WHO FRAMEWORK CONVENTION
ON TOBACCO CONTROL
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 www.history.qmul.ac.uk/research/modbiomed/
wellcome_witnesses/
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.
CONTENTS
Illustrations and credits v
Abbreviations vii
Witness Seminars: Meetings and publications; Acknowledgements
E MTansey and LA Reynolds ix
Introduction
Virginia Berridge xxi
Transcript
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
ILLUSTRATIONS AND CREDITS
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
ofWHO.
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.
11
22
42
49
58
59
14
17
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
43
(2009): 158.
ABBREVIATIONS
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,
Switzerland
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- )
INFOTAB
ITGA
NATT
NGO
PAHO
SEARO
STAT
TFI
TobReg
UNCTAD
UNDCP
UNICEF
VCLT
WHA
WHO
WTO
A conglomeration of all the tobacco companies in the UK
(Tobacco Documentation Centre from 1992), Brentford,
Middx
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
WITNESS SEMINARS:
MEETINGS AND PUBLICATIONS 1
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,
London.
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.
ACKNOWLEDGEMENTS
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
VOLUMES IN THIS SERIES
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
(2005)
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
(2006)
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
(2009)
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
(2011)
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 www.history.qmul.ac.uk/research/
modbiomed/wellcome_witnesses
Hard copies of volumes 21-44 can be ordered from www.amazon.co.uk;
www.amazon.com; and all good booksellers for £6/$10 each plus postage,
using the ISBN.
UNPUBLISHED WITNESS SEMINARS
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.
OTHER PUBLICATIONS
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.
INTRODUCTION
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 http://tobaccodocuments.org/ti/TIMN0106201-6205.html (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 http://hansard.millbanksystems.com/lords/1967/dec/20/health-education-l
(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 www.rcpe.ac.uk/library/read/biography/
sir-john-crofton/sir-john-crofton-autobiographypdf (visited 1 1 May 2012), particularly 'War with the weed'
from page 611.
See www.theunion.org/index.php/en/who-are-we/history-of-the-union (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, http://legacy.library.ucsf.edu/tid/fqj84bOO/pdf;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 http://www.legacy.library.ucsf.edu/documentStore/z/
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 http://www.who.int/tobacco/dy_speeches8/en/ (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
WHO FRAMEWORK CONVENTION
ON TOBACCO CONTROL
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
WHO FRAMEWORK CONVENTION
ON TOBACCO CONTROL
Participants
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 www.who.int/tobacco/framework/WHO_FCTC_
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 www.history.qmul.ac.uk/research/modbiomed/what-is-a-witness-
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
they?
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 www.wfu.edu/history/
HSTWFU/perry.html; James Buchanan Duke (1856—1925) endowed Duke University through his family
foundation, see www.dukeendowment.org/about-us/our-history (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
discussion.
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 http://legacy.library.ucsf.edu/action/
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 http://library.wellcome.ac.uk/node49.html (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 www.searo.who.int/LinkFiles/
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.
10
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 www.cia.gov/library/publications/the-world-factbook/geos/mi.html (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 www.who.int/governance/eb/who_
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).
11
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.
12
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
28
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 www.smoke-free.ca/pdf_l/Trade&Tobacco-
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).
13
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
Trade
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
Travel
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
radiation
Accumulation of greenhouse gases and global
warming
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
Technology
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
tobacco
Foreign policies based on national self-interest,
xenophobia, and protectionism
Threat to multilateralism and global cooperation
required to address shared transnational health
concerns
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).
14
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 www.paho.org-rl99518c (visited 6 October 201 1).
See page 30.
15
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: www.who.int/tobacco/media/en/who_inquiry.pdf (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.
16
WHO Framework Convention on Tobacco Control
Company
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
(www.altria.com/en/cms/About_Altri 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
(www.pmi.com/eng/pages/homepage.aspx (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
(www.reynoldsamerican.com/index.cfm (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 (www.bat.com/ (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
(www.jti.com/About/about_history (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
(www.imperial-tobacco.com/index.asp?page=43 (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.
17
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 www.unodc.org/unodc/en/data-and-analysis/bulletin/
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.
18
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 www.pbs.org/wgbh/pages/frontline/shows/settlement/interviews/glantz.html
(visited 7 July 2010). See also Glantz (1996); Brandt (2007). For a guide to searching the documents,
see www.emro.who.int/tfl/TobaccoIndustry-English.pdf (visited 16 November 2011). For one analysis
of how the dollars from of tobacco industry settlement have been spent, see www.legacyforhealth.org/
PDFPublications/TobaccoAsASocialJusticelssue.pdf (visited 20 December 201 1).
