Thousands of Nigerians lose their lives yearly to tobacco-related diseases. But, as the 2023 Tobacco Industry Interference Index shows, tobacco entities are still exploiting legal loopholes to interfere in tobacco control at the risk of public health ROBERT EGBE reports.
The rumour that Mr. Friday had been diagnosed with cancer did not shock his neighbours at Pedro, a community in Shomolu Local Government Area (LGA) of Lagos. They all knew the junior policeman as a chain smoker and heavy marijuana user.
“I remember that my parents and other neighbours were concerned,” Patrick (pseudonym), who lived next door, said. “It got to a year when he was always coughing heavily, his breathing was laboured, and he stopped going to work. He soon relocated to his hometown in Bayelsa. We were not surprised about a year later to hear that he was dead.”
Friday is one of the casualties of the global tobacco epidemic. Many struggle to break cigarette addiction but find it an uphill task. According to the United States Food and Drug Administration (FADA), cigarettes, e-cigarettes, and other tobacco products are so hard to quit because they contain nicotine, a highly addictive chemical that keeