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The transcript of aWitness Seminar organized by the Wellcome Trust 
Centre for the History of Medicine at UCL, in collaboration with the 
Department of Knowledge Management and Sharing, WHO, held in 
Geneva, on 26 February 201 

Edited by LA Reynolds and E MTansey 

Volume 43 2012 

©The Trustee of the Wellcome Trust, London, 2012 

First published by Queen Mary, University of London, 201 2 

The History of Modern Biomedicine Research Group is funded by the Wellcome Trust, which is 
a registered charity, no. 210183. 

ISBN 978 090223 877 

All volumes are freely available online at 

Please cite as: Reynolds LA.Tansey E M. (eds) (2012) WHO Framework Convention onTobacco 
Control. Wellcome Witnesses to Twentieth Century Medicine, vol.43. London: Queen Mary, 
University of London. 


Illustrations and credits v 

Abbreviations vii 

Witness Seminars: Meetings and publications; Acknowledgements 

E MTansey and LA Reynolds ix 


Virginia Berridge xxi 


Edited by LA Reynolds and E MTansey 1 

Appendix 1 

Selected provisions of the Framework Convention on 

Tobacco Control 73 

Appendix 2 

WHO regions 74 

Appendix 3 

WHO FCTC, timeline, 1 993-201 1 75 

Appendix 4 

World's leading unmanufactured tobacco producing, trading, 

and consuming countries, 1 997 79 

Appendix 5 

Reflections on FCTC negotiations: China and Japan 

Dr Judith Mackay 15 December 2011 81 

References 85 

Biographical notes 1 09 

Glossary 119 

Index 125 


Figure 1 Dr Gro Brundtland, Director-General, WHO, 1998 

to 2003. Reproduced by permission of WHO. 

Figure 2 Article 19 of the WHO constitution. Reproduced 

by permission of WHO. 

Figure 3 Dr Ruth Roemer (1916-2005) and Dr Judith 

Mackay, WHA, May 2003. Provided by and 
reproduced by permission of Dr Judith Mackay. 

Figure 4 Orchid award and Dirty Ashtray award from the 

FCAs Alliance Bulletin, 2000. Reproduced by 
permission of FCA. 

Figure 5 WHO FCTC history, published on 26 February 

2010, the fifth anniversary of the Framework 
Convention. Reproduced by permission of WHO. 

Figure 6 Death clock displayed at pre-INB-6 sessions, 

Geneva, February 2003. Provided by and 
reproduced by permission of Dr Judith Mackay. 

Figure 7 The first session of the Conference of the Parties 

following the FCTC coming into force, 17 February 
2006. Provided by and reproduced by permission 

Table 1 Outline programme for 'WHO Framework 

Convention on Tobacco Control' Witness Seminar 

Table 2 Health and global change in the 1900s. Adapted 

from Yach and Bettcher (1998): 737. 

Table 3 Big six tobacco companies, details from company 

websites, 14 February 2012. 









Table 4 Global cigarette market share, per cent of total 

number of cigarettes produced, 2000 and 2008. 
Provided by Dr Judith Mackay. 

Table 5 Recipients of FCA awards by Framework 

Convention Alliance Bulletin, Issues 1—45, 

1999-2003, adapted from Mamudu and Glantz 

(2009): 158. 


ACS American Cancer Society 

AFRO Regional Office for Africa, WHO 

ASEAN Association of Southeast Asian Nations 

BAT British American Tobacco 

CARICOM Countries of the Caribbean Community 

CCLAT Convention-cadre pour la lutte antitabac (French, FCTC) 

CICG Centre International de Conferences Geneve, Geneva, 


COP-n Conference of the Parties, the governing body of the FCTC 

made up of all Parties to the FCTC. 

DG Director-General 

EC European Community 

ECOSOC Economic and Social Council, UN 

EMRO Regional Office for the Eastern Mediterranean, WHO 

EURO Regional Office for Europe, WHO 

FAO Food and Agriculture Organization of the United Nations 

FCA Framework Convention Alliance 

FCTC Framework Convention on Tobacco Control, WHO 

GATT General Agreement on Tariffs and Trade, Geneva (the World 

Trade Organization from 1994) 

IMF International Monetary Fund 

INB-n Intergovernmental Negotiating Body for FCTC, six bodies 

met, 2000-03 

Infact Infant Formula Action Coalition (1977-84), Infact 

(1984-2004), Corporate Accountability International (2004- ) 

















A conglomeration of all the tobacco companies in the UK 
(Tobacco Documentation Centre from 1992), Brentford, 

International Tobacco Growers Association, formed in 1984 
by growers' organizations from Argentina, Brazil, Canada, 
Malawi, United States and Zimbabwe, of which only Brazil 
and Canada have ratified the FCTC 

Network for Accountability of Tobacco Transnationals includes 
75 NGOs from 50 countries 

Non-governmental organization 

Pan-American Health Organization, WHO 

Regional Office for South East Asia, WHO 

Stop Teenage Addiction to Tobacco 

Tobacco Free Initiative, WHO 

WHO Study Group on Tobacco Product Regulation 

UN Conference on Trade and Development 

UN Office on Drugs and Crime 

UN Children's Fund 

Vienna Convention on the 'law of treaties' 

World Health Assembly 

World Health Organization 

World Trade Organization 



In 1990 the Wellcome Trust created a History of Twentieth Century Medicine 
Group, associated with the Academic Unit of the Wellcome Institute for the 
History of Medicine, to bring together clinicians, scientists, historians and others 
interested in contemporary medical history. Among a number of other initiatives 
the format of Witness Seminars, used by the Institute of Contemporary British 
History to address issues of recent political history, was adopted, to promote 
interaction between these different groups, to emphasize the potential benefits 
of working jointly, and to encourage the creation and deposit of archival sources 
for present and future use. In June 1999 the Governors of the Wellcome Trust 
decided that it would be appropriate for the Academic Unit to enjoy a more 
formal academic affiliation and turned the Unit into the Wellcome Trust Centre 
for the History of Medicine at UCL from 1 October 2000 to 30 September 
2010. The History of Twentieth Century Medicine Group has been part of the 
School of History, Queen Mary, University of London, since October 2010, as 
the History of Modern Biomedicine Research Group, which the Wellcome Trust 
continues to fund. 

The Witness Seminar is a particularly specialized form of oral history, where several 
people associated with a particular set of circumstances or events are invited to 
come together to discuss, debate, and agree or disagree about their memories. To 
date, the History of Twentieth Century Medicine Group has held more than 50 
meetings, most of which have been published, as listed on pages pages xiii— xvii. 

Subjects are usually proposed by, or through, members of the Programme 
Committee of the Group, which includes professional historians of medicine, 
practising scientists and clinicians, and once an appropriate topic has been agreed, 
suitable participants are identified and invited. This inevitably leads to further 
contacts, and more suggestions of people to invite. As the organization of the 
meeting progresses, a flexible outline plan for the meeting is devised, usually with 
assistance from the meeting's chairman, and some participants are invited to 'set 
the ball rolling' on particular themes, by speaking for a short period to initiate and 
stimulate further discussion. 

The following text also appears in the 'Introduction' to recent volumes of Wellcome Witnesses to Twentieth 
Century Medicine as listed on pages xiii— xvii. 

Each meeting is fully recorded, the tapes are transcribed and the unedited transcript 
is immediately sent to every participant. Each is asked to check his or her own 
contributions and to provide brief biographical details. The editors turn the 
transcript into readable text, and participants' minor corrections and comments 
are incorporated into that text, while biographical and bibliographical details are 
added as footnotes, as are more substantial comments and additional material 
provided by participants. The final scripts are then sent to every contributor, 
accompanied by forms assigning copyright to the Wellcome Trust. Copies of all 
additional correspondence received during the editorial process are deposited 
with the records of each meeting in archives and manuscripts, Wellcome Library, 

As with all our meetings, we hope that even if the precise details of some of the 
technical sections are not clear to the non-specialist, the sense and significance 
of the events will be understandable. Our aim is for the volumes that emerge 
from these meetings to inform those with a general interest in the history of 
modern medicine and medical science; to provide historians with new insights, 
fresh material for study, and further themes for research; and to emphasize to 
the participants that events of the recent past, of their own working lives, are of 
proper and necessary concern to historians. 


WHO FCTC was suggested as a suitable topic for a Witness Seminar by 
Dr Sanjoy Bhattacharya, who assisted us in planning the meeting. We are very 
grateful to him and to Dr Faith McLellan for her excellent moderating of the 
occasion. We are particularly grateful to Professor Virginia Berridge for writing 
the Introduction to the published proceedings. We thank Dr Judith Mackay, 
Dr Hoomen Momen of the the Department of Knowledge Management and 
Sharing and co-ordinator of WHO press and Dr Doug Bettcher, WHO TFI, 
for their help with the photographs; and Professor Richard Ashcroft for reading 
the final draft. For permission to reproduce images included here, we thank the 
World Health Organization. Additionally, we would like to thank Ms Marine 
Perraudin and Dr Hooman Momen of the Department of Knowledge 
Management and Sharing at the Geneva headquarters of WHO for their help 
with the meeting. 

As with all our meetings, we depended a great deal on the audiovisual 
department, catering, reception, and security at the Geneva headquarters of 
WHO to ensure its smooth running; Mr Akio Morishima has supervised 
the design and production of this volume; we thank our indexer, 
Ms Liza Furnival, and our readers, Mrs Sarah Beanland, Ms Fiona Plowman 
and Mr Simon Reynolds. Mrs Debra Gee is our transcriber, and Mrs Wendy 
Kutner assisted us in running this meeting. Finally, we thank the Wellcome 
Trust for supporting this programme. 

Tilli Tansey 

Lois Reynolds 

School of History, Queen Mary, University of London 


1. Technology transfer in Britain: The case of monoclonal antibodies 
Self and non-self: A history of autoimmunity 

Endogenous opiates 

The Committee on Safety of Drugs (1997) 

ISBN 1 86983 579 4 

2. Making the human body transparent: The impact of NMR and MRI 
Research in general practice 

Drugs in psychiatric practice 

The MRC Common Cold Unit (1998) 

ISBN 1 86983 539 5 

3. Early heart transplant surgery in the UK (1999) 

ISBN 1 84129 007 6 

4. Haemophilia: Recent history of clinical management (1999) 

ISBN 1 84129 008 4 

5. Looking at the unborn: Historical aspects of 
obstetric ultrasound (2000) 

ISBN 1 84129 011 4 

6. Post penicillin antibiotics: From acceptance to resistance? (2000) 

ISBN 1 84129 012 2 

7. Clinical research in Britain, 1950-1980 (2000) 

ISBN 1 84129 016 5 

8. Intestinal absorption (2000) 

ISBN 1 84129 017 3 

9. Neonatal intensive care (2001) 

ISBN 85484 076 1 

1 0. British contributions to medical research and education in Africa 
after the Second World War (2001) 

ISBN 85484 077 X 

1 1 . Childhood asthma and beyond (2001) 

ISBN 85484 078 8 

1 2. Maternal care (2001) 

ISBN 85484 079 6 

1 3. Population-based research in south Wales: The MRC Pneumoconiosis 
Research Unit and the MRC Epidemiology Unit (2002) 

ISBN 85484 081 8 

1 4. Peptic ulcer: Rise and fall (2002) 

ISBN 85484 084 2 

15. Leukaemia (2003) 

ISBN 85484 087 7 

1 6. The MRC Applied Psychology Unit (2003) 

ISBN 85484 088 5 

1 7. Genetic testing (2003) 

ISBN 85484 094 X 

1 8. Foot and mouth disease: The 1967 outbreak and its aftermath (2003) 

ISBN 85484 096 6 

1 9. Environmental toxicology: The legacy of Silent Spring (2004) 

ISBN 85484 091 5 

20. Cystic fibrosis (2004) 

ISBN 85484 086 9 

21 . Innovation in pain management (2004) 

ISBN 978 85484 097 7 

22. The Rhesus factor and disease prevention (2004) 

ISBN 978 85484 099 1 

23. The recent history of platelets in thrombosis and other disorders 

ISBN 978 85484 103 5 

24. Short-course chemotherapy for tuberculosis (2005) 

ISBN 978 85484 104 2 

25. Prenatal corticosteroids for reducing morbidity and mortality 
after preterm birth (2005) 

ISBN 978 85484 102 8 

26. Public health in the 1980s and 1990s: Decline and rise? (2006) 

ISBN 978 85484 106 6 

27. Cholesterol, atherosclerosis and coronary disease in the UK, 
1950-2000 (2006) 

ISBN 978 85484 107 3 

28. Development of physics applied to medicine in the UK, 1945-1990 

ISBN 978 85484 108 

29. Early development of total hip replacement (2007) 

ISBN 978 85484 1110 

30. The discovery, use and impact of platinum salts as 
chemotherapy agents for cancer (2007) 

ISBN 978 85484 112 7 

31 . Medical ethics education in Britain, 1963-1993 (2007) 

ISBN 978 85484 113 4 

32. Superbugs and superdrugs: A history of MRSA (2008) 

ISBN 978 85484 114 1 

33. Clinical pharmacology in the UK, c. 1950-2000: Influences and 
institutions (2008) 

ISBN 978 85484 117 2 

34. Clinical pharmacology in the UK, c. 1950-2000: Industry and 
regulation (2008) 

ISBN 978 85484 118 9 

35. The resurgence of breastfeeding, 1975-2000 (2009) 

ISBN 978 85484 119 6 

36. The development of sports medicine in twentieth-century Britain 

ISBN 978 85484 121 9 

37. History of dialysis, c.1950-1980 (2009) 

ISBN 978 85484 122 6 

38. History of cervical cancer and the role of the human papillomavirus, 
1960-2000 (2009) 

ISBN 978 85484 123 3 

39. Clinical genetics in Britain: Origins and development (2010) 

ISBN 978 85484 127 1 

40. The medicalization of cannabis (2010) 

ISBN 978 85484 129 5 

41 . History of the National Survey of Sexual Attitudes and Lifestyles 

ISBN 978 90223 874 9 

42. History of British intensive care, C.1950-C.2000 (201 1) 

ISBN 978 90223 875 6 

43. WHO Framework Convention on Tobacco Control (2012) 

ISBN 978 90223 877 (this volume) 

44. History of the Avon Longitudinal Study of Parents and Children 
(ALSPAC), c.1980-2000 (2012) 

ISBN 978 90223 878 7 

All volumes are freely available online at 

Hard copies of volumes 21-44 can be ordered from;; and all good booksellers for £6/$10 each plus postage, 
using the ISBN. 


1 994 The early history of renal transplantation 

1 994 Pneumoconiosis of coal workers 

(partially published in volume 13, Population-based research 
in south Wales) 

1 995 Oral contraceptives 

2003 Beyond the asylum: Anti-psychiatry and care in the community 

2003 Thrombolysis 

(partially published in volume 27, Cholesterol, atherosclerosis and 
coronary disease in the UK, 1950—2000) 

2007 DNA fingerprinting 

The transcripts and records of all Witness Seminars are held in archives 
and manuscripts, Wellcome Library, London, at GC/253. 


Technology transfer in Britain: The case of monoclonal antibodies 

Tansey E M, Catterall P P. (1993) Contemporary Record9: A09-AA. 

Monoclonal antibodies: A witness seminar on contemporary medical history 

Tansey E M, Catterall P P. (1994) Medical History 38: 322-7. 

Chronic pulmonary disease in South Wales coalmines: An eye-witness 

account of the MRC surveys (1937-42) 

P D'Arcy Hart, edited and annotated by E M Tansey. (1998) 

Social History of Medicine 11: 459—68. 

Ashes to Ashes — The history of smoking and health 

Lock S P, Reynolds L A, Tansey E M. (eds) (1998) Amsterdam: Rodopi BV, 
228pp. ISBN 90420 0396 (Hfl 125) (hardback). Reprinted 2003. 

Witnessing medical history. An interview with Dr Rosemary Biggs 

Professor Christine Lee and Dr Charles Rizza (interviewers). (1998) 
Haemophilia 4: 769-77. 

Witnessing the Witnesses: Pitfalls and potentials of the Witness Seminar 
in twentieth century medicine 

Tansey E M, in Doel R, SoderqvistT. (eds) (2006) Writing Recent Science: 
The historiography of contemporary science, technology and medicine. London: 
Routledge: 260-78. 

The Witness Seminar technique in modern medical history 

Tansey E M, in Cook H J, Bhattacharya S, Hardy A. (eds) (2008) History 
of the Social Determinants of Health: Global Histories, Contemporary Debates. 
London: Orient Longman: 279—95. 

Today's medicine, tomorrow's medical history 

Tansey E M, in Natvig J B, Sward E T, Hem E. (eds) (2009) Historier om helse 
{Histories about Health, in Norwegian). Oslo: Journal of the Norwegian Medical 
Association: 166—73. 


Internationalism in health has a long history. The nineteenth century 
international sanitary conferences were part of a process which led to the inter- 
war League of Nations, its health committee, and its work on standardization. 
In the years after World War Two, the World Health Organization (WHO) 
developed cross-national programmes and initiatives in areas as diverse as 
malaria, mental health, smallpox, and subsequently HIV/ AIDS. 1 

Internationalism and globalization in health was the subject of this witness 
seminar, which brought together people who had been involved since the 
1990s in WHO's emergent role in tobacco control. The idea of a 'framework 
convention' was new, and the seminar tells us much about how that mechanism, 
never used before, was chosen (pages 28, 11, 18, 30 and 44). 

The timeline covered in the seminar begins in 1993, but the international 
networks which led to that series of events had a longer history. In the immediate 
postwar years, such connections did not exist. Wynder and Graham in the US 2 
and Doll and Hill in the UK 3 published their research on smoking and lung 
cancer at the same time, but one set of researchers did not know the other. 4 
Networks developed in the 1970s. The World Conferences on tobacco or health 
became an important meeting place for smoking researchers and activists. The 
first was held in New York in 1967, with Robert Kennedy as keynote speaker, 
followed by one in London in 1971. 5 George Godber, the Chief Medical Officer 
(CMO) of the Department of Health and Social Security (1960-73), who had 

Professor Virginia Berridge wrote: 'Earlier sections of this introduction are based on research for my book 
Marketing Health (Berridge (2007)) and also given as a paper for the Global Health Histories seminar at 
WHO in October 2010.' Note on draft introduction, 30 March 2012. 

2 Wynder and Graham (1950). 

3 Doll and Hill (1950). 

Berridge (2007): 36; Doll (1991); although this was not mentioned in his contribution to Lock et al. 
(1998): 135. 

5 Berridge (2007): 162. 

been instrumental in pushing forward the first Royal College of Physicians 
report on smoking in 1962, gave a rousing address, 'It Can be Done'. 6 He 
looked to international networks to take forward the anti-smoking case. 

Older international organizations changed to take on tobacco as an issue. Sir 
John Crofton in Edinburgh, and his wife Eileen, the first director of ASH 
Scotland, were early advocates of smoking control through his initial interest 
in tuberculosis (TB). In his unpublished autobiography," he recalled how the 
International Union against Tuberculosis (IUAT) became the International 
Union against TB and Lung Disease (IUAT LD) in 1984. 8 It set up a special 
committee on smoking. Crofton and Kjell Bjartveit from Norway produced a 
booklet, The Smoking Epidemic: How You can Help, which was distributed to all 
IUAT LD members and affiliated organizations. 9 

The role of personalities was important and also the cross-national transfer of national 
experiences. A key figure was Nigel Gray in Australia, director of the Anti-Cancer Council 
of Victoria from 1968 until 1995. Gray became the director of the smoking work 
of the International Union against Cancer in 1974. 10 Here was another international 
organization which, with Norwegian funding, changed its emphasis and began to do 
work in developing countries. Successful examples of anti-tobacco activity were used 
as models for action internationally. Gray's work on the Victoria Tobacco Act of 1987 
which raised taxes and restricted advertising, was used in this way" 

' Berridge (2007): 164 n3 ; see also TNA MH154/861. Godber G, Piatt R. (1971) Patt vii: Smoking as 
International Public Health Problem 'It Can Be Done', 24 September 1971. Bates no. TIMN0106201- 
TIMNO 106205, freely available at (visited 27 
March 2012); see also the House of Lords debate on health education, in Hansard, 20 December 1967, 
vol 287 cols 1464-1553 at 
(visited 27 March 2012). 

Sir John Crofton (191 2—2009) was Professor of Respiratory Diseases and TB at the University of Edinburgh 
(1952—77); see Dalyell (2009). His unpublished autobiography has been deposited in the archives of the Royal 
College of Physicians of Edinburgh and is freely available online at 
sir-john-crofton/sir-john-crofton-autobiographypdf (visited 1 1 May 2012), particularly 'War with the weed' 
from page 611. 

See (visited 27 March 2012). 

Crofton and Bjartveit (1986); see also International Union against Tuberculosis and Lung Disease and 
International Union against Cancer (1986). 

Gray (ed.) (1977), the outcome of the Workshop on Smoking and Lung Cancer, held in Geneva, 13—17 
December 1976; Gray and Daube (eds) (1980). 

11 See Borland et al. (2009). 

The pace quickened. More organizations were developing an international 
focus — for example David Simpson, the director of British ASH, set up his 
International Agency on Tobacco and Health in 1991, which specifically 
focussed on low-income countries and on Eastern Europe, on information 
dissemination, on providing the tools for activism. 12 

Europe started to play a role — the impetus came with the establishment in 1987 
of the Europe against Cancer programme, initially as a response to Chernobyl, 
but also expanding its remit as Europe developed its competence to take on 
matters of public health. Directives and resolutions on tobacco began to be 
adopted there in the late 1980s and early 1990s. 

WHO began to be involved, although progress was initially slow. There was only 
one officer in Geneva at that time, Dr Roberto Masironi, Tobacco or Health 
programme coordinator, with a small budget and little support. 13 Crofton, and 
John Reid, CMO for Scodand, who was also on the WHO Board, met Halfdan 
Mahler, Director-General (DG) of WHO, and tried to persuade him to take up the 
issue. Despite a couple of reports from expert committees, the issue had not been 
very prominent and Mahler agreed, at the 6th international conference in Tokyo in 
1987, to convene a group to prepare a Global Action Plan on Tobacco or Health. 
This met in Geneva in 1988 with Judith Mackay as rapporteur. Although adopted 
by the World Health Assembly unanimously in 1988, matters stalled again with 
the advent of Nakajima as DG and changes in the tobacco unit which caused some 
disruption — these are touched upon in the witness seminar discussion (pages 31— 2) 
and also in Crofton's unpublished memoir. 

Personalities and new areas of research were crucial. The role of Judith Mackay, 
covered in the seminar, was an important one (pages 27—9, 31). Mackay had 
been a student of the Croftons in Edinburgh in the 1960s and has attributed 

See Simpson and Lee (2003). 

Dr Roberto Masironi wrote: 'Four major benchmarks ought to be emphasized as the early WHO action, 
namely: the World Health Assembly resolution WHA24 on 20 May 1 97 1 , which first requested WHO to initiate 
action on the control and prevention of smoking; the first WHO Expert Committee on smoking and its effects 
on health, which I organized in 1973; the launching of the annual World Tobacco Day on 7 April 1988 on the 
anniversary of the founding of WHO, still ongoing; and the founding of the Tobacco or Health programme, 
initiated by me, based on the 4lst World Health Assembly resolution on 13 May 1988. Several years later what 
was originally the Tobacco or Health programme became the Tobacco Free Initiative created by Dr Brundtland 
in 1998, as it is at present. After retirement from WHO in 1991, 1 became president of the European Medical 
Association on Smoking or Health (EMASH), my present position.' E-mail to Mrs Lois Reynolds, 29 March 
2012. See, for example,;jsessionid=9D6FCDB7E1708C72BED9 
46726A930279.tobacco03 (visited 28 March 2012); Masironi and Gibson (1988). 

her subsequent interest in smoking to their influence. China became an area 
of concern, in part because of her work. Changes in epidemiological research 
also impacted. Richard Peto's epidemiological research went global, looking at 
the implications of the 'smoking epidemic' for China (page 20). Christopher 
Murray and Alan Lopez in their World Development Report in 1993 highlighted 
tobacco and Lopez moved into WHO tobacco control. 14 

Hirayama's research on passive smoking emanated from Japan." New forms of 
epidemiology were based on new international networks. In the crucial area 
of health economics, similar networks developed. The health economist Joy 
Townsend recalled how she first became involved at a World Conference in 
Winnipeg in 1983 and how subsequently a very strong international tobacco 
control constituency developed within health economics. 16 The World Bank 
became involved and its report Curbing the Epidemic, was published in 1999. 7 

Matters came to a head in the 1990s, as the transcript makes clear. There was 
pressure from without. In 1993, Ruth Roemer at UCLA, with long standing 
WHO advisory connections, and Allyn Taylor decided to apply Taylor's argument 
that WHO had the constitutional power to develop international conventions 
to advance global health to tobacco control. Despite initial opposition by WHO 
officials, the idea gained wide acceptance for tobacco (page 44). 

A head of steam from outside was important. Roemer brought the issue to the 
first All Africa Conference on Tobacco or Health co-chaired by Derek Yach, 
who was then with the Medical Research Council (MRC) of South Africa. 18 
Strong support emerged from Judith Mackay, by then director of the Asian 
consultancy for tobacco control, who helped with drafting a resolution at the 
Ninth World Conference in Paris in 1994 (pages 10, 20, 33). 

14 World Bank (1993); see also Lopez etal. (eds) (2006). 

15 Hirayama (1981); see also Ong and Glantz (2000a); Appendix 5, pages 81—3. 

Dr Joy Townsend, MRC Epidemiology and Medical Care Unit, Harrow, delivered a paper at the Fifth 
World Conference on Smoking or Health, Winnipeg, Canada, 10—15 July 1983 on 'Cigarette Tax and 
Social Class Patterns of Smoking 1 , freely available at 
v/n/zvn93f00/Szvn93f00.pdf (visited 27 March 2012). Interview with Professor Joy Townsend by Dr David 
Reubi, April 2011, London School of Hygiene and Tropical Medicine. 

17 World Bank (1999). 

For details of the First All African Conference on Tobacco or Health, 14—17 November 1993, held 
in Harare, Zimbabwe, see (visited 27 March 2012); See 
Chapman et al. (1994); for a review of the developments, see Roemer et al. (2005). 

Support came from Jean Lariviere, a senior medical adviser at Health Canada, 
who drafted a resolution tabled at WHO executive board in January 1995. It 
requested that the DG report to the board on the feasibility of developing an 
international convention. Mackay was a key figure in pushing this forward and 
in promoting the idea of a framework convention rather than a code, as had 
been the case with breastmilk substitutes (page 38). 

The election of Dr Gro Harlem Brundtland as DG in 1998 made a difference. 
Matters had developed so far, but there was still a lack of support at the political 
and global level. Her two priorities were tobacco control and malaria. The 
Tobacco Free Initiative, headed by Yach, was charged with developing the 
framework convention. Brundtland had been the Norwegian Prime Minister 
and had experience within WHO and the United Nations (UN) - she had been 
commissioner of the sustainable development commission for the Secretary- 
General in the 1980s and knew how to get things done (pages 34—9). 

The growth and influence of coalitions was important, encompassing both rich 
and poor countries and those in between. The example of how such coalitions had 
operated to mobilize support for other areas, such as in the environmental field, 
was drawn upon. Canada had a long track record in international public health, 
dating back to the Lalonde report in the 1970s." But resource-poor countries 
and countries like Brazil, one of the top three tobacco growing countries, were 
also involved. France, Finland, and Switzerland made contributions to get the 
treaty underway. NGOs from the south also helped drive the process. South 
Africa and Kenya were centrally involved. The other UN agencies were brought 
on board with a Secretary-General's United Nations Ad Hoc Interagency Task 
Force on Tobacco Control operating from 1999. 

Even the tobacco industry could see some advantages to the new system (pages 
62, 67, 68). Philip Morris and the Big Three realized that it might be an 
opportunity for them. It would open markets, give them more power, destroy 
smaller companies and make the bigger ones grow. The convention split the 
industry. A country such as Japan with a strong national tobacco industry 
worked in the opposite direction, to water down the convention (pages 81—2). 
On-going revelations from tobacco industry archives emerged from the late 
1990s also put pressure on and aided activism; so a form of history had its role 
to play (pages 16, 19, 20). 

19 Canada, Department of National Health and Welfare (1974), known as the Lalonde Report after 
Mr Marc Lalonde, the Minister of National Health and Welfare at the time. 

In 1996, WHO voted to proceed with development of the convention, it was 
adopted in 2003 and came into force in 2005. There have been further networks 
developing since then (pages 54—60). The treaty strengthened the international 
tobacco NGO community. The Framework Convention Alliance was set up 
in 1999 and is made up of over 35 organizations from 100 countries working 
on the development of the treaty. Funding from the Bloomberg initiative and 
from Gates has followed, offering serious financial support for tobacco control 
in low- and middle-income countries. 

The Framework Convention, it is clear from the seminar, has taken on a life 
of its own and is an on-going enterprise. It offers a different model to that of 
international drug control, in some ways its closest comparator. Contributors 
to the seminar make it clear that that model of supply control, in operation 
since the 1920s, was seen as one to avoid (pages 3, 21, 41). The Framework 
Convention was conceived as a model of demand reduction and its advocates 
envisage a long-term restructuring of global economies to take account of 
that aim. 

Virginia Berridge 

London School of Hygiene and Tropical Medicine, London 


The transcript of aWitness Seminar organized by the Wellcome Trust 
Centre for the History of Medicine at UCL, in collaboration with the 
Department of Knowledge Management and Sharing, WHO, held in 
Geneva, on 26 February 201 

Edited by LA Reynolds and E MTansey 



Dr Najeeb Al-Shorbaji Dr Martina Potschke-Langer 

Dr MaryAssunta Dr Judith Mackay 

Dr Douglas Bettcher Dr Faith McLellan (co-moderator) 

Dr Sanjoy Bhattacharya Ms Kathy Mulvey 

(co-moderator) Dr Haik Nikogosian 

Mr Neil Collishaw Dr Ahmed Ezra Ogwell 

DrVera Luiza da Costa e Silva ProfessorTilliTansey 

Mr Rob Cunningham DrThomas Zeltner 

Others attending the meeting: Mr Nils Fietje, Dr Hooman Momen, 
Ms Marine Perraudin, Dr David Reubi, Ms Liz Shaw, MrVijayTrivedi 

WHO Framework Convention on Tobacco Control 

Dr Haik Nikogosian: Good afternoon, colleagues, and thank you very much 
for attending this Witness Seminar. I understand this is the first Witness 
Seminar in the series of prestigious seminars to be held outside of London. 
In that case, it could also be part of history. [Laughter] The World Health 
Organization (WHO)'s Department of Knowledge Management and Sharing, 
and colleagues at the Wellcome Trust Centre for the History of Medicine at 
UCL have organized this seminar in connection with the fifth anniversary of 
the Framework Convention on Tobacco Control (FCTC) because we felt that, 
firstly, there is a strong history to be reviewed in more detail with the witnesses. 
Secondly, this occasion was a very nice one, because most of the people who 
were involved in the past were here in Geneva, which is why I sent additional 
letters to the people who I felt could be part of this, asking: 'Would you please 
also contribute to this seminar after the main anniversary event?' I am very 
grateful for your acceptance and availability. Thank you very much. 

Continuing on from this morning's event/the Convention Secretariat are ready, 
so that we can touch on the high points in the History of the WHO Framework 
Convention on Tobacco Control, because, to us, it goes beyond the issue of tobacco 
control. This convention is a milestone in public health, a new instrument in public 
health. This new legal dimension for international cooperation possibly opens 
new horizons for global thinking in public health — new expectations in global 
cooperation for public health. We would like very much to see all these angles 
reviewed and given attention as much as possible. I won't say more now: my role is 
to open this meeting, and to pass on the best wishes of the Convention Secretariat 
for the seminar. I am going to a press conference for the fifth anniversary event 
now, so I'll be busy in a similar engagement with the media. 

Professor Tilli Tansey: I'd like to begin by thanking Dr Nikogosian and the 
FCTC Secretariat for setting up this meeting. I'd also like to thank Dr Al- 
Shorbaji, the director of the Department of Knowledge Management and 

The launch of the History of the WHO Framework Convention on Tobacco Control (WHO , Framework 
Convention on Tobacco Control Secretariat (2010)) was held at the Geneva headquarters of WHO on 26 
February 2010. The convention, 'an evidence-based treaty that presents a regulatory strategy for addressing 
addictive substances and stresses the importance of strategies for reducing both demand and supply' (WHO 
(2008): 3) entered into force on 27 February 2005, the 90th day after the 40th ratification and had 174 
parties as of 21 June 2011. For the convention, see 
english.pdf (visited 21 February 2012); for details of WHO and WHA, see Glossary, page 123; Figure 7. 

Mackay (2003). See also notes 56 and 82; Appendix 1, page 73. For a background to international legal 
instruments of tobacco control, see Taylor and Bettcher (2000); Taylor et al. (2003). 

