Interview: Vera Luiza da Costa, Head of the Framework Convention on Tobacco Control (FCTC)21/05/2018
On 20 June 2014 Dr Vera Luiza da Costa e Silva, from Brazil, took office as the new Head of the Convention (FCTC) Secretariat for a term of office of 4 years, replacing Dr Haik Nikogosian.
Dr da Costa e Silva is a medical doctor with a Ph.D. in Health Sciences from Oswaldo Cruz Foundation (FIOCRUZ). She actively participated in the negotiations for the WHO FCTC and held important positions at WHO. Before joining the Convention Secretariat, Dr da Costa e Silva worked as coordinator for the Center for Studies on Tobacco and Health of the National Public Health School (ENSP/FIOCRUZ).
What are the best practices in South America for tobacco control?
South America is a continent that has very rich experiences in the area of tobacco control. There are countries like Uruguay that is one of the leading countries in this topic. This small, but brave country, fought against the tobacco industry and earned the right to put images of warnings for the benefit of its population. In fact, this information measure reduced consumption drastically. Uruguay is a country that fully implements the WHO Framework Convention on Tobacco Control and is an example in the region. The other one is Brazil. Brazil is a country that has different characteristics from Uruguay, as it is a large country with the largest population in South America and is also the largest exporter of tobacco and the second largest producer of tobacco in the world. Yet, Brazil has not only led the WHO Framework Convention negotiations, it is also considered one of the most successful countries in the world to implement its measures. For instance, Brazilians are one of the largest populations in the world in smoke-free environments. Brazil was also one of the first countries to introduce a ban on the terms light and mild, which we call misleading descriptors, and it was a country that fought a lot with the industry to ban tobacco additives. This process was considered constitutional in a last ruling by the country’s Supreme Court.
There are other countries that have also advanced a lot. Colombia is an example. The pressures of the industry are huge. They have, like all South American countries, issues that get in the way of the tobacco control agenda, but the government is very strong in implementing these measures. The same I would say in relation to Peru, which has had recent increases in taxes. Ecuador is of the same path. Chile, which has relatively the biggest smoking population in the region, has recently implemented health warning measures, and could be one of the first to implement what we call generic packs of cigarettes.
So, we see in the region a big movement towards increasing adherence to the Treaty measures and also strengthening collaboration. The secretariat of the treaty, which I lead, has a knowledge center in Uruguay that has worked with several countries in the region to support the implementation of smoke control measures. This region also has a very active and fairly interactive civil society. It should be noted that without this civil society many of the region’s achievements would not have been achieved.
With regard to international action, Brazil has pioneering groups that propose strong implementation measures. In the recent case of the International Labor Organization, Colombia, Ecuador and Uruguay expressed very strongly that the Organization should not receive funds from the tobacco industry to carry out programs to eradicate child labor. So, I think this region has a strong political force in that area. It is very important that ISAGS gets more involved in the promotion of this Treaty, in its implementation. It could bring into the Treaty countries like Argentina, which are not yet a party. At the same time, it also promotes adherence to the Protocol on the Elimination of Illicit Trade, which is one of the major public health problems affecting the region.
What has been its practical impact in the countries where the Framework Convention on Tobacco Control has been ratified in South America? And in the country where it has not been ratified?
The case of Argentina is a case of a country that has not ratified the Framework Convention and we expect it to do so soon. In fact, it is undeniable that Argentina has advanced in measures of tobacco control. Recently they have increased tax and prices. But the reason why the Treaty exists is not necessarily to strengthen domestic policies, but to allow international cooperation in the implementation of policies that go beyond countries’ borders. So, in spite of the fact that the country is evolving in tobacco control measures, it will not benefit, for example, from the articulated work of the South-South and triangular collaboration of the parties in South America, or the Protocol of Illicit Trade, and most likely will not have legal instruments that internally subsidize regulatory measures to prohibit cross-border advertising.
When it comes to production, goal 17 of the Framework Convention on Tobacco Control establishes economically viable alternatives for workers in the tobacco production chain. How is this being addressed in the region and how important are these measures?
