DISPARITIES IN GLOBAL TOBACCO HARM REDUCTION

Abstract

In “Origins of the WHO Framework Convention on Tobacco Control,” Roemer et al. present a compelling argument for a unified global approach to tobacco control.1 However, the Framework Convention on Tobacco Control will not benefit nonsignatory countries, which tend to have few or no existing tobacco control measures in place. Indonesia is the only Asian country that failed to sign the treaty. Significantly, Indonesia is also one of the largest tobacco markets in the world, with smoking rates in excess of 60% for adult males and 20% for 10-year-old males.2 Altria, the parent company of US cigarette giant Philip Morris (PM), recently acquired Sampoerna, Indonesia’s second-largest cigarette manufacturer, and appears poised to exploit the virtual absence of tobacco industry regulation in that country. In the United States, where more rigorous tobacco control measures are in effect, PM appears to be making some progress toward reducing the harms associated with tobacco use. Positive initiatives such as harm reduction, youth smoking prevention, and adult cessation programs are part of a strategy employed by PM in the United States in response to public health initiatives. PM recently announced plans to construct a US$300 million facility in Richmond, Va, to develop “reduced exposure” tobacco products and introduced Marlboro UltraSmooth, a cigarette with a carbon filter designed to reduce toxic gas phase smoke constituents, in test markets. In Indonesia, more than 90% of cigarettes smoked are kretek, or clove cigarettes. These often unfiltered cigarettes contain a blend of ground clove buds and tobacco and deliver significantly higher levels of tar, nicotine, and carbon monoxide than a conventional US cigarette and much higher levels still than Marlboro UltraSmooth (Table 1 ▶). TABLE 1— Smoke Chemistry Data for an Indonesian Kretek (Clove Cigarette), a Conventional US Cigarette, and Marlboro UltraSmooth Unfortunately, it is difficult to reconcile PM’s expressed commitment to harm reduction with the company’s investment in a product with such questionable health implications in a country with little or no regulation of marketing and sales to minors. PM’s actions in Indonesia cast serious doubt on the company’s purported reforms. PM’s involvement in the Indonesian tobacco market emphasizes the need for public health advocates to pressure multinational tobacco companies to support the principles of the Framework Convention on Tobacco Control. We welcome this momentous initiative. Nevertheless, a truly unified global tobacco control treaty must also have the capacity to prevent transnational tobacco companies from continuing to undermine public health in the developing world.