WHO Framework Convention on Tobacco Control 

Sharing at WHO, and Dr Momen of WHO press, who first proposed having 
such a seminar to Dr Sanjoy Bhattacharya some months ago. I'm also very 
grateful to all of you for attending this meeting. 

As Dr Nikogosian said, this is the first Witness Seminar that we have held outside 
London. A Witness Seminar is a specialized form of oral history, a technique 
to record contemporary medical history 3 It involves a round-table discussion 
guided by facilitators between individuals who were involved in particular 
debates, discussions or discoveries. We want to hear what happened, and how 
and why. These meetings are recorded, transcribed and edited for publication. 
You will be provided with the draft transcript of the meeting so you may amend 
it in any way you wish, and of course, nothing will be published without your 
express written permission. The facilitators of these meetings play a vital role in 
the smooth running of them, and we're delighted that Dr Faith McLellan has 
volunteered to help us in this way. Faith is a distinguished medical writer and 
commentator, and she is supported by my colleague Dr Sanjoy Bhattacharya, 
who is a distinguished medical historian of global health issues. So, without any 
further ado, I'm going to hand the meeting over to Faith and Sanjoy. 

Dr Sanjoy Bhattacharya: I too would like to thank the Department of 
Knowledge Management and Sharing for suggesting that we hold a Witness 
Seminar today. Dr Momen and Dr Al-Shorbaji were very supportive in helping 
us set up this collaboration with the FCTC Secretariat, and we're very grateful 
for all the hard work that the FCTC Secretariat has done over the past weeks. 
I would just like to second my colleague's (Tansey's) thanks to all of you for 
attending; we know you are very busy people. It's an important day and you 
have other business, I'm sure. But thank you very much for attending. I am 
sure the Witness Seminar volume that will arise from this will be an important 
document — important historically — for academics and for students of medicine 
and public health. 

Dr Faith McLellan: I'd like to add my welcome and, without much further ado, 
get on with the programme of the afternoon. Does everybody know each other? 
Would it be helpful to say your name and where you're from? Dr Ogwell, can 
we start with you? 

See 'What is a Witness Seminar' at 
seminar/index.html (visited 21 February 2012). For a description of conventions and protocols, see 
Glossary, page 120. 

WHO Framework Convention on Tobacco Control 

Dr Ahmed Ezra Ogwell: I'm proud to be Kenyan, but am currently with the 
Convention Secretariat of the WHO FCTC here in Geneva. 

Dr Mary Assunta: I'm a Malaysian and on the board of directors for the 
Framework Convention Alliance (FCA). 

Ms Kathy Mulvey: I'm from the US and work in the non-governmental 
organization (NGO) Corporate Accountability International, which was known 
as Infact during the negotiations. 

Dr Vera Luiza da Costa e Silva: I am a Brazilian medical doctor and I was 
the director of the Tobacco Free Initiative (TFI) during the period 2001-05, 4 
therefore I oversaw the work of WHO's Secretariat when the treaty was 
negotiated. 5 

Dr Najeeb Al-Shorbaji: I work as director for the Department of Knowledge 
Management and Sharing here at the WHO headquarters, Geneva. It's a 
pleasure and honour to have you all around this table for this first Witness 
Seminar organized with the Wellcome Trust Centre for the History of Medicine 
and WHO. So, welcome. Please, feel at home. At least those who are not from 
headquarters. [Laughter] 

Dr Martina Potschke-Langer: I'm a German medical doctor working in the 
German Cancer Research Center as head of the Unit Cancer Prevention, and 
for WHO as head of the WHO Collaborating Centre on Tobacco Control. 

Dr Douglas Bettcher: I'm Canadian, a medical doctor and a public health and 
international relations specialist. I was the co-coordinator for the Framework 
Convention negotiations from 1998 to 2007 and I have been the director of the 
WHO TFI programme for WHO since 2007. 

Mr Neil Collishaw: I'm currently the research director at Physicians for a 
Smoke-free Canada in Ottawa. From 1991 to 1999 I served here in Geneva as 
part of the secretariat working in the 'Tobacco or Health programme of WHO 
and was involved in some of the very early stages of getting the convention on 
the road. 

The Tobacco Free Initiative was established by WHO in 1998 under the directorship of Dr Derek Yach 
(1998-2000). See, for example, Wipfli et al. (2004); note 13, page xxiii. 

Dr Vera Luiza da Costa e Silva wrote: 'I have been senior public health consultant and associate professor 
at the National Public Health School, Oswaldo Cruz Foundation in Rio de Janeiro since 201 1.' Note on 
draft transcript, 26 January 2011. 

WHO Framework Convention on Tobacco Control 

Figure 1: Dr Gro Brundtland, Director-General.WHO, 1998 to 2003. 

Mr Rob Cunningham: I'm with the Canadian Cancer Society and I was involved 
in an NGO capacity throughout the negotiations. 

Dr Thomas Zeltner: Until a couple of weeks ago I was director-general of 
health and secretary of health in Switzerland, and head of the Swiss delegation 
to WHO since 1991. At the critical phase of starting the FCTC negotiations, I 
was a member of the executive board of WHO and chair of the committee that 
was asked by Dr Gro Harlem Brundtland, former prime minister of Norway and 
Director-General (DG) of WHO, to look into the ways the tobacco industry 
was using to try to influence the policies of WHO.' In 2010 I was a fellow of 
the Advanced Leadership Initiative of Harvard University. 

Dr Judith Mackay: I'm a medical doctor from Edinburgh and have lived in 
Hong Kong since 1967, quite a long time. I've been involved with the FCTC 
negotiations since their conception, as a WHO consultant, not as an NGO. 
Being on the WHO team has enabled me to nurture the FCTC throughout. I'm 
currently working for World Lung Foundation, a component of the Bloomberg 
Initiative, to reduce tobacco use in low- and middle-income countries. 

Dr Gro Harlem Brundtland was three-times prime minister of Norway in 1981, 1 986— 89, and 1 990— 96 
and Director-General of the World Health Organization from 1 998 to 2003. She appointed the Committee 
of Experts on the Tobacco Industry, which reported in 2000 (Zeltner et al. (2000)). 

For further discussion on whether the currently acceptable term is 'developing countries' or 'low- and 
middle-income countries', see note 74. Terms used in the meeting have been retained. 

WHO Framework Convention on Tobacco Control 

What preceded the FCTC in WHO, in relation to anti-smoking and anti-tobacco lobbies? 

What was the role of the WHO Director-General's office in encouraging the move towards 
the FCTC? 

What was the role of the countries in making FCTC possible? Who played an important part 
in lobbying for the convention? 

What was the role played by different non-governmental organizations (NGOs) in supporting 
- and opposing - FCTC? 

Who were the dissenters? What was the role played by pro-tobacco lobbies and who were 

Table 1: Outline programme for 'WHO Framework Convention on 
Tobacco Control' Witness Seminar 

McLellan: A quick word about logistics. You have before you the five topics for 
discussion this afternoon (Table 1). 

When I was asked to do this, I couldn't quite figure out why I'd been asked 
to moderate this session. I thought I heard a few things like 'loud-mouthed 
American' and 'ruthless time-keeper', so I will try to keep us to a schedule that 
gets us out of here by tomorrow. But, by the same token, we want all voices 
to be heard here, so I will try, as the Quakers say, 'to achieve the sense of the 
meeting' as we move from one question to another. I hope that we'll have a 
lively and informal discussion. 

If you'd like to loosen your tie, we're interested in the real story today, we want 
to know what happened. The other thing is, I think it's usually best in this 
kind of forum if the moderator doesn't know a lot about the topic, so fine, 
I'm eminently qualified because I don't know very much about the Framework 
Convention, so I'll be interested to hear the real history of it. 

However, I think the people who asked me probably did not know what my 
real connection to tobacco is: I was born into a tobacco-farming community in 
the largest tobacco-growing county — Johnston county — of the largest tobacco- 
growing state in the US — North Carolina. I went to an undergraduate college 
funded by one, Mr R J Reynolds. 8 [Laughter] I went to graduate school at 

The surviving children of R J Reynolds (1850-1918) donated part of the family estate for Wake Forest 
University campus and funded the university's relocation to Winston-Salem, see 
HSTWFU/perry.html; James Buchanan Duke (1856—1925) endowed Duke University through his family 
foundation, see (both visited 7 February 2012). 

WHO Framework Convention on Tobacco Control 

a university funded by the other North Carolina tobacco magnate, James 
Buchanan Duke. So, I feel eminently qualified to be in the milieu of the 

Mackay: May I ask a question about sensitive information? The previous 
published Witness Seminars name the contributors for what is said, which is 
fine. But we are asked to look at some of the obstructions and some of the 
difficulties, because the real story does involve some quite sensitive issues, both 
within and outside of WHO. I think you mentioned earlier that we're going 
to have an opportunity to review this before it goes out, so do you have any 
guidelines on that for us? 

Tansey: Yes. As I said, you will get the transcript. If there is material you don't 
want published, just indicate it. What we also do with this material, with your 
permission, is to put it in the archives of the Wellcome Library for present 
and future scholars. Again, if there is material that you don't want in the 
public domain at the moment, you just strike it out. We encourage you to 
put some sort of publishing embargo on the release of sensitive or confidential 
information, but we would appreciate it if you could be frank today. We have 
had this situation before with some of our other meetings, as you can probably 
guess, looking at the titles. We have embargoed materials in the archives at the 
request of participants. 

Cunningham: Would an option be to make certain comments, to make them 
expressly anonymously? If we give you no names, and say 'this is from an 
anonymous person'. 

Tansey: That would be an option we could discuss if we were going to publish 
it. We would prefer to be able to attribute your comments to you, because if it's 
attributable to you, it has authority. But we could discuss that. 

Bettcher: In WHO, where members speak for different organizations, it is 
difficult to know which countries they represent, for example. It's easy for WHO 
to cite countries or groups moving in the positive sense. But it is more difficult 
for WHO to be cited as criticizing particular member states. NGOs would be 

See pages xiii— xvii, for a list of published transcripts in the Wellcome Witnesses to Twentieth Century 
Medicine series. 

WHO Framework Convention on Tobacco Control 

more able to freely discuss and cite these. For WHO, it would be very difficult 
if a country was going to be cited by name, to say XYZ countries did such and 
such, and that this was very negative in a certain phase of the negotiations. 

Tansey: Yes, we entirely understand and are sensitive to the issues. 

Bhattacharya: From what I understand, we are seeking to achieve a diversity of 
views today and often, as an historian, silences tell me a lot. So if a colleague says 
something and you don't disagree, then it's wonderfully informative. [Laughter] 

McLellan: If hard on the moderators. So, with all that behind us, shall we move 
along? To set the Framework Convention in context, we'd like to talk first about 
what preceded it. I'm sure there were some anti-tobacco and anti-smoking 
efforts in WHO before the Framework Convention, so who would like to tell 
us how it all began. 

Mackay: As the oldest person here, and possibly having the longest association 
with WHO since the 1970s, I will have the first stab at this. I think that we 
have to remember what happened in WHO before the convention came in. If 
you look back at the 1970s, there were already resolutions at the World Health 
Assembly (WHA) on smoking. The first committee on smoking was formed in 
1973, which was the Expert Committee. I joined the Expert Advisory Panel on 
Tobacco or Health in the 1980s. And, I've got here a list as long as your arm 
of publications that came out of this panel on tobacco and women, and other 
tobacco issues. Various expert panels were set up; we discussed many issues, 
including smokeless tobacco. There is quite a long and rich history and I'm 
happy to note some of the details of this. 

WHO involvement was not only at headquarters but also at the regional level. 
For example, the Western Pacific region, which is where I live, had its first five- 
year action plan starting in 1990, and they've had five-year action plans ever 
since then. Many of the regions had undertaken quite a lot of activities, so 

For a sense of the activities and attitudes of national interest groups, see Legacy Tobacco Documents 
Library, University of California, San Francisco, entering queries at 
search/basic;jsessionid=D17B281F4E5550EF6FB390EF93A3F344.tobacco03 (visited 9 February 2012). 

See, for example, the catalogue for records of Witness Seminar meetings held in archives and manuscripts, 
quote GC/253 under Reference, at (visited 25 October 201 1). 

12 See, for example, WHO (1975, 1979, 1983, 1988); Masironi (1979, 1984); see also page xxiii. 

13 See, for example, WHO, Western Pacific Regional Office (2005, 2009). 

WHO Framework Convention on Tobacco Control 

I think that when we are documenting this history, we need to look back and 
recognize the efforts that went on quite a long time before people like Neil 
Collishaw, Derek Yach and Vera da Costa e Silva and others came on the scene. 

Collishaw: I'm not sure I can agree that Judith is the oldest person here. 

McLellan: Our first point of disagreement. [Laughter] 

Collishaw: I certainly defer to Judith's experience, if not her age. As I mentioned, 
I began in the secretariat in 1991, but I would like to reinforce what Judith 
said: there were many resolutions passed by the WHA beginning in 1970, 
continuing right up until the 1990s. These resolutions, if you add them up, 
all called for comprehensive tobacco control, much as we see in the Framework 
Convention, but I think the member states came to realize that these resolutions 
were not being implemented. They also realized the power of resolutions, even 
if resolutions are a consensus statement of all the member states, they are also 
a consensus of good intentions and — a place that we're all familiar with — the 
road is paved with good intentions and it went there. Long experience of more 
than two decades, with many resolutions — there were 14 adopted from 1970 to 
1996 — taken together, called for comprehensive tobacco control, but did not 
achieve it. 15 That became part of the motivation in 1995 and 1996 when the 
executive board and the WHA got the idea that they could have an international 
treaty, and many people who had been associated with those resolutions said: 
'Yes, yes, we need something stronger.' This is part of the reason why consensus 
was rapidly achieved for a convention. 

Since you asked about anti-tobacco lobbies, I would like to tell you one story: 
it turned out, as we all know, that Malawi is one of the countries in the world 
that is heavily dependent on tobacco-growing. During the late 1980s and the 
1990s, the minister of health for Malawi would frequently stand up when these 
tobacco resolutions were being debated in the WHA and ask for something to 
be inserted at the behest of both his country and the people who bought its 
products — the tobacco industry. If you look through those resolutions, you will 

The World Health Assembly is an association of 194 governments under the auspices of WHO. The 
48th WHA in 1995 passed resolution WHA48.11, An international strategy for tobacco control', based 
on approaches adopted at the 9th World Conference on Tobacco or Health in Paris, October 1994, citing 
resolutions WHA33.35, WHA39.14, WHA43.16 and WHA45.20. See 
WHO_FCTC_WHA_48_l l.pdf (visited 10 August 2010); see also Barnham (1994); Glossary, page 122-3. 

15 Mr Neil Collishaw wrote: 'The WHA adopted an additional five FCTC-related resolutions from 1995 to 
2001 and then the final one (WHA56.1) to adopt the FCTC in 2003.' Note on draft transcript, 25 March 
2010; see also page xxiii. 


WHO Framework Convention on Tobacco Control 

always find something that I came to fondly call the 'Malawi clause' and usually 
had to do with the need to acknowledge tobacco farmers, which everybody 
agreed was a good thing to do. There was a constant pressure through the voice 
of this official representative to the WHA for a weakening of these resolutions. 
To the credit of everybody else, I think the potential damage was always limited, 
but I think it is important to signal that, indeed, there was pressure going the 
other way that the WHA had to deal with. 

Bettcher: Let me start where Neil left off. Before the 1999 resolution to put 
in place the machinery for tobacco control negotiations was agreed by the 
WHA - something that WHO had never done - there was Article 19 of our 
constitution. Some people thought we would never use it, that we were too 
conservative an organization to get into a treaty negotiation. 

McLellan: Article 19 gives us the power to make a treaty? 

Article 19:The Health Assembly shall have authority to adopt conventions or agreements 
with respect to any matter within the competence of the Organization. A two-thirds vote of 
the Health Assembly shall be required for the adoption of such conventions or agreements, 
which shall come into force for each Member when accepted by it in accordance with its 
constitutional processes. 

Figure 2: Article 19 of the WHO constitution. 

Bettcher: It does, yes. In the mid-1990s, there was a review of our constitution 
and some countries thought that Article 19 could be dropped; it had never 
been used. It seemed to be rather dormant. Did WHO need to develop treaties? 
There was also a sense at WHO that it had been a scientific organization since 
its inception and that it didn't get into politics. Of course, that's pretty illusory, 
as there was all of our work on HIV/ AIDS and breastmilk substitutes in the late 
1980s, so that argument was a bit of a fig leaf, but we have kept up the pretence. 

For details of the case of Malawi, see Otanez et ai (2009). For example, the CIA website notes that 
'landlocked Malawi ranks among the world's most densely populated and least developed countries. The 

economy is predominately agricultural with about 80 per cent of the population living in rural areas 

The economy depends on substantial inflows of economic assistance from the IMF, the World Bank, and 
individual donor nations.' See (visited 
28 October 201 1). Malawi was the tenth largest producer of tobacco in 2000, the product accounting for 
more than 70 per cent of its export income. 

The WHO constitution, adopted in 1946, is freely available at 
constitution_en.pdf (visited 21 July 2010). 

For WHO activities described at the 2007 Witness Seminar on 'The Resurgence of Breastfeeding', see 
Crowther et d. (eds) (2009). 


WHO Framework Convention on Tobacco Control 

Jumping into the deep end of a treaty negotiation seemed pretty intimidating. 
Those 16 WHA resolutions, which were adopted before the treaty mechanics were 
set up, covered almost everything, I would say, except tobacco product regulation 
and the new areas, such as the illicit trades like smuggling. That particular issue 
hadn't been touched, it was something that hadn't been seen to overlap with 
the competencies of WHO. Also, product regulation was the preserve of the 
International Organization for Standardization (ISO). This was a troubling piece 
of history as well, because, for a few decades, a tobacco group at ISO had been 
developing testing mechanisms, and then tobacco companies re-engineered their 
products in line with the ISO methods to be able to sell light/mild products, 20 
so then they could deceive the customers that these were safer. WHO was not 
present in these product regulation discussions; the tobacco companies dominated 
the ISO processes. So product regulation was missing from our remit. 

What was also missing in 1 996 was the sense that tobacco control is a transnational 
problem. In the early years there was a lack of understanding or a notion that there 
is a transnational aspect, that you can't only regulate at a domestic level alone, that 
there will be certain international features of our control, like differential taxes, 
advertising across borders, differences between countries, smuggling, products 
being dumped without the appropriate warning labels. This became described 
as part of WHO dealing with the globalization of public health. 24 

I was brought onto the team after I finished my doctorate at the London School 
of Economics to work in the area of globalization. One of my specialties was 
international relations, so I did some of the first work in the Organization on 

19 It was estimated in 1992 that 10-35 per cent or 171 billion cigarettes worldwide were smuggled (Mackay 
and Crofton (1996): 217). See, for example, Collin et al. (2004); Lee and Collin (2006); Legresley et al. 
(2008); see also Youderian (2009). 

For an analysis of ISO standards based on tobacco industry documents, see Bialous and Yach (2001): 96; 
see also Glossary, page 120—1. 

For a discussion of light/mild ratings as misleading, see Jarvis et al. (2001); Glossary, page 121. See also 
US, Food and Drug Administration (2010). It could be said that the Tobacco Working Group at ISO was 
manipulating the standards on issues such as tar and nicotine yields to facilitate the marketing of light and 
mild products. 

22 SeeBaris et al. (2000). 

23 See, for example, LaFaive et al. (2008). 

Yach and Bettcher (1998a and b); for an earlier approach, see Roemer and Roemer (1990); Table 2, 
page 14. 


WHO Framework Convention on Tobacco Control 

defining what globalization meant for WHO. Dr Derek Yach and I published 
some of the first articles in the American Journal of Public Health on the 
globalization of public health. Globalization was really picked up as a theme 
for the pre-negotiations and negotiations of the treaty. In fact, there are 'global 
goods' for public health, but there are also 'global bads', which are associated 
with trade liberalization and moving and liberalizing products across borders 
and allowing marketing and advertising. That issue had never been grappled 
with by WHO, for example, in the area of tobacco control. During the two 
years before I took up work with the Tobacco Free Initiative, we had defined 
many of these globalization issues for public health. 

The tobacco control community hadn't worked much with a transnational 
definition that tobacco was a 'global bad', and by virtue of being a 'global bad', it 
was something that should not be subject to trade liberalization, where opening 
up of borders, etc., would lead to a dissemination of products to underdeveloped 
countries, thus to increased marketing and increased consumption. There were 
some very good economic studies, starting in the late 1980s, that showed that 
low-income countries in an era of liberalization were more vulnerable. There 
are two or three econometric studies that show that what happens is that you get 
more advertising, you get more competition, the prices of the tobacco products 
fall, and therefore you get more consumption. In the early days, that notion 


was missing. 

WHO was starting to grapple with that problem just in the run up to the 
negotiations. It created a dynamic, especially for low- and middle-income 
countries then, to say why we need a global regulatory complement to national 
laws to regulate the tobacco companies. As I've described it in the past, it 
is necessary to 'make the international and global regulatory environment as 

See, for example, Yach and Bettcher (1998a and b, 2000); for one evaluation of the background, see 
Brown etal (2006). 

See, for example, Callard et al. (2001), freely available at 
April%202000.pdf (visited 31 January 2012); see also Mamudu etal. (2011). 

27 See, for example, Chaloupka and Laixuthai (1996); Hsieh et al. (1999); Taylor et al. (2000); Bettcher 
etal. (2001). 

28 See, for example, Yach (1998); World Bank (1991); Taylor and Roemer (1996); Bettcher etal. (2000); 
Bettcher and Yach (1998); Brown etal. (2006). 

29 See, for example, Townsend (1998); see also British American Tobacco (1994); Diethelm et al. (2005); 
GAmoK etal. (2007). 


WHO Framework Convention on Tobacco Control 

Global transnational factor 

Consequences and probable impact on health status 

Macroeconomic prescriptions 

Structural adjustment policies and downsizing 
Structural and chronic unemployment 

Marginalization, poverty, inadequate decreased social 

safety nets" 
Higher morbidity and mortality rates 


Tobacco, alcohol, and psychoactive drugs 
Dumping of unsafe or ineffective pharmaceuticals 
Trade of contaminated foodstuffs/feed 

Increased marketing, availability and use 

Ineffective or harmful therapy 

Spread of infectious diseases across borders 


More than 1 million persons crossing borders/day 

Infectious disease transmission and export of harmful 
ifestyles (eg high-risk sexual behaviour) 

Migration and demographic 

Increased refugee populations and rapid 
population growth 

Ethnic and civil conflict and environmental degradation' 

Food security 

Increased demand for food in rapidly growing 
economies, for example, countries in Asia 

Increase in global food trade continuing to outstrip 
increases in food production, and food aid 
continuing to decline 

Structural food shortages as less food aid is available 
and the poorest countries of the world are unable to 
pay hard currency 

Food shortages in marginalized areas of the world; 
increased migration and civil unrest" 

Environmental degradation and unsustainable 
consumption patterns 

Resource depletion, especially access to 

fresh water 
Water and air pollution 
Ozone depletion and increases in ultraviolet 

Accumulation of greenhouse gases and global 


Global and local environmental health impact 
Epidemics and potential violence within and between 

countries (water wars) 
Introduction of toxins into human food chain and 

respiratory disorders 
Immunosuppression, skin cancers, and cataracts 
Major shifts in infectious disease patterns and vector 
distribution (eg malaria), death from heat waves, 
increased trauma due to floods and storms, and 
worsening food shortages and malnutrition in many 
regions of the world 


Patent protection of new technologies under the 
trade-related aspects of intellectual property 

rights agreement 

Benefits of new technologies developed in the global 
market are unaffordable to the poor c 

Communications and media 

Global marketing of harmful commodities such as Active promotion of health-damaging practices 

Foreign policies based on national self-interest, 
xenophobia, and protectionism 

Threat to multilateralism and global cooperation 
required to address shared transnational health 

Possible short-term problem that could reverse in time; Long-term negative impact; 
Great uncertainty 

Table 2: Health and global change in the 1900s. 
Adapted fromYach and Bettcher (1998): 737. 

For country-by-country mortality attributable to tobacco, see WHO.TFI (2012). 


WHO Framework Convention on Tobacco Control 

difficult and as strict as possible for the tobacco companies', because before the 
FCTC the transnational regulatory environment was a global void, a black hole. 
The companies didn't like the proposed global regulation, and that's when they 
started talking about 'sensible regulation', 'voluntary regulation' and that sort 
of stuff. 

McLellan: That got their attention, I'm sure. 

Bettcher: It certainly did. 

da Costa e Silva: During the period between the 1970s and the 1990s, including 
the end of the 1990s when the negotiations of the treaty were initiated, I worked as 
coordinator of the Brazilian Tobacco Control Programme. What I saw at that point 
was that the Pan-American Health Organization (PAHO) was not very involved in 
tobacco control. Dr Enrique Madrigal, an adviser for alcohol control, was the only 
person in power who managed to do something about tobacco control. Do you 
remember him, Neil? The American Cancer Society (ACS) was the organization 
that was trying to bring together the medical associations in the different Latin 
American countries in order to push forward the process in the region to undertake 
tobacco control as a real activity. 31 A representative from PAHO was attending 
the meetings, especially those of the Comite Latino Americano Coordinador del 
Control delTabaquismo (CLACCTA), a specialist committee that was created with 
support from ACS. 32 It was through the creation of this committee and through 
the Brazilian doctors' associations that Brazil's tobacco control movement from the 
health groups started to reach the government. As part of the Brazilian Ministry 
of Health's National Cancer Institute (INCA), we were contacted for the first time 
in the 1 990s by Neil Collishaw from WHO Geneva. He didn't have a department 
or a strong standing in the organization as far as I can remember — please correct 
me if I'm wrong — no funding and a lack of people; he was the king of a reign with 
himself. This was the early stages of tobacco control. For Brazil, for instance, and 
probably for all tobacco-growing countries, the reaction was: 'Let's not address 

Dr Vera Luiza da Costa e Silva wrote: 'Dr Enrique Madrigal worked at PAHO during the 1990s as 
regional adviser on alcohol and tobacco, coordinating PAHO work in the region of Americas and 
supporting government initiatives in these areas, and collaborating with the American Cancer Society 
in the establishment and organization of CLACCTAs work and meetings.' Note on draft transcript, 
26 January 2012. 

See press release, 'Regional plan to control tobacco', Office of Public Information, Washington, DC 
(PAHO), 21 May 1999 at (visited 6 October 201 1). 

See page 30. 


WHO Framework Convention on Tobacco Control 

tobacco control, because it's too complicated an issue to discuss'. I think this was 
the reality for most countries, even for those that were not tobacco growers during 
this period. I am talking about 20 years ago, between 1970 and close to 2000 when 
the treaty negotiating process was initiated. 

Zeltner: May I add three points here. One is that if you want to write a history 
of tobacco control and WHO, you need to look at the regions as well. 33 Because 
the regions are very active in some areas, tobacco control is typically one where 
there were major differences at regional level: the European region being very 
active, with the Nordic countries in the driving seat, pushing the agenda at the 
regional level. From that perspective, it's very interesting how things may move 
on, and that's why it is interesting to look at public health history: some issues 
may be raised or have their origin, babyhood and childhood in a region and 
then come to the centre. I think that is what happened in WHO. The tobacco 
industry's Boca Raton action plan was the Philip Morris plan to fight against 
WHO and dates from 1988. 34 It was well before that time when the tobacco 
industry said: 'WHO is one of our no. 1 enemies'. This is very surprising because 
if you look at the programme here (Table 1, page 7), it was not. If you look 
at the tobacco industry statements, they say: 'We need to get the developing 
countries to understand that it is a first-world issue.' That's why Malawi and all 
these countries were so important for the tobacco companies. So, you need to 
see how these things moved in the regions and how it then became a global issue 
at some stage and moved here to Geneva, at the centre. 

The 194 member countries of WHO are divided into six regions and their headquarters are: Africa 
(Brazzaville, Congo); the Americas (Washington, DC); South-East Asia (New Delhi, India); Europe 
(Copenhagen, Denmark); Eastern Mediterranean (Cairo, Egypt); Western Pacific (Manila, Philippines); for 
a complete list see Appendix 2, page 74. 

The meeting of Phillip Morris executives from which the action plan took its name was held in Boca 
Raton, Florida, 29 November-3 December 1988. The WHO Committee of Experts on Tobacco Industry 
Documents wrote: 'The Plan identified 26 global threats to the tobacco industry and multiple strategies 
for countering each. First among these threats was the World Health Organization'. (Zeltner et al. (2000): 
4; freely available at: (visited 6 January 2012). The 
13 December 1988 document, Bates No. 2021596422/6432 (see Glossary, page 119), said: '(1) WHO/ 
UICC/IOCU INITIATIVE: This organization has extraordinary influence on government and consumers 
and we must find a way to diffuse [sic] this and re-orient their activities to their prescribed mandate.' See 
Legacy Tobacco Documents Library, University of California, San Francisco, at http://legacy.library.ucsf. 
edu/tid/izf58e00 (visited 26 September 2011). See also Kaufman (2000); for an example of more recent 
litigation against Uruguay, see Lencucha (2010). 

See pages 32—3. 


WHO Framework Convention on Tobacco Control 


Subsidiaries and brands 

Philip Morris/Altria Renamed as Altria in 2003 and is the parent corporation of Philip Morris USA. 
(US) Four strong premium brands: Marlboro, Copenhagen, Skoal and Black & Mild 

( a/Financial_Strength/default.aspx?src=top_nav 

(visited 14 February 2012)). 

Philip Morris A separate international operation created in 2008 by the sale of all shares of Philip 

International Inc Morris International to Altria's shareholders, based in Lausanne, Switzerland, operating 

(Swiss) in 1 80 countries, with an estimated 1 6 per cent share of the international cigarette 

market outside of the US or 27.6 per cent excluding the People's Republic of China 
(2010). Top 25 PMI brands: Marlboro, L&M, Bond Street, Philip Morris, Chesterfield, 
Fortune, Parliament, Sampoerna A, Lark, Morven Gold, Dji Sam Soe, Next, Optima, 
Red & White, Muratti, Diana, Merit, Sampoerna Hijau, Champion, Virginia Slims, Apollo- 
Soyuz, Hope, Delicados, Benson & Hedges, Longbeach 
( (visited 14 February 201 2)). 

Reynolds American A new publicly traded parent company (RAI) from the merger of Brown & Williamson 
Inc (US) (formerly BAT) and RJ Reynolds in 2004, whose subsidiaries are: RJ Reynolds 

Tobacco Company (second-largest US tobacco company); American Snuff Company 
(smokeless tobacco); Santa Fe Natural Tobacco Company, Inc. (additive-free tobacco 
products); Niconovum AB (nicotine replacement therapy) and produces five of the 10 
best-selling US cigarette brands: Camel, Winston, Kool, Salem and Doral 
( (visited 14 February 2012)). 

British American A joint venture between the UK's Imperial Tobacco Company and the American 

Tobacco (UK) Tobacco Company founded by James Buchanan Duke in 1902; acquired American 

Tobacco Company in 1994 and Rothmans International in 1999; divested Brown & 
Williamson in 2004 to RJ Reynolds, retaining a 42 per cent share in RAI. BAT's 200 
brands include the 4 'global drive brands' of Dunhill, Kent, Lucky Strike and Pall Mall, as 
well as cigars and smokeless tobacco ( (visited 14 February 2012)). 

Japan Tobacco Wholly owned by the Japanese government from 1 904 to exclude James Buchanan 

(Japan) Duke's American Tobacco Company from Japanese commerce ; renamed Japan 

Tobacco and Salt Public Corporation (JTSPC) from 1949. Japan Tobacco Incorporation 
Law, 1984, required the Minister of Finance to hold two-thirds ofJT's stock, which fell 
to 50 per cent from April 2004. Acquired all RJ Reynolds non-US operations in 1999 
(Camels, Winstons or Salems sold outside the US); acquired UK's Gallaher Group in 
2007; and in 2009 acquired part ofTribac Leaf Limited, which trades tobacco in Africa. 
Brands: Benson & Hedges, Mayfair Ronson, and Silk Cut, Camel, Mild Seven, Salem, 
Winston, Winchester Gold Coast, Genghis Khan, and Peace 
( (visited 14 February 2012)). 

Imperial Tobacco Bristol-based, started as a WD & HO Wills shop in 1786; in brief ownership by 

(UK) the American Tobacco Co., Ogden's became a branch of Imperial Tobacco in 1 902; 

by 1980s 22 constituent companies reduced to three, WD & HO Wills, John 
Player & Sons and Ogden's; briefly owned by Hanson pic, returning to corporate 
ndependence in 1996. Acquisitions: Reemtsma (2002, mainly EU and rest of the 
world), Commonwealth Brands (2007, Americas) and Altadis (2008). Brands: Davidoff 
Gauloises Blondes and fine cut tobacco, cigars, papers and tubes 
( (visited 14 February 2012)). 