See Ciresi et al. (1999); for background details of tobacco litigation, see http://law.jrank.org/
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 www.bluecrossmn.com/bc/wcs/
idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=Latest&dDocName=
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 www.rkmc.com/
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 http://law.jrank.org/pages/10805/Tobacco-Tobacco-Litigation.html (visited
7 July 2010); for the Legacy Tobacco Documents Library, University of California, San Francisco, see
http://legacy.library.ucsf.edu/ (both visited 26 September 201 1); see also Infact (2003).
19
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.
20
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: www.usaid.gov/policy/ads/200/tobacco.pdf, 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 www.who.int/tobacco/
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.
21
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 http://ozone.unep.org/Ratification_status/
evolutionofmp.shtml (visited 8 July 2010).
For the text of the Vienna Convention for the Protection of the Ozone Layer, see http://ozone.unep.org/
new_site/en/Treaties/treaty_text.php?trearyID=l (visited 19 January 2012).
22
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 www.who.int/fctc/protocol/illicit_trade/en
(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
www.un.org/Depts/los/convention_agreements/convention_historical_perspective.htm#The%20Future
(visited 8 July 2010). For details of these precedents, see http://apps.who.int/gb/fctc/PDF/inb6/einb6id2.
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
www.tobaccoleaf.org/conteudos/default. 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.
23
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 (www.who.int/inf-pr-2001/en/note2001-04.html, 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.
24
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).
25
WHO Framework Convention on Tobacco Control
Company Global Market Share (%)
2000 2008
Philip Morris International
15.5%
17.4%
Altria/Philip Morris USA
3.8%
2.8%
British American Tobacco
11.0%
12.0%
Japan Tobacco International
7.2%
9.6%
Imperial Tobacco
0.8%
4.9%
China National Tobacco Corporation
33.3%
37.1%
Other
32.2%
19.0%
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).
26
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
www.tobaccocontrollaws.org/legislation/country/brazil; 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 http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ
:L:2001:194:0026:0034:EN:PDF; for details of the European implementation of the FCTC, see and
www.smokefreepartnership.eu/IMG/pdf/ers-SL-01.pdf; 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 www.who.int/
tobacco/framework/WH O_FCTC_english.pdf, page 9—10, and a database of pictorial health warnings at
www.who.int/tobacco/healthwarningsdatabase/en/index.html (all sites visited 21 February 2012).
For the Brazilian requirements for picture warnings, RDC n° 104 of 31 May 2001, see
www.tobaccocontrollaws.org/legislation/country/brazil; for regulations in Canada, see Tobacco Products
Information Regulations, SOR/2000-272, see http://laws.justice.gc.ca/eng/regulations/SOR-2000-
272/201 10922/PlTT3xt3.html (all sites visited 21 February 2012).
See also note 27, page 69 and Appendix 5.
See note 187.
27
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: http://legacy.library.ucsf.edu/ (visited 14 February 2012).' Note on draft
transcript, 26 January 2012. See also note 42.
28
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 http://legacy.library.ucsf.edu/tid/yqu78e00 (visited 16
November 2011). For one background on 'fake experts', see Hirschhorn (1999) at www.globalink.org/
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 http://tobaccodocuments.org/pm/2501109726-9727.
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.
29
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 http://portal.anvisa.gov.br/wps/wcm/connect/62382e804745885f91e3d53f
bc4c6735/A_ANVISA_E_0_CONTROLE_DOS_PRODUTOS_DERIVADOS_DO_TABACO_
PORT_Dez08_M_AC.pdf?MOD=AJPERES (visited 27 January 2012); see also www.who.int/bulletin/
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 .
30
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: http://www.library.ucsf.edu/tobacco/swiss (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.
31
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.
32
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: www.who.int/
mediacentre/factsheets/smallpox/en/ (visited 14 November 201 1)). For details of the WHO onchoserciasis
programme, see www.who.int/topics/onchocerciasis/en/ (visited 18 October 2010); see also page 44.
For resolution WHA48.11, 'An international strategy for tobacco control', see www.who.int/tobacco/
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.
33
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).
34
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.
un-documents.net/wced-ocf.htm (visited 15 November 201 1).
35
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
36
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 www.forces-nl.org/
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 www.who.int/tobacco/
framework/wha_eb/wha54_18/en/index.html (visited 21 July 2010).
37
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 www.who.int/fctc/guidelines/
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 http://whqlibdoc.who.int./hq/1999/WHO_NCD_
TFI_99-3.pdf and http://whqlibdoc.who.int./hq/1999/WHO_NCD_TFI_99.4.pdf (visited 16 December
201 1); see also Crowther etal. (2009): 25-6, 35, 43-8, 54-5; WHO/UNICEF (1989).
38
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 http://www.who.int/ncd/mip2000/documents/
annual_tfi_en.pdf (visited 14 February 2012).
Dr Franklin Apfel was managing director of World Health Communication Associates in Axbridge,
Somerset (see www.whcaonline.org/about-us.html (visited 28 October 2011)). See, for example, Semenza
et al. (2008); see also www.euro.who.int/_data/assets/pdf_file/0006/97827/WHYReport_Bonn.pdf
(visited 22 July 2010).
39
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.
40
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 www.fctc.org/index. 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).
41
WHO Framework Convention on Tobacco Control
All five newsletters published this week, 16-20 October 2000, are available or line at
http://www.fctc.org
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
sponsorship."
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
practice."
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.
42
Dates of INB sessions
Orchid award
WHO Framework Convention on Tobacco Control
Dirty Ashtray award
INB-1
16-21 October 2000
Canada, Uganda, Kenya and Thomas
Zeltner
Tobacco Industry and Marketing
Board of Zimbabwe, and CIGG
Lobby Vending Machine
INB-2
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
Delegation
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
INB-3
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
INB-4
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
INB-5
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)
INB-6
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.
43
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. org.uk/information/tobacco-industry/university-funding-
the-tobacco-industry; for one discussion of the ethical, legal and policy issues associated with tobacco
industry funding, see http://cancercontrol.cancer.gov/tcrb/tfms.pdf (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).
44
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 www.who.int/
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 www.publications.parliament.uk/pa/cml99900/cmselect/
cmhealth/27/27 18.htm (visited 29 November 201 1).
45
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: www.fao.org/docrep/006/y4997e/y4997e00.
htm#Contents (visited 22 July 2010).
See US, Surgeon General, Advisory Committee on Smoking and Health (1964), freely available at
http://profiles.nlm.nih.gov/NN/Views/Exhibit/narrative/smoking; 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 www.cdc.gov/tobacco/
data_statistics/sgr/pre_1994/index.htm; for Centers for Disease Control and Prevention factsheet on health
effects of cigarette smoking, see www.cdc.gov/tobacco/data_statistics/fact_sheets/healtheffects/effects_
cig_smoking/ (all sites visited 15 February 2012).
46
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 www.who.int/inf-pr-2001/en/note2001-
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.
47
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.
124
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 http://www.ash.org.uk/
files/documents/ASH_371.pdf (visited 3 November 2011)); see also Infact's guidelines for ratification at:
www.ctcpak.org/docs/fctc/Rat_handbook.pdf (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 http://whqlibdoc.who.int/publications/2009/
978924l563925_eng.pdf (visited 5 November 2010); for timeline, see Appendix 4, page 79.
48
WHO Framework Convention on Tobacco Control
msrcxgnr
orTWE
C0WVEW120N
on<to®acco COWItipL
WHO TOKEWOflK CONVENTION
M T03ACCO CONTfltSL
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.
49
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 www.who.int/fctc/about/whofctc_inb/consultations/en/ (visited
19 July 2010).
Professor Judith Mackay wrote: 'The truth is we were all starting from scratch.' Note on draft transcript,
26 January 2012.
50
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.
who.int/hq/1999/WHO_NCD_TFI_99.7.pdf (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).
51
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 http://www.who.int/tobacco/dy_speeches4/en/
(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 www.no-smoking.org/oct03/10-02-03-l.html (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 www.who.int/tobacco/policy/advertising/en/
(visited 3 November 201 1)).
52
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
http://tobaccodocuments.org/landman/2046875317-5351.html (visited 16 March 2012).
Ms Kathy Mulvey wrote: 'Burson-Marsteller worked with Philip Morris to implement the Boca Raton
Action Plan at http://legacy.library.ucsf.edu/tid/xke42e00/pdf;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).
53
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: www.stopcorporateabuse.org/sites/default/files/Dirty_Dealings.pdf
(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 http://apps.who.int/gb/fctc/PDF/inb6/einb6d2rl.pdf, and FCA
Bulletin article of 27 February 2003 for details (visited 10 January 2012).
