Minnesota, USA, 1994
They had never lost a case in the United States of America, winning over 300 in 40 years. Selling death as life to people around the world, the tobacco industry was invincible. Smoke when you are happy, sad, thin, short, fat, worried, black, bored, white, blue and green. They hired the best spin-doctors, they lied about science, they captured the mood, they had the country, they had the colour, the race, even the saliva, all sorted out. Our children were and continue to be their next targets. And then, in 1994, Minnesota happened. In a 15-week court trial that saw several CEOs of tobacco companies testify – the case went up to the US Supreme Court – the bottom was blown out of Big Tobacco seven i.e. Philip Morris, Inc, RJ Reynolds Tobacco Co, Brown and Williamson Tobacco Corp, BAT Industries plc, Lorillard Tobacco Co, American Tobacco Co, Liggett Group Inc.
Roberta Walburn – lead litigator of the Minnesota law firm, Robins, Kaplan, Miller and Ciresi – blasted her way into tobacco industry vaults, forcing them to release documents including scientific evidence the world had never seen before. In what was to become the fourth largest settlement in the history of the world, tobacco companies were asked to pay $6 billion to Blue Cross Blue Shield and the State of Minnesota for having lied about how they marketed their death machine. More importantly, over 40 million documents were now in the public domain – documents that told a terrifying tale of lies, deception, corruption and greed that caused death, devastation and disease. The US Surgeon General, Everett M Koop called the court case one of the greatest public health achievements of the 20th century.
Geneva, Switzerland 1998
Outraged by this mounting evidence of manufactured death and disease, Dr Gro Harlem Brundtland – former Norwegian Prime Minister who took over as the first woman Director General of the World Health Organisation (WHO) in Geneva – called on health ministers from WHO’s 194 member countries to take decisive action to stop and reverse this death machine. “I am a doctor. I believe in science and evidence…tobacco should not be advertised, glamourised or subsidised”, she said as she called for legally binding action. She created the Tobacco Free Initiative (TFI) and appointed Dr Derek Yach, an epidemiologist and health activist from South Africa as its head with clear instructions – do what it takes to expose the tobacco industry and ignite and catalyse public health action. Dr Douglas Bettcher, a medical doctor from Canada and I were among a handful of people brought on board to help get TFI off the ground. Within three months, Dr Brundtland chaired a meeting of international agencies, journalists and lawyers including members of the Minnesota team to identify ways to protect health and counter the tobacco industry.
In 1999, Dr Brundtland initiated a previously unutilised power of the WHO to develop a Framework Convention on Tobacco Control (FCTC) as the world’s first treaty devoted entirely to public health. She invited Brazil’s formidable diplomat, Celso Luiz Nunes Amorim – then Ambassador to the United Nations and the World Trade Organisation in Geneva and currently Brazil’s Minister of Defense – to chair the negotiations. Amorim’s negotiating skills in the international arena, especially international trade, is the stuff of legends and he played a key role in the Doha declaration which offers important clarifications on trade and health (TRIPS).
In a bold and unprecedented move, Dr Brundtland also set up an enquiry at the WHO to see if tobacco companies had infiltrated the organisation. Working with Roberta Walburn, Dr Yach and I documented preliminary evidence that unequivocally showed tobacco industry presence and manipulation in key WHO committees. Dr Thomas Zeltner, a lawyer-doctor and for 18 years the Director General of Switzerland’s National Public Health Authority and one of the world’s finest public health experts, led the enquiry. India was among the countries that refused to join him – all Indians who were asked said, without exception, that it was too dangerous to antagonise an economic power as large and influential as the tobacco industry. The Zeltner committee report was a bombshell. It showed how top executives of the tobacco industry sat together to design and set in motion elaborate strategies to subvert the WHO. Documents revealed many “tactics” use by the tobacco industry to – attack the WHO, discredit key individuals, allocate resources to stop WHO in their tracks, work with (and pay) journalists to question WHO priorities, establish front groups like the international tobacco growers association, to lobby against WHO, and undertake long-term programmes to discredit tobacco control activities worldwide.
As we went about our work at the TFI, the tobacco industry, their public relations companies and lobbyists complained that they were not being given a voice. The WHO responded by announcing the first-ever public hearings in the history of the United Nations system so the public could judge the importance of exposing the tobacco industry as the most critical step in tobacco control.
Around the same time, Jeffrey Wigand, a tobacco industry whistleblower was telling the true story of the nicotine-delivery device, the tobacco industry’s name for a cigarette to Hollywood filmmakers and stars Michael Mann, Al Pacino and Russell Crowe. The Hollywood blockbuster, The Insider, was born out of this collaboration. Some courageous countries like Thailand, Brazil, South Africa, Canada, Australia and Ireland began to take on the tobacco industry and counter their deadly tactics. Thailand was especially concerned about trade snuffing health out. The world of public health could not have asked for anything better than the combined intellectual force, stamina and vision of Walburn, Amorim and Zeltner. Suddenly it seemed as if the tobacco industry had nowhere to run and nowhere to hide.