' Kolandai (2007) * Levin (2004) at Levin-tobacco-control-policy-2004 (visited 6 January 2012) 

Table 3: Big six tobacco companies, details from company websites, 14 February 2012. 

See Table 4, page 26, for market share in 2000 and 2008. 


WHO Framework Convention on Tobacco Control 

The second point I would like to make is, properly speaking, the FCTC is the 
first convention on public health globally. There are, however, three others: the 
Single Convention on Narcotic Drugs (1961), the Convention on Psychotropic 
Substances (1971) and the Convention against Illicit Traffic in Narcotic Drugs 
and Psychotropic Substances (1988). Many of the ministers of health or 
delegates sit in WHO in Geneva and at the UN Drug Control Programme 
(UNDCP) in Vienna and, frankly speaking, many of us do not think the 
conventions of Vienna are a great achievement for public health. Some of the 
more progressive people even thought that conventions are a difficult way to 
go, because — and we see this with the conventions in Vienna — once you have 
more than 170 country signatures, you cannot change the convention any 
more. The coca leaf regulation, ' and the prohibition of cannabis, which only 
slipped into these conventions by chance in the late night hours of negotiations, 
have major negative consequences up until today: the 'social use of cannabis, in 
many developing countries seen as comparable to the social use of alcohol in the 
developed world at the time, and chewing or drinking coca in the Andean region, 
comparable to drinking coffee, were thus condemned to be abolished.' Being 
now encoded in the 1961 convention, you can't get rid of these regulations. 
These international conventions can also block developments in public health. 
Some of us were somewhat reluctant because we thought: 'Yes, tobacco needs to 
be regulated, but this is dangerous.' 

The last point — not alluded to during this morning's celebrations — is that we 
have to salute the US and its lawyers. Without the lawsuits against the tobacco 
industry in the US and the opening of the files of Philip Morris, we would 
never have seen the creation of such a strong anti-tobacco movement. I think 
that's another lesson: the law can be an extremely powerful instrument in public 

A UN commission of inquiry went to Peru and Bolivia during the autumn of 1949 to investigate the 
effects of chewing the coca leaf and the possibilities of limiting production and controlling distribution 
(see Bulletin on Narcotics 1, October 1949) and reported in May 1950. For the Commission's method 
of work, its conclusions and recommendations, see 
bulletin_1950-01-01_4_page005.html (visited 7 July 2010). 

37 Bewley-Taylor and Jelsma (2012): 78. 

For a discussion of the 1925 League of Nations' International Opium Convention, see Crowther et at 
(eds) (2010): 4. 

39 See Carter (2002). 

See note 1 . 

See note 45. 


WHO Framework Convention on Tobacco Control 

health. Doctors tend to think that public health is mostly about caring for 
people, but actually, I think these legal issues in the US created the momentum 
for things to start happening globally. 

Bettcher: In 1994 the first box of documents were left in Stan Glantz's office at 
the University of California, San Francisco. It is known as the 'Mr Butts' story. 2 
Then in 1998, 1999 was the Blue Cross and Blue Shield of Minnesota case 
against the tobacco companies for health damages (1994—99), which then led to 
the litigation by the Minneapolis-based law firm of Robins, Kaplan, Miller and 
Ciresi. 3 Roberta Walburn, one of the top world litigators, had been involved in 
the Bhopal case (the government of India on behalf of the victims of the Bhopal 
disaster against Union Carbide) and the Dalkon Shield case (women injured 
by the Cu-7 intrauterine device against G D Searle Co., the manufacturer), 
and she took them to task. The lawyers locked themselves up in a St Paul/ 
Minneapolis hotel for about eight months and started requesting the documents 
from the tobacco companies. 5 It turned out there were over 70 million pages 
of documents hidden under client— attorney privilege going back to the 1950s, 

For further details, see 
(visited 7 July 2010). See also Glantz (1996); Brandt (2007). For a guide to searching the documents, 
see (visited 16 November 2011). For one analysis 
of how the dollars from of tobacco industry settlement have been spent, see 
PDFPublications/TobaccoAsASocialJusticelssue.pdf (visited 20 December 201 1). 

See Ciresi et al. (1999); for background details of tobacco litigation, see 
pages/ 10805/Tobacco-Tobacco-Litigation. html; for Blue Cross and Blue Shield of Minnesota, see Group 
Health Plan, Inc., vs Philip Morris, Inc., R J Reynolds Tobacco Co., Brown & Williamson Tobacco Corp., 
BAT Industries pic, Lorillard Tobacco Co., American Tobacco Co., Liggett Group, Inc., the Council for 
Tobacco Research — USA, Inc., and the Tobacco Institute, Inc., including not only tobacco companies as 
named defendants, but also the Kimberly-Clarke Corporation, the developer of the tobacco reconstitution 
process that enables tobacco companies to manipulate nicotine levels, see 
POST71A_016058 (both sites visited 7 July 2010). See also Lilyard and Anderson (2000). 

For details of the class actions (mass tort cases) of Robins, Kaplan, Miller, and Ciresi, see 
results.aspx?group=1259 (visited 7 July 2010). 

For details of the decision by the Minnesota Court of Appeals, in the 1995 settlement between the State 
of Minnesota, Blue Cross and Blue Shield of Minnesota and Philip Morris Incorporated, R J Reynolds 
Tobacco Company, Brown and Williamson Tobacco Corporation, BAT Industries pic, Lorillard Tobacco 
Company, the American Tobacco Company, Liggett Group Inc., the Council for Tobacco Research and 
the Tobacco Institute, see (visited 
7 July 2010); for the Legacy Tobacco Documents Library, University of California, San Francisco, see (both visited 26 September 201 1); see also Infact (2003). 


WHO Framework Convention on Tobacco Control 

which had nothing to do with the client— attorney privilege. The documents 
described how the tobacco companies had defrauded countries and customers; 
how they had manipulated and re-engineered the product and described the 
whole insider story of nicotine spiking, ' where tobacco companies converted 
nicotine from a salt to its base form, adding ammonia to cigarettes in the early 
1970s to create a cigarette equivalent of crack cocaine, a 'free-base nicotine' 
cigarette. The documents also described how the industry tried to get kids 
hooked; how the industry was dreaming about penetrating markets in China 
through trade liberalization. The documents unlocked Pandora's box for us. At 
around the same time, Dr Zeltner was appointed by Dr Brundtland to chair an 
expert group to investigate the implications of 50 years' actions by the tobacco 
companies for WHO and other UN organizations. 48 

Potschke-Langer: I fully agree that the emotional impact factor of the tobacco 
industry documents was overwhelming, I would say, for the whole world. We 
never thought that the tobacco industry would be so strong and could influence 
governments and health authorities in such a way. Coming from countries 
in Central or Eastern Europe, with not very well-developed tobacco control 
activities, we said: 'No, this cannot be true, and we must act immediately; we 
must form this international group and support all activities very strongly' This 
was a very moving, a very touching issue. Then in the 1990s, two other events 
were very important for us: the conference of Paris in 1994 when Ri chard Peto 
presented the data on the tobacco epidemic worldwide. I will never forget the 
big book of Sir Richard Peto and his colleagues.' This was so impressive that 
we all said: 'Look at the data; it's so visible and we must act immediately' The 

For a description of nicotine manipulation, see Kessler (1994); for a retraction of an earlier analysis of 
WHO that relied on work by an American economist paid by BAT, see Godlee (2000), discredited by 
WHO's Committee of Experts on Tobacco Industry Documents (Zeltner et al. (2000): 128). 

7 Pankow et al. (2003); Ashley et al. (2009); Stevenson and Proctor (2008); for research on the role of 
ammonia from Philip Morris, see Callicutt et al. (2006). 

WHO, Committee of Experts on Tobacco Industry Documents (Zeltner et al. (2000)). The members 
of this committee, established in 1999, were: Professor Thomas Zeltner, director, Federal Office of Public 
Health, Switzerland and chairman; Dr David Kessler, dean, Yale School of Medicine, USA; Dr Anke 
Martiny, executive director of Transparency International, Germany; Dr Fazel Randera, inspector general 
of intelligence, South Africa. The Committee was assisted by eight outside researchers. Freely available at: 
www. who. int/tobacco/media/en/whoinquiry.pdf (visited 9 January 2012). 

49 Peto and Lopez (1990); see also Crofton (1990); Simpson (1994). 

Peto et al. (1994); see also Biographical notes, page 1 15. 


WHO Framework Convention on Tobacco Control 

other factor was the World Bank report, Curbing the Epidemic, which brought 
up measures of what we could do in the political and economic fields.' To my 
mind, these three points were the breakthrough. 

McLellan: I'd like to move us to the question of the role of the Director-General 
in pushing the agenda. 

Collishaw: I would like to come back to regulatory toxicology and pharmacology, 
and to something my colleague Dr Zeltner said. I think I can summarize it as: 
'There are good treaties and not so good treaties.' In the mid- 1 990s, in addition to 
my responsibilities for tobacco control, for a time I acquired other responsibilities 
here in the secretariat on controlling alcohol and illicit drugs as well. They didn't 
give me any money for those either. [Laughter] However, they did send me to 
Vienna occasionally and I worked with colleagues who were administering the 
treaties that Dr Zeltner mentioned. So, at the same time, I was trying to think of 
ideas to follow up on the 1995 and 1996 resolutions of the WHA: 'How were we 
going to create a treaty?' Like Dr Zeltner, I concluded that these narcotics-control 
treaties, in terms of public health, were in the 'bad treaty' class from a public 
health point of view; they wouldn't help us. On the other hand, with the advice 
and encouragement from Ruth Roemer and Allyn Taylor, who had been working 

World Bank (1999), freely available at:, report team led by 
Prabhat Jha and Frank J Chaloupka (visited 1 December 2011). Demand- reduction measures suggested: 
raising taxes, non-price measures (bans on advertisements, counter advertisements; prominent health 
warnings on packaging, research findings on health consequences, restriction of smoking in public places) 
and nicotine replacement and cessation therapies; supply restrictions are not very successful (alternative 
crops, diversification, trade restrictions), with the exception of action against smuggling (prominent trade 
stamps on packages, local language warnings and aggressive enforcement of laws against smuggling) (World 
Bank (1999): 6-8). 

Tobacco product regulation is covered by FCTC's Articles 9 and 10 (see page 73 and Glossary, page 
122). A WHO Study Group (TobReg/IARC) working group wrote: 'Existing product regulatory strategies 
based on the machine-measured tar, nicotine and carbon monoxide (CO) yields per cigarette with the 
current ISO regimen are causing harm. By allowing communication of the yields as measures of exposure 
or risk, they mislead smokers into believing that low-yield cigarettes carry less risk and are a reasonable 
alternative to cessation. This harm precludes continued acceptance of strategies of product regulation based 
on per-cigarette machine-measured tar and nicotine and necessitated the development of a new approach.' 
WHO, Study Group on Tobacco Product Regulation (2008): 45, freely available at 
global_interaction/tobreg/publications/978924l209519.pdf (visited 6 March 2012); see also note 172. 

For discussion of bad treaties, see page 18. 

See Roemer et al. (2005); see also Figure 3, page 22. 


WHO Framework Convention on Tobacco Control 

Figure 3: Dr Ruth Roemer (1916-2005) and 
Dr Judith Mackay.WHA, May 2003. 

on some of the legal aspects, the concept of a framework treaty was a more flexible 
instrument where you could adopt protocols and was, I saw, a good direction to 
go. There were other treaties in this class — many of the environmental treaties — 
and in particular the Vienna Convention for the Protection of the Ozone Layer 
and related Montreal protocol." The Vienna Convention was a good model for 
us. It is a framework convention with very little of substance in it, other than 
general agreement to do something about the hole in the ozone layer, and, 
importantly, the authority to negotiate protocols with more detailed agreements on 
just how to protect the ozone layer. The subsequent Montreal Protocol is just such 
a detailed agreement. The Vienna Convention with its protocols were, and are, very 
successful international agreements. And they served as good models for preparing 
for negotiations on a new tobacco treaty." So, these were good models, and we 
pushed things in that direction. They continued in that direction, and I'm happy 

The Montreal protocol of the Vienna Convention for the Protection of the Ozone Layer concerns 
substances that deplete the ozone layer opened for signature in September 1987 and entered into force 
in January 1989, with seven revisions. For further details, see 
evolutionofmp.shtml (visited 8 July 2010). 

For the text of the Vienna Convention for the Protection of the Ozone Layer, see 
new_site/en/Treaties/treaty_text.php?trearyID=l (visited 19 January 2012). 


WHO Framework Convention on Tobacco Control 

to say that the FCTC eventually adopted the best of both worlds, because there are 
many substantive elements in the treaty itself, but it also has the capacity of having 
protocols added, and we're seeing one now and there might be more in the future. 

There is another 'bad example' I would like to talk about when I was trying to 
talk up the treaty in the mid-1990s — a lonely occupation. I'd say: 'Well, you 
know, we have the "Law of the Sea" now' It is a book several inches thick.' 8 It 
took 25 years of negotiations up to that point, and it had been concluded. There 
it was, hundreds of pages of gobbledygook and nobody can change a word in it 
ever again.' I said: 'We don't want one of those. We want something that's small 
and flexible, and is going to move with the times, because we know there are 
forces against us and we're going to have to be nimble and adapt to them.' 

Ogwell: Many times whenever we look at this treaty, I think it is the 
comprehensive nature of it that will strike you, as it cuts across many aspects 
of society. One section that stands out to me is the one on tobacco farmers. 
The farmers have been looked at as the impediment, the barrier, in very many 
instances. But the truth is, and I speak for the African region here, if it were 
not for the farmers, the African region would not have come out as strongly 
as it did. Evidence was very thin in Africa as far as tobacco use is concerned. 
Our heads of state, especially in the mid-1990s, were a very closed group of 
relatively old chaps whose word, basically, was law and who didn't see the 

The final negotiations on a protocol to the FCTC (Article 15) on 'Illicit trade in tobacco products', 
were conducted at INB-5 in March— April 2012 in Geneva, see 
(visited 31 January 2012). 

The UN Convention on the 'Law of the Sea' began with the work of the Seabed Committee in 1968, 
was adopted in 1982 and came into force in November 1994 with 60 signatories. For further details, see 
(visited 8 July 2010). For details of these precedents, see 
pdf (visited 19 July 2010). 

The International Tobacco Growers Association (ITGA) describes itself as a non-profit organization 
founded in 1984 to represent the interests of the tobacco farmers, with members from Argentina, Brazil, 
Canada, Malawi, US and Zimbabwe, of which only Brazil and Canada have ratified the FCTC. Its role is 
'presenting the cause of millions of tobacco farmers to the wo rid... to provide a strong collective voice on 
an international and national scale in order to ensure the long-term security of tobacco markets... run as 
a three-person organization from its headquarters in the eastern Portuguese city of Castelo Branco.' See asp?ID=7&IDP=2&P=2 (visited 28 November 201 1). For further 
discussion, see pages 24, 41, 42, 54 and 56. 

Of the 46 countries in the WHO African region, Eritrea, Ethiopia, Malawi, Mozambique and Zimbabwe 
have not ratified the FCTC. 


WHO Framework Convention on Tobacco Control 

link between tobacco use and health. The information coming from farming 
communities is what galvanized the need to broaden any tobacco control issues 
with the interests of the farmers. If the interests of the farmers had not been 
well catered for, the African region would probably not have played the key role 
that they did during the negotiations. Farmers, for us, have contributed a lot 
to the success that brought together the whole of the African region, because 
we have some very key tobacco growing countries, whose leaders were pretty 
influential on the African continent and whose resistance to a position that 
would not include solutions for them would have actually resulted in a very 
big barrier. 61 When there was appreciation that the farmers would be catered 
for, the comprehensive nature of discussing the convention as an agricultural 
issue, as a development issue, under the WHO then that made a lot of the 
countries comfortable enough to be able to go along with what their public 
health colleagues were proposing. So when farmers are considered — in fact 
they are exposed more than any smoker, any chewer of tobacco — because their 
work is with tobacco every day, all day. The level of exposure they have to 
tobacco as a plant is more than can be said of any other tobacco users and their 
experiences resulted in the pressure for colleagues, especially from the African 
region, to take them into account during the negotiations. I think this was 
key in opening up the multi-sectoral nature of the treaty that we have today. 
There are many things that can be said negatively about the farmers but, for 
me, they were the original anti-tobacco lobby, because they suffered this health 
risk every day. Whenever we look at the history, the farmer is the original anti- 
tobacco lobby. ' 

Commercial tobacco growers in Africa include Kenya, Malawi, Mozambique, Tanzania, Zambia and 
Zimbabwe among others. 

Ms Kathy Mulvey wrote: 'I have some concerns about this representation of the motives underlying 
African solidarity and leadership on the FCTC. As I remember it, the strong positions of the AFRO region 
were driven primarily by a desire to stop the spread of this preventable epidemic — and its negative health, 
social and economic consequences. African leaders pushed for the concerns of farmers to be addressed, in 
large part because the tobacco industry was spreading misinformation and attempting to divide the region. 
See the Johannesburg Declaration of March 2001 (, visited 
21 July 2010) as the initial expression of a unified African position. See also the 1999 WHO/World Bank 
monograph Curbing the Epidemic on pages 21 and 30 and for insights into the tobacco industry's strategy, 
see Carter (2002).' Note on draft transcript, 20 July 2010. Dr Ahmed Ogwell wrote: 'My point was and 
still is that by addressing the issue of farmers we brought everybody in our region on board. Not doing this 
would have been divisive and we avoided that by ensuring that the FCTC was encompassing all issues, 
particularly including alternative livelihoods for tobacco farmers.' Note on draft transcript, 2 April 2012. 


WHO Framework Convention on Tobacco Control 

Assunta: Earlier, someone queried how many resolutions there have been 
at the WHA since 1970. There were 17. When I discovered the number of 
resolutions by the WHA sometime in the 1990s, I used to wonder how our 
governments kept going to the WHA, why they kept drawing up resolution 
after resolution, to come back home and do so little? It was one of the questions 
that I asked myself. 

Coming from a developing country and starting to do tobacco control in the 
1980s, I found that there was very little documented evidence or information 
that I could obtain from Malaysia or from other developing countries. So I 
appreciated the documentation that was put out by WHO. I also appreciated 
all the wonderful reports that came from the US and the UK 63 and from 
our colleagues who had started on this work much earlier. I used to try to 
localize some of those reports, so that I could put together information to take 
to my government and ask for policy change. Without that information my 
government would come back to me and say: 'That's in the US; it doesn't apply 
to Malaysia.' 

Having said that, I also found that in the international arena — this was 
particularly so in the mid-to-late 1990s when I started to get involved in 
international tobacco control — that the perspective from developing countries 
was lacking. Many of the policy measures being proposed would work very well 
in an environment where considerable effort had already gone into tobacco 
control, along with freedom of information and freedom of the press. Those 
conditions might not necessarily apply to some countries in my part of the world. 
Therefore I took it upon myself to ensure that I would carry the perspective of 
developing countries to the international arena, bringing a different perspective 
and a different sense of reality to some of the policy measures. Having said 
that, of course, I had a particular interest in tracking the transnational tobacco 
companies and the big three: Philip Morris, BAT (British American Tobacco) 
and Japan Tobacco. I knew that to address the smoking epidemic we needed 
international action, that there was very little that I could accomplish working 
in Malaysia alone. 

63 See, for example, Doll and Hill (1950, 1952, 1954, 1956a and b, 1964a and b, 1966); see also Larson 
etal. (1961); for derails of Glantz's work on tobacco control in the UK, see Berridge etal. (2006): 35—6. For 
post-Doll and Hill tobacco industry ractics, see Brandt (2012). 


WHO Framework Convention on Tobacco Control 

Company Global Market Share (%) 

2000 2008 

Philip Morris International 



Altria/Philip Morris USA 



British American Tobacco 



Japan Tobacco International 



Imperial Tobacco 



China National Tobacco Corporation 






Source: The Tobacco Atlas, 4th Edition. Chapter 1 8. Tobacco Companies. Data derived from ERC. (201 0). World 
cigarette reports 201 0. 

Table 4: Global cigarette market share, per cent of total number of 

cigarettes produced, 2000 and 2008; see also Table 3, page 1 7. 

My third point has to do with the treaty-making process: I had zero experience 
or knowledge in treaty-making, and you know that very often in international 
treaty-making, developing countries do not provide leadership or drive the 
process. Therefore I had very little experience to fall back on, or even people 
to talk to in Malaysia when I was trying to find out what one could do. Where 
does one start with treaty-making? I was starting from scratch. 

So it was quite difficult, because we had very little information. Therefore I 
had to talk to my friends from the north and I proceeded to participate in 
the start of the FCTC negotiations, armed only with strategies in international 
tobacco control, learning as I went along. I think this also applied to many of 
my colleagues from developing countries. 

Cunningham: In terms of what preceded the FCTC, I think one very important 
factor was successful country experience in many of the subject areas that 
became the articles of the FCTC. We had many countries that had banned 
advertising; we had learned the arguments and counter-arguments — how to 
defeat the tobacco industry on that issue. 6 We had the experience that partial 
advertising bans were inadequate. For package warnings and labelling, Brazil 
banned light and mild descriptors in 2001, followed by adoption of the 
European Community Directive later in 2001. That was incorporated as it was 

64 Framework Convention Alliance (2005); ASH (1996); World Bank (1999). 


WHO Framework Convention on Tobacco Control 

in Article ll. 65 Canada's picture warnings were adopted in 2000, followed in 
200 1 by adoption of the EC Directive with optional use of picture warnings, and 
by Brazil's requirement for picture warnings. ' These formed the basis for Article 
1 1 . If you look at liability, had the FCTC been negotiated ten years earlier, it 
would have been far weaker. Even a section on liability, you know, on taxation, 
was good. We had lots of country experience on taxation and we were able to 
say conclusively that taxation decreases consumption.' Areas like cessation or 
education or sales to minors, were all influenced by country experience.' We 
also had people who had been working on the issue for many years, inside 
of government and outside. There was some capacity to successfully influence 
the negotiations, with fairly strong content for many issues. There was also 
recognition that this was the right thing to do, in terms of tobacco control. Why 
do we have the FCTC? It's the right thing to do. I think many people in many 
countries — more in developing countries, but also some in developed countries 
— said they needed help. They wanted to do this, they were faced with tobacco 
industry opposition, they faced opposition from other parts of government. 
This treaty would help them, and they were right. Those are some of the things 
that preceded the FCTC. 

Mackay: I would like to document the role of Ruth Roemer in this, because 
I think history demands it. In 1993 Ruth Roemer read an article by Allyn 
Taylor in the American Journal of Law and Medicine calling on WHO to use 

For the Brazilian ban on tobacco advertising, RDC n° 46 of 28 March 2001, see; for the European Community's ban on tobacco 
advertising, see note 139 and Directive 2001/37/EC of the European Parliament and of the Council of 
June 5 2001 ...concerning the manufacture, presentation and sale of tobacco products, Official Journal 
of the European Communities Ll 94/26 at 
:L:2001:194:0026:0034:EN:PDF; for details of the European implementation of the FCTC, see and; for a discussion of deceptive labels 'mild', 
'light', etc., see note 21. For the provisions of the FCTC, see Appendix 1, page 73 and at 
tobacco/framework/WH O_FCTC_english.pdf, page 9—10, and a database of pictorial health warnings at (all sites visited 21 February 2012). 

For the Brazilian requirements for picture warnings, RDC n° 104 of 31 May 2001, see; for regulations in Canada, see Tobacco Products 
Information Regulations, SOR/2000-272, see 
272/201 10922/PlTT3xt3.html (all sites visited 21 February 2012). 

See also note 27, page 69 and Appendix 5. 

See note 187. 


WHO Framework Convention on Tobacco Control 

a legal mechanism for the 'health for all' goal. ' Ruth Roemer contacted Allyn 
Taylor and suggested that she applied her ideas to tobacco control. So there 
was a twin birth. What then happened was that Ruth Roemer met with me 
at a meeting in the US on 26 October 1993 and said to me: 'Has WHO ever 
thought of having a convention?' I replied: 'Oh, they have conventions all 
the time. The last thing they want are more conventions,' thinking she was 
meaning meetings, such was my ignorance of this possibility at the time. She 
said: 'No, no, I don't mean meeting-kind-of-convention, but having a UN- 
style convention on tobacco issues.' We discussed this and she said: 'You are a 
WHO consultant. Can you go back to WHO with the idea?' My initial role 
was as a messenger. Commensurate with that was that Ruth and I drafted a 
resolution for the 1994 Conference on Tobacco or Health, which called upon 
WHO to adopt a tobacco control convention. This is why this treaty has its 
roots in civil society. Frankly speaking, I think it is true to say that in 1993, 
1994, 1995 -while Neil was struggling on his own at HQ- the resolution had 
a very bleak reception in WHO. The first thing that was said was: 'It takes ten 
years to develop a treaty' Well, that's fine, ten years passes, as indeed we know. 
'It was too difficult; it was a very different mechanism from anything that 
WHO had undertaken.' I have to say there was a lot of very negative caution, 
and even antagonism, towards the idea. And then, what Ruth did was to draft 
a lot of preparatory papers, which went to the United Nations Conference 
on Trade and Development (UNCTAD), which then went backwards and 
forwards. I think the role of the late Ruth Roemer needs to be most clearly 
placed in this history, and that of Allyn Taylor. Of course, when we come 
to Dr Brundtland's role as Director-General (DC) of WHO, I can certainly 
explain how tobacco control came to be her cabinet project. 

The second thing I would just like to comment on is Dr Zeltner's comments 
about the tobacco industry documents. I think it came as a shock to all of us 
to realize how early on the tobacco industry had been tracking us, looking at 
us, criticizing WHO internally, 71 much earlier than we ever dreamt of. The 

Dr Halfdan Mahler, WHO Director-General (1973—83), set 'Health for All', as one programme goal of 
WHO, in 1981 (Mahler (1981); WHO (1981)). 

See Biographical note for Dr Ruth Roemer (1916—2005) on page 115. 

Dr Judith Mackay wrote: 'There are 13 million tobacco industry documents with 70+ million pages that 
can be accessed and searched at: (visited 14 February 2012).' Note on draft 
transcript, 26 January 2012. See also note 42. 


WHO Framework Convention on Tobacco Control 

documents gave us a sense of betrayal, because they showed that many of our 
colleagues, in public health in particular, had been paid off by the industry 
to deny the evidence, particularly on issues of passive smoking, and to try to 
obstruct tobacco control legislation. In most countries in Asia there were two or 
three people who had been recruited, including people I myself knew in Hong 
Kong — I was shocked, really shocked, to realize that the tobacco industry had 
recruited colleagues. It was called Project Whitecoat in Asia. They recruited the 
whitecoats, that is, the doctors and scientists, and paid them to try to obstruct 
tobacco-control measures. 

Although it pre-dated and was in a sense divorced from the treaty, I think 
another key event was in 1985, when many of us were working separately all 
over the world in tobacco control. The American Cancer Society (ACS) held a 
meeting in Washington, DC, which in true American style was called the First 
International Summit of World Smoking Control Leaders [laughter], 73 which 
slightly amused the non-Americans in its grandiose terminology. But many of 
us met together then for the first time and realized what was happening in 
other countries. It was the first time I personally met colleagues from China, for 
example, which was a very, very important connection as it so happened. I think 
the ACS needs to be recognized for having facilitated the particular meeting 
that brought us all together. 

My final plea is that when this is all written up, may we use the term 'low- and 
middle-income countries' rather than 'developing' and 'developed'? I can argue 
this forever, but the former term does give respect to developing countries, and 
the latter is erroneous in so many respects. I put that plea on the table. 7 

For an example of 'whitecoats' documents, see (visited 16 
November 2011). For one background on 'fake experts', see Hirschhorn (1999) at 
tobacco/docs/secretdocs/whitecoat.shtml (visited 9 July 2010); Diethelm et a I. (2005, 2009). 

In September 1985, world smoking control leaders from 39 countries recommended that a task force 
from major international non-governmental health organizations be convened, chaired by Dr Charles 
LeMaistre, then ACS national president. See 
html?pattern=&ocr_position=&rotation=0&zoom=750&start_page=l&end_page=2#images (visited 9 
July 2010). LeMaistre was a director of Enron Corporation (1985-2001). See also page 15. A list of the 
1985 international experts, provided by Dr Judith Mackay, will be deposited, along with other records of 
this meeting, at GC/253, archives and manuscripts, Wellcome Library, London. 

Participants' own descriptions of countries have been retained throughout. 


WHO Framework Convention on Tobacco Control 

da Costa e Silva: By the end of the 1990s, Brazil already had almost 15 years 
of tobacco control and many measures were already in place. At this point in 
WHO, by the mid-1990s, either colleagues like Neil or consultants like Judith 
were promoting the idea that a treaty was needed. The first person I heard talking 
about a convention was Neil. He said: 'We need a Framework Convention on 
Tobacco Control', and at that point, I could not understand what it was all about. 
Additionally, through the commitment of some people from key organizations and 
countries and from those that were part of the executive board, efforts were made to 
establish a strategy, which was fully supported when Dr Brundtland joined WHO. 
Some factors impacted on the momentum that resulted in the establishment of 
the treaty's negotiation mechanism, including the creation of a cabinet project at 
the TFI, which was absolutely relevant for tobacco control. Furthermore, Thomas 
Zeltner's committee study on the interference of the tobacco industry on WHO's 
policies created indignation against the tobacco industry's misleading strategies to 
oppose public health. WHO had also funded the World Bank's economic study 
Curbing the Epidemic as a strategy to bring the World Bank on board, giving the 
intersectoral dimension and visibility to the real economic arguments about the 
problem and also bringing in the global aspects of the tobacco epidemic. In the 
end, Brazil was invited to co-chair the first intergovernmental working group that 
prepared the basis of the treaty negotiations, along with China — both tobacco- 
growing developing countries — and chaired by Finland, a member state from the 
executive board pushing for the treaty negotiation, and having Japan as rapporteur, 
a country that had a very strong tobacco industry influence at that point. I think 

Dr Vera Luiza da Costa e Silva wrote: 'Brazil has banned misleading descriptors on cigarette brands 
through a legally binding resolution from the Brazilian regulatory agency, Agenda Nacional de 
Vigilancia Sanitaria (ANVISA) resolution issued in March 2001.' Note on draft transcript, 26 January 
2012. Freely available at 
PORT_Dez08_M_AC.pdf?MOD=AJPERES (visited 27 January 2012); see also 
volumes/87/1 1/09-031 109/en/index.html (visited 28 October 201 1). 

See note 6. 

77 See ZAtnet etal. (2000). 

78 World Bank (1999); see also notes 51 and 109. 

79 See, for example, Lee et al. (2010). 

For a review of China's progress in tobacco control during six years since ratification of the FCTC, see 
Gao et al. (201 1); for a discussion of Japanese tobacco control, see Kolandai (2007); see also Appendix 5, 
page 8 1 . 


WHO Framework Convention on Tobacco Control 

this was all about using successful strategies at WHO, with the support of those 
people who were either part of WHO, friends of WHO or consultants to WHO. 
Anyway, this was to bring WHO member states on board to start to negotiate 
the treaty. Finally, selecting Brazil to chair the negotiation of the treaty for the 
same reasons, because Brazil was a big tobacco-growing country and, furthermore, 
already had a strong tobacco control movement at that point, has proven to be 
the right choice. 81 This is how I perceived the process of initiation of the practical 
negotiations of the Framework Convention. 

Bhattacharya: I have a question, perhaps, that links us to the second theme to be 
discussed. One of the things I'm not hearing about is what happened during the 
Nakajima tenure. Specifically, I understand that there was a Swiss government 
report about conflict of interest in relation to the tobacco industry 83 Did that 
report have any impact on fuelling the move towards FCTC, I wonder? It's just 
an innocent question from an historian. 

See notes 65 and 66. 

Director-General Nakajima asked Dr Judith Mackay in spring 1995 to conduct a formal review of the 
WHO Programme on Substance Abuse (which included tobacco), and she wrote: 'I strongly recommended 
an FCTC as a core component of future development. In May 1995, WHA Resolution WHA48.11 
outlined the concept of an international strategy for tobacco control, which marked the start of the formal 
WHO process.' (Mackay (2003): 551). Dr Nakajima wrote in 1997: 'Tobacco-related diseases represent a 
global problem of epidemic proportions. This transnational health issue should also be a matter of concern 
for foreign policymakers.' (Nakajima (1997): 327). Samet et al. (1998a) reported on the deliberations of 
working groups at the Tenth World Conference on Tobacco or Health in Beijing and these were published 
in the British Medical Journal. See also Nakajima (1995); notes 85, 86 and 87. 