54
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
www.streetparty.sk/subtitles/ (visited 23 July 2010).
55
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 http://act.tobaccochina.com/englishnew/index.HTM (visited
21 February 2012).
56
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).
57
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' (www.unfoundation.org/) at www.apfn.org/apfn/turner.htm (both
sites visited 16 July 2010).
58
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://
info.babymilkaction.org/node/458 (visited 20 December 201 1).
59
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.
162
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.library.ucsf.edu/tid/qmel8a99/pdf; http://legacy.
Iibrary.ucsf.edu/tid/fvf63a99/pdf (both visited 7 February 2012).
60
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.
61
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
www.tobacco.org/resources/documents/secretdocuments.html (visited 9 February 2012).
62
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: www.healthbridge.ca/itgabr.pdf; www.hallmarkpr.co.uk (visited 3 November 2011)); see also Rimmer
(2005).
171 For international convention flexibility, see Taylor and Bettcher (2000): 922.
63
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).
64
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 http://parlinfo.aph.gov.au/
parlInfo/search/display/display.w3p;adv-yes;orderBy-customrank;page-0;query-plain%2Bpackaging%2B
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: www.who.int/fctc/guidelines/en/ (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 www.ash.org.uk/current-policy-issues/advertising/
why-ban- tobacco-advertising (visited 17 November 2011).
65
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://
apps.who.int/gb/archive/pdf_files/WHA52/ew38.pdf) included strong language in support of NGO
participation, and the May 2000 WHA resolution on the FCTC (WHA53.16, online at http://apps.
who.int/gb/archive/pdf_files/WHA53/ResWHA53/16.pdf) 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 www.gatesfoundation.org/
topics/Pages/ tobacco. aspx; www.tobaccocontrolgrants.org/Pages/44/About-the-Bloomberg-Initiative (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).
66
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 www.stopcorporateabuse.org/sites/default/files/INB3%20
English%20FINAL.pdf) for details (visited 18 April 2012).
67
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.
68
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 www.who.int/fctc/
guidelines/article_5_3.pdf).' Note on draft transcript, 20 July 2010.
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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.
70
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: www.who.int/tobacco/
communications/TImanualcontent.pdf (visited 16 November 2001).
See, for example, www.bbc.co.uk/news/world-11845158 (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 www.who.int/fctc/protocol/illicit_trade/en (visited 3 April 2012).
71
WHO Framework Convention on Tobacco Control -Appendix 1
Appendix 1
Selected Provisions of the
Article Topic
Articles
6&7
FCTC 193
Measure
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
Awareness
Education, communication, training and public awareness
for the consequences of smoking
Article 13
Tobacco
Comprehensive ban on tobacco advertising, promotion and
advertising
sponsorship, unless the national constitution forbids it
Article 14
Addiction
Demand-reduction measures concerning tobacco
dependence and cessation
Article 15
Smuggling
Action is required to eliminate illicit trade in tobacco
products
Article 16
Minors
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
Environme
:nt
Protection of the environment and the health of persons
Article 19
Liability
Legislative action or promotion of existing laws, to deal
with criminal and civil liability, including compensation
Articles 20, 21
&22
Research
Tobacco-related research and information sharing among
the parties
'See www.who.int/tobacco/framework/WHO_FCTC_english.pdf (visited 16 July 2010).
73
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,
Denmark)
Regional Office for the
Eastern Mediterranean
(EMRO, Cairo, Egypt)
Western Pacific Regional
Office (WPRO, Manila,
Philippines)
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
74
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
www.who.int/fctc/copdecisionrevone.pdf (both visited 6 December 2011). For other timeline details, see
Framework Convention Alliance at www.fctc.org/index.php?option-com_content&view-article&id-7&It
emid=8 (visited 21 December 201 1); for Conference of the Parties, see Glossary, page 1 19— 20.