This is an area where South-South and triangular collaboration has also been consolidated. Brazil has been leading these initiatives for the simple reason that it is the major producing country, and as part of the ratification of the Treaty, it has made a commitment to support the families of tobacco growers in diversification with a view to eliminating tobacco production. As international demand falls, supply also tends to fall. And this will not be different for Brazil, where 85% of its production is exported. Brazil needs to prepare for the reduction of international demand, working with alternative measures to cultivate the labor of families that depend on the tobacco production chain. There are countries outside the region that are already starting to declare themselves free from tobacco cultivation. I think it is an international trend as the international market recedes.
Advertising is changing rapidly and the tobacco industry now has new ways to advertise its products, such as social networking, and interfere with anti-smoking policies. What are the recommended measures to control this new advertising?
The Conference of the Parties, which is the highest body monitoring the implementation of the Treaty and determines follow-up measures, established a group of experts to propose to the Conference some kind of approach for the control of cross-border advertising. When the guidelines for the implementation of Article 13, which is the article prohibiting the promotion of sponsorship and advertising of tobacco products, were adopted, there were no Facebook, Whatsapp, Instagram, Youtube. With the increase in the number of smartphones, access to information is immense and these large media are a means for this type of cross-border advertising to take place. In addition, it is not only through social networks that this type of reaction is promoted. There are a lot of websites where you can download free videos and movies, which promote tobacco products and enter without any kind of censorship in anyone’s home. There is a great concern nowadays not only regarding the contents, but with the expansion of the means of dissemination of this information and the lack of mechanisms to control who this information reaches. This is a topic that will be discussed at the next Meeting of the Parties in October in Geneva.
Many solutions are pointed out as harm reduction for smoking such as lozenges, stickers and even electronic cigarette. Is there harm reduction for smoking? Which measures are considered most effective?
Look, lozenges and patches are treatments to stop smoking. So, they are considered medicines and do not fit into the category of harm reduction. What exists today is an attempt by the tobacco industry to use electronic devices to replace conventional cigarettes: electronic cigarettes and heated cigarettes. Electronic cigarettes have been available in the market in several countries for some time now, but there is no scientific unanimity that they effectively benefit the population as a whole. They are known to have less risk, but when released and applied on a population basis, there are several unexpected effects, like the uptake of children and adolescents, the dual use of cigarettes and electronic cigarettes. Industries make harm reduction calls that are not evidence-based. These electronic cigarettes can push back all tobacco control measures that have already at an advanced stage in several countries. If, for instance, smoking indoors with these electronic devices becomes acceptable, it’s a step back in terms of normalizing tobacco and nicotine use. So, there is a risk we move from a generation of cigarette addicts to a generation of nicotine addicts in South America. In the United States, there are pen drives that the kids are taking to school to smoke inside the classroom. On the other hand, in England, for example, electronic cigarettes are being marketed as a medicine and, as far as the latest reports show, this seems to be beneficial for the British population. In Australia, these devices are considered poisons and are banned. So, there is no unanimity.
With the issue of heated cigarettes, there is an invasion of these cigarettes in some countries, such as Japan and South Korea, and there is no information available, even whether these products present a lower risk.
How can ISAGS support implementation of the Convention?
I think ISAGS has to advise the ministers of health of the countries of the region to prioritize the implementation of the Framework Convention and the ratification of the Protocol on the Elimination of Illicit Tobacco Trade. It should encourage countries that haven’t subscribed yet to do so, to take part in this international cooperation effort. This is one of ISAGS main goals, right?
Other than that, I think it is very important to raise awareness among governments about being very cautious in interacting with the tobacco industry. This interaction should be restricted to absolutely necessary. For example, when we are creating regulations, there are talks with the industry. But it is not acceptable to open up to the industry’s lobbies.
One of the examples of this is a foundation for a cigarette free world that is fully funded by Phillip Morris International and which is going after governments for partnership projects.