Lee and Glantz (2000). The report, prepared in response to a request from the WHO's Tobacco Free 
Initiative and available at: (visited 27 January 2012), remarked: 
'A first comprehensive 5-year tobacco prevention program, 1996 to 1999, issued by the Swiss Federal 
Office of Public Health lacked adequate financial resources, focus on specific interventions, cooperation 
between partners for tobacco prevention, and program coordination and management. It ignored the role 
of the tobacco industry.' (page 3). Dr Thomas Zeltner wrote: 'The co-author Chung- Yol Lee had been 
a collaborator of the Swiss Federal Office of Public Health for couple of years. Before joining the team 
of the office, Yol Lee spent time as a research associate at a certain time at Stan Glantz's lab. He had a 
grant from the Swiss National Science Foundation. The report (Lee and Glantz (2000)) was not, however, 
commissioned by the Swiss Government or the Federal Office of Public Health. The report got some media 
attention in Switzerland when published at the time. I don't know, however, whether it had any impact on 
the elaboration of the FCTC Note on draft transcript, 30 January 2012. 

Dr Judith Mackay wrote: 'There have been three reports on this: Zeltner (2000); Lee and Glantz (2000) 
and WHO, TFI (2008).' Note on draft transcript, 26 January 2012. 


WHO Framework Convention on Tobacco Control 

Zeltner: Good question and I can't give you an answer. But maybe Neil can, 
because, yes, I know, we were always a little puzzled about a couple of things 
of transparency in WHO, Nakajima's election included. 85 But I don't know 
whether the Swiss request had any impact. 

Collishaw: I was in the secretariat in the 1990s and I'm not aware of the report 
you're talking about, so I would guess it didn't have much impact. However, 
I can say your question pertains to the role of the Director-General's office. 
Certainly Dr Nakajima — the DG for most of my tenure in WHO — was always 
very interested in tobacco control. 86 He was supportive of what we were doing. 
He was not particularly successful in attracting funding from member states 
for tobacco control. He was somewhat successful particularly with respect to 
his home country, but other than that, perhaps not so successful. But he was 
interested in tobacco control. It was not an initiative of the Director-General's 
office that we ought to be working on a convention, but he did not put up 
roadblocks to any such development, and certainly he was interested in stronger 
tobacco control and made many speeches in that regard. 

However, in the early 1990s, as both Judith and Vera have alluded to, this 
was a very unfamiliar concept and there were few people in this institution 
who understood what tobacco control was about. Previously WHO had been 

Dr Hiroshi Nakajima (b. 1928), the first Japanese to lead a UN agency and a specialist in drug monitoring 
and evaluation, directed WHO Western Pacific Regional Office, Manila, before becoming Director-General 
(1988—98). See Lewis (1988); '"Fire in the global village" is how Dr Hiroshi Nakajima termed the tobacco 
epidemic' at the Tenth World Conference on Tobacco or Health, Beijing (WHO (1997b)). 

A 1998 editorial in Tobacco Control noted: 'WHO had let its practical commitment to tobacco wither 
away, from a staff of 10.5 in the early 1990s, to just 3.5 by early 1998, and from four regular budget posts 
to one. This had come about through a lack of senior-level advocacy on tobacco within WHO, the apparent 
demotion of the Tobacco or Health Unit (TOH) by its absorption into the Programme on Substance Abuse, 
and cutting, freezing, or sharing of TOH positions, ending up with only one full-time staff member (and 
that a one-year post ending in December), and the other two posts being spread over five people, all part- 
time or temporary' Anon. (1998): e227. For alternative analyses, see Walt (1993); Godlee (1993, 1994a— c, 
1995a— b, 1997, 1998a-b)). Note that Godlee retracted some of her previous Lancet analysis following the 
release of the tobacco legacy documents (Godlee (2000)), see note 46 and Zeltner et al. (2000): 128. 

The Zeltner committee wrote: 'It would appear that WHO is unwilling to boost the [Tobacco or Health] 
programme significantly, either in terms of budget or status within the Organization [WHO] for fear of 
offending its biggest budgetary contributor, the USA, whose pro-tobacco lobby is still powerful in Congress, 
a body that loses no opportunity to threaten the UN system with cuts in funding.' Zeltner et al. (2000): 
37. Quote cited from CASIN, 11 January 1991. British American Tobacco Company. 300557237-7259 
at 7241. Guildford Document Depository. UQ 33350. The Guildford depository is run by BAT. For 
difficulties searching the tobacco documents, see Zeltner et al. (2000): 27. 


WHO Framework Convention on Tobacco Control 

devoted to public health and science and didn't bother with conventions at all. 
I have to say that my initial reaction was supportive when Ruth Roemer first 
broached the subject with me in 1994 after she'd spoken to Judith about it. 
My initial reaction was supportive but cautious. But over time, I became very 
enthusiastic and by late 1994 I'd become a fervent in-house advocate of the 
concept to the extent that a public servant in this place can be an advocate of 
anything. [Laughter] 

However, there was some suspicion about it and in 1 995, after the initial resolution 
calling for a feasibility study to look at whether this could be done, it was adopted. 
I became aware that this was like waving a red flag in front of our legal counsel. 
Since the WHO had such good success in the past without conventions, our legal 
counsel pretty much had a policy that we didn't like conventions in WHO: 'They 
were just a bunch of trouble in the other branches of the UN and we weren't going 
to have them because they'd get in the way, because, after all, who could be against 
getting rid of smallpox?' Or 'Who could be against getting rid of onchoserciasis?' 88 
Some of these other success stories of WHO, to which I obviously replied: 'Well, 
there are lots of people who are against getting rid of tobacco, including those 
people who sell it to you.' So the legal department and I had many discussions, 
and, I think that if it were up to them, which, of course, it was not, they probably 
would have said: 'Let's not have one of those.' But, of course, it was not up them; 
it was up to the WHA. When the WHA adopted the 1996 resolution there was 
not much room for the legal department to continue with its opposition. Now, 
I'm sure Doug would say some of his strongest support comes from the office of 
the legal counsel in operating this treaty. 

Bettcher: There's a missing link here: at the World Conference on Tobacco or 
Health in Paris in 1994, a resolution was adopted supporting the idea of an 
international law for tobacco control. 89 As I recall it was an NGO movement 
in Canada that linked up with the Canadian government after the World 
Conference in 1994 to promote the idea of a treaty for tobacco control. In this 
regard, a name that hasn't appeared in our history is Dr Jean Lariviere, who 
was the head the Canadian delegation to the WHO executive board in January 

The eradication of smallpox was certified in 1979 by WHO (see WHO factsheet at: 
mediacentre/factsheets/smallpox/en/ (visited 14 November 201 1)). For details of the WHO onchoserciasis 
programme, see (visited 18 October 2010); see also page 44. 

For resolution WHA48.11, 'An international strategy for tobacco control', see 
framework/wha_eb/wha48_l 1/en/ (visited 28 November 201 1). For a contemporary report on the Ninth 
World Conference on Tobacco or Health, see Simpson (1994): 302. 


WHO Framework Convention on Tobacco Control 

1995. Lariviere got a caucus of countries together in January 1995, despite the 
caution of the legal counsel of WHO, to get a resolution to do a feasibility study 
on a possible treaty solution to be commissioned. He continued to support the 
idea of a treaty in the executive board in January 1996, which led to the first 
launch of the idea of a tobacco control treaty, not the mechanism to negotiate 
it, but just saying it should be done. The name of Jean Lariviere is an important 
part of the history. 

Assunta: I want to put on record that an article by Roemer etal called 'Origins 
of the WHO FCTC captures quite a bit of this and appeared in June 2005. 90 
To take off from the point that Doug made about Lariviere, Roemer and 
Taylor presented an outline of the treaty on 27 July 1995, the options for an 
international legal strategy to WHO, and on 28 July a letter was sent in reply 
to Roemer criticizing the proposal as 'ambitious, to a fault' and that it was 
important to be 'realistic'. The recommendation was that there should be a 
non-binding code instead. We have Drs Kimmo Leppo from Finland and John 
Hurley from Ireland to thank, because they sponsored the resolution, which 
went up at the WHA in May 1996." 

McLellan: I'm going to move along to a quick question, which I want to spend 
a few minutes on, and then to what I think is the heart of this history today, 
which is country experience, NGO experience, and to get the kind of tales on 
record that have not been published. So, we've got Mr Collishaw sitting in his 
office with no money and no staff; probably Dr Zeltner is in the same position, 
and maybe others of you. How would you characterize the importance of the 
influence of one person at that time — the Director-General — on moving this 
forward? You only get three sentences each. 

Mackay: I was on Dr Brundtland's transition team. She was looking for a second 
cabinet project: malaria was already a done deal, so she invited different 
specialties to make a presentation. Sir Richard Peto from Oxford, 93 and Neil 
Collishaw and I put forward to her the idea that tobacco could be a very 
appropriate project, she accepted that and the rest is history. 

90 Roemer etal. (2005). 

91 See WHO, FCTC Secretariat (2010); see also note 92. 

92 'Roll back malaria', the RBM partnership, was launched in 1998 by WHO, UNICEF, UNDP and the 
World Bank, in an effort to provide a coordinated global response to the disease. 

For a contemporary description of Richard Peto's work in China, see Anon. (1999). For tobacco-induced 
mortality in China, see Liu etal. (1998); Peto etal. (1999); Lam etal. (2001); see also Chen etal. (2003). 


WHO Framework Convention on Tobacco Control 

Zeltner: I think Dr Brundtland was very instrumental. She was, to some 
extent, I think, torn. One interesting point is that she had hired a bunch of 
very active people like Derek Yach and Chitra Subramaniam, and others in the 
headquarters of WHO didn't like it. I recall, and we will come back to that in 
a minute, when these people in the tobacco programme started looking at the 
documents of the tobacco companies and made the preliminary report, which 
showed that there had at least been trials to influence WHO. 9 I don't know 
whether someone can expand on this, but there was a debate very close to her: 
'Do we need to look into that or don't we need to look into that?' Of course, the 
tobacco-control people said: 'Yes, we need to' and others wanted not to do so, 
because they thought it would be such a big mess and so difficult to consider. 
But, in the end, she decided: 'Yes, we must do that before we start getting into 
the Framework Convention'. Again, two things were important: the tobacco 
industry documents were key, because they pushed the agenda such that WHO 
and the DG couldn't look away. The second very interesting thing is to see 
how a couple of key people could move things along very fast. The history of 
public health is also a history of personal courage, seizing the moment and 
saying: 'We can and need to do something.' Dr Brundtland was certainly very 
instrumental in that. 

Bettcher: Courage certainly is an important variable. Everyone can agree that 
Dr Brundtland is a very courageous person. If you embark on using Article 19 
of the WHO Constitution for the first time, you can't be a timid DG. She's not 
like that. She's been known all the way through her political career as having 
courage and foresight. She played a critical part in this undoing of WHO's 
conservative, very narrow model of public health; this idea that you can't have 
legal instruments and the WHO is afraid of messy political negotiations and all 
that stuff. She had been, as you remember, the commissioner of the Sustainable 
Development Commission for the UN Secretary-General in the 1980s. She 
knew all about complex negotiations. ' She was the Norwegian prime minister 
three times, so she was much attuned with how health links with foreign affairs, 
how it links with different sectors, how it links with social determinants and 

Zeltner et al. (2000); see also note 6. 

See page 19; for the companies named in the 1995 settlement, see note 45. 

The Brundtland report, Our Common Future, was published in 1987 by the World Commission on 
Environment and Development, called for' by the General Assembly of the UN. The report laid out the 
concept of sustainability as containing environmental, economic and social aspects, freely available at: www. (visited 15 November 201 1). 


WHO Framework Convention on Tobacco Control 

how negotiations can be a messy mud fight. But she was committed that WHO 
had to do it, had to get in there and had to stand up for the truth and what is 
right. Also, she realized you can't do that with the small budget that WHO had 
for tobacco control. WHO said: 'Of course, tobacco control is a great priority, 
it's a total priority, it's the largest preventable cause of death.' But poor Neil only 
had one staff member with him, and there was one regional adviser in Europe 
working on tobacco control almost full-time; for other regions there were only 
staff working part-time for tobacco control. So Dr Brundtland said: 'We have 
to have a platform for this. We need a high-level cabinet project in WHO 
to advance tobacco control, and this project is very important. The tobacco- 
control group must be accountable to me. It's got to be accountable to my 
office, to my cabinet. I'm going to watch the negotiation of the treaty closely. 
I'm going to make sure this is a success. It's got to have money, and we've got to 
do it now, and we have to get moving, and we have to develop the mechanics for 
the negotiation to proceed.' WHO had never had a notion of how to develop a 
treaty negotiation-making apparatus, so she sent us out in the field to the other 
treaty secretariats to get the precedents and get moving with the precedents to 
develop the mechanics to do this. She also established a new budgeting system. 

Before, we had a kind of system for planning our budget that was like a 
patchwork quilt. It was a lot of little things, and we never really knew what the 
priorities were. She developed a notion of budget prioritization in the WHO, 
and tobacco became one of the top priorities. The prioritization was done on the 
basis of disease burden, death and the potential to make a public health impact, 
which also put tobacco up towards the top. We were then placed in a situation 
where we could do this. We were living in the real world. When she retired, I 
remember, in July 2003, Dr Brundtland was quoted on the BBC in answer to 
the question: 'What were your greatest successes of your administration?' She 
said: 'Controlling SARS and the adoption of the Framework Convention on 
Tobacco Control.' 

da Costa e Silva: One very important aspect here, apart from WHO's political 
priority, is that the financial resources were often scarce and insufficient for 
the TFI, Dr Brundtland's cabinet project, established in 1998. Some funds 
were regularly allocated to the initiative after the establishment of TFI, but 
for the treaty negotiation and regular tobacco control activities implemented 
by WHO, neither TFI nor even the non-communicable disease cluster has 
hardly ever received financial priority. At one point TFI was getting less than 
1 per cent of the organization's total budget, considering the global burden of 


WHO Framework Convention on Tobacco Control 

diseases and deaths caused by tobacco use. As a result, there was no regular 
budget allocated for most meetings held during the negotiation period of the 
treaty. There was a need to identify another budget line in order to run the 
treaty-related activities. In fact, there were many competing themes and the 
treaty was only one among WHO's many priorities, and, as a result, funding 
had to be identified for every single session of the negotiation. This was a real 
battle during the entire period of negotiation. I think that neither tobacco 
control, nor even non-communicable diseases in general, had ever received 
more than insufficient funds to fully move the agenda requested by member 
states. Even though the treaty negotiation was seen as a top priority and even 
though this was a cabinet project, the tobacco control agenda never received 
a sound regular financial contribution for its implementation. Nevertheless, 
the project's progress was due to more than financial resources: it was about 
people's commitment and political will. 

Mulvey: I'll get a word in here as another loud-mouthed American. A lot of 
what people have been describing here is the transformation of tobacco control 
from a public health issue to a political issue for the public health community. 
For the tobacco industry, and for the tobacco transnationals in particular, all 
along it has been a political and economic issue, but it was a learning curve, in 
which the Director-General played an instrumental role. I think that initiating 
the inquiry (Zeltner committee) when the tobacco-industry documents became 
available 98 was the first point that we as an NGO noticed the stepping up of 
WHO activity around this subject, and applauded it. This decision and the 
report by Dr Zeltner's committee led to a further series of decisions within this 
process, which took account of tobacco control as a political and economic 
issue. It led to the decision not to give the tobacco industry a role in the 
negotiating process, which was fundamental to the success of the convention, 
it led to WHA Resolution 54.18 on transparency in tobacco control," it led 

One critic suggested that $8m of the more than $9m budget for TFI in 2000—01 came from outside 
sources, including pharmaceutical companies supplying nicotine replacement therapy. See 
WHO/ (visited 13 December 201 1); for a similar stance, see Scruton (2000). 

See pages 19—20. 

99 See Zeltner et al. (2000); see also note 48. 

For the 2001 resolution WHA54.18 on transparency in tobacco control, see 
framework/wha_eb/wha54_18/en/index.html (visited 21 July 2010). 


WHO Framework Convention on Tobacco Control 

to the inclusion of Article 5.3 in the convention itself, 01 and it is still playing 
out in the implementation of the convention now. I think the other point 
where the leadership was critical was in looking for a new partnership with civil 
society and evolving WHO's work with civil society beyond where it had been 
in the past. We, as Infact then, were asked to conduct a study of the role of 
NGOs and the media in mobilizing support for other international codes and 
conventions in the environmental field. But also here at WHO itself, where 
the only other time that WHO had taken on a commercial issue, the code of 
marketing on breastmilk substitutes, which had helped to demonstrate that a 
code wasn't a sufficient instrument for this political issue. 

Bettcher: Exactly what I wanted to say: she had been a head of state. When 
things got dicey, she could phone heads of state. When it got messy, she could 
phone them up and say: 'Get your act together!' 

Potschke-Langer: For me, three points were of interest. Dr Brundtland was 
very popular, a charismatic personality with a high reputation, especially in the 
European region. Governments as well as NGOs appreciated her very much. The 
second was about the creative team, a team of fantastic people, enthusiastic and 
also very motivating. This team succeeded because of one very important thing: 
building up a network. I must remind you that one TFI programme was called 
'Don't be duped, the change agents programme'. People from all regions were 

See guidelines for implementation of Article 5.3 (2008), online at 
article_5_3/en/index.html (visited 21 July 2010); see also note 102. 

For documents reporting discussions during the implementation of the FCTC, see http://apps.who. 
int/gb/fctc/ (visited 14 November 2011). Activities prohibited by Article 5.3: partnerships, non-binding 
or non-enforceable agreements between tobacco industry and governments; contributions by tobacco 
industry to government; tobacco industry-drafted legislation or policy, or voluntary codes as substitutes for 
legally enforceable measures; investments by governments or public officials in tobacco industry; tobacco 
industry representation on government tobacco control bodies or FCTC delegations. See www. l4wctoh. 
org/abstract/abstract/NCPA/09%20-%20March/ 1 330%20-%20 1 500%20hrs/Experimental%20Theatre/ 
Why_Securing_Article_5.pdf (visited 5 December 2011). 

Ms Kathy Mulvey wrote: 'The organization changed its name from Infact to Corporate Accountability 
International in 2004.' Note on draft transcript, 20 July 2010. 

104 WHO, TFI (1999a), WHO/NCD/TFI/99.3, prepared by Infact. 

105 See WHO, TFI (1999a and b), freely available at 
TFI_99-3.pdf and (visited 16 December 
201 1); see also Crowther etal. (2009): 25-6, 35, 43-8, 54-5; WHO/UNICEF (1989). 


WHO Framework Convention on Tobacco Control 

taught and empowered. ' The capacity-building process was done with NGOs 
and individuals in the regions. The last point was that we also set up a health 
communication network, very well run by Franklin Apfel. He worked at the 
WHO regional office for Europe (EURO) together with Chitra Subramaniam 
at the WHO headquarters and made a tremendous success of communicating 
about tobacco control. I think it was very important to involve the media. 

McLellan: I'm going to ask Dr Ogwell in just a minute to restart our discussion 
on the role of countries: 'What was the role of countries in making the 
Framework Convention possible?' I was very struck by your observation about 
farmers being an important part, and I'd like to hear from the rest of you as we 
discuss the role of countries. If there is something very specific that stands out 
for you about how countries either helped, or perhaps, impeded your work? 

Ogwell: I was going to take a different position in as far as the DG's office is 
concerned — and not negatively — before I talk about the country level. Not 
negatively. The question for me is: 'What should the DG's office role be?' We 
have a lot of praise for Dr Brundtland, and I think her leadership was excellent, 
spot on. It has not been repeated in any field of public health to date, at least 
from the way I read public health. But she was doing exactly what someone 
in her position should do. Are we, in retrospect, saying that the others who 
were in leadership were not doing exactly what they should have done? Is that 
why she stands out so far ahead of everyone? This is what has been playing 
on my mind. I think your students of public health history need to dig into 
some of these questions. She did well — way, way above average. But was she 
being compared with average people or people below average? This is a good 
question. [Laughter] 

Now, let's go to the role of the countries. At least from the Kenyan angle, I will 
say that we suffered some of the very early pressures from the industry when it 
came to the negotiation of the FCTC. The first days when we were developing 

'Tobacco Kills — Don't be Duped', a two-year UN Foundation-sponsored project on media and NGO 
advocacy for policy change in 1999, was piloted in 16 countries: South Africa, Zimbabwe, Mali, Pakistan, 
India, Islamic Republic of Iran, China, Ukraine, Germany, Venezuela, Brazil, Switzerland, Lebanon, 
Thailand, and the Philippines. See WHO, TFI (2000) at 
annual_tfi_en.pdf (visited 14 February 2012). 

Dr Franklin Apfel was managing director of World Health Communication Associates in Axbridge, 
Somerset (see (visited 28 October 2011)). See, for example, Semenza 
et al. (2008); see also 
(visited 22 July 2010). 


WHO Framework Convention on Tobacco Control 

the initial positions, I think it must have been prior to the intergovernmental 
negotiating body (INB-3), our technical boss, then the permanent secretary in 
the Kenyan Ministry of Health received visitors one evening — it must have been 
on a Friday because people were travelling on Saturday — a tobacco industry 
member came to his office with a raft of proposals on how Kenya would handle 
the negotiations, which were tilted towards the general codes of self- regulation. 
He was very insistent that global frameworks like the FCTC would not work. 
He informed us at about 7pm that Friday evening and said that he was not very 
sure that he was going to be in post on Monday. We were very curious why he 
thought so. And he said: 'You see, the industry representative came and tried to 
influence us.' The Kenyan voice was pretty significant in the African group. If 
the tobacco industry could influence the group's position in certain areas, they 
could tilt them towards this self-regulating position. They were very clear with 
him: 'You know, if you don't take the money and influence your team, then you'll 
not be in a job come Monday' For sure, come Monday, on the 1 o'clock news — 
usually the time when people were sacked from or appointed to government in 
Kenya — he was no longer the permanent secretary, but was sent to a country as 
ambassador, which is a step down in the civil service. Before countries engaged 
at the regional and global level, there were a lot of challenges at country level. 

I think that the challenges being faced at the national level were way above those 
that we were seeing at the global level, where we could easily identify who was 
from where. At country level it was the ministry of health on its own, and very 
often it would be two if you were lucky, but often only one person within the 
ministry who was truly passionate enough about the development of a treaty, 
not the rest of the ministry, because they had a million other things to worry 
about. So the challenges faced at country level disappear when we talk about 
the global level negotiations, but these, I think, were very key in the kind of 
positions that eventually were taken at the global level. 

Most delegates did not know anything about negotiation at international level, as 
you (Mary Assunta) were saying. What drove most of the delegates was a passion 
for tobacco control. That was it; that was all that they had, and they gave it their 
all. Everyone learned along the way what needed to be done. I must say that the 
small, low-resource countries were the ones driving the process. It was not the 
big countries; it was not the rich countries; it was the truly, truly resource-poor 
countries that drove this process. Without them standing on a platform for public 
health, we would have a very different convention from the one we have now. 


WHO Framework Convention on Tobacco Control 

Bettcher: I was going to address the issue of which country was selected and 
then became the chair for the negotiations, because, I think, the selection of a 
chair from Brazil was so crucial for the success of this negotiation. It does come 
down to addressing both the supply and demand issues of tobacco control. 
No other drug treaty had ever touched demand reduction before. All the drug- 
control treaties that Thomas Zeltner referred to concentrate on supply measures 
only. I recall that some Scandinavian countries in the early 1990s tried to launch 
a demand-reduction drug-control treaty, but it was resisted by other states. 
Countries said: 'Demand-reduction for drugs is our sovereign prerogative: stay 
away from that.' From our experience with the drug treaties, we know that 
reducing supply is not going to reduce demand. If demand is still there, it's 
going to crop up somewhere else — no pun intended. 

The question of alternative livelihoods was an important door to get through 
in order to negotiate the demand-reduction measures in the treaty. It is the 
political economy of tobacco control: you've got to deal with those issues — 
both supply and demand — especially in countries that are very dependent on 
either tobacco manufacturing or agricultural production. Having a middle- 
income country (Brazil), one of the top three growers of tobacco, in favour of 
tobacco control was very important in the negotiation of the WHO FCTC. 
Because, as Vera has described, Brazil decided in the 1980s that tobacco- 
growing and tobacco-control issues weren't mutually exclusive, you could do 
strong tobacco control and also deal with the inevitable restructuring of your 
economy sometime later on down the road. I remember discussing this with a 
top-level diplomat: 'In the first half of the twentieth century it would have been 
inconceivable to think that typewriters would gradually become redundant. 
But that's exactly what happened from the 1980s. There was a gradual period 
of phasing out typewriter production and its replacement with the modern 
computer. This is what will happen with tobacco production. Tobacco will not 
disappear overnight as the scare-mongering tactics of the tobacco companies 
to counteract effective tobacco control regulation. The phasing out of tobacco 
will be a gradual process, which will certainly benefit humankind.' Brazil was 

108 c t, 

See page 21. 

For demand reduction measures in the FCTC, see the Framework Convention Alliance 'Part III: 
Measures relating to the reduction of demand for tobacco' at php?option-com_content 
&view=article&id=25&Itemid=31 (visited 15 November 2011). 

For demand and supply measures, see note 51; see also Nutt et al. (2007). 


WHO Framework Convention on Tobacco Control 

All five newsletters published this week, 16-20 October 2000, are available or line at 

Orchid Award 

Dr. Thomas Zehner 

Led effort to expose tobacco industry 

infiltration of WHO 

Dirty Ashtray Award 

We're watching..,. 

Egypt - "Tobacco product 
companies in recent times 
have fixed their trademarks 
on various other products - 
matches, suitcases, and 
other products, including 
products that children like. 
We must be aware of this 
hidden publicity." 

Jordan - "Tobacco repre- 
sents a threat for all age 
groups. In Jordan, we pro- 
hibit advertising aimed at the 
population as a whole, not 
just children and adoles- 
cents, but adults as well." 

Kenya - "We wish to in- 
clude strong anti-tobacco 
advertising in addition to 
restricting and if possible 
prohibiting all forms of to- 
bacco advertising, promotion 
and sponsorship." 

Paraguay - "Advertising 
is what has made tobacco 
into an epidemic and a pub- 
lic health problem,,.. In the 
developing countries, we are 
invaded by tobacco advertis- 
ing and publicity. Theywill 
use any kind of gap, any kind 
of kink, to get in and exploit 
this opportunity," 

Sri Lanka - "Partial re- 
strictions have been of little 
use in reducing consump- 
tion. Therefor, we recom- 
mend a total ban on all di- 
rect and indirect tobacco 
advertising, promotion and 

Switzerland - "In reality, 
it is extremely difficult to dis- 
tinguish between advertising 
targeted at minors and ad- 
vertising targeted at adults. 
It is practically impossible to 
make that distinction in 

ALLIANCE BULLETIN 20 October 2000 

Figure 4: Orchid award and Dirty Ashtray award from the FCA's Alliance Bulletin, 2000. 

a country willing to stand up firmly and to broker a way forward that would 
accommodate the needs of countries that were producers and growers, etc., and 
with those that weren't. 

Potschke-Langer: I think we have wonderful historical documents in the 
form of the FCA Bulletins (see, for example, Table 5), the newsletter of the 
Framework Convention Alliance, where we listed those countries, organizations 
and individuals that were the 'good countries', the supportive countries and 
received the Orchid award from the very beginning; those countries and others 
that were the 'bad countries' received the Dirty Ashtray award. I think this list 
is very impressive, and thus you see very well all the countries and organizations 

The image chosen for World No-Tobacco Day 1 999 was an orchid in an ashtray — a symbol of life not death; 
a flower instead of ashes. (WHO, Western Pacific Regional Office (1999): 1 1); see also Glossary, page 122. 

Ms Kathy Mulvey wrote: 'It may be important to emphasize that this does not mean a compromise with 
the tobacco industry, but instead a treaty that addresses the economic concerns of growers (whose interests 
are not truly represented by the tobacco transnationals), as well as the enormous harm to health.' Note on 
draft transcript, 20 July 2010. 


Dates of INB sessions 

Orchid award 

WHO Framework Convention on Tobacco Control 

Dirty Ashtray award 


16-21 October 2000 

Canada, Uganda, Kenya and Thomas 

Tobacco Industry and Marketing 
Board of Zimbabwe, and CIGG 
Lobby Vending Machine 


30April-5 May 2001 

Brazil, Hungary, South Africa and 
Russia (pre-INB2), WHO African 
region (AFRO), WHO Southeast 
Asian region (SEARO), countries 
in support of total ban on tobacco 
advertising, Canada and India 

Nottingham University (before 
INB2,see note 116), British 
American Tobacco (2*), Philip 
Morris, Japan Tobacco, countries 
determined to exclude NGOs 
from working groups, the USA, 
countries that did not support 
total ban on tobacco advertising 
and China 


22-28 November 2001 

President Arap Moi of Kenya, Kenya Philip Morris, the USA, tobacco 

Medical Association, Kenya Dental 
Practitioners Association, Kenya 
Times newspaper and local and 
international NGOs, Ireland, Palau 
and India 

companies, Germany, International 
Tobacco Growers' Association and 
Japanese government 


18-23 March 2002 

David Byrne (EU Commissioner for Zigarettenrepublik Deutschland, 

Health and Consumer Protection), 
the Espresso guy at CIGG**, Pacific 
and Caribbean countries, Palau, 
Thailand, India and AFRO 

speakers ofWorking Group 1 of 
the CCLAT Australia, Canada, the 
UK, Pakistan and Japan 


14-25 October 2002 

Malaysia, WHO Director-General 
Gro Harlem Brundtland, Ireland, 
SEARO, AFRO, European 
Forum of Medical Association, 
Commonwealth and World Medical 
Association, the Pacific Islands, 
English-speaking Caribbean nations 
and Maldives 

Japan Tobacco (3*), Singapore, 
Germany, the USA, Pakistan, 
organizations and countries that 
sought consensus on issues where 
there should be no compromise, 
countries that seek to exclude 
civil society groups from the 
negotiation, WHO European 
region (EURO) 


17-28 February 2003 

AFRO(2*), SEARO(2*), Pacific 
Islands (2*), Iceland, China, Saudi 
Arabia, Baltic States, WHO Eastern 
Mediterranean region (EMRO), 
English-speaking Caribbean states 
and India 

The revised chair's text (before 
INB6),Argentina,the USA(2*), 
China(2*), Russia, United 
Nations and WHO, Cuba, Greek 
presidency of EU, Germany and 
Lifetime Achievement Award for 
the USA 

*The number of awards received in a single INB session 

** Centre International de Conferences Geneve, Geneva, where the hearings took place 

Table 5: Recipients of FCA awards by Framework Convention Alliance Bulletin, Issues 1—45, 
1 999-2003, adapted from Mamudu and Glantz (2009): 1 58. See also Figure 4. 


WHO Framework Convention on Tobacco Control 

that were under heavy influence of the tobacco industry. These were the big 
countries, the high-income countries; the others that were not so influenced, or 
where NGOs were much stronger received the Orchid awards. [Dr Potschke- 
Langer left the meeting at this point.] 

Zeltner: I'll come back to the committee and why I think the issue that we 
were dealing with here is important to your question about what made the 
Framework Convention possible. 

I don't know why Dr Brundtland asked me to chair that committee. [Laughter] 
No, it is an interesting question and I don't know why, but I bring that question 
up. She called me in the summer of 1 999, because there was a short internal report 
prepared by the Tobacco Control Unit (Derek Yach and Chitra Subramaniam) 115 
and everybody seemed a little bit annoyed, first of all in the WHO legal office. 
The first thing we did together was to look into the mandate of such a committee. 
I was working with her, the legal counsel, plus David Nabarro, who was very 
instrumental at that phase in the work. The main question was whether it 

Nottingham University appeals in Table 5 as a recipient of the Dirty Ashtray award, having accepted £3.8 
million from British American Tobacco in 2000 to establish an International Centre for Corporate Social 
Responsibility, resulting in the resignation of several teaching staff, including Dr Richard Smith, editor of 
the BMJ (\99l— 2004), who resigned his unpaid part-time professorship of medical journalism. For details 
of the episode, see the ASH website at www.ash. 
the-tobacco-industry; for one discussion of the ethical, legal and policy issues associated with tobacco 
industry funding, see (both visited 15 November 201 1). 

The Committee of Experts on the Tobacco Industry Documents, chaired by Professor Thomas Zeltner, 
reported in 2000 (Zeltner etal. (2000)); see also notes 6, 48, 77, 103, 121 and 149. 

71 Dr Derek Yach wrote: 'I recall very clearly why Chitra Subramaniam, my Tobacco Free Initiative media 
head, and I suggested Zeltner to Brundtland. We needed a solid public health person with a law background 
from a country that was home to a tobacco company and would stick to what was best for public health! 
The report motivated for an unprecedented review to be done of the impact of a multinational on UN 
policy development. The legal office was deeply fearful of what it might show. We had worked with Roberta 
Walburn (a lead litigator on the Minnesota Court case) to prepare the report using a few documents from 
the court case, showing several specific examples of how Philip Morris and BAT had tried to subvert WHO 
tobacco control policy on marketing restrictions, epidemiology of second-hand smoke by IARC and more. 