Working together with Dr Franklin Apfel, who was then head of communication at WHO’s European office in Copenhagen, Denmark, we designed the WHO’s first global media advocacy campaign “Tobacco Kills – Don’t be Duped” in 17 pilot countries. The campaign was launched by Jeffrey Wigand.
This media advocacy initiative was followed by the creation and launch of the Framework Convention Alliance (FCA) which we called “Channeling the Outrage” and brought together leading members of civil society from around the world. The world’s first public health treaty was sincerely pursued and constructed. Big Tobacco, however, quickly adapted their tactics and saw an opportunity in the treaty and systematically and steadily made themselves part of the process. Knowing fully well that the WHO is driven by its member-states, they shaped and influenced the treaty through “receptive”, well “scripted” and paid-for country delegations, diplomatic missions, civil society, media and academia. They bought influence and gathered intelligence about potential supporters and opponents. The tobacco industry was able to use the FCTC development process to help guide their expansion into globalised markets. Their losses in the developed markets were offset by millions of new smokers in the developing world, some as young as three. The Marlboro Man rode out of the West into the Indian sunset.
Tobacco kills six million people a year in the world today – one million in India alone. Eight million people will die yearly by 2020, with large developing countries carrying a major part of the disease burden. The FCTC negotiations were completed in 2003 and it entered into force in 2005 with 40 ratifications. Today 176 countries have signed the treaty, accounting for 90% of the world. The FCTC process and commitments include vitally important public health policy initiatives that have been shown to reduce tobacco uptake and use. Clearly, the FCTC has been a significant public health victory. However, tobacco stocks continue to rise and tobacco use is spreading in countries like India, China, large parts of Africa and Eastern Europe. Smoking among women is on the rise.
What happened? According to Dr Zeltner, the tobacco industry probably realised very early in the process that the FCTC was in their interest because they knew that the world of public health was naïve, malleable and even corrupt.
“Tobacco kills – I hope my children will never smoke”, the CEO of a tobacco company had told us during the public hearings. Was that a slip or a spin? Was he telling us the tobacco industry had factored in short-term “losses” with their “own” children, but long-term gains with those in the developing world. “They will stop at nothing. The tobacco industry is ruthlessly organised. Never forget that”, Roberta Walburn had told me in 2000.
The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COPTA) is India’ main law governing tobacco control. India became party to the FCTC in 2004.
India adds 5,700 new cigarettes smokers a day and tobacco kills 3,300 people daily – the new recruits largely compensating for deaths in India and worldwide. It is the only freely available consumer product that kills one in two regular users. Earlier this year, Dr Zeltner told The Economic Times that the tobacco industry works with the foreign offices of nations as well as their secret service and that countries such as China and India were areas of targets.
The government of India says there is no evidence based nation-wide study to determine the impact of tobacco control on tobacco-related deaths in India. In other words, a decade after India enacted its tobacco legislation and a decade after the FCTC was signed, India does not have national data and is dependent on international studies such as the Global Adult Tobacco Survey (GATS).
Could tobacco industry activities have anything to do with this? Is the tobacco industry active in India? In July 2013, the Supreme Court of India slammed the government for colluding with the tobacco industry and failing to impose marketing guidelines and labeling guidelines. “While the nation is pre-occupied with Coalgate, Railgate and IPL match-fixing, we are completely missing out on one of the greatest tragedies to afflict our nation – this scam is what I call Tobaccogate which is causing 3,300 deaths every day”, says Dr Pankaj Chaturvedi, noted cancer surgeon and tobacco control activist at the Tata Memorial hospital in Mumbai. “How can we promote an industry selling death and disease to every third Indian? How can we get justice in this regard when many of our Cabinet ministers and opposition leaders are legal counsels representing the tobacco industry and earning fat legal fees? How can we expect action against Tobaccogate while all political parties are being funded by huge donations from the tobacco industry”, asks this doctor who received the World No Tobacco day (WNTD) Award from the New York-based Campaign for Tobacco Free Kids (CTFK) earlier this year. In September, the government of India is hosting an international meeting of tobacco control experts to discuss what it calls endgame strategies.
Some Ministry of Health officials say it is premature to talk about an endgame in India. They are not alone. “The use of the term ‘endgame’ implies that conditions are in place to be certain that the end of tobacco use and harms associated with tobacco are assured”, said Dr Yach who is now Executive Director, Vitality Institute (US). “With 1.3 billion smokers around the world, with tobacco use increasing among girls and young women in most countries, with a lag-phase between these trends and almost certain tobacco deaths likely, with modest and slow progress in tobacco control in the world’s largest countries …contemplating an endgame seems a fruitless pursuit that could distract policy-makers away from thinking differently about options for accelerated tobacco control and separating the deadly consequences of tobacco from how we address nicotine use”, he added. He should know, considering he led the core team for WHO to fight Big Tobacco with the FCTC.
This is Part One of a two-part series. The author is writing a book on global tobacco control and India.