname. 4
Further efforts are needed to ensure that the bans apply to all forms of tobacco advertising, promotion and sponsorship, including indirect forms and promotion via the Internet, and cross-border advertising originating from or entering the country s territory. Article 14: Affordability of medications is a significant concern in the Region and many Parties expressed a wish to work with subregional organizations and PAHO/WHO on a collective approach to acquiring medications at the lowest possible cost, as recommended in the guidelines for implementation of Article 14 of the Convention. Various tools exist to assist countries in implementing Article 14, especially the following: o o o The WHO training package Strengthening health systems for treating tobacco dependence in primary care. A set of newly developed tools currently piloted in Uruguay, and with interest expressed by several other countries from the Region aimed at helping Parties to conduct a national situation analysis and develop a national cessation strategy and national treatment guidelines quickly, cheaply and easily. Most of these tools are completed and available now in English and Spanish, and all will be made freely available on, inter alia, the following web site: www.treatobacco.net. National treatment guidelines developed and implemented in other Parties to the Convention are available on the WHO FCTC web site as attachments to the implementation reports submitted by Parties. Many examples of such guidelines, including several Spanish language guidelines, can also be accessed on the following web site: www.treatobacco.net. Such examples can be used as templates for the development of treatment guidelines in the countries that have not yet put them in place. Attention should also be given to the regular updating of these guidelines, to capture and reflect new evidence and effective practices. D. Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes Participants discussed the issue of nicotine addiction and its possible link to e- cigarettes, and potential measures for the prevention of nicotine addiction in line with Article 5.2(b) of the Convention. Six countries in the Region 1 stated that, given the potential health issues, they have already banned electronic cigarettes. E. Overall implementation matters, and resources and mechanisms of assistance All governments in the Region should take effective measures to comprehensively implement the Convention. Those countries not yet Parties to the Convention are encouraged to accede to the Convention as soon as possible. In addition to developing and implementing comprehensive multisectoral tobacco control strategies and plans in accordance with Article 5.1, WHO FCTC implementation should also be incorporated into broader national health, development and poverty reduction strategies, policies and priorities, programmes on the prevention and control of 1 Argentina, Chile, Colombia, Mexico, Panama, and Uruguay. 5
noncommunicable diseases (NCDs), as well as on social determinants of health and social equity. A multisectoral coordination mechanism at national level (including pertinent ministries, representatives of civil society and United Nations organizations, with the composition of the mechanism to be determined on the basis of the institutional arrangements and legal framework applicable in each country) should be developed, to enable the Parties in the Region to meet multisectoral challenges related to implementation of the Convention. Countries call for United Nations Country Teams to support the inclusion of implementation of the Convention in the United Nations Development Assistance Frameworks (UNDAFs). Countries should include WHO FCTC implementation in their bilateral cooperation agreements with international agencies, such as WHO, the World Bank, UNDP, UNCTAD, and other relevant development partners and bilateral donors. Further coordination can be achieved through the Andean Commission for the prevention and control of NCDs of the Andean Health Agency, chaired by Colombia. The international community should increase technical, legal, financial, and other forms of assistance and cooperation to help Parties to introduce effective tobacco control policies, and to support tobacco-growing countries in the transition to economically viable alternative crops and livelihoods and in integrating concrete programming activities at country level. It was noted that NCDs had not been included in the Millennium Development Goals. Countries should advocate for them to be included in the post-2015 development agenda, taking into account the fact that WHO FCTC is a unique legal instrument that can serve as a strong resource for profiling public health. F. Priorities for action in the Caribbean subregion Parties that have not yet adopted comprehensive tobacco control laws in line with the Convention should do so by: strengthening advocacy efforts, creating a solid evidence base to support action by promoting research, facilitating sensitization of key stakeholders, and promoting intersectoral dialogue. Implement the CARICOM Regional Standard for the labelling of retail packages of tobacco products and strengthen intercountry cooperation for the development of CARICOM standards on implementation of Article 13 of the Convention and the implementation guidelines. Set up a subregional coordination mechanism