It was convincing enough to get Brundtland to initiate the review Our legal office had to undertake new 

research to find out how to ensure all these people were covered by an international convention to protect 
against litigation! At the time of the FCTC work, we in TFI employed more and a diverse range of lawyers 
than the law office. . . another reason they felt threatened.' E-mail to Mrs Lois Reynolds, 28 February 20 12. 
For the composition of the Zeltner committee, see note 48. 

Head of the WHO's Roll Back Malaria project (1998-2003) and executive director in the Office of the 
Director-General, was a former chief of health and strategic director of the UK's Department for International 
Development. For the importance of 'health for all', see Brown (1999). 


WHO Framework Convention on Tobacco Control 

should be just a report looking into the documents or should the report also have 
recommendations? I advocated recommendations very strongly, but some people 
in WHO didn't want that. Then we moved on to the question of who should be 
on the committee. That brings me back to the point I want to make: we were 
looking to get members from low- and middle-income countries and we asked a 
couple of people, but they all refused. They all said: 'It's too dangerous for us: we 
will lose our jobs because the influence of the tobacco industry, of our economy 
or our farmers is way too high to allow me to accept, and I even fear for my 
family' We had a couple of people who said: 'I wish I could do, but I will not.' 
We were very happy at the end to get one person, Dr Fazel Randera from South 
Africa, to come onto the committee. We wanted to have someone from a very 
low-income country, but we didn't find anyone. 

The next point relevant to today's discussion is that we then came up with 
recommendations, many had to do with transparency that were implemented 
very rapidly by WHO. Two key recommendations were never implemented, 
the first being that the country delegations coming to the WHA should be 
transparent about the affiliation of their members, because we feared that the 
tobacco companies or their front organizations might be sitting on some of the 
delegations. This had happened in the past and could jeopardize the whole process. 
There was a short debate on that recommendation in the executive board. The 
US delegation of the time was against it: 'We do not accept that point, because it 
involves national sovereignty. Membership of the delegations is our business and 
we're not open to this kind of disclosure.' It is quite interesting that Mary Assunta 
says that the smallest countries were eventually clean of that kind of influence. 

The second thing, which I still think is a little puzzling, is that we had not 
even looked through all the documents. You may remember that the tobacco 
companies never had to disclose the most controversial documents. 18 So 

For the background to the appointment of 1999 Committee of Experts to research tobacco company 
documents publicly available as a result of lawsuits against the tobacco industry in the US and its report, 
Tobacco Industry Strategics to Undermine Tobacco Control Activities at the World Health Organization, included 
a case study on Philip Morris' 1988 Boca Raton action plan (Zeltner et al. (2000): 4-6 at 
tobacco/media/en/whoinquiry.pdf (visited 22 July 2010)). See also, for example, Ong and Glantz (2000b). 

The terms of the 1995 settlement between the State of Minnesota, Blue Cross and Blue Shield of 
Minnesota and the tobacco companies (see note 43), required the tobacco companies to place material 
in the public domain, but excluded public access to 'privileged documents and Category II trade secret 
documents (relating to blends and formulae)' and should be open to the public for a period of 10 years 
from February 1998. For further details, see 
cmhealth/27/27 18.htm (visited 29 November 201 1). 


WHO Framework Convention on Tobacco Control 

we only saw the documents that were innocuous. Then we made another 
recommendation, we asked WHO to make sure that other UN agencies 
undertook the same procedure, because it was very obvious from looking into 
the documents that Food and Agriculture Organization (FAO) and other 
organizations had the same problem, if not a bigger one. That has never been 
done. So, there was no transparency at that time on how much influence the 
tobacco companies might have had via these organizations and through the 
delegations coming to the Framework Convention debates. 

da Costa e Silva: I think that the role of countries in making the FCTC 
possible is pretty evident. The FCTC exists because countries were able to push 
the process to the end. But this, I think, was not an easy process for many 
reasons. Firstly, the delegations were mainly composed of the same people who 
came to the World Health Assemblies. That means doctors and public health 
people, people who were used to dealing with health-related issues, but had no 
understanding of the economics of illicit trade, marketing, advertising or any 
other issues not directly related to health. What could they say about issues such 
as liability or sustainable alternatives to tobacco crops? 

Secondly, even though there were around 17 WHA resolutions, governments 
were mostly not implementing tobacco-control measures at home. Even the 
US, which was heavily involved in litigation against the tobacco industry, and 
with preparing the Surgeon General's reports on smoking and the consequences 
to health that were so important during this process, didn't have a strong 
national tobacco-control programme to demonstrate the way forward. Few 
states had strong programmes, and at that point we could not say that apart 
from isolated experiences and the evidence-base produced by their academic 
institutions, the US could lead the process of international tobacco control by 
sharing their own best practices. Even other developed countries with quite a 
lot of the tobacco companies under their domain had difficulties in this regard. 

'"See, for example, UN, FAO (2003), freely available at: 
htm#Contents (visited 22 July 2010). 

See US, Surgeon General, Advisory Committee on Smoking and Health (1964), freely available at; US, Department of Health and Human 
Services (1981, 1989); for a 1989 evaluation of progress, see http://profiles.nlm.nih.gOv/NN/B/B/X/S/_/ 
nnbbxs.ocr; for a list of the Surgeon General's reports on tobacco and smoking, see 
data_statistics/sgr/pre_1994/index.htm; for Centers for Disease Control and Prevention factsheet on health 
effects of cigarette smoking, see 
cig_smoking/ (all sites visited 15 February 2012). 


WHO Framework Convention on Tobacco Control 

The treaty negotiation process therefore had two objectives: the first and most 
important was to negotiate an international treaty, which could tackle the 
international dimension of tobacco control. The second was to create awareness, 
to bring more people from other sectors on board, to establish a consensus on 
some approaches to various aspects of tobacco control and to stimulate exchange 
of countries' experiences. In this respect some African and South East Asian 
countries have offered sound examples of how the dynamics of the negotiation 
process have definitely changed tobacco control reality on the ground. If you 
compare the way some countries started the negotiation of the treaty, and how 
they ended the negotiation process, you could see representatives of the health 
sector just growing, growing, growing in terms of addressing the multisectoral 
nature of the issue, participation, discussion and implementation of tobacco- 
control measures in their own countries. In this regard, I think WHO also 
played a very important role, facilitating regional meetings and integrating 
the different groups, including the full participation of the civil society. The 
negotiation process was also a sort of Open University. 122 The NGOs also had 
a very important role in this regard. There was a huge 'behind-the-scenes' 
workload in terms of bringing people together to make them more aware of the 
complexities of tobacco control. 

Thirdly, the tobacco industry was present, many times as part of member states' 
delegations, as they are still, and will continue to be, present in every government 
and at every single meeting where tobacco control is discussed. I think one 
issue of the utmost importance is monitoring the tobacco industry, in terms of 
implementation of the treaty. This is not something that most governments were 
regularly doing at this point. Therefore there are still countries today that have 
signed the treaty but have not yet ratified it, because of the interference of the 
tobacco industry 123 Among other arguments, they use the tobacco growers to 

Ms Kathy Mulvey wrote: 'The 46 member states of the WHO African region negotiated as a block from 
INB-2 onward. See Johannesburg Declaration (March 2001) at 
04.html (visited 21 July 2010)).' Note on draft transcript, 20 July 2010. 

Dr Vera Luiza da Costa e Silva wrote: 'Many sessions of the INB took place in a two-week period with 
extensive cross-fertilization of ideas and views between participants. Furthermore, every single time slot 
was used to promote awareness: several lunchtime briefing seminars were convened either by WHO or 
by the NGO community, providing an opportunity for delegates to learn from each other.' Note on draft 
transcript, 25 June 2010. 

See notes 59, 60 and 61. 


WHO Framework Convention on Tobacco Control 

make the case of a doomsday scenario with the loss of employment by farmers, 

to avoid the ratification of the treaty, a third component adding complexity to 
i i 

the negotiations. 


Collishaw: I wish to make three points about the countries' roles, and going 
back to the very beginning when countries got involved. The resolutions of 

1995 and 1996 were adopted unanimously by WHA, and that was quite a 
remarkable achievement, because this was breaking new ground. We've talked 
about certain individuals who have helped to germinate the idea and bring it 
along. 125 Eventually it all came to the WHA, and they adopted the 1995 and 

1996 resolutions unanimously, a strong expression of consensus. That was a 
vote of confidence from member states that something ought to happen. 

However, the 1996 resolution was a grand statement commanding the Director- 
General and staff to go forth and produce a Framework Convention; it didn't 
actually come with any money. Now I want to go back to the comment made 
by my colleague here about 'poor Neil'. 'Poor' has a couple of meanings in 
English and I'm going to assume that this wasn't my performance evaluation, 
Doug, that you were giving there? [Laughter] Ah, it was 'impecunious Neil' that 
you were talking about. Well, yes, at that point we had zero money to actually 
implement what the WHO and the WHA were talking about. 27 I'd like to refer 
to this wonderful book, which was released today (Figure 5), and I wish to 
thank my friend Vera very much for its production. 

BAT's 'Grower Public Relations Programmes 1 targeted the FCTC and was designed to demonstrate the 
importance of the tobacco ctop to poor farmers (Rimmer (2005): 14, note 11 at 
files/documents/ASH_371.pdf (visited 3 November 2011)); see also Infact's guidelines for ratification at: (visited 16 November 201 1). 

Mr Neil Collishaw wrote: 'Ed Aiston of Canada deserves a lot of credit. Along with his colleague Jean 
Lariviere of Canada, both successfully guided the groundbreaking 1995 and 1996 resolutions through the 
executive board and the WHA. Ed remained a strong booster and tireless supporter of the FCTC from 
initiation in 1995 to adoption in 2003. Individuals can get things started, but nothing much happens 
around here unless there is consensus.' Note on draft transcript, 25 March 2010. 

'During the 1995 WHA, resolution 48.11 officially introduced the concept of an international strategy 
for tobacco control. Resolution 49.17 in 1996 asked the WHO Director-General to initiate preparation of 
a framework convention on tobacco control. For discussion of the importance of the WHA resolutions, see 
pages 10, 12, 21, 33-4 and 37; see also Roemer et al (2005). 

See page 21 and note 86. 

128 WHO, FCTC Secretariat (2010): 40-1. Freely available at 
978924l563925_eng.pdf (visited 5 November 2010); for timeline, see Appendix 4, page 79. 


WHO Framework Convention on Tobacco Control 



on<to®acco COWItipL 


Figure 5:WHO FCTC history, published on 26 February 2010, 
the fifth anniversary of the Framework Convention. 

If you look in the back on page 40, you'll see a timeline that mysteriously skips 
from 1996 to 1998. It's as if 1997 didn't exist, but that was the year in which 
the impecunious Neil, ably assisted by Barbara Zolty, another tireless tobacco- 
control worker who continues to work for TFI here in WHO, had to go round 
to raise some money from, guess whom? Member states. I'm proud to say that 
there were four member states that made voluntary contributions to WHO to 
get the treaty under way and I'm happy to name them: France, Finland, Canada 
and Switzerland. The largest contribution of these four was given by Switzerland, 
and I'm very confident, through the good offices of Dr Zeltner, that Switzerland 
will indeed ratify the treaty, perhaps some day before I retire. [Laughter] But 
let the record show that Switzerland — I think it was one of Zeltner's employees, 

See also note 83. 


WHO Framework Convention on Tobacco Control 

Brigitte Caretti, who must have persuaded him to open up his pockets — helped 
to fund the Framework Convention. The $750 000 or so raised from those four 
member states in that year became the seed money, the initial investment that 
allowed the Framework Convention to take off, beginning with the other work 
you see in the timeline in 1998 and 1999 (Appendix 4). 

The third point about member states is that in my initial thinking about the 
FCTC, I thought that this was going to be quite a modest undertaking and 
that there wouldn't be that many people who would sign up, because, after all, 
most of what was being talked about could be done in national law. I thought 
the more important things a treaty had to address were those that crossed 
national boundaries. The outstanding examples of cross-border advertising that 
I saw in the early 1990s, a big problem at the time, were Formula 1 racing 
and smuggling. What I didn't see, and what I am delighted to have been 
wrong about, is how quickly this treaty would be embraced by low- and middle- 
income countries, because they were facing such problems, some of which we've 
heard about today. They could not get tobacco on the national agenda, and 
without an international standard and the force of international law, tobacco 
control at the national level in many low- and middle-income countries was 
going to go nowhere. It is still a very big challenge in many of these countries, 
but at least we're much, much farther ahead and it's those countries that have 
made the treaty into what it is, and it has succeeded way beyond my initial far- 
too-modest expectations. 

Cunningham: On the first question: there was a pre-negotiation phase and there 
were six Intergovernmental Negotiating Bodies (INBs). 131 Before the INBs, there 
were two working group meetings that involved all parties. I think that it was 
important to sensitize countries, to get them to the issue, to get them involved, so 
when the negotiations began the government delegations weren't starting from 
scratch. Even before that, there were some meetings in Vancouver and Halifax 

For background briefing on cross-border advertising, see hrtp://apps.who.inr/gb/fcrc/PDF/cop4/FCTC_ 
COP4_10-en.pdf (visited 15 February 2012); see also note 19. 

The six INB meetings were held in Geneva (Table 3, page 44) with regional meetings leading up to 
some INBs, documents freely available at (visited 
19 July 2010). 

Professor Judith Mackay wrote: 'The truth is we were all starting from scratch.' Note on draft transcript, 
26 January 2012. 


WHO Framework Convention on Tobacco Control 

to generate ideas that contributed to this process. The phrase 'the power of 
the process' I think happened here, where governments learned, parties learned, 
and in many cases, they implemented, measures as the process of negotiations 
went along, which increased their stake to see a successful outcome, and to see 
those measures they had adopted included in the final treaty. 

Regions were very important to these negotiations and the regional consensus 
that you had in the African region (AFRO), the Eastern Mediterranean region 
(EMRO) and the South East Asia region (SEARO) was in support of a strong 
FCTC. The Western Pacific region included Japan and China, dissenters 
on many issues, that region split and could never come to a consensus. The 
subregions involved were the Pacific Islands and also the Association of Southeast 
Asian Nations (ASEAN) countries with very strong voices." There was also a 
Caribbean subgroup (CARICOM) supporting a strong FCTC. 

The regional meetings that preceded the INBs were helpful for preparation of 
government delegations and having a stronger position as a region. Greg Jacob, 
a lawyer for the US delegation, wrote an article where he complained. The US 
was not happy with the outcome — they didn't get what they wanted — so they 
complained. ' One of these complaints was that US responses to regions had 
no effect on regional positions. That was part of the dynamic. Two examples of 
country champions — we don't have time to name them all — one is Thailand, 
which had been on the receiving end of a US government trade challenge to its 

For the report of the Vancouver public health experts meeting, December 1998, see http://whqlibdoc. (visited 23 July 2010). 

The Association of Southeast Asian Nations (ASEAN), established in 1967, consists of Brunei Darussalam, 
Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. 

^ Jacob (2004). Ms Kathy Mulvey wrote: 'This commentary (not peer-reviewed) was a political attack. I 
don't think it merits inclusion in the history of the FCTC. But if it is cited, please also include the rebuttal 
by Corporate Accountability International.' Note on draft transcript, 20 July 2010. Ms Kathy Mulvey's 
letter to the editor in reply to the Jacob article, noted: 'The activities of the tobacco transnationals were the 
target of the treaty, not the US government.' No date, one of several documents attached to an e-mail to Mrs 
Lois Reynolds, 20 July 2010, which will be deposited along with other records of the meeting in archives 
and manuscripts, Wellcome Library, London, in GC/253. Ms Kathy Mulvey wrote: 'The letter, submitted 
in May 2005, was not published. It did rebut some specific complaints by Mr Jacobs (this is the rebuttal by 
Corporate Accountability International).' Note on draft transcript, 30 January 20 12. Other concerns on the 
10-year treaty negotiations are discussed in Lo (2006). 


WHO Framework Convention on Tobacco Control 

earlier advertising ban and its other tobacco legislation. 136 At INB-1 (October 
2000), Thailand raised the issue of trade and tobacco and the need for some 
protection. 137 At INB-2 (April-May 2001), 'trade and health became a huge 
issue, and continued to be so throughout, until the very end of INB-6. It is 
still an issue. But in a passionate plea at INB-1, Thailand began that part of the 
process, although it's not as if the issue hadn't come up before that statement. 

The second is Ireland: the advertising ban was a big issue there and the European 
Community (EC) had a common position, where almost every country among 
the then 15 countries in the EC — plus the ten accession states and the latest 
two make 27 EC countries — were in favour of a comprehensive advertising ban, 
except for Germany. The usual protocol when the EC went into negotiations 
with a common voice. Well, people were just so fed up with this that Ireland 
led the ranks, broke protocol and at INB-5 (October 2002) they called in 
negotiations for a total ban on tobacco advertising. That broke the ice and 
many other EC members followed on to the floor. It was an incredible display 
of what's not supposed to happen when the EC is involved in negotiations. 
Ultimately, the outcome was very good. 

It is surprising to note that when negotiations were complete — INB-6 
(February 2003) — the EC was short of consensus only because of Germany. 
The negotiations were complete, it was only Germany that held out by 26 
to 1 and eventually they buckled. 139 By the time the 56th WHA received the 
convention in May 2003, the EC was on board. But note, certain countries 
were very good champions, although on certain issues it wasn't necessarily 100 
per cent. So, you could be good on most things, but it could vary on the issue. 

For details of the 1990 case involving Thailand's ban on cigarette imports and advertising, see GATT 
(1990); Taylor et al. (2000): 348-50; see also note 192. 

See, for example, Vateesatokit et al. (2000). 

For details of German tobacco industry support, see 
(visited 1 March 2012). 

139 The EC's Directive 98/43/EC to end all tobacco advertising and sponsorship in EC member states by 
2006 was first proposed in 1989, adopted in 1998 and annulled by the European Court of Justice in 2000 
(Neuman et al. (2002)). A limited version, Directive 2001/37/EC, banning misleading descriptors and 
introducing voluntary graphic health warnings, was approved in 2001. A revised directive is not expected 
to be proposed until 2012. See (visited 3 November 2011). 
The tobacco industry lobbied individual member states of the EC to prevent the introduction of a total ban 
on tobacco advertising in 1998 (Neuman et al. (2002); see also 
(visited 3 November 201 1)). 


WHO Framework Convention on Tobacco Control 

Mulvey: In answer to the question about countries, the Framework Convention 
is fundamentally about countries: it is a multilateral, international legal 
instrument. So the decision had to be made by political bodies. The role of 
NGOs working with that leadership from low- and- middle-income countries 
was absolutely critical, and a number of people have alluded to that. Therefore, 
for NGOs to underscore that it was global South-led and global South-driven 
was critical as well. Because the tobacco industry had said that this was a first 
world issue, it was critical to get across the message of the preventive benefit and 
to turn off the tap of this epidemic in countries where it had not even hit yet, 
and where we could stop it. 

Secondly, Rob has spoken of the solidarity within the regional groups — the 
unprecedented work that started with the Johannesburg Declaration in 2001, 
but then the cross-regional consensus among the African group (AFRO), the 
South East Asia group (SEARO) and the Eastern Mediterranean (EMRO) 
group was also critical. 1 2 Those three regions worked together and kept the bar 
as high as it could be. 

Again the tobacco industry mapped out its own plan, with the public relations 
firm Burson-Marsteller - Mary Assunta can probably speak more about this — 
and Mongoven, Biscoe and Duchin, to undermine the negotiations, to weaken 
and delay the convention. It had to do so by trying to use the regional groupings 
as the way to bring it down to the lowest common denominator. The low- and 
middle-income countries were able to resist that strategy. As Vera said, the tobacco 
industry was there, is there, will continue to be there, and the NGOs play a 

140 See pages 24, 56, 71,81. 

141 See Assunta (1999); Mulvey (1999). 

142 SeeFCA(2001). 

143 SeeMalone(2002). 

For details of this public relations company's work, see Burson-Marstellar and Philip Morris (1986) at (visited 16 March 2012). 

Ms Kathy Mulvey wrote: 'Burson-Marsteller worked with Philip Morris to implement the Boca Raton 
Action Plan at;jsessionid=30E2ACD5BD035CEB8E28 
5FC8392534BA (visited 23 July 2010). The report of the Committee of Experts on Tobacco Industry 
Documents (Zeltner et al. (2000)) exposed the Boca Raton plan, including Philip Morris's strategy to use 
its food businesses to gain influence with WHO and other UN agencies.' Note on draft transcript, 20 July 
2010. See note 117; see also Carter (2002); Muggli et al. (2004); Gonzalez et al. (2011). 


WHO Framework Convention on Tobacco Control 

critical role in monitoring and in watchdog activities. Corporate Accountability 
International, working with allies in the Network for Accountability for 
Tobacco Transnationals (NATT) and pursuant to WHA Resolution 54.18, was 
monitoring in-country during the negotiating process, and brought reports like 
'Dirty Dealings' ' to the negotiations, but also systematically asked everyone that 
we encountered there who they were and who they represented. This ferreting 
out of tobacco industry allies — law firms, the tobacco growers' groups, the duty- 
free groups — that were fronting for them and publishing that information for 
delegates in NATT updates and the FCA Bulletin, were NGO activities at the 
INBs. In addition to the Orchid and the Dirty Ashtray awards, there were also the 
Marlboro Man awards, which went to the countries that were behaving most 
like the tobacco industry in the negotiations. Three wealthy countries consistently 
came to the top of the list: the US, Japan and Germany. Of course, the tobacco 
industry was actually on delegations in the form of state-owned tobacco companies 
as well as through the growers — one of the Malawian delegates was with the 
ITGA; one Russian delegate was actually a BAT employee. I think all of this 
came to light through the watchdog activity, and helped to neutralize the negative 
roles being played by certain countries. 

Cunningham: To add to the subject of NGOs, I agree that the NGOs had a 
positive role in the negotiations. Some delegates remarked on the passion that 
the NGOs had, and I think that the NGOs were perceived to be very credible 
about wanting to have a convention that did the right thing. So, there were no 
ulterior motives, no splits at the ministries. The NGOs also had a lot of technical 
expertise to counter either tobacco industry arguments or arguments as to why 
something couldn't be done. There were a variety of backgrounds among the 
NGO delegations, including lawyers and physicians. NGOs prepared 'side-by- 
sides' with recommended amendments to the chair's text for various stages of the 
negotiations. There were two main umbrella groups: the Framework Convention 

' Mulvey (ed.) (2002), freelyavailableat: 
(visited 15 November 201 1). 

147 Ms Kathy Mulvey wrote: 'At INB-5 in October 2002, Marlboro Man awards went to the US, China, 
Germany, BAT and Japan. At INB-6 in February 2003, Japan, Cuba, the US (twice) and the chair of the 
negotiations received this dubious honour.' Note on draft transcript, 20 July 2010. See Table 5, page 43. 

For evidence of US obstruction of other treaties, see Mulvey (ed.) (2003). 

145 For details, see Infact (2003). 

150 See INB-6 delegate list online at, and FCA 
Bulletin article of 27 February 2003 for details (visited 10 January 2012). 


WHO Framework Convention on Tobacco Control 

Alliance (FCA) and the Network for Accountability of Tobacco Transnationals 
(NATT). The FCA did not have formal observer status, so they were like other 
NGOs, in that their delegates were members of International Union Against 
Cancer, World Heart Federation, International Union Against Tuberculosis and 
Lung Disease and so on. The FCAs Alliance Bulletin was widely read by delegates, 
and the first thing they did on receipt would be to turn to the last page to see who 
had won the Dirty Ashtray and who had won the Orchid (see Figure 4). 

Mackay: Kathy has said quite a number of the things that I was going to say. I 
would say that we are all rather reluctant to identify some of the real baddies 
here. I have often said that I thought this treaty got through because of them. 
Some of the big countries were very overbearing, very bullying and offered 
inducements. There was a groundswell of feeling among the low- and middle- 
income countries that they didn't want to be bullied in this way. In fact, we'll 
have to look back at the record, but I think it was the Indian minister of health, 
who said at one point on the floor that 'public health could not be bought.' In 
a sense, the real big baddies helped us, because many nations felt that they were 
not going to be browbeaten: they were going to get this treaty through. So, in a 
funny sense, I think they were quite helpful to the process. [Laughter] 

Assunta: Rob and Kathy have covered some of the points I also wanted to make, 
but I think the concept of 'champion countries' was very important to the NGOs 
and we needed to identify who our champion countries were. One point that 
I made earlier when I talked about what happens when low-income countries 
and poorly resourced countries go into the international arena, the message we 
want to bring with us is the connection between tobacco and poverty. When the 
countries spoke, often this experience and the reality of tobacco being a poverty 
issue, I think, was very evident on the floor. And, I agree with Ahmed that it was 
the low-income and the poorly resourced countries that drove the process. 152 So, 
I'm going to name names. 

Corporate Accountability International founded the Network for Accountability of Tobacco 
Transnationals (NATT), a group of more than 100 consumer, human rights, environmental, faith-based 
and corporate accountability non-governmental organizations (NGOs) in 50 countries. NATT developed 
a 'Gold Standard' text for the treaty and published Key Principles for a Strong, Effective FCTC in 200 1 , and 
provided legal, technical, and advocacy support. See NATT (2003). A copy of Gold Standard FCTC 'will be 
deposited along with other records of the meeting in GC/253. 

Ms Kathy Mulvey wrote: Absolutely essential point. Mary Assunta says it beautifully in Making a Killing: 
Philip Morris, Kraft and Global Tobacco Addiction, a documentary video by AndersonGold Films, 2000, 
at https://salsa.democracyinaction.Org/o/22 15/t/9547/shop/item.jsp?storefront_ICEY=629&t=&store_ 
item_KEY=2283.' Note on draft transcript, 20 July 2010. For the script of the 30-minute film, see (visited 23 July 2010). 


WHO Framework Convention on Tobacco Control 

There were two levels at which we had our champion countries and our champion 
regions. I'm told that for the first time the AFRO region galvanized and spoke 
as one voice, and that was important and I'm told that this had not happened 
in other treaty experiences. South Africa played a crucial role in the galvanizing, 
as did Kenya. You've already heard about the Framework Convention Alliance's 
Dirty Ashtray and Orchid awards: the African region received the Orchid from 
us at least four times. This is to give you an idea of how this system of supporting 
and also acknowledging the countries that played a positive role worked, and 
shaming countries that tried to derail or to undermine the process with the Dirty 
Ashtray. Kenya, for example, was awarded the Orchid three times, and India, 
mentioned earlier by Judith, together with Thailand, played a very important part 
in the SEARO region. India, by virtue of its sheer size and the kind of complex 
problems that it has in implementing tobacco control was evident. As a country, 
Thailand has suffered under the hands of the US government through the World 
Trade Organization (WTO), but went on to put in place strong tobacco control 
measures. 53 Therefore the powerful combination of India and Thailand, two 
countries supporting tobacco control issues, provided very important leadership 
to the SEARO region. Of course, Australia and New Zealand in the Western 
Pacific region were our champions, because they stood up to some of the weak 
proposals and positions that were being put forward by China and Japan. So, 
there were regions, and countries as well, that supported civil society's positions, 
and this needs to be recognized, I think. Canada, for example, and, of course, 
South Africa and the Eastern Mediterranean region, stood up for NGOs and 
insisted that NGO participation and involvement and engagement were essential 
in tobacco control. Hence you have the word 'essential' in the FCTC. 

My other point is that size did not matter, so you had little Palau with a population 
of 20 000 standing up and pushing for Article 5.3, being the conscience of the 
treaty negotiation process. One anecdotal comment about creativity: I still 
remember in INB-6 when, speaking on behalf of the region, a South African 
delegate held up a little T-shirt and said that this illustrated why it was important 
to have a comprehensive ban on tobacco advertising and sponsorship activities, 
because the little child-sized T-shirt promoted or advertised for Marlboro. 

See pages 52 and 68. 

" As did the Pacific Islands. For further details on the role of China and Japan, see notes 80, 93 and 
Appendix 5, page 81. For tobacco news, see (visited 
21 February 2012). 


WHO Framework Convention on Tobacco Control 

In terms of the role of NGOs in supporting the FCTC: yes, we learned as we 
went along. Rob Cunningham spoke about the diversity of the expertise that 
the NGOs drew upon. We operated under several principles: the first was that 
we all had an equal voice and that we were as inclusive as possible. We left our 
egos outside the door, so when we were inside, the focus was on getting the best 
outcome in the negotiations. We also learned to speak with one voice. Not only 
did we have members from individual organizations, we had alliances who were 
also our members. The richness of this diversity can be quite difficult when it 
comes to making decisions. But we applied one principle, the 'can we live with 
it?' principle, and that helped us tremendously. 

You've already heard about the publication of the newsletter, the FCA's Alliance 
Bulletin. One of the things that we realized was that a lot of words spoken from 
the floor were not crystallized into key points. To set out what we wanted to 
achieve, to summarize the points to give to the delegates in a very simple form 
was very important, I think. The FCA played this role through the Bulletin and 
through daily reporting. The Bulletin also made some very candid comments in 
order to bring some life into an otherwise very, very serious and complex, and 
very highly legal process. The shaming symbolism and the awarding symbolism 
worked very effectively and applied pressure. Of course, there was media 
advocacy. ' You've heard about the 'death clock (Figure 6), and I think we 
needed this image to symbolize the urgency in the process, because there were 
times when the delegates had no qualms about spending three hours discussing 
one sentence. [Laughter] The process would start with 'there's one death every 
six seconds', but when it came to the actual wording of the treaty, that urgency 
went out of the window. Therefore we started every INB with a death clock just 
to remind people. 

McLellan: May I take the chair's prerogative to intervene for just a moment. My 
reputation for ruthless time-keeping has been destroyed. This is your meeting, 
this is your history and I would like to go on, with your pleasure. We're going 
to spend 10—15 minutes, letting everybody say the most important thing they 
need to say on any of these topics, but in a very brief, concentrated, not 'three- 
hour negotiation over the sentence' fashion, if you would please, and then I'll 
wind us up. Is that acceptable to everybody? 

For guidelines for advocacy, see American Cancer Society and International Union Against 
Cancer (2003). 


WHO Framework Convention on Tobacco Control 

i I3.H5 ID IZ 

Global Tobacco Deaths Since 25 October 199' 

Figure 6: Death clock displayed at pre-INB-6 sessions, 
Geneva, February 2003. 

Bettcher: I want to highlight how fast the NGO movement galvanized itself in 
this process. When we sat together in a meeting that Dr Brundtland convened 
in October 1998, there were five NGOs, all from the North, that knew about 
the Framework Convention. There wasn't a movement, at least on these 
global issues. The movement replicated itself very, very quickly; the UN 
Foundation, Ted Turner's foundation, also helped to support the movement 
by providing a grant to TFI to support civil society to advance tobacco control 
and the negotiation of the WHO FCTC. It has now become a self-sustaining 
movement, which has different NGOs from around the world as members. 
Different movements have come out of the WHO FCTC negotiation process 
and this is indeed a very positive outcome for tobacco control. We published 
Kathy Mulvey's paper in early 1999, which is very important, because a health 

Dr Doug Bettcher wrote: 'Five is an estimate of the number of NGOs I met with.' Note on draft 
transcript, 6 February 2012. 

See, for example, a collection of newspaper articles on the UN Foundation, created and chaired by Ted 
Turner, who is described as an 'advocate for the UN and a platform for connecting people, ideas, and capital 
to help the UN solve global problems' ( at (both 
sites visited 16 July 2010). 


WHO Framework Convention on Tobacco Control 

Figure 7:The first session of the Conference of the Parties following the FCTC 

coming into force, 17 February 2006. L to R: DrYumiko Mochizuki-Kobayashi, 

director.TFI (2005-07), Dr Douglas Bettcher, FCTC coordinator and director, 

TFI (2007- ), and Dr Lee Jong-wook, D-G, WHO (2003-06). 

group had not previously negotiated a treaty. NGOs had never been galvanized 
to support a treaty-making process. ' Kathy's paper looks at the experience of 
the environmental treaty movement and how the tobacco-control movement 
could learn from the successes of the movement that civil society built to 
successfully support the negotiation of environmental agreements such as the 
Basel Convention and the climate-change convention." 

The public hearings before the negotiations started in October 2000 are another 
issue. Dr Brundtland called them, because very many groups said they were 
being left out, including tobacco companies. But also let's not forget the NGO 
community is not homogeneous; there's a whole NGO community in favour 
of the tobacco industry, loves the tobacco industry and are front groups for the 
tobacco industry. They were all there at the WHO public hearings as well. 

""WHO, TFI (1999a). Ms Kathy Mulvey was Infact's executive director (1996-2007) and international 
policy director of Corporate Accountability International until 2009. 

"'WHO, FCTC (1999b); see also Malone (2002). 

Ms Kathy Mulvey wrote: 'BINGOs (business-interest not-for-profit organizations) funded by the tobacco 
industry' Note on draft transcript, 20 July 2010. See also note 151; for another view of NGOs, see http:// (visited 20 December 201 1). 