75
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
convention
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
headquarters
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
76
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
sponsorship
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
awareness)
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)
77
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
sponsorship
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
sponsorship
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
78
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
1993
1994
1995
1996
1997*
Production
World total
7 325 157
5 609 552
6 579 289
5 547 668
7312915
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
India
522 540
475 200
528 390
506 475
544 050
Brazil
509 000
365 000
323 500
367 000
497 053
Turkey
280 803
155 818
170 070
190 391
245 260
Zimbabwe
201 992
152 490
179 243
1 78 605
1 65 240
Exports
World total
1 735 554
1 694 877
1 768 823
1 956 381
1 924 745
Brazil
243 500
275 500
256 300
282 500
294 000
United States
207 747
196 792
209 482
222 316
221 509
Zimbabwe
188 261
203 485
174 289
195 958
175 572
Turkey
91 350
112 411
136 392
1 70 098
156 200
India
91 000
22 390
77 680
118 000
1 1 5 000
Italy
Imports
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
Germany^
154 175
182 785
209 761
235 855
250 000
Russian
Federation
144 125
143 080
148 110
125 296
148 800
United Kingdom 124 324
97 958
141 467
166 027
131 876
Netherlands
83 623
86 546
89 075
97 368
97 500
Japan
118 651
135 543
1 1 5 072
85 634
96 000
Estimate f General imports (actual arrivals) £ Unified Germany
79
WHO Framework Convention on Tobacco Control -Appendix 4
1993
1994
1995
1996
1997*
Consumption
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
India
426 045
438 605
463 920
472 070
478 760
Indonesia
139 733
165 786
183 050
196 670
200 550
Japan
179 235
190 000
196 900
197 250
1 95 700
Brazil
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.
80
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.
Japan
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).
81
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
China
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 www.who.int/fctc/signatories_parties/en/index.html
(16 December 2011).
201 Yach (2005).
Assunta and Chapman (2004): 751.
203 Nullis (2002); seewww.tobacco.org/news/105929.html (visited 16 December 201 1); Wilkenfeld (2001)
at www.tobaccofreekids.org/press_releases/post/id_04l6; Brinson (2003) at www.tobaccoreporter.com
(both visited 16 December 201 1); Assunta and Chapman (2004).
British American Tobacco (2000).
205 Bialous (2004).
82
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
Chronic Disease Prevention and Health Promotion (201 1).
83
WHO Framework Convention on Tobacco Control - References
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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
Alliance.
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.
109
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
110
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
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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
Pulmonology.
Dr Judith Mackay
OBE SBS FRCP(Edinb)
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
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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://
tobaccodocuments.org/profiles/
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
113
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 www.pbs.org/
wgbh/pages/frontline/
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
114
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.
115
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
PhD PhD DSc HonFRCP
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
116
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.
117
WHO Framework Convention on Tobacco Control - Glossary
Glossary*
Action on Smoking and Health
(ASH)
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
www.who.int/tobacco/policy/
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
119
WHO Framework Convention on Tobacco Control - Glossary
groups to elaborate guidelines
and recommendations for the
implementation of different treaty
provisions. See www.who.int/fctc/
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.
(1999b).
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/
catalogue_tc/catalogue_tc_browse.
htm?commid=52158 (visited
120
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
www.advisorybodies.doh.gov.uk/
scoth/technicaladvisorygroup/
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 http://law.jrank.org/
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.
justice.gov/civil/cases/tobacco2/
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://
legacy.library.ucsf.edu/ (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://
tobaccodocuments.org/ (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
121
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
http://bat.library.ucsf.edu/history
html and http://cgch.lshtm.ac.uk/
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.
int/tobacco/global_interaction/
tobreg/en/ (visited 5 December
201 1). See, for example, their
third report, freely available
at http://whqlibdoc.who.int/
ublications/2009/9789241209557
_eng.pdf (visited 5 December
2011).
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
122
WHO Framework Convention on Tobacco Control - Glossary
www.who.int/mediacentre/events/
governance/wha/en/index.html
(visited 25 November 201 1).
World Health Organization
(WHO)
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 www.who.int/about/en/
(visited 25 November 201 1).