on implementation led by interested Parties with a coordinating/facilitating role played by the PAHO Caribbean offices and the Convention Secretariat. Identify priority technical support needs that are appropriate for engagement with the UNDP offices of the Organisation of Eastern Caribbean States (OECS) in Barbados and Panama (the two Regional Support Centres of the UNDP), based on Article 5 of the Convention (General obligations), in particular on the establishment or strengthening of national coordination mechanisms, integration of WHO FCTC implementation into the UNDAFs and into national health and development priorities including prevention and control of NCDs at country level, and the prevention of tobacco use among indigenous populations. I. Steps to be taken by the Convention Secretariat and international development partners to facilitate implementation of the Convention 6
Parties in the Region took note of report of the Secretary-General (E/2013/61) and the ECOSOC decision on the growing interagency contribution to mechanisms of assistance under the Convention, and noted the potential of the United Nations system as a resource available to Parties to support implementation of the Convention. The Convention Secretariat will: facilitate and/or provide technical inputs to Parties, upon request, to meet their obligations under the Convention. Such assistance will be provided in cooperation with PAHO/WHO, international development partners and civil society organizations, where appropriate; complete the Information Platform as planned to further facilitate knowledge exchange; upon request, through joint needs assessment missions, assist Parties in identifying specific gaps and challenges related to lack of expertise and resources and in meeting the identified gaps and needs towards comprehensive implementation of the Convention; facilitate the granting of permission/licences to use pictorial health warnings, upon request from Parties; liaise with development partners, such as UNDP, UNCTAD and the World Bank to facilitate provision of multisectoral expertise to Parties; publish best practices from the Region with a view to promoting intercountry exchange of information and expertise and mutual assistance to Parties as outlined, in particular, in Articles 22 and 26 of the Convention; provide the necessary technical assistance to Parties in complying with their reporting obligations under the Convention. The Secretariat shall further coordinate and facilitate technical assistance and provision of expertise from intergovernmental partners, in particular in the following areas: UNDP will provide the following: capacity building in strengthening national multisectoral coordination mechanisms; technical assistance relating to integration of implementation of the Convention into national development policies and programmes and the UNDAFs at country level; support to national efforts to reduce the influence of the tobacco industry in accordance with Article 5.3 of the Convention; and support to integration of tobacco control into programmes for indigenous peoples. The World Bank: The World Bank can support tobacco control measures on the basis of governments formal demands through appropriate channels. This support can be provided by means of several instruments and tools. Examples include: 7
technical advice for tobacco control activities in general, and especially tobacco taxes, through grants/credits for health investment projects or Sector-Wide Approaches; technical assistance linked to World Bank grants/credits, to prepare and support arguments for policy dialogue on tobacco taxes, including the following areas: impact on poor tobacco-consuming households, health and economic costs of tobacco use, tobacco farmers and producers, industry reaction to tax reform, illicit trade in tobacco products, fiscal space/revenue allocation created by increased tobacco tax; technical advice and financial resources for interventions to support alternative livelihoods of tobacco farmers, through credits/loans to finance agricultural projects. Examples of activities generally financed include research, design, piloting and implementation of alternative livelihoods interventions; technical advice for poverty and household expenditure surveys, and research in the area of tobacco and poverty. The Bank also supports poverty and social impact analysis prior to and after the introduction of national policies and reforms, including tobacco tax increases. UNCTAD will provide the following: technical assistance to Parties, upon request, in the area of crop diversification, including through analysis of the value chain of tobacco, to help Parties identify suitable economically viable alternatives to tobacco growing; technical input and advice to Parties in the areas of trade policy and bilateral trade agreements to help insulate against further challenges by the tobacco industry under bilateral investment agreements; provision of technical expertise concerning TRIPS, Technical Barriers to Trade agreements and trademark issues, and tobacco trade-related data for policy inputs related to taxation and trade policy development; provision of training to judges and legal counsels on TRIPS agreements and WHO FCTC implementation and international jurisprudence, specifically in relation to implementation of Articles 11 and 13 of the Convention. 8