WHO Framework Convention on Tobacco Control 

A whole group of governments and NGOs spoke on behalf of comprehensive 
regulation, but then the tobacco industry and their front groups were also there 
talking about minimalist approaches, such as youth access restrictions, which 
don't work very well, and nothing much else. 

There were very key players like the ITGA, which Ahmed referred to earlier. 
The farmers are virtuous, but then front groups of the tobacco companies — the 
ITGA, for example — used the arguments of the plight of the farmers to their 
advantage. During the negotiation they sent a book with about 5000 letters 
signed by farmers to put on Dr Brundtland's desk saying: 'Stop the negotiations.' 

The tobacco industry also tried to manipulate the process through the use of 
front groups. For example, the International Hotel and Restaurant Association 
is a group that focuses on small bars and restaurants, etc. Every time a round of 
negotiations would gear up, the tobacco industry would be up to some funny 
business, like getting these front groups to gather the letters from the farmers, 
or getting the hospitality sector to create a kind of ruckus, or to try to influence 
finance ministers, etc. 


Something we haven't mentioned is what other UN agencies did about tobacco. 
Here is a very interesting history from 1992 or 1993: a resolution was passed in 
the Economic and Social Council (ECOSOC), one of the main governing bodies 
of the UN that brings together the specialized UN agencies, like the World Bank, 
the IMF, UNICEF, WHO, ILO, FAO etc. ECOSOC had agreed to have a 'focal 
point', one who was established at UN Conference on Trade and Development 
(UNCTAD). When the tobacco industry documents become publically available 
in 2000 — I won't mention a name, you can research it — this person's name 
was everywhere as the focal point. The documents commented how much they 
appreciated the focal point's work. 1 ' 3 He was apparently friendly to the industry 
positions and he had a lot of meetings with the tobacco companies. 

See note 59 and page 63. 

See, for example, Dearlove et ah (2002). 

' The focal point is a person appointed by a UN organization to be the 'point person' on an issue. The 
ECOSOC resolution was no. 1993/79; see Zeltner et ai (2000): 44—5. For early discussions on the FCTC, 
see tobacco industry papers, for example,; http://legacy. (both visited 7 February 2012). 


WHO Framework Convention on Tobacco Control 

The light of day that came with these industry documents also saw the messy 
business that was going on within the UN, vis-a-vis inter- agency cooperation. 
Dr Brundtland got hold of Kofi Annan and also the head of UNCTAD, Rubens 
Ricupero, ' and said: 'We'd like a more comprehensive mechanism for UN 
cooperation on tobacco control. We'd like to bring the agencies together at one 
table. We'd like a task force; we need the agencies to work together to support 
this, so we'd like to propose a mechanism to change this.' Finally a resolution 
in the summer of 1999 established the Secretary-General's UN Task Force on 
Tobacco Control, with WHO in the chair. 65 We had our eighth meeting last 
week in New York (February 2010). 

This is not one of those dead-letter groups that go to sleep as soon as they are 
created; there are UN task forces that do that, but this one hasn't. It was crucial in 
looking at key issues that were plaguing the negotiations. For example, the whole 
issue of the tobacco companies saying: 'If this treaty comes into effect the sky 
will fall, millions of jobs will be lost; we're all dead.' That's crazy, but we knew it 
was crazy. The World Bank, FAO and WHO got together and actually mobilized 
funds from a Swedish donor to support the Food and Agriculture Organization 
to do a study. Their study projected agricultural production to the year 2010." 

The report showed a restructuring of agricultural farming going on, with a 
reduction of tobacco farming in high-income countries. In low- and middle- 
income countries, the trend right now is for more jobs, and the transfer of growth 
is from high- to low- and middle-income countries. The FAO study showed that 
the trend would be for more tobacco-growing jobs in low- and middle-income 
countries. The reduction of tobacco farming jobs in low- and middle-income 
countries would be in the more distant future. The World Bank came to every 

Mr Kofi Annan was Secretary-General of the United Nations (1997-2006) and Mr Rubens Ricupero was 
Secretary-General of UNCTAD (1995-2004). 

The UN Ad Hoc Interagency Task Force on Tobacco Control was established in 1999 to coordinate 
tobacco-control work carried out by different UN agencies. Their focus was the implementation of 
multisectoral collaboration on 'tobacco or health', in particular the development of appropriate strategies to 
address the social and economic implications of the impact of tobacco or health initiatives. See for example, 
UN Ad Hoc Interagency Task Force on Tobacco control (1999, 2000); see also note 52. 

'The FAO study, started in March 2000, made projections for the year 2010 on the economic impact 
of a fall in tobacco consumption and considered economic growth, GDP, employment in agricultural and 
non-agricultural industries, household income, government revenue and food security, including a set of 
projections on tobacco production, consumption and trade, along with country case studies on China, 
India, Malawi, Turkey and Zimbabwe and Brazil. See UN, FAO (2004); see also Appendix 4, page 79. 


WHO Framework Convention on Tobacco Control 

session of the treaty negotiations, so when claims were made by countries that 
might not be so friendly to the treaty (regarding job losses, for example), the 
World Bank would be there to say: 'I'm sorry, in fact, that is not going to affect 
jobs and there is going to be redistribution, with jobs created elsewhere.' Due 
to the close collaboration between the UN organizations made possible by the 
creation of the UN Task Force, there would always be the capacity to respond 
to these types of issues. So we reformulated UN cooperation and started to use 
our collaboration with UN agencies. WHO chaired the task force to address 
the crucial questions about tobacco supply issues, the economic questions of 
tobacco trade, etc., which WHO couldn't speak about on its own. 

Zeltner: I will try to be brief, and speak about the last point on the programme 
(see Table 1) about the tobacco industry. I think we have to be aware that there 
were two groups: the 'big three' and then the rest. ' And now I come to the point 

— and I agree with Vera da Costa e Silva — we stopped being as cautious and as 
observant as we should have been at both the country level and at WHO level. I 
have the feeling, but can't prove it, that rather early in the process, the big three 

— first of all, Philip Morris — realized that the FCTC might be an opportunity for 
them. They figured out that the convention could open markets, give them more 
power, would probably destroy small companies and make bigger ones grow. 
That is something, I think, we will have to look into much more carefully in the 
future, because member states tend to believe that everything is under control 
now we have the FCTC and attention directed towards the tobacco industry is 
actually decreasing. This lack of awareness is a window of opportunity for the 
tobacco companies. I very strongly sense that with Philip Morris. 1 8 

McLellan: The next three parts of this meeting will take place as follows: Part 
no. 1 — instructions will be given in just a moment. That will take ten minutes. 
Sanjoy, my co-moderator, who is supposed to break up fights and has had 
nothing to do, will then speak. And then I will turn it over to Tilli to wrap up. 
So, we're going in alphabetical order, conveniently for Dr Assunta, and I'll give 
you one minute — one minute only, I've got my watch with the second hand — 
to tell us something you meant to say but you forgot; something that nobody 
knows; or one thing that is utterly essential to the living history of this issue. 

The big three in the 1990s: Philip Morris, BAT (British American Tobacco) and Japan Tobacco. See 
Tables 3 and 4, pages 17 and 26, for the current composition of the tobacco industry. 

'Atria since 2003. See, for example, Philip Morris International (2011). Kelsey (2011); see also (visited 9 February 2012). 


WHO Framework Convention on Tobacco Control 

Don't forget, I'm wearing the crest of the McLellan family today. It is a head 
impaled on a sword. So, I just need to set the tone for the last few minutes of 
this very interesting discussion. 

Assunta: I spoke about the candid language, the description of the US, Japan 
and Germany as 'the axis of evil' worked very well, especially on Japan, 
because the advocates were able to use that terminology back in Japan to lobby 
their government and thus helped to make their delegation behave better at 
the negotiations. I spoke about the ITGA and I wanted to say that this was 
a group that was set up to 'front' for the third world farmers to lobby against 
WHO. It was run by a PR company based in the UK that also had BAT as their 
client. Doug referred to the submissions and I have to say while there were 
514 written submissions to the WHO FCTC public hearings in October 2000, 
80 per cent of those were supportive and, I think, those submissions sent a very 
strong signal of initial support for the treaty. The most important thing is that 
the treaty has some 'wriggle room', which is why there is a lot of support for it. 
Countries like Japan and China were able to go away with something that they 
could implement. They may not actually change legislation, because there is 
'wriggle room', through words in the FCTC like 'administrative process'. 171 On 
the other hand, there's enough language in there for countries to do far more 
than what is indicated. This satisfied the groups that wanted to establish a much 
higher standard, I think. The treaty therefore has something in it for every 
country, whether they want to put in stringent measures or weaker ones. Those 
are some of the main points that I wanted to make, and my one minute is up. 

da Costa e Silva: The first of two things I have to say is that the tobacco 
industry came up with strategies to derail the treaty negotiations. The three 
main transnational tobacco companies came up with a voluntary agreement 
to counteract the treaty and wanted to be part of the discussion, claiming to 
be part of the solution, trying to engage in a dialogue with WHO. WHO's 
Secretariat addressed the issue by creating the Scientific Advisory Group on 

169 Assunta and Chapman (2004): 755. 

170 In 2001, Hallmark Public Relations, Winchester, UK, served the ITGA (Must (2001)), freely available 
at:; (visited 3 November 2011)); see also Rimmer 

171 For international convention flexibility, see Taylor and Bettcher (2000): 922. 


WHO Framework Convention on Tobacco Control 

Tobacco Product Regulation. During the meetings of this group, we were 
able to listen to presentations from the tobacco industry. This was an open door 
for the tobacco industry to bring information, while keeping the organization, 
WHO, protected from any mention of a non-existent 'dialogue'. The group 
has recently changed the focus because the tobacco industry was not bringing 
relevant input. In fact, it looked like they didn't want to collaborate, they just 
wanted to move their agenda of advancing their business forward. 

The second thing is that we had three important players there: the governments, 
of course; the NGO community, of course; and the WHO Secretariat, which 
is barely mentioned. The importance of the secretariat in supporting the 
process and in continuing the work on tobacco control with the different 
WHO member states proved to help the process itself. Finally, I think that 
the multisectoral approach to tobacco control is still the big challenge — for 
example, to make tobacco control an integral part of the UN agenda — but we 
are still not there yet. At the country level, the challenge is the same. Efforts to 
bring the ministries for culture and trade on board and to have tobacco control 
on their agendas have proven very difficult. Finally, I think we have a successful 
story here that is an example for other programmes: for health promotion, for 
non-communicable diseases and for other areas of public health. 

Cunningham: First of all, the secretariat was very important in terms of the 
success of the treaty, because of their high capabilities and their energy. On 
the last question, please note: the industry did make a lot of effort to weaken 
things. The duty-free lobby was present throughout negotiations, especially in 
week two of the INB-6 (February 2003), when the tobacco industry started 
appearing in numbers all over the place. The voluntary tobacco advertising 
code, released in September 2001, was a major tobacco industry initiative to 
weaken the advertising provisions. 73 They had the coincidence of launching 

See, for example, the Scientific Advisory Group's third report, freely available at http://whqlibdoc.who. 
int/publications/20097978924l209557_eng.pdf (visited 5 December 2011); see also Glossary, page 122. 

British American Tobacco (BAT), along with Philip Morris and Japan Tobacco, announced International 
Tobacco Product Marketing Standards in 2001 and invited international discussion. The companies agreed 
voluntarily to adopt measures that would prevent tobacco marketing activities directed at young people. It is 
claimed that voluntary codes of advertising were first adopted in the US, Canada and Britain in the 1960s. 
See Saloojee and Hammond (2001); see also Assunta and Chapman (2004); Mamudu et al. (2008). 


WHO Framework Convention on Tobacco Control 

that initiative on 11 September 200 1. 17 They had been preparing this public 
relations initiative for a very long time and received no public relations impact, 
because there was no media coverage; it was launched in Europe before the 
disaster, which dominated the media for months afterwards. 

So what are some big picture comments? The FCTC has been an incredible success. 
Personally, I started to appreciate the full potential of this fact only at INB-1 
(October 2000). When I saw what happened at INB-1, I thought: 'We could 
achieve something here', in a way that I hadn't fully appreciated before this date. 
The success of the convention has exceeded my expectations. People said: 'If you 
implement the advertising ban, people aren't going to ratify it' and stuff like that. 
The ratifications have been fantastic. People are implementing their obligations 
and let's just keep at it. We have a lot of work to do and there are going to be more 
issues, you know, for example, plain packaging, which has been cited in the most 
recent Guidelines for Article 11, Article 13 — that's an issue for the future, which 
will require the involvement of all the stakeholder groups around this table. 17 

Mackay: I think the FCTC has brought about a sea change from 30 years ago 
when many of us started working in tobacco control. There's no doubt about it. 
This treaty makes it much more difficult for the industry to pick off individual 
countries, one-by-one, and influence them. They can't go to Laos and say: 
'No-one in their right mind would ban advertising.' It has given a sense of 
togetherness, community and information sharing, so the tobacco companies 
can't do that any more. 

Secondly, it's worth putting on record that the inclusion of the NGOs in this 
process was treated with quite a bit of negativity by some of the government 
delegations — whether the NGOs should even be allowed to participate or be 

The date of the destt uction of the Twin Towef s in New York and the attack on the Pentagon, 9/11. 

See also notes 144 and 145. 

Fot one debate sut rounding plain packaging of cigarettes, see the Parliament of Australia's Tobacco Plain 
Packaging Bill 2011, which received Royal Assent on 1 December 2011, at 
debate;rec-0;resCount-Default (visited 30 April 2012). For seven guidelines for the implementation of 
Articles 5.3, 8, 9 and 10, 11, 12, 13 and 14, see FCTC (2009b) at: (visited 
16 July 2010). 

For an ASH briefing on the UK tobacco advertising and sponsorship ban following the implementation 
of the Tobacco Advertising and Promotion Act 2002, see 
why-ban- tobacco-advertising (visited 17 November 2011). 


WHO Framework Convention on Tobacco Control 

allowed to speak. This was quite controversial in the beginning. But anyhow, 
that prevailed. The treaty considerably strengthened the international NGO 
tobacco-control community. 

Thirdly, this treaty has also lent itself to funding. We now have big funders for 
tobacco control, like Bloomberg and Gates, with funding going to government 
organizations, NGOs and WHO's TFI, although unfortunately, not directly 
to the FCTC process. The problem here is that, firstly, the funders felt that 
it would be difficult for foundations to give money to governments. And 
secondly, if they did so, then this act of giving would reduce the responsibility of 
governments to fund the FCTC. Funding went to countries and is being used, 
but not directly for the FCTC process. 

Finally, for the first time in Asia we are now seeing a whole set of new arguments 
to try to fight against the FCTC. I would say that it is only within the last six to 
nine months (2009/1 0) that they, these extreme right-wing libertarian arguments, 
have, are and will be calling for 'less government, not more government', and 
describe tobacco-control measures as 'heavy-handed, paternalistic'. In fact we 
discovered that one of these right-wing groups, funded by the industry, actually 
said in public in 2010 that government does not have the responsibility to care 
for the health of its people. It's ridiculous. I know some of you have had this 
for a long time, but this argument is now being used in the low- and middle- 
income countries of the world. 

178 Ms Kathy Mulvey wrote: 'The WHA resolution launching the negotiations (May 1 999, online at http:// included strong language in support of NGO 
participation, and the May 2000 WHA resolution on the FCTC (WHA53.16, online at http://apps. called on the INB "to examine the question 
of an extended participation, as observers, of non-governmental organizations according to criteria to be 
established by the Negotiating Body." As a result, WHO adopted an accelerated process for admitting 
NGOs into official relations, and two NGOs (Infact and INGCAT) were so admitted in 2002.' Note on 
draft transcript, 20 July 2010. 

Dr Judith Mackay wrote: 'For example, the Framework Convention Alliance (FCA) was founded in 1999 
and now [in 2010] is made up of over 350 organizations from more than 100 countries working on the 
development, ratification and implementation of the international treaty, the WHO's FCTC. In addition, 
funding from the Bloomberg Initiative and subsequently from the Bill and Melinda Gates Foundation 
followed, offering serious funding for tobacco control for the first time in low- and- middle-income 
countries in support of the FCTC Note on draft transcript, 1 July 2010. See 
topics/Pages/ tobacco. aspx; (both 
visited 5 December 201 1). 

For another view of the effects of the 50 per cent increase in Hong Kong tobacco tax in in 2009, see 
Alpert (2010). 


WHO Framework Convention on Tobacco Control 

Mulvey: I have three points, one on NGOs, one on the industry and one on the 
other players. One critical issue around NGOs was their involvement beyond 
the public health community and their ability to draw in environmental groups, 
groups working on fair trade, consumer groups and faith organizations. A big 
part of the draw was the potential precedents that this treaty could set for the 
other issues that NGOs care about and are working on, particularly with regard 
to placing health before trade and preventing commercial conflicts of interest 
from intruding into public policy-making. The NGOs could name names - 
we've spoken about this, but just to say it clearly — it gave us a different role in 
the process. Also, we haven't spoken much about the media today, but as Dr 
Mackay said earlier, when we first heard the word 'convention', we thought 
it was a meeting — I thought that the first time too. So, we needed to be able 
to take what was happening here and translate it in a way that could then 
go out through the media to the public, and there were critical points where 
media attention, either internationally or in particular countries, made a huge 
difference in the negotiations. 181 

In terms of the tobacco industry: to follow up on what Dr Zeltner said about 
Philip Morris. 82 While I think they express support for the treaty, they have an 
'a la carte' menu approach to it. The tobacco industry doesn't like the advertising 
ban, they don't like that the treaty addresses litigation, they don't like taxation, 
and last year when we asked them about Article 5.3, they said they would never 
back off from public policy-making. So they are definitely trying to put a 

Ms Kathy Mulvey wrote: 'At INB-6 in February 2003, media coverage helped put pressure on negotiators 
to deliver a strong, effective text. For example, Infact and NATT gave the chair, Ambassador Luis Felipe de 
Seixas Correa, the Marlboro man award on the opening day of INB-6, because in our analysis the chair's 
text was too weak to reverse the global tobacco epidemic. The award received extensive media coverage in 
Brazil, the chair's home country, including in the major national newspaper O Estado de Sao Paulo, which 
put significant pressure on him to respond to the majority of countries that were calling for the text to be 
strengthened dramatically' Note on draft transcript, 30 January 2012. 

See note 1 17. 

183 Ms Kathy Mulvey wrote: 'See Philip Morris/Altria/Philip Morris International annual reports for their 
corporate responses to the FCTC. For a critique of current tobacco industry positions on the FCTC 
and the proposed Illicit Trade Protocol, see my commentary (Mulvey (2010)).' Note on draft transcript, 
20 July 2010. 

For Article 5.3, see Appendix 1, page 73. See Clearing the Smoke-Filled Room: An expose on how the tobacco 
industry attempts to undermine the global tobacco treaty and the illicit trade protocol (Corporate Accountability 
International and NATT, 2009, online at 
English%20FINAL.pdf) for details (visited 18 April 2012). 


WHO Framework Convention on Tobacco Control 

positive face forward. A final point on this process: it strikes me — this has been 
a fascinating discussion - I'm sure the lead negotiators, the bureau members, 
the people who kept their regional groups together could add so much richness 
to this discussion. 

Ogwell: As we close this Witness Seminar, I have two things to say: first is 
that history teaches us that history doesn't teach us anything. [Laughter] I say 
this, because we have had a lot of discussion at the international level since, I 
think, the mid-1990s, and, as far as tobacco control at the international level 
is concerned, we are stuck there. We don't seem to be moving to where the 
industry is. And on Zeltner's 'split theory': it's not a theory, it is reality. The 
split is on two levels: internationally, so we start seeing that this group says this 
and that group says that, and we are mesmerized by the fact that: 'Some are 
actually saying something that sounds like us.' Yet it is all by design. I say it's by 
design, because at the national level, there are the local industries and then there 
are the multinationals. The multinationals play the good chaps and the local 
industry play the bad chaps. The local industry is local, so it strikes a very good 
tone with the local politicians. In the meantime, when push comes to shove, 
then the multinationals provide the funds to be able to disorganize any activities 
of tobacco control within the country. So we are stuck with discussions at the 
international level and we have not got to the country level yet. Having said 
that, I must say that the convention has been a huge success at the global level, 
but we still need to do more at the national level. 

This brings me to my second point. We have been led to believe that we need 
a lot of money to be able to achieve success. Wrong. Look at all the countries 
that have achieved huge improvements, such as Thailand. They didn't get 

^ For the background to the composition of this Witness Seminar, see pages 3—4. 

'See page 62. 

One example of the lack of improvement at national level is the absence of national support for cessation, 
see Meier (2005). For comments on the FCTC's failure to address directly smoking cessation and harm- 
reduction strategies, see Meier and Shelley (2006); for a rational scale of assessment of potential harm of 
tobacco, see Nutt et al. (2007). 

Thailand established the National Committee for Control of Tobacco Use in 1989 and the Institute of 
Tobacco Consumption Control under the Ministry of Public Health in 1990. Thailand's Parliament passed 
the Nonsmoker's Health Protection Act and the Tobacco Products Control Act in 1 992, under the guidance 
of Dr Hatai Chitanondh. See, for example, Chitanondh (2001); see also Vateesatokit (2003); Roemer 
(2004); for other champion countries, see pages 24, 43, 56, 69, 81. 


WHO Framework Convention on Tobacco Control 

any money internationally, everything was national. Now if we reorganize 
our debates, if we reorganize our thoughts and messages to the local people, 
then we can get the successes that we are looking for now. It's not necessary 
for money to come from outside, but it's good to support the international 
processes, meetings, conventions, etc. It does not contribute to the successes 
at the national level. It is local resources that will achieve what is required. By 
local resources, it is going to be tax money, because this tax money comes from 
me and you as the taxpayer, so it is our money that is actually going to make 
the difference. But, we have been led to believe that we should wait for this 
big money to come internationally, so that it trickles down to the national level. 
A lot of the international money disappears in travel, meetings and payments 
to whatever, the system that supports the process, not the activities at national 
level. If we stop thinking of this big international money and start thinking 
of the little national level resources, and fix our attention on that, then we are 
going to be able to win the next level of the discussion. But the tobacco industry 
has focused our discussion on international issues and we have ignored the fact 
that it is the national level that will help us to achieve our goal. But I hope that 
this history will actually teach us something. 

McLellan: Dr Zeltner, by virtue of the Z, you have the last word. Unfortunately 
you have minus three minutes to speak. [Laughter] 

Zeltner: I will be very brief. I think there are lessons to be learned and I'm 
glad that you will write this up. There are three things that strike me: one is 
the disruptive power of transparency, of bringing hidden facts into the public 
domain. The second lesson is that leadership is key. I think maybe five people 
have made that happen, in the end. One is Amorim, one is Brundtland, and 
some others, some are the staff at WHO. The reason that could happen brings 
me to my third lesson, which is that telling a convincing story is very important 
and allows new alliances to emerge that did not seem possible before. A story 
that makes people think: 'Yes, we need to do something now.' And then to say: 
'We submit ourselves to leaders and these leaders commit themselves not to 

Ms Kathy Mulvey wrote: 'I think Dr Ogwell may have meant taxation and the "polluter pays" principle. 
If so, it would be helpful to make it clear that this is not talking about voluntary industry contributions, but 
compensation due to legal settlements or mandated by law or legally binding and enforceable agreements 
(see Recommendation 6.4 of the Article 5.3 implementation guidelines, online at 
guidelines/article_5_3.pdf).' Note on draft transcript, 20 July 2010. 


WHO Framework Convention on Tobacco Control 

egoism, but to this story and to bringing it to a positive ending.' I think that 
this history has shown us that great steps forward can be made, and that's a 
wonderful lesson from the FCTC. 

Bhattacharya: This has been fascinating. Thank you all for joining us. As a 
student of the history and politics of global health, what I take home today is the 
importance of HQ-level action at the WHO. But I also recognize that regions 
and countries play an incredibly important role. So when I get legions of MA 
and PhD students to look at global health in critical ways, this is the message 
I will give them; the message I'm taking back from all of you. Multisectoral 
action is very important; it's something that's underlined in the official histories 
that have been distributed. But, you know, documents are often a product of 
a particular age. What this highlights is the importance of horizontal action. 
This is, after all, the age of the resurgence of primary health care. However, I 
think vertical actions, from what you've said, are also very important. What do 
I mean by vertical? The global strengthening of national positions, something 
Dr Assunta was able to talk about in a very sensitive way. So, horizontal action 
within nations is important, but the vertical where international bodies can step 
in and empower governmental agencies at crucial moments, seems to be very 
important. So I would call this what I like to label in my classes as 'intermeshed 
histories'; histories that don't ignore the many facets of a very complex mosaic. 

Tansey: May I finally reiterate our thanks to staff here at the WHO, to thank 
Sanjoy and in particular, Faith, for excellent facilitation. Your timekeeping 
has been shot to pieces, Faith, but we gave you an absolutely impossible task. 
Thank you very much. Thank you all very much for coming, for participating 
so engagingly and whole-heartedly. This is not my field at all, but I have learned 
so much, and I am going back to London with so many ideas. But, I also have 
all your addresses and your e-mails [laughter] and we will continue to be in 
touch with you as we transcribe and start editing this material. 

Al-Shorbaji: Thank you, Faith, for moderating the session, and I hope you will 
continue to provide this support in future series. It has been a pleasure to have 
all of you, and, of course, to have colleagues from the Wellcome Trust Centre 
for the History of Medicine at UCL. 190 Since this is the first Witness Seminar in 
collaboration with WHO, I hope it will be the first in a series of seminars that we 
will collaborate on, as there are so many other topics, other public health issues, 

""Reconstituted as the Histoty of Modern Biomedicine Research Group at the School of History, Queen 
Mary, University of London, from October 20 1 0, funded by the Wellcome Trust. 


WHO Framework Convention on Tobacco Control 

this wealth of knowledge that we probably need to explore, to experience and to 
learn from history. I would sincerely like to thank you for joining us today and 
for sharing with us and the world these historical moments. We look forward 
to seeing the published transcript of this seminar. I hope the final publication 
will also be augmented by regional inputs on the topic. I am aware of the efforts 
made by many staff in WHO regional offices to convince governments and 
to lobby with governments and the NGOs to ratify the FCTC. When I was 
working for the WHO Regional Office for the Eastern Mediterranean in Cairo, 
there was a lot of lobbying and working with community and religious leaders 
to secure their support for the convention and to ban smoking by all means.' 1 

Ogwell: From the Convention Secretariat's perspective, I think our message is 
that history is still being made, as we speak. 192 The FCTC is being implemented 
at country level; the first protocol of the Convention itself is also currently 
being negotiated. A lot of history is still being made, and the lesson we take 
away is that we need to keep our records a little bit better [laughter], in order to 
to record some of these issues when they are still fresh in our minds, so that the 
students of tomorrow will be able to utilize that information. 

See, for example, WHO, EMRO (2002). Freely available as a revised edition at: 
communications/TImanualcontent.pdf (visited 16 November 2001). 

See, for example, (visited 3 April 2012). The final negotiations 
on an FCTC protocol (Article 15) on 'Illicit trade in tobacco products', were conducted in March— April 
2012 in Geneva, see (visited 3 April 2012). 


WHO Framework Convention on Tobacco Control -Appendix 1 

Appendix 1 

Selected Provisions of the 

Article Topic 


FCTC 193 


Article 5.3 Lobbying Call for a limitation in the interactions between lawmakers 

and the tobacco industry 

Demand- Price and non-price measures and tax measures to reduce 

reduction the demand for tobacco 

Article 8 Passive Obligation to protect all people from exposure to tobacco 

smoking smoke in indoor workplaces, public transport and indoor 

public places 

Article 10 Regulation The contents and emissions of tobacco products are to be 

regulated and ingredients are to be disclosed 

Articles Packaging and Large health warning - at least 30 per cent of the packet 

9 & 1 1 labelling coven 50 per cent or more recommended; deceptive labels 

-'mild', light', etc.- are prohibited 

Article 12 


Education, communication, training and public awareness 
for the consequences of smoking 

Article 13 


Comprehensive ban on tobacco advertising, promotion and 


sponsorship, unless the national constitution forbids it 

Article 14 


Demand-reduction measures concerning tobacco 
dependence and cessation 

Article 15 


Action is required to eliminate illicit trade in tobacco 

Article 16 


Restricted sales to minors 

Article 1 7 Viable Provision of support for economically viable alternatives 

alternatives for tobacco workers, growers and, as the case may be, 

ndividual sellers 

Article 18 



Protection of the environment and the health of persons 

Article 19 


Legislative action or promotion of existing laws, to deal 
with criminal and civil liability, including compensation 

Articles 20, 21 


Tobacco-related research and information sharing among 
the parties 

'See (visited 16 July 2010). 


WHO Framework Convention on Tobacco Control -Appendix 2 

Appendix 2 

WHO regions 

Regional Office for Africa 
(Brazzaville, Congo) 

Regional Office 
for the Americas 
(Washington, DC) 

Regional Office for 
South-East Asia (SERO, 
New Delhi, India) 

Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, 
Cape Verde, Central African Republic, Chad, Comoros, Congo, Cote 
d'lvoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, 
Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, 
Liberia, Madagascar Malawi, Mali, Mauritania, Mauritius, Mozambique, 
Namibia, Niger Nigeria, Rwanda, SaoTome and Principe, Senegal, 
Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United 
Republic ofTanzania, Zambia, Zimbabwe 

Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia 
(Plurinational State of), Brazil, Canada, Chile, Colombia, Costa Rica, 
Cuba, Dominica, Dominican Republic, Ecuador, El Salvador Grenada, 
Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, 
Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent 
and the Grenadines, Suriname, Trinidad and Tobago, United States of 
America, Uruguay, Venezuela (Bolivarian Republic of) 

Bangladesh, Bhutan, Democratic People's Republic of Korea, India, 
Indonesia, Maldives, Myanmar Nepal, Sri Lanka, Thailand, Timor-Leste 

Regional Office for Europe 
(EURO, Copenhagen, 

Regional Office for the 
Eastern Mediterranean 
(EMRO, Cairo, Egypt) 

Western Pacific Regional 
Office (WPRO, Manila, 

Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia 
and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, 
Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, 
Ireland, Israel, Italy Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg 
Malta, Monaco, Montenegro, Netherlands, Norway, Poland, Portugal, 
Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, 
Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former 
Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United 
Kingdom of Great Britain and Northern Ireland, Uzbekistan 

Afghanistan, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, 
Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar Saudi 
Arabia, Somalia, South Sudan, Sudan, Syrian Arab Republic, Tunisia, 
United Arab Emirates, Yemen 

Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, 
Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands, 
Federated States of Micronesia, Mongolia, Nauru, New Zealand, Niue, 
Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, 
Singapore, Solomon IslandsTonga, Tuvalu, Vanuatu, Vietnam 


WHO Framework Convention on Tobacco Control -Appendix 3 

Appendix 3 

WHO Framework Convention on Tobacco Control, 
timeline, 1 993-201 1 m 

1993/4 Initial conceptualization of an international legal approach to tobacco control 

1994 October: resolution passed at the 9th World Conference on Tobacco or Health in 
Paris urging adoption of an international instrument for tobacco control 

1995 12 May: World Health Assembly officially introduces the concept of an international 
strategy for tobacco control in resolution WHA48. 11 

1996 25 May:WHA requests (resolutionWHA 49.17) the WHO Director-General to 
initiate preparation of a framework convention on tobacco control 

1 998 15 May: Dr Gro Harlem Brundtland elected WHO Director-General and makes 
tobacco control one of her priorities 

July: WHO Tobacco Free Initiative is created 

1999 25 May:WHA decides (resolution WHA.52.1 8) to establish an intergovernmental 
negotiating body (INB) to draft and negotiate a framework convention on tobacco 
control and a working group ofWHO member states to undertake preparatory work 
for the intergovernmental negotiating body 

25-29 Oct: first meeting of the FCTC technical working group 

2000 27-29 Mar: second meeting of the FCTC technical working group 

20 May: FCTC Working Group reports to WHA and WHA recognizes (resolution 
WHA53.1 6) that proposed draft elements of the framework convention as a basis 
for initiating negotiations by the intergovernmental negotiating body and requests the 
WHO Director-General to convene the first negotiating session 

12-13 Oct: WHO conducts public hearings on the proposed framework convention 
on tobacco control 

1 6-21 Oct: INB-1 with Ambassador Celso Nunes Amorim of Brazil as chair; work on 
chair's text of the framework convention starts 

2001 Jan: INB chair's text of the framework convention is released 

194 Adapted from WHO, FCTC Secretariat (2010): 40-1; for budget details of the Convention, see FCTC/ 
COP4(20) 'Workplan and budget for the financial period 2012/13', freely available at pages 78-96 at (both visited 6 December 2011). For other timeline details, see 
Framework Convention Alliance at 
emid=8 (visited 21 December 201 1); for Conference of the Parties, see Glossary, page 1 19— 20. 