123
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),
64-5
African region, WHO (AFRO), 23-4,
47,51,53,56,74
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,
27-8
American Journal of Public Health, 1 3
Americas region, WHO, 74
ammonia, 20
anti-tobacco/anti-smoking movement,
18-19
early WHO activities, xxiii— xxiv,
9-15,32-3
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,
30,31,41-2,67
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
Canada
role in FCTC, xxv— xxvi, 33-4, 49,
50-1,56
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,
82-3
tobacco industry documents, 20
125
WHO Framework Convention on Tobacco Control - Index
China National Tobacco Corporation,
26, 81,83
cigarettes
global market shares, 26
light/mild, 12, 26, 119
nicotine spiking, 20
package warnings and labelling,
26-7
plain packaging, 65
regulation, 21
civil society, 28, 38, 47, 58-9
see also non-governmental
organizations
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,
59,67
countries
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
countries
developing countries see low- and
middle-income countries
Director-General (DG), WHO
role in FCTC development, xxv, 28,
34-9
setting up Zeltner Committee, 6,
20, 37, 44-5
stances before FCTC, xxiii— xxiv,
31-2
Dirty Ashtray award, 42-4, 54, 55, 56,
81, 120
'Dirty Dealings report (Mulvey, 2002),
54
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,
xxiii
European Community (EC), 26-7, 52
126
WHO Framework Convention on Tobacco Control - Index
European Medical Association on
Smoking or Health (EMASH),
xxiii
European region, WHO (EURO), 16,
39,74
Expert Advisory Panel on Tobacco or
Health, WHO, 9
Expert Committee, WHO, xxiii
FCA see Framework Convention
Alliance
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,
48-50
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
funding
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,
12-15
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,
46
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
International
Intergovernmental Negotiating Bodies
(INBs), 47, 50, 51-2, 75
127
WHO Framework Convention on Tobacco Control - Index
death clock, 57, 58
INB-1 (October 2000), 30, 52,
65,75
INB-2 (April-May 2001), 47 ',
52,76
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,
120-21
International Summit of World
Smoking Control Leaders, First
(1985), 29
International Tobacco Growers
Association (ITGA), viii, 23, 54,
60,63
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,
64,82
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,
18-20,45
low- and middle-income countries
adverse effects of globalization,
13-15
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,
40,45
restructuring of farming, 61—2
role in FCTC, 40-1, 50, 53-4,
55-6
use of term, 6, 29
lung cancer, xxi
malaria, xxv, 34, 44
Malawi, 10-11, 16, 54
'Malawi clause,' 1 1
128
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,
17,26
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,
53,63
regions, WHO, 9-10, 16, 51, 53,
56,74
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,
67-8
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
129
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,
67-8
documents see tobacco industry
documents
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,
31-2
role in FCTC negotiations, 37-8,
45-6, 47-8, 53-4, 59-60, 63-5
targeting of WHO, 16, 28-9, 30,
35,44
transnational aspects of regulation,
13-15
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,
9-15,32
historical origins, xxi— xxiii
low- and middle-income country
perspectives, 23-6, 27
measures preceding FCTC, 26-
27,30
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
Assembly
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,
79-80
Africa, 24
restructuring of farming, 61—2
role in FCTC negotiation, 30-1,
41-2
tobacco industry see tobacco companies
tobacco industry documents, 1 8-20,
119-20
influence on FCTC, 28-9, 35, 37,
44-6
released to public in 2000,
19-20, 119
UN agencies and, 46, 60-1
see also Committee of Experts on
Tobacco Industry Documents
130
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,
20-1
see also smoking
trade
liberalization, 13, 14, 20
US pressures, 51-2, 56
transnational aspects, tobacco control,
12-15,50
transparency, 32, 37-8, 45-6, 69
treaties (international conventions),
18,21-3
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,
51-2,54,63
influence over WHO, 32
lawsuits against tobacco companies,
18-20,45
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,
xxiii
Vienna Convention for the Protection
of the Ozone Layer, 22
Vienna conventions on narcotic drugs,
18,21
Wake Forest University, North
Carolina, 7
warnings, package, 26-7
Wellcome Trust Centre for the History
of Medicine at UCL, London, 3,
70
Western Pacific region, WHO, 9, 51,
56, 74
WHA aw World Health Assembly
whitecoats, 29
World Bank, xxiv-xxv, 21, 30, 60,
61-2
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),
122-3
131
WHO Framework Convention on Tobacco Control - Index
resolution WHA24 (1971), xxiii
resolution WHA41 (1988), xxiii,
xxiv
resolution WHA48. 11 (1995), 31,
33, 48, 75
resolution WHA49. 17 (1996), 33,
34, 48, 75
resolution WHA52. 18 (1999),
66,75
resolution WHA53. 16 (2000),
66,75
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,
30-4
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
Documents
132
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,
28,30,34-9,44,58,59,60,61,
69,75
Caretti, Brigitte, 50
Chaloupka, Frank J, 21
Collishaw, Neil, 5, 10-11, 15, 21-3,
28, 30, 32-3, 34, 36, 48-50,
110-11
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,
22,27-9,30,31,33,34,55,59,
65-6,67,81-3,112-13
McLellan, Faith, 4, 7-8, 9, 11, 15, 21,
34,39,57,62-3,69,113
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
133
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,
116-17
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
134
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
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