WHO Framework Convention on Tobacco Control -Appendix 3 

Mar-May: regional inter-sessional consultations are held in preparation for INB-2 session 

30 Apr-5 May: second INB meeting produces first partial draft of framework 

Sep-Nov: regional inter-sessional consultations are held in preparation for the third 
INB session 

22-28 Nov: INB-3 meeting 

2002 Feb-Mar: regional inter-sessional consultations are held in preparation for the fourth 
INB session 

18-23 Mar: INB-4 meeting; Ambassador L F de Seixas Correa replaces Amorim as 
chair and a revised chair's text produced 

July-Aug: international technical conference at UN, New York, on illicit trade in tobacco 
products organized by US government 

14-25 Oct:INB-5 meeting 

2003 Revised chair's text released 

17-28 Feb: INB-6.A draft framework convention sent to 56th WH A for adoption 

21 May:WHA unanimously adopts FCTC, and establishes an open-ended 
ntergovernmental working group to consider and prepare proposals from the FCTC 
for consideration and adoption at the first session on the conference of the parties 

1 6-22 June: FCTC open for signature at WHO headquarters in Geneva: 28 
member states and the EU sign the treaty on the first day and from 30 June at UN 

2004 21-24 June: first meeting of the open-ended intergovernmental working group 

29 June: 1 68 signatories at the end of signature period 

29 Nov:The deposit of the 40th instrument of ratification brings entry into force of 
the FCTC, acceptance, formal confirmation or accession. Both Armenia and Ghana 
deposit their instruments in New York on this day 

2005 31 Jan-4 Feb: second meeting of the open-ended intergovernmental working group 

27 Feb: WHO FCTC enters into force, 90 days after the deposit of the 40th 
instrument of ratification, acceptance, approval formal confirmation or accession 

2006 February: first session of Conference of the Parties (COP-1) in Geneva 

May: convention secretariat established by 59th WHA as requested by the Conference 
of the Parties 

1 6-1 8 Nov: second meeting of the expert group to prepare a template for a protocol 
on cross-border tobacco advertising, promotion and sponsorship 


WHO Framework Convention on Tobacco Control -Appendix 3 

3-5 Dec: second meeting of the expert group to prepare a template for a protocol on 
illicit trade in tobacco products 

2007 26 Feb: public hearing for the FCTC on agricultural diversification and alternative crops 
to tobacco 

27-28 Feb: first meeting of the ad hoc study group on alternative crops 

30 June-6 July: COP-2. Dr Haik Nikogosian is appointed the first head of the 
convention secretariat 

6 July: guidelines for implementation of Article 8 (protection from exposure to tobacco 
smoke) are adopted by the Conference of the Parties (COP-2) 

26-28 Sep: third meeting of the working group for development of guidelines on 
Article 9 (regulation of the contents of tobacco products) and Article 10 (regulation 
of tobacco product disclosures) 

7-9 Nov: meeting of the working group for development of guidelines on 
mplementation of Article 11 (packaging and labelling of tobacco products) 

27-29 Nov: first meeting of the working group for development of guidelines on 
mplementation of Article 1 3 (tobacco advertising, promotion and sponsorship) and 
recommendations on key elements of a protocol or other measures that would 
contribute to the elimination of cross-border tobacco advertising, promotion and 

12-14 Dec: meeting of the working group for development of guidelines on 
mplementation of Article 5.3 (protection of tobacco-control policies from commercial 
and other vested interests of the tobacco industry) 

2008 11-16 Feb: first meeting of the Intergovernmental Negotiating Body on a Protocol on 
Illicit Trade in Tobacco Products in Geneva 

21-23 Feb: first meeting of the working group for development of guidelines 
on implementation of Article 12 (education, communication, training and public 

3-4 Mar: meeting of the drafting group for development of guidelines on 
mplementation of Article 5.3 (protection of tobacco-control policies from commercial 
and other vested interests of the tobacco industry) 

4-5 Mar: meeting of the drafting group for development of guidelines on 
mplementation of Article 11 (packaging and labelling of tobacco products) 

5-7 Mar: Fourth meeting of the working group for development of guidelines on 
Article 9 (regulation of the contents of tobacco products) and Article 10 (regulation 
of tobacco product disclosures) 


WHO Framework Convention on Tobacco Control -Appendix 3 

31 Mar-Apr 2: second meeting of the working group for development of guidelines 
on implementation of Article 1 3 (tobacco advertising, promotion and sponsorship) 
and recommendations on key elements of a protocol or other measures that would 
contribute to the elimination of cross-border tobacco advertising, promotion and 

3-4 Apr: meeting of the drafting group for development of guidelines on 
implementation of Article 1 3 and recommendations on a protocol or other measures 
to contribute to the elimination of cross-border tobacco advertising, promotion and 

17-19 June: second meeting of the study group on economically sustainable 
alternatives to tobacco growing (formerly known as the ad hoc study group on 
alternative crops) 

20-25 Oct: second meeting of the Intergovernmental Negotiating Body on a Protocol 

on Illicit Trade in Tobacco Products 

17-22 Nov: third meeting of the Conference of the Parties 

22 Nov: COP-3, held in Durban, South Africa, adopts guidelines for implementation of 
Article 5.3 (protection of tobacco-control policies from commercial and other vested 
interests of the tobacco industry); Article 11 (tobacco product packaging and labelling); 
and Article 1 3 (tobacco advertising, promotion and sponsorship) 

2009 28 June-5 July: third meeting of the Intergovernmental Negotiating Body on a Protocol 
on Illicit Trade inTobacco Products, held in Geneva 

2010 27 Feb: fifth anniversary of the entry into force of the convention 

14-21 Mar: fourth INB on a Protocol on Illicit Trade inTobacco Products 

14-20 Nov: fourth meeting of the Conference of the Parties (COP-4) 

20 Nov: COP-4 adopts guidelines for implementation of Articles 9 and 10 (partial 
guidelines on tobacco flavourings and additives); Article 12 (education and awareness), 
Article 14 (demand-reduction measures) 

201 1 4-8 July: first meeting of the Informal Working Group on a protocol to eliminate illicit 
trade in tobacco products 


WHO Framework Convention on Tobacco Control -Appendix 4 

Appendix 4 

World's leading unmanufactured tobacco producing, trading and 
consuming countries, metric tons dry weight, as presented to 10th 
World Conference on Tobacco or Health, Beijing, 24-28 August 1997 






World total 

7 325 157 

5 609 552 

6 579 289 

5 547 668 


China, People's 
Republic of 

3 1 1 8 000 

2 000 000 

2 082 600 

2 910 600 

3 315 600 

United States 

651 511 

641 181 

51 3 247 

625 454 

667 680 


522 540 

475 200 

528 390 

506 475 

544 050 


509 000 

365 000 

323 500 

367 000 

497 053 


280 803 

155 818 

170 070 

190 391 

245 260 


201 992 

152 490 

179 243 

1 78 605 

1 65 240 

World total 

1 735 554 

1 694 877 

1 768 823 

1 956 381 

1 924 745 


243 500 

275 500 

256 300 

282 500 

294 000 

United States 

207 747 

196 792 

209 482 

222 316 

221 509 


188 261 

203 485 

174 289 

195 958 

175 572 


91 350 

112 411 

136 392 

1 70 098 

156 200 


91 000 

22 390 

77 680 

118 000 

1 1 5 000 


124 563 

110 332 

118 839 

138 829 

1 07 000 

World total 

1 765 584 

1 786 902 

1 797 557 

1 977 436 

1 939 307 

United States! 

359 738 

264 390 

199 088 

326 455 

306 838 


154 175 

182 785 

209 761 

235 855 

250 000 


144 125 

143 080 

148 110 

125 296 

148 800 

United Kingdom 124 324 

97 958 

141 467 

166 027 

131 876 


83 623 

86 546 

89 075 

97 368 

97 500 


118 651 

135 543 

1 1 5 072 

85 634 

96 000 

Estimate f General imports (actual arrivals) £ Unified Germany 


WHO Framework Convention on Tobacco Control -Appendix 4 







World total 

6 958 079 

6 860 867 

6 332 896 

6 504 763 

6 303 870 

China, People's 
Republic of 

2 907 029 

2 808 734 

2 208 554 

2 313 705 

2115 134 

United States 

725 241 

667 146 

699 200 

714 138 

710 000 


426 045 

438 605 

463 920 

472 070 

478 760 


139 733 

165 786 

183 050 

196 670 

200 550 


179 235 

190 000 

196 900 

197 250 

1 95 700 


143 000 

152 500 

1 66 900 

1 79 400 

1 87 400 

Estimate f General imports (actual arrivals) ^ Unified Germany 

Source: US Department of Agriculture, Foreign Agricultural Service, 
Circular Series FT-02-98, February 1998,Table 1, page 8. 
Adapted from: Samet et al. (1999): 77. 


WHO Framework Convention on Tobacco Control -Appendix 5 

Appendix 5 

Reflections on FCTC negotiations: China and Japan 
Dr Judith Mackay, 15 December 201 1 

The FCTC negotiations were complex for both China and Japan, particularly 
as China is the world's biggest producer and both countries being large tobacco 
manufacturing states. In fact, the Chinese government is the largest tobacco 
company in the world, with approximately a one-third share of the global 
market. 'The concerns voiced by these two nations were principally economic: 
the misconception that tobacco control would be an economic debit and 
harmful to their tobacco industries and, for example, leading to loss of jobs 
and decreased tobacco tax revenues. The reality has been the opposite. Because 
of population expansion in the low- and middle-income countries, there will 
be more smokers up to at least 2035, even if prevalence is reduced. Both 
countries received the NGO Framework Convention Alliance 'Dirty Ashtray' 
awards for bad behaviour during the negotiations: China (4 times) and Japan 
(14 times, the most given to any single country). In March 2002 at INB-4, 
Japan was openly labelled by an NGO as an 'axis of evil', which had an impact 
on Japan's negotiating stance. Latterly both countries won an Orchid award 
for recognition of leadership. 


The Japanese government is also an important shareholder in the Japanese tobacco 
industry. Negotiations to develop the WHO FCTC were based on consensus, 
resulting in countries needing to agree to the lowest acceptable common 
denominator in clause development. The Japanese government's proposals for 
'appropriate' and optional measures were reflected in the final FCTC text that 
accommodates flexibility on interpretation and implementation. Japan's success 
in arguing for extensive optional language seriously weakened the FCTC. 
Japan called for deletion of text that was too prescriptive or stringent at least 35 
times during the course of the negotiations. For example, on ingredient listing, 
Japan proposed that the word 'all' should be deleted from 'all ingredients'" and 

195 Eriksen et al. (2012). 

'Assunta and Chapman (2004): 755; see also page 63. 
197 WHO (2002a). 


WHO Framework Convention on Tobacco Control -Appendix 5 

that 'including counter advertising' 198 be deleted as an education and public 
awareness strategy. At INB-6, Japan called for a deletion of the text on liability. 
Accordingly, international tobacco control can be expected to be less successful 
in reducing the burden of disease caused by tobacco use. 199 

In June 2004 Japan ratified the WHO Framework Convention on Tobacco 
Control (FCTC) being among the first 20 countries to do so. 200 The ratification 
was described as an 'extraordinary turn-around' by the former head of the 
WHO's Tobacco Free Initiative 201 and surprised many in global tobacco 
control. The Japanese government's substantial ownership of the world's fourth 
largest transnational tobacco company, Japan Tobacco (JT, see Table 4, page 
26), was seen by many as responsible for its weak tobacco-control measures. 
Japan's decision to ratify the FCTC was said to have been done with 'marked 
reluctance.' 202 During the negotiations, Japan, along with the US and Germany 
were viewed as working against the FCTC. 203 


In 2000, China, along with other countries, all nations with significant tobacco 
industries (US, Germany, Russia, India, Argentina, Zimbabwe, Malawi and 
Turkey), called for a broad treaty, leaving decisions in specific matters to 
individual governments. 204 

In 2004, Chinese officials reputedly asked the president of Brazil's tobacco 
growers association, Afubra, to intervene with the Brazilian Embassy, to ensure 
that Brazil did not ratify the FCTC, given that China 'will not ratify this 
document'. 205 China finally ratified in 2005, two years after signing the treaty. 

198 WHO (2002b). 

Assunta and Chapman (2004): 755. 

For the parties to the WHO FCTC, see 
(16 December 2011). 

201 Yach (2005). 

Assunta and Chapman (2004): 751. 

203 Nullis (2002); (visited 16 December 201 1); Wilkenfeld (2001) 
at; Brinson (2003) at 
(both visited 16 December 201 1); Assunta and Chapman (2004). 

British American Tobacco (2000). 

205 Bialous (2004). 


WHO Framework Convention on Tobacco Control -Appendix 5 

However, China has still not fully fulfilled its FCTC commitment. 206 Many of 
the tobacco-control laws remain outdated, e.g. the ban on tobacco advertising, 
promotion and sponsorship, and China still has only small, non-pictorial 
packet warnings. While tobacco tax was increased in 2009, the rise in tax 
was not passed on to the retail cost of cigarettes, which remained at the same 
retail price, defeating the whole purpose of tax increases from a public health 
standpoint. The Chinese tobacco monopoly is thought to be a hindrance to 
the effective implementation of the FCTC. There has been much discussion 
about separating the dual functions of the government tobacco monopoly, as 
in Thailand, into a commercial state-controlled organization, separate from any 
tobacco-control function. 

More recently, China published several authoritative reports on smoking in 
China, 207 and announced bans on smoking in many public places. 

Lv etal. (2011). 

Chinese Center for Disease Control (201 1); China, Office on Smoking and Health, National Center for 
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WHO Framework Convention on Tobacco Control - Biographical Notes 

Biographical notes' 

Dr Najeeb Al-Shorbaji 

PhD (b. 1954), born in Jordan, 
gained a PhD in information 
sciences in 1986 and has been 
director of the department of 
knowledge management and 
sharing at WHO headquarters in 
Geneva since September 2008. His 
portfolio covers WHO publishing 
activities and programmes, library 
and knowledge networks, eHealth 
and WHO collaborating centres. 

Dr MaryAssunta 

MPhil PhD (b. 1957), a Malaysian, 
obtained her higher degrees at the 
School of Public Health, University 
of Sydney where her research 
reviewed internal documents of 
the tobacco industry (Kolandai 
(2007)). She was the first chair 
of the Framework Convention 
Alliance and a member of the 
board until 2011. She played 
an active role in leading civil 
society participation at the INB 
negotiations; served on WHO's 
policy and strategy advisory 
committee on tobacco control. 
She previously worked with the 
Consumers Association of Penang 
as the media officer where she 
coordinated the anti-tobacco 
campaign. She received the 

2003 Luther L Terry award for 
outstanding individual leadership 
in tobacco control and has been 
the director of the International 
Tobacco Control Project, Cancer 
Council Australia since 2008 and 
serves as the senior policy adviser of 
the Southeast Asia Tobacco Control 

Dr Douglas Bettcher 
MD MPH Dip(LSE) PhD(Econ) 
(b. 1956) qualified at the University 
of Alberta, completed a Master's of 
public health at the London School 
of Hygiene and Tropical Medicine 
and a PhD in international 
relations from the London School 
of Economics and Political Science. 
He was the coordinator of the 
WHO FCTC Office, Tobacco 
Free Initiative (TFI), at WHO 
in Geneva (1998-2007) and its 
director since 2007. He sits on 
the editorial board of the scientific 
journal Bulletin of the World Health 
Organization and the journal Global 
Governance. He has served as vice- 
chair of the public health interest 
group of the American Society of 
International Law; was WHO's 
principal focal point (1998-2007) 
for providing Secretariat support 
for the negotiation of WHO's 

* Contributors are asked to supply details; other entries are compiled from conventional 
biographical sources. 


WHO Framework Convention on Tobacco Control - Biographical Notes 

first treaty, WHO FCTC; 
managed the interim secretariat 
support to parties, and provided 
technical support to assist in the 
implementation of the treaty. 
He is currently responsible for 
coordinating the work of the 
TFI with the FCTC Secretariat 
to support the comprehensive 
implementation of the WHO 
FCTC; for the scaling up of 
WHO's country-level tobacco 
control work, as one of the five 
partners in the Bloomberg Initiative 
for Reducing Tobacco Use, and 
for overseeing the implementation 
of the new WHO project to 
establish a capacity building 
resource centre for tobacco control 
in Africa, supported by the Bill 
and Melinda Gates Foundation. 
He has also worked in the areas 
of clinical medicine, public health 
and, international health policy in 
a number of countries, notably in 
developing countries, including 
Ethiopia and Jamaica. 

Dr Sanjoy Bhattacharya 

MA PhD (b. 1968) was educated at 
St Stephen's College, University of 
Dehli, Jawaharlal Nehru University, 
New Delhi and SOAS, University 
of London. He specializes in 
the history of nineteenth- and 
twentieth-century South Asia, as 
well as the history of international 
and global health programmes 
in the Indian subcontinent and 

beyond. His work examines the 
structures and workings of health 
programmes sponsored and 
managed by UN agencies like 
WHO, the development of public 
health and medical institutions at 
different levels of national and local 
administration, and the diversity 
of social and political responses 
to state and non-governmental 
organization-run schemes of 
preventive and curative medicine. 
He also continues to work on 
research programmes dealing 
with refugee health, as well as the 
absorption of medical professionals 
from across South Asia, with 
particular reference to India and 
Sri Lanka, into the UK's NHS. He 
has been reader in the history of 
medicine, department of history, 
University of York, and has directed 
the Centre for Global Health 
Histories there since 2010. 

Mr Neil Collishaw 

MA (b. 1946) worked in the 
Canadian Department of National 
Health and Welfare (1974-81); 
helped the Canadian government 
to improve Canada's tobacco 
control policies (1981-91) and was 
lead tobacco control expert with 
the WHO's 'Tobacco or Health' 
Programme (1991-99), actively 
supporting WHO member states 
in their efforts to implement 
comprehensive tobacco control 
programmes, and in initiating 


WHO Framework Convention on Tobacco Control - Biographical Notes 

action to create the FCTC. He 
has been the research director for 
Physicians for a Smoke-free Canada 
since 2000, and has co-authored 
publications for WHO (WHO 
(1997, 1998)). See also Callard 
etal. (2001). 

DrVera Luiza da Costa e Silva 
MD PhD MBA (b. 1952) qualified 
in medicine from the University 
of Sao Paulo, Brazil, in 1975 and 
obtained a PhD in public health 
epidemiology at the Fundacao 
Oswaldo Cruz, Rio de Janeiro, 
Brazil, in 1997, with an MBA 
in the health sector in the Rio 
de Janeiro Federal University/ 
COPPEAD in 1999. She began 
her public health career working 
at the National Cancer Institute 
of Brazil's Ministry of Health 
(INCA) in 1980, becoming head 
of the tobacco-control programme 
there (1985-2000), where she 
coordinated the INCA cancer 
prevention and surveillance 
programmes (1998-2000); was 
involved in legislative, economic 
surveillance and regulatory 
tobacco-control measures, the 
establishment of a country-wide 
tobacco-control network and 
the creation of a federal tobacco 
products regulatory authority. 
She was the director of the TFI at 
WHO, Geneva (2001-05), where 
she supervised the secretariat and 
the negotiations on the WHO 

FCTC and had an important role 
in global tobacco control activities 
including fundraising, coordination 
of global campaigns, tobacco 
product regulation activities 
and capacity building activities 
at country level in partnership 
with international agencies and 
local governments. She was 
acting team leader of tobacco 
control and consumers' health 
at PAHO based in Washington, 
DC, in 2007. She has been a 
senior public health consultant to 
international organizations and 
to Brazil's government since 2006 
and is a member of the WHO/ 
US Global Tobacco Surveillance 
System advisory group, and the 
WHO Study Group on Tobacco 
Product Regulation. In 20 1 1 she 
joined the National Public Health 
School, Fundacao Oswaldo Cruz as 
associate professor. 

Mr Rob Cunningham 

LLB MBA (b. 1964) has been a 
lawyer and senior policy analyst 
with the Canadian Cancer Society 
since 1996 and has worked in 
tobacco control since 1988. He 
has contributed to numerous 
initiatives supporting the adoption 
of tobacco-control legislation 
in Canada, appeared in court 
in tobacco cases, including 
before the Supreme Court of 
Canada, participated as an NGO 
representative at negotiations for 


WHO Framework Convention on Tobacco Control - Biographical Notes 

the WHO FCTC and was actively 
involved with health warnings on 
tobacco packages adopted in 2000 
in Canada and more recently with 
the international implementation 
of graphic health warnings. See also 
Cunningham (1996). 

Professor Sir Richard Doll 
Kt CH OBE FRCP FRS (1912- 
2005) was director of the MRC 
Statistical Research Unit (1961-69) 
and Regius professor of medicine 
at the University of Oxford 
(1969-79), later emeritus. He was 
honorary consultant, MRC/Cancer 
Research UK/BHF Clinical Trial 
Service Unit and Epidemiology 
Studies Unit, Radcliffe Infirmary, 
Oxford, from 1983 until his death. 

Dr Martina Potschke-Langer 

MD MA (b. 1951) qualified at the 
University of Heidelberg. Since 
1997 she has been head of the 
Unit of Cancer Prevention in the 
German Cancer Research Center, 
Heidelberg, and since 2002 head 
of the WHO Collaborating Centre 
for Tobacco Control (1997- ) and 
has been temporary adviser to 
WHO (1999- ). She participated 
in the 'Change Agent' programme 
of WHO's 'Don't be duped' 
campaign (1999-2003) as well as 
in the fellowship programme of the 
Advocacy Institute, Washington, 
DC (2000). She founded the 
German Quitline (1999), was joint 

founder of the European Quitlines 
Network (2000), is a member of 
the steering committees of the 
German Smoke-Free Alliance 
and represents Germany in the 
European Network for Smoking 
Prevention (ENSP) (1998-2011) 
and the International Woman 
against Tobacco (IN WAT Europe). 
She received the Order of the Cross 
of Merit on Ribbon of the Federal 
Republic of Germany for cancer 
prevention and nonsmokers' rights 
initiatives (2007) and WHO's 
Tobacco Free World Award for 
outstanding contributions to 
public health (1999), and together 
with her team in 2007 and 201 1. 
She is an honorary member 
of the German Association of 

Dr Judith Mackay 
FRCP(Lond) MBE (b. 1943) has 
lived in Hong Kong since 1967, 
initially working as a hospital 
physician, and concentrating on 
public health since 1984. She has 
been senior adviser, World Lung 
Foundation/Bloomberg Initiative 
to reduce tobacco use since 2006; 
director of the Asian Consultancy 
on Tobacco Control; and a senior 
policy adviser to the WHO. She 
has authored several atlases on 
health, cancer, cardiovascular 
disease, tobacco, surveillance and 
oral health. In addition to many 


WHO Framework Convention on Tobacco Control - Biographical Notes 

international awards, ranging 
from the WHO Commemorative 
Medal to the TIME 100 award; 
she received a lifetime achievement 
award from the British Medical 
Journal (BMJ) in 2009 for her 
contribution to the fight against 
tobacco across the world. She has 
been identified by the tobacco 
industry as one of the three most 
dangerous people in the world in 
a leaked document in October 
1989 (INFOTAB (1989), http:// 
people/tdc.html (visited 30 January 
2012)). See Figure 3, page 22. 

Dr Faith McLellan 

PhD (b. 1960) is a graduate of 
Wake Forest University, Winston- 
Salem, NC, and took her PhD 
in the medical humanities 
(literature and medicine) at the 
University of Texas medical 
branch in Galveston, Texas. She 
has been an author's editor in 
departments of anaesthesiology 
at the Bowman Gray School of 
Medicine, Wake Forest University, 
and the University of Texas Medical 
Branch; she was North American 
editor of the Lancet (2001-08) 
and came to WHO as head of the 
Guidelines Review Committee 
Secretariat in 2009. 

Ms Kathryn (Kathy) Mulvey 

BA (b. 1966) has been an advocate 
for public health, human rights 
and corporate accountability for 
more than two decades. From 
1993-2009, she led Corporate 
Accountability International 
(formerly Infact) challenging 
'big tobacco', contributing to 
the adoption of the FCTC and 
advancing its implementation and 
enforcement. She has authored 
and edited dozens of publications, 
including the WHO technical 
briefing document (WHO (1999). 
She participated as an NGO 
observer throughout the WHO 
FCTC process, including in the 
working group that developed 
implementation guidelines for 
Article 5.3 (2007/8) and in a 
WHO TFI expert group on 
tobacco industry interference 
(2007). She presented and led 
workshops on tobacco industry 
tactics and effective advocacy at 
World Conferences on 'Tobacco 
or Health' in Paris (1994), Beijing 
(1997), Chicago (2000), Helsinki 
(2003), Washington, DC (2006) 
and Mumbai (2009). She trained 
and led delegations of activists 
to challenge top decision-makers 
of the world's largest tobacco 
transnational, Philip Morris 
International (formerly a subsidiary 
of Philip Morris, which changed its 
name to Altria in 2003) at annual 


WHO Framework Convention on Tobacco Control - Biographical Notes 

shareholders' meetings (1994- 
2009). Since February 2012, 
she has been the director of the 
Conflict Risk Network at United 
to End Genocide, working with 
institutional investors to pressure 
corporations to respect human 
rights and avoid complicity in mass 
atrocities and genocide. 

Dr Hiroshi Nakajima 
MD (b. 1928) qualified at Tokyo 
Medical University, Japan, 
and joined WHO in 1974 as a 
scientist in the drug evaluation 
and monitoring section. He was 
appointed chief of the WHO 
Drug Policies and Management 
unit where he played a key role in 
developing the concept of essential 
drugs, and was secretary of the first 
expert committee on the subject. 
He was elected regional director 
for the Western Pacific region 
(1978-88) and Director-General 
of WHO (1988-98) for two 
terms. His conflict with Jonathan 
Mann, then head of the WHO's 
AIDS programme (1986-90), 
is documented in the two-part 
US Public Broadcasting System's 
Frontline documentary 'The age 
of AIDS', (broadcast 30-31 May 
2006), available at 
aids/ (visited 16 July 2010). 

Dr Haik Nikogosian 

MD PhD DSc (b. 1955) was 
Minister of Health (1998-2000) 
and chairman of the National 
Institute of Health of Armenia 
(1992-94) and has held various 
managerial positions with the 
WHO Regional Office for 
Europe, most recently as head 
of noncommunicable diseases 
and lifestyles (2000-07). He has 
been the head of WHO's FCTC 
Secretariat since the inception of 
the secretariat in June 2007, with 
an initial mandate for four years, 
renewed for a further three years in 
201 1. He supports the Conference 
of the Parties and its subsidiary 
bodies, translating the decisions 
of the conference into programme 
activities and supporting the parties 
to fulfil their obligations under 
the FCTC. He also promotes the 
implementation of the FCTC 
internationally, organizes the 
reporting arrangements and 
coordination with WHO and other 
relevant international organizations 
and bodies. 

Dr Ahmed Ezra Ogwell Ouma 
MPH PhD (b. 1969), a committed 
tobacco control advocate and 
expert, holds a Masters of Public 
Health from the University of 
Nairobi, Kenya, and a Masters of 
Philosophy in International Health 
from the University of Bergen, 
Norway. He has worked with 


WHO Framework Convention on Tobacco Control - Biographical Notes 

the Ministry of Health in Kenya 
as head of non-communicable 
diseases where a key activity was 
implementing tobacco control 
measures at country level and also 
later the head of international 
health relations where he was chief 
negotiator for public health matters 
for the Government of Kenya. 
He also served as the founding 
regional coordinator for the 
Framework Convention Alliance, 
an international NGO established 
to support implementation of 
the FCTC. During the Fifth 
Anniversary of the FCTC coming 
into force in 2010, Ahmed was 
team leader at the Convention 
Secretariat in Geneva and he is 
currently working with the WHO's 
Regional Office for Africa as 
regional advisor, one who has the 
unique experience of working from 
the government side (Kenya), with 
the Convention Secretariat and 
currently with WHO Regional 
Office for Africa. 

Professor Sir Richard Peto 

FRS (b. 1943) has been professor of 
medical statistics and epidemiology 
at the University of Oxford since 
1992. He was an MRC research 
officer at the Medical Research 
Council's statistical research unit 
in London (1967-69) where he 
began work with Richard Doll. He 
moved to the University of Oxford 
in 1969, set up the Clinical Trial 

Service Unit (CTSU) there in 1975 
and has been its co-director with 
Professor Rory Collins since 1985. 
He received a lifetime achievement 
award from the British Medical 
Journal (BMJ) in 20 1 1 , for his 
work showing a clear link between 
smoking and cancer. 

Professor Ruth Roemer 

JD (1916-2005), 'a lawyer in a 
field dominated by physicians' 
(Taylor (2005): 291) and advocate 
of legislative approaches to 
tobacco control, was professor 
of health law at the University 
of California Los Angeles School 
of Public Health from 1962. 
She graduated from Cornell Law 
School in 1939, acted as a labour 
lawyer representing the unions 
and became interested in health 
law when working in a landmark 
study of the law governing New 
York state's admission to mental 
hospitals, before joining the UCLA 
School of Public Health in the 
1960s. She was a consultant to the 
WHO for more than 40 years. In 
the early 1990s she teamed up with 
Allyn Taylor of the University of 
Maryland to initiate the idea of a 
convention on tobacco control and 
in 1993 co-authored the feasibility 
study for the WHO executive 
board that was the foundation for 
FCTC. See Taylor (2005); Roemer 
(1993). See Figure 3, page 22. 


WHO Framework Convention on Tobacco Control - Biographical Notes 

Ms Chitra Subramaniam 

MA (b. 1958), an Indian journalist, 
was educated in English literature 
at Lady Sri Ram College, Delhi 
University, and in media and 
communications at Stanford 
University, California. She 
completed doctoral course work 
at the University of Geneva, 
but did not complete her thesis, 
which was to look at the role of 
communications as a determinant 
of public health. Her investigative 
work for the Bofors-India arms deal 
is widely believed to have led to a 
change of government in India in 
the late 1980s. She was part of Dr 
Gro Brundtland's campaign team 
for WHO's Director-General in 
1997/8, which included a cabinet 
project with a mandate to negotiate 
the world's first treaty focused 
entirely on health. Under the 
guidance of Dr Derek Yach, she 
developed several strategies and led 
the work of WHO's global policy 
analysis and communications 
team in 197 countries. This work 
underpinned all of TFI's work, 
resulting in the FCTC coming 
into force, which has 174 parties 
by 2012. She has also written 
extensively on international trade 
and disarmament issues, and set 
up CSD consulting in Switzerland 
in 2004. 

Professor Tilli Tansey 
FMedSci (b. 1953) is convenor of 
the History of Twentieth Century 
Medicine Group — known as the 
History of Modern Biomedicine 
Research Group from 2010 - and 
professor of the history of modern 
medical sciences at Queen Mary, 
University of London. 

Professor Allyn Taylor 

JD PhD was a doctoral student 
at Columbia Law School when 
she and Ruth Roemer wrote the 
foundation study for the FCTC 
in 1993, for what became the first 
treaty negotiated at the WHO. She 
developed the idea of a framework 
convention on tobacco control as 
part of her doctoral dissertation 
at Columbia University School of 
Law and was a Ford Foundation 
Fellow in public international 
law there. She was a senior health 
policy and legal adviser on the 
staff at the WHO and the senior 
legal adviser for the negotiation 
and the adoption of the FCTC. 
She has been visiting professor 
of law, Georgetown University, 
Washington, DC, since 2007, an 
adjunct professor of international 
relations at the Johns Hopkins 
University's Paul H Nitze School 
of Advanced International 
Studies (SAIS), Washington, 
DC, and has taught at the Johns 
Hopkins Bloomberg School of 


WHO Framework Convention on Tobacco Control - Biographical Notes 

Public Health, Baltimore, MD, 
the University of Maryland 
Schools of Law and Medicine, 
Baltimore, MD, and the American 
University Washington College 
of Law, Washington, DC. See 
Taylor (1996). 

Dr DerekYach 

MPH DSc(Honoris Causa) 
(b. 1955) was executive director of 
the WHO's non-communicable 
diseases and mental health cluster 
(2000-03). During the INB 
negotiations on FCTC, he was 
the project manager for WHO's 
TFI (1998-2000) and coordinated 
WHO's global consultation that led 
to adoption by WHO's member 
states of a new global policy: 
Health for All in the 21st Century 
(1995-98) He played a leadership 
role in developing South Africa's 
epidemiological and community 
health research and policy capacity 
(1985-95). He has been senior vice- 
president of global health policy and 
agricultural policy at PepsiCo since 
2007. Previously, he headed global 
health at the Rockefeller Foundation 
and the division of global health 
at Yale University and professor of 
public health. He is on the advisory 
boards of the Clinton Global 
Initiative, the World Economic 
Forum's New Vision for Agriculture, 
the NIH's Fogarty International 
Center and has published over 200 
articles and chapters. 

Dr Thomas Zeltner 

MD LLM (b. 1947) holds a specialist 
degree in human pathology and 
forensic medicine and an MD and 
a Master's degree in law from the 
University of Bern, Switzerland, 
where he was head of medical services 
(1989-90) and held various positions 
in the medical faculty there (1975- 
85) and at the Harvard School of 
Public Health, Boston, MA (1986- 
88). He has been professor of public 
health at the University of Bern since 
1992. He was the eighth Director- 
General of the Federal Office of 
Public Health and State Secretary of 
Health of Switzerland (1991-2009), 
where he initiated several national 
prevention programs (including one 
to reduce tobacco consumption in 
Switzerland), some of which attracted 
worldwide attention for their 
pioneering character, a model for 
other countries. He was a member 
and vice-president of the executive 
board of the WHO (1999-2002) 
and has chaired many international 
committees, such as the renowned 
committee on multinational tobacco 
companies and their attempt to 
undermine the tobacco-control 
activities of the WHO (Zeltner etal. 
(2000)). He was a 2010 fellow of 
the advanced leadership initiative of 
Harvard University, is president of 
the Swiss Foundation Science et Cite 
and serves on the boards of various 
non-governmental organizations. 


WHO Framework Convention on Tobacco Control - Glossary 


Action on Smoking and Health 

Established in 1971 under the 
auspices of the Royal College of 
Physicians of England to make 
non-smoking the norm in society, 
and to inform and educate the 
public about the death and disease 
caused by smoking. Its first 
president was Lord Rosenheim, 
then president of the RCP, with 
Professor Charles Fletcher as 
chairman, Dr Keith Ball was 
honorary secretary and Dr John 
Dunwoody, the first director. 

Advertising bans by 2001 

Countries with bans on tobacco 
advertising: Italy (1962); Singapore 
(1970); Iceland (1972); Norway 
(1975); Finland (1978); French 
Polynesia (1982); Portugal (1983); 
Papua New Guinea (1987); 
Thailand (1989); New Zealand 
(1990); Australia (1993); Botswana 
(1993); France (1993); Malaysia 
(1994); Maldives (1994); Mongolia 
(1994); Sweden (1994); Belgium 
(1997); Slovenia (1997); South 
Africa (1999). Further details at 
advertising/en/ (visited 1 6 July 
2010); Saloojee and Hammond 
(2001): 11. 

Bates number x 
A method of indexing legal 
documents for easy identification 
and retrieval and is used to keep 
track of large numbers of legal 
documents, such as those in the 
Legacy Tobacco Documents. The 
Bates Manufacturing Company 
of Edison, NJ, holds the patents 
(1891-93) on the original Bates 
Automatic Numbering Machine 
with numbered wheels. 

Conference of the Parties (COP) 
The governing body of the WHO 
FCTC made up of all those who 
are party to the convention, 
which keeps under regular review 
the implementation of the 
FCTC and takes the decisions 
necessary to promote its effective 
implementation. The conference 
may also adopt protocols, annexes 
and amendments to the FCTC and 
observers may also participate in 
its work, which is governed by its 
rules of procedure. Starting from 
COP-3, the regular sessions are 
held at two-year intervals. The 
COP may establish such subsidiary 
bodies as needed, such as the INB 
on a Protocol on Illicit Trade in 
Tobacco Products. The COP 
also established several working 

* Terms in bold appear in the Glossary as separate entries 


WHO Framework Convention on Tobacco Control - Glossary 

groups to elaborate guidelines 
and recommendations for the 
implementation of different treaty 
provisions. See 
cop/en/ (visited 13 February 2012). 

International legal instruments: 
framework convention-protocol 
The framework convention- 
protocol approach in international 
law is a flexible combination, 
which permits additional protocols 
and annexes to a basic agreed 
framework as improved scientific 
understanding is reached and 
political consensus for concrete 
action develops. The 'framework 
convention' establishes a general 
consensus about the relevant facts, 
broad international standards and 
an institutional structure for global 
governance. Protocols supplement, 
clarify, amend or qualify a 
framework convention and usually 
sets out specific commitments or 
added institutional arrangements, 
which are ratified individually, 
separate from the convention itself. 
A weak convention will be ratified 
by most countries, but one with 
strong protocols may face many 
delays and gain few signatories, 
whereas a strong convention 
may be initially ratified by fewer 
countries. Taylor and Bettcher 
(2000): 922; see also WHO, TFI. 

International Organization 
for Standardization (ISO) and 
ISO numbers 

Established in 1947 in Geneva as 
a worldwide non-governmental 
organization of national standards 
bodies to promote standardization. 
ISO standards ensure quality 
control among the member 
nations concerning, for example, 
surgical implant materials. Similar 
testing methods for tobacco and 
tobacco products were adopted 
by the ISO, known as the ISO 
method in Europe and separate 
ISO numbers issued followed by 
the date of issue. For example: 
atmosphere for conditioning 
and testing, ISO 3402:1999; 
cigarettes: determination of 
total and nicotine-free dry 
particulate matter using a routine 
analytical smoking machine, 
ISO 4387:2000; cigarettes: 
determination of nicotine in smoke 
condensates, gas-chromatographic 
method, ISO 10315:2000; 
cigarettes: determination of 
water in smoke condensates, 
part 1, gas-chromatographic 
method, ISO 10362-1:1999; 
cigarettes: determination of 
carbon monoxide in the vapour 
phase of cigarette smoke, NDIR 
method, ISO 8454:2007. See 
www. iso. org/iso/iso_catalogue/ 
htm?commid=52158 (visited 


WHO Framework Convention on Tobacco Control - Glossary 

9 January 201 1). For further 
details, see Bialous and Yach 
(2001); Pollay and Dewhirst 
(2002); Anon. (2004). 

Light/mild cigarettes 
Light/mild ratings are those 
measuring 15 mg or lower yield 
of tar on a standardized smoking 
machine compared with smoke 
yields from a regular cigarette. 
Changes in cigarette design to 
achieve a low-yield classification 
included adding filters of different 
size and density, ventilation holes 
to dilute the smoke measured, and 
chemical additives in the paper 
and/or tobacco. Advertisements to 
promote the low-yield cigarettes 
implied that they were safer 
than regular cigarettes. For a 
comparison of methods, see 
Hammond etal. (2006); for a 
list of permitted additives to 
tobacco products in the UK, see 
additiveslist.pdf (visited 18 
November 201 1); see also Wertz 
etal. (2011). 

Legacy Tobacco Documents 
In 2000, the Minnesota Court 
of Appeals decided that tobacco 
company documents could be 
released to the public, confirming 
a decision made during the 
initial Minnesota tobacco trial 
(1994-98) at 

pages/ 10805/Tobacco-Tobacco- 
Litigation.html (visited 7 July 
2010); see also the US Department 
of Justice litigation against tobacco 
companies (1999-2007) at www. 
index.htm. The Legacy Tobacco 
Documents Library (LTDL), 
University of California, San 
Francisco, originally compiled by 
Dr Norbert Hirschhorn, contains 
more than 1 1 million documents 
(60+ million pages), most of which 
are dated 1950-2002, at http:// (both 
visited 26 September 201 1). Under 
the terms of a 1998 settlement 
with the state of Minnesota, 
tobacco corporations were 
required to disclose documents 
related to US tobacco litigation. 
This responsibility included 
maintaining a website until 2010, 
with new documents uploaded 
regularly. As part of the master 
settlement agreement, the tobacco 
industry was required to make the 
documents used during the trials 
available and that the industry 
turn over a snapshot of their sites 
as of July, 1999 (see Tobacco 
Documents Online at http:// (visited 
9 February 2012)). Copies of 
documents are in a warehouse in 
Minnesota also available on the 
internet, and another in Guildford, 
Surrey, mostly from the British 


WHO Framework Convention on Tobacco Control - Glossary 

American Tobacco Company, 
which are not online, except 
for a small subset used in the 
Minnesota trial, and a few small 
collections copied from Guildford 
by tobacco-control groups, and 
put on to websites, although more 
are being made available through 
the Guildford Archiving Project at 
html and 
tobacco/guildford.htm (both visited 
16 November 2011). 

Orchid and ashtray 
The image adopted by WHO for 
World No Tobacco Day, 1999, 
was designed by Ashvin Gatha, a 
photographer and former smoker, 
a white marble ashtray on which is 
poised a bright red orchid (WHO, 
Western Pacific Regional Office 
(1999): 1 1). For the orchid and 
astray awards adopted by the FCA 
Bulletin during the INB meetings, 
see Table 5, page 43; also Figure 4. 

WHO Scientific Advisory 
Group on Tobacco Product 
Regulation (SACTob)/WHO 
Study Group on Tobacco Product 
Regulation (To b Reg) 
Began work in 2000 in an advisory 
capacity (status changed to a study 
group in 2003) and is composed 
of national and international 
experts in product regulation, 
tobacco-dependence treatment, 
and laboratory analysis of tobacco 

ingredients and emissions, with 
product regulation agencies' 
representatives and advocates 
whose purpose is to provide the 
WHO Director-General with 
scientifically sound, evidence- 
based recommendations for 
member states on tobacco product 
regulation. TobReg identifies 
regulation approaches for tobacco 
products that pose significant 
public health issues and raise 
questions for tobacco control 
policy under Articles 9 and 10 of 
the WHO FCTC. See www. who. 
tobreg/en/ (visited 5 December 
201 1). See, for example, their 
third report, freely available 
_eng.pdf (visited 5 December 

World Health Assembly (WHA) 
The decision-making body of 
WHO made up of delegates 
from all WHO member states. 
Its annual meeting considers a 
specific health agenda prepared by 
the executive board and where the 
policies of WHO are determined, 
such as the appointment of the 
Director-General, the supervision 
of financial policies, and the review 
and approval of the proposed 
programme budget. The WHA is 
held in Geneva, Switzerland. For 
a list of previous assemblies, see 


WHO Framework Convention on Tobacco Control - Glossary 
(visited 25 November 201 1). 

World Health Organization 

WHO is the authority for health 
within the United Nations 
system, which is responsible for 
providing leadership on global 

health matters, shaping the health 
research agenda, setting norms and 
standards, articulating evidence- 
based policy options, providing 
technical support to countries and 
monitoring and assessing health 
trends. For the background to 
WHO, see 
(visited 25 November 201 1). 


Index: Subject 

WHO Framework Convention on Tobacco Control - Index 

Action on Smoking and Health 

see ASH 
advertising, tobacco 

bans, 26, 27, 52, 65, 119 
child's T-shirt, 56 
cross-border, 50 
industry's voluntary code (2001), 

African region, WHO (AFRO), 23-4, 

Agenda Nacional de Vigilancia 

Sanitaria (ANVISA), Brazil, 30 
All African Conference on Tobacco or 

Health, First (1993), xxv 
Alliance Bulletin (FCA newsletter), 

42-4, 54, 55, 57 
Altria/Philip Morris USA, 17, 26 

see also Philip Morris 
American Cancer Society (ACS), 15, 29 
American Journal of Law and Medicine, 

American Journal of Public Health, 1 3 
Americas region, WHO, 74 
ammonia, 20 
anti-tobacco/anti-smoking movement, 

early WHO activities, xxiii— xxiv, 

origins, xxi— xxiii 
ASH (Action on Smoking and Health), 

xxiii, 119 
ASH Scotland, xxii 
Asia, 29, 66 
Association of Southeast Asian Nations 

(ASEAN), 51 
Australia, 56 
'axis of evil' label, 63, 81 

BAT see British American Tobacco 

Bates numbers, 117 

Bhopal case, 19 

Bill and Melinda Gates Foundation, 

xxvi, 66 
Bloomberg Initiative, xxvi, 6, 66 
Blue Cross and Blue Shield of 

Minnesota, 19, 45 
Boca Raton action plan, 16, 45, 53 
Brazil, 15-16, 82 

role in FCTC development, xxvi, 

tobacco control measures, 26, 27, 30 
breastmilk substitutes, 11, 38 
British American Tobacco (BAT), 17, 
25, 44, 62 
FCTC involvement, 48, 54, 63 
global market share, 26 
voluntary tobacco advertising 
code, 64 
Brundtland report, Our Common 

Future (1987), 35 
budget allocation, WHO, 36-7 
Burson-Marsteller, New York, NY 53 


role in FCTC, xxv— xxvi, 33-4, 49, 

tobacco control measures, 27 
Canadian Cancer Society, 6 
cannabis, 18 
Caribbean Community Countries 

(CARICOM), 51 
champion countries, 51-2, 55-6 
China, xxiv, 29, 81, 82-3 

FCTC involvement, 30, 51, 56, 63, 

tobacco industry documents, 20 


WHO Framework Convention on Tobacco Control - Index 

China National Tobacco Corporation, 

26, 81,83 

global market shares, 26 
light/mild, 12, 26, 119 
nicotine spiking, 20 
package warnings and labelling, 

plain packaging, 65 
regulation, 21 
civil society, 28, 38, 47, 58-9 
see also non-governmental 
coca leaf, 1 8 
Collaborating Centre on Tobacco 

Control, WHO, 5 
Comite Latino Americano Coordinator 
del Control del Tabaquismo 
(CLACCTA), 15 
Committee of Experts on Tobacco 
Industry Documents (Zeltner 
committee), 6, 20, 32, 37, 44-6 
Conference of the Parties (COP), 76, 

77,78, 119-20 
Convention against Illicit Traffic in 
Narcotic Drugs and Psychotropic 
Substances, 18 
Convention on Psychotropic 

Substances, 18 
conventions, international see treaties 
Corporate Accountability International 
(previously Infact), 5, 38, 54, 55, 

champion, 51-2, 55-6 
funding FCTC, 49-50 
Orchid and Dirty Ashtray awards, 

42-4, 56, 81 
role in FCTC negotiations, 39, 

40-4, 46-53, 63 
tobacco producing, trading and 
consuming, 79-80 

see also high-income countries; low- 
and middle-income countries; 
tobacco-growing countries 
Curbing the Epidemic (World Bank, 
1999), 21,30 

Dalkon Shield case, 19 
death clock, 57, 58 
demand- reduction measures, 41 
Department of Knowledge 

Management and Sharing, WHO, 

3-4, 5 
descriptors, misleading, 26, 30, 52 
developed countries see high-income 

developing countries see low- and 

middle-income countries 
Director-General (DG), WHO 

role in FCTC development, xxv, 28, 

setting up Zeltner Committee, 6, 

20, 37, 44-5 
stances before FCTC, xxiii— xxiv, 

Dirty Ashtray award, 42-4, 54, 55, 56, 

81, 120 
'Dirty Dealings report (Mulvey, 2002), 

documents, tobacco company see 

tobacco industry documents 
Duke University, Durham, North 

Carolina, 7, 8 

Eastern Mediterranean region, WHO 

(EMRO), 51, 53, 56, 71,74 
Economic and Social Council 

(ECOSOC), UN, 60 
epidemiological research, smoking, xxi, 

xxiv, 20—1 
Europe against Cancer programme, 

European Community (EC), 26-7, 52 


WHO Framework Convention on Tobacco Control - Index 

European Medical Association on 

Smoking or Health (EMASH), 

European region, WHO (EURO), 16, 

Expert Advisory Panel on Tobacco or 

Health, WHO, 9 
Expert Committee, WHO, xxiii 

FCA see Framework Convention 

FCTC see Framework Convention on 

Tobacco Control 
financing see funding 
Finland, xxvi, 30, 34, 49-50 
focal point, UN, 60 
Food and Agriculture Organization, 

UN (FAO), 46, 61-2 
Formula 1 racing, 50 
Framework Convention Alliance 
(FCA), xxvi, 5, 54-5, 56, 57, 66 
newsletter see Alliance Bulletin 
Framework Convention on Tobacco 
Control (FCTC), WHO 
5th anniversary (2010), 3, 78 
adoption (2003), xxvi, 76 
Article 5.3, 38, 67 
countries' roles, 39, 40-4, 46-53, 63 
current attitudes of tobacco 

companies, xxvi, 62, 67-8 
Director-General's role, 28, 34-9 
entry into force (2005), xxvi, 3, 76 
funding of negotiations, 36-7, 

NGOs' participation, 39, 47, 53- 

60, 65-6, 67 
origins, xxv, 10, 21-3, 28, 30-4 
regional roles, 51, 53, 56 
Secretariat, 3-4, 5, 71 
selected provisions, 73 
success, 65-6 
timeline, 49, 75-8 

tobacco industry involvement, 37-8, 
45-6, 47-8, 53-4, 59-60, 63-5 
framework convention— protocol 

approach, 22-3, 120 
France, xxvi, 49—50 

FCTC negotiations, 36-7, 48-50, 58 
tobacco control, 66, 68-9 

Gates Foundation, Bill and Melinda, 

Seattle, WA, xxvi, 66 
German Cancer Research Center, 

Heidelberg, 5 
Germany, 52, 54, 63 
Global Action Plan on Tobacco and 

Health, xxiii— xxiv 
'global bads' for public health, 13 
globalization of public health, xxi— xxvi, 


Hallmark Public Relations, 

Winchester, UK, 63 
health, effects of tobacco use, xxi-xxii, 

xxiv, 20—1 
health communication network, 39 
health economics, xxiv 
high-income countries 

implementation of tobacco control, 

reduction in tobacco farming, 61 
role in FCTC, 41,44, 54, 55 
History of the WHO Framework 

Convention on Tobacco Control 
(WHO, 2010), 3, 48-9 
HIV/AIDS, 1 1 

Imperial Tobacco, Bristol, 17, 26 

India, 55, 56 

Infact see Corporate Accountability 

Intergovernmental Negotiating Bodies 

(INBs), 47, 50, 51-2, 75 


WHO Framework Convention on Tobacco Control - Index 

death clock, 57, 58 

INB-1 (October 2000), 30, 52, 

INB-2 (April-May 2001), 47 ', 

INB-3 (November 2001), 40, 76 
INB-4 (March 2002), 76 
INB-5 (October 2002), 52, 54, 76 
INB-6 (February 2003), 52, 54, 56, 

64, 67, 76 
on Protocol on Illicit Trade in 

Tobacco Products, 77, 78 
recipients of FCA awards, 43 
International Agency for Research on 

Cancer (IARC), 21,44 
International Agency on Tobacco and 

Health, xxiii 
International Centre for Corporate 

Social Responsibility, Nottingham 
University, AA 
International Hotel and Restaurant 

Association, 60 
international legal instruments 
framework convention— protocol 

approach, 22-3, 120 
see also treaties 
International Organization for 

Standardization (ISO), 12, 21, 
International Summit of World 

Smoking Control Leaders, First 
(1985), 29 
International Tobacco Growers 

Association (ITGA), viii, 23, 54, 
International Union against Cancer, 

xxii, 55 
International Union against 

Tuberculosis and Lung Disease 
(IUAT LD), xxii, 55 
internationalism in health, xxi— xxvi 
Ireland, 34, 52 

Japan, xxiv, 81-2 

FCTC involvement, xxvi, 30, 54, 

56, 63, 81-2 
ratification of FCTC, 82 
regional negotiations, 5 1 
Japan Tobacco International, Geneva, 
Switzerland, 17, 25, 26, 62, 
Johannesburg Declaration (2001), 53 

Kenya, xxvi, 40, 56 

labelling, package, 26-7 

Lalonde Report (1974), Canada, xxvi 

leadership, 69 

legacy tobacco documents, 121-22 

see also tobacco industry documents 
legal department, WHO, 33, 44-5 
liability, 27, 82 
light/mild cigarettes, 12, 26, 121, see 

also descriptors 
litigation, against tobacco companies, 

low- and middle-income countries 
adverse effects of globalization, 

evidence on health effects, 25 
extreme right-wing groups, 66 
funding for tobacco control, 66 
perspectives on tobacco control, 

23-6, 27 
pressures from tobacco industry, 16, 

restructuring of farming, 61—2 
role in FCTC, 40-1, 50, 53-4, 

use of term, 6, 29 
lung cancer, xxi 

malaria, xxv, 34, 44 
Malawi, 10-11, 16, 54 
'Malawi clause,' 1 1 


WHO Framework Convention on Tobacco Control - Index 

Malaysia, 25, 26 
Marlboro Man award, 54, 67 
media, mass, 38, 39, 65, 67 
ministries of health, 40 
Mongoven, Biscoe and Duchin, 

Washington, DC, 53 
Montreal protocol, 22 
'Mr Butts', 19 
multisectoral approach, tobacco 

control, 64 

Network for Accountability for 

Tobacco Transnationals (NATT), 
54, 55, 67 
New Zealand, 56 
nicotine spiking, 20 
non-governmental organizations 
(NGOs), xxvi 
business interest, 59 
environmental codes and 

conventions, 38 
FCTC involvement, 39, Al , 53-60, 
65-6, 67 
Nottingham University, UK, 43, AA 

onchocerciasis, 33 

Orchid award, 42-4, 54, 55, 56, 

81, 122 
ozone layer, 22 

subversion of WHO, AA 
voluntary advertising code, 64 
Philip Morris International Inc., New 

York , NY; Lausanne, Switzerland, 

Philip Morris USA/Altria, Henrico 

County, Virginia, 17, 26 
Physicians for a Smoke-free Canada, 5 
picture warnings, 27 
political issue, tobacco control as, 35-8 
poverty tobacco and, 55 
Programme on Substance Abuse, 

WHO, 31, 32 
Project Whitecoat, 29 
public health, 3, 28, 55, 70 
public relations (PR) companies, 


regions, WHO, 9-10, 16, 51, 53, 


Reynolds American Inc., Winston- 
Salem, NC, 17 

right-wing groups, 66 

Robins, Kaplan, Miller and Ciresi, 
Minneapolis, MN, 19 

Roll Back Malaria (RBM) project, 34 

Royal College of Physicians of 
London, xxi— xxii 

Russia, 54 

Pacific Islands, 5 1 

package warnings and labelling, 26-7 

packaging, plain, 65 

Palau, 56 

Pan-American Health Organization, 
WHO(PAHO), 15 

passive smoking, xxiv, 29 

Philip Morris, 25, AA 

Boca Raton action plan, 16, 45, 53 
current attitudes to FCTC, xxvi, 62, 

lawsuits against, 1 8-1 9 

Scientific Advisory Group on Tobacco 

Product Regulation (SACTob), 

WHO, 63-4, 120 
GDSearleCo., 19 
Secretariat, WHO, 64 
sensitive information, publication, 8-9 
Single Convention on Narcotic 

Drugs, 18 
smallpox, 33 
smokeless tobacco, 9 
smoking, effects on health, xxi— xxii, 

xxiv, 20-1 


WHO Framework Convention on Tobacco Control - Index 

smuggling, tobacco, 12, 50 
South Africa, xxvi, 45, 56 
South China Morning Post, 83 
South East Asian region, WHO 

(SEARO), 47, 51, 53, 56, 74 
Study Group on Tobacco Product 

Regulation (TobReg), WHO, 

21, 122 
supply measures, 21 
Switzerland, xxvi, 6, 31-2, 49-50 

T-shirt, child's, 56 
taxation, 27, 83 
Thailand, 51-2, 56, 68-9 
timeline, FCTC, 49, 75-8 
tobacco companies 
big six, 17 
big three, 62 

Boca Raton action plan, 16, 45, 53 
current attitudes to FCTC, xxvi, 62, 

documents see tobacco industry 

funding of universities, 7-8, AA 
global market share, 26 
pressures on low- and middle- 
income countries, 16, 40, 45 
product regulation role, 12 
report on activities in Switzerland, 

role in FCTC negotiations, 37-8, 

45-6, 47-8, 53-4, 59-60, 63-5 
targeting of WHO, 16, 28-9, 30, 

transnational aspects of regulation, 

UN agencies and, 60-1 
US litigation, 18-20,45 
tobacco control 

American region, WHO, 15-16 
demand-reduction approach, 41 
early WHO actions, xxiii— xxiv, 


historical origins, xxi— xxiii 

low- and middle-income country 

perspectives, 23-6, 27 
measures preceding FCTC, 26- 

multisectoral approach, 64 
as a political issue, 35-8 
transnational aspects, 12-15, 50 
UN inter-agency cooperation, 60-2 
WHA resolutions see World Health 

WHO budget allocation, 36-7 
Tobacco Control (journal), 32 
Tobacco Free Initiative (TFI), WHO 
financing, 36-7, 49-50, 58, 66 
initiation, xxiii, 75 
report on tobacco control in 

Switzerland, 31 
role in FCTC, xxv, 5, 30 
'Tobacco Kills - Don't be Duped' 

programme, UN, 38-9 
Zeltner Committee initiation, AA 
tobacco growers/farmers 

alternative livelihoods, 41-2, 61-2 
FCTC negotiations and, 23- 4, 

47-8, 60, 63 
WHA resolutions, 10-11 
tobacco-growing countries, 10-11, 

Africa, 24 

restructuring of farming, 61—2 
role in FCTC negotiation, 30-1, 

tobacco industry see tobacco companies 
tobacco industry documents, 1 8-20, 

influence on FCTC, 28-9, 35, 37, 

released to public in 2000, 

19-20, 119 
UN agencies and, 46, 60-1 
see also Committee of Experts on 

Tobacco Industry Documents 


WHO Framework Convention on Tobacco Control - Index 

'Tobacco Kills - Don't be Duped' 

programme, UN, 38-9 
Tobacco or Health programme, WHO, 

xxiii, 5, 32 
Tobacco or Health Unit (TOH), 

WHO, 32 
tobacco products 

manipulation and re-engineering, 20 
regulation, 12, 21 
see also cigarettes 
tobacco use 

effects on health, xxii— xxiii, xxiv, 

see also smoking 

liberalization, 13, 14, 20 
US pressures, 51-2, 56 
transnational aspects, tobacco control, 

transparency, 32, 37-8, 45-6, 69 
treaties (international conventions), 
bad examples, 21, 23 
framework-protocol approach, 

22-3, 120 
WHO power to make, 1 1-12, 33 
tuberculosis (TB), xxii 
typewriters, 41-2 

Union Carbide, 19 
United Nations (UN) 

Ad Hoc Interagency Task Force on 

Tobacco Control, xxvi, 61, 62 
agencies, 46, 60-2, 64 
Convention on the Law of the 

Sea, 23 
focal point, 60 
United Nations Conference on Trade 
and Development (UNCTAD), 
28, 60, 61 
United Nations Drug Control 
Programme (UNDCP), 18 

United Nations (UN) Foundation, 58 
United States (US) 

FCTC negotiation process, 45, 

influence over WHO, 32 
lawsuits against tobacco companies, 

pressure on Thailand, 51-2, 56 
tobacco control, 46 
universities, funding by tobacco 
industry, 7-8, 44 

Vancouver, Canada, 50-1 

Victoria Tobacco Act 1987, Australia, 

Vienna Convention for the Protection 

of the Ozone Layer, 22 
Vienna conventions on narcotic drugs, 


Wake Forest University, North 

Carolina, 7 
warnings, package, 26-7 
Wellcome Trust Centre for the History 

of Medicine at UCL, London, 3, 

Western Pacific region, WHO, 9, 51, 

56, 74 
WHA aw World Health Assembly 
whitecoats, 29 
World Bank, xxiv-xxv, 21, 30, 60, 

World Commission on Environment 

and Development, UN, 35 
World Conferences on Smoking/ 

Tobacco or Health, xxi— xxii, xxiv, 

xxv, 28, 33-4 
Paris (1994), xxiv, 10, 20, 33, 75 
World Development Report 1993 

(World Bank), xxiv 
World Health Assembly (WHA), 



WHO Framework Convention on Tobacco Control - Index 

resolution WHA24 (1971), xxiii 
resolution WHA41 (1988), xxiii, 

resolution WHA48. 11 (1995), 31, 

33, 48, 75 

resolution WHA49. 17 (1996), 33, 

34, 48, 75 

resolution WHA52. 18 (1999), 

resolution WHA53. 16 (2000), 

resolution WHA54. 18 (2001), 

37-8, 54 
resolutions on tobacco control (1970s 

to 1990s), 9, 10-12,25,46 
World Health Communication 

Associates, Axbridge, 

Somerset, 39 
World Health Organization (WHO), 

Geneva, Switzerland, xxi, 123 
budget prioritization, 36-7 
Constitution, Article 19, 11, 35 
earlier anti-tobacco activities, xxiii- 

xxiv, 9-15, 32-3 
origins of FCTC, xxv, 10, 21—3, 28, 

Secretariat, 64 

targeting by tobacco companies, 16, 
28-9, 30, 35, 44 
World Heart Federation, 55 
World Lung Foundation, 6 
World No-Tobacco Day, xxiii, 42 
World Trade Organization (WTO), 
Geneva, Switzerland, 56 

Zeltner committee see Committee 
of Experts on Tobacco Industry 


Index: Names 

Biographical notes appear in bold 

WHO Framework Convention on Tobacco Control - Index 

Aiston, Ed, 48 

Al-Shorbaji, Najeeb, 3-4, 5, 70-1, 109 
Amorim, Celso, 69, 75, 76 
Annan, Kofi, 61 
Apfel, Franklin, 39 
Assunta, Mary, 5, 25-6, 34, 40, 45, 
53, 55-7, 62, 63, 70, 109 

Berridge, Virginia, xxi— xxvi 

Bettcher, Douglas, 5, 8-9, 11-15, 19- 

20, 33-4, 35-6, 38, 41-2, 58-62, 

63, 109-10 
Bhattacharya, Sanjoy, 4, 9, 31, 70, 110 
Bjartveit, Kjell, xxii 
Bradford Hill, Sir Austin, xxi 
Brundtland, Gro Harlem, xxv, 6, 20, 



Caretti, Brigitte, 50 

Chaloupka, Frank J, 21 

Collishaw, Neil, 5, 10-11, 15, 21-3, 

28, 30, 32-3, 34, 36, 48-50, 

Costa e Silva, Vera Luiza da, 5, 10, 

15-16, 30-1, 36-7, 41, 46-8, 62, 

63-4, 111 
Crofton, Eileen, xxii, xxiv 
Crofton, Sir John, xxii, xxiii, xxiv 
Cunningham, Rob, 6, 8, 26—7, 50—2, 

54-5,57,64-5, 111-12 

Doll, Sir Richard, xxi, 112 
Duke, James Buchanan, 7, 8 

Glantz, Stan, 19, 31 
Godber, Sir George, xxi— xxii 

Graham, Evarts, xxi 
Gray, Nigel, xxii— xxiii 

Hill, Sir Austin Bradford, xxi 
Hirayama, T, xxiv 
Hurley, John, 34 

Jacob, Greg, 51 
Jha, Prabhat, 21 

Kennedy, Robert, xxi 
Kessler, David, 20 

Lariviere, Jean, xxv, 33-4, 48 
Lee, Chung- Yol, 31 
Lee, Jong-wook, 59 
LeMaistre, Charles, 29 
Leppo, Kimmo, 34 
Lopez, Alan, xxiv 

Mackay, Judith, xxiv, xxv, 6, 8, 9-10, 

McLellan, Faith, 4, 7-8, 9, 11, 15, 21, 

Madrigal, Enrique, 15 

Mahler, Halfdan, xxiii-xxiv 

Martiny Anke, 20 

Masironi, Roberto, xxiii 

Mochizuki-Kobayashi, Yumiko, 59 

Momen, Hoomen, 4 

Mulvey, Kathryn (Kathy), 5, 24, 37-8, 
53-4,58-9,67-8, 113-14 

Murray, Christopher, xxiv 

Nabarro, David, 44 

Nakajima, Hiroshi, xxiv, 31, 32, 114 

Nikogosian, Haik, 3, 77, 114 


WHO Framework Convention on Tobacco Control - Index 

Ogwell, Ahmed Ezra, 5, 23-4, 39-41, 
55,60,68-9,71, 114-15 

Peto, Sir Richard, xxiv, 34, 115 
Potschke-Langer, Martina, 5, 20-1, 
38-9,42-4, 112 

Randera, Fazel, 20, 45 
Reid, John, xxiii 
Reynolds, Richard Joshua, 7 
Ricupero, Rubens, 61 
Roemer, Ruth, xxv, 21-2, 27-8, 33, 
34, 115 

Seixas Correa, Luis Felipe de, 67, 76 

Simpson, David, xxiii 

Smith, Richard, 44 

Subramaniam, Chitra, 35, 39, 44, 116 

Tansey, E M (Tilli), 3-4, 8, 9, 70, 116 
Taylor, Allyn, xxv, 21-2, 27-8, 34, 

Townsend, Joy, xxiv 
Turner, Ted, 58 

Walburn, Roberta, 19,44 
Wynder, Ernst, xxi 

Yach, Derek, xxv, 10, 13, 14, 35, 
44, 117 

Zeltner, Thomas, 6, 16-19, 20, 21, 
28, 30, 32, 34, 35, 37, 41, 44-6, 
49-50,62,67,68,69-70, 117 

Zolty, Barbara, 49 


Key to cover photographs 

Front cover, left to right 

Dr Mary Assunta 
DrThomas Zeltner 
Ms Kathy Mulvey 
Dr Douglas Bettcher 
DrVera Luiza da Costa e Silva 

Back cover, left to right 

Mr Neil Collishaw 

Dr Martina Potschke-Langer 

Mr Rob Cunningham 

Dr Judith Mackay 

Dr Ahmed Ezra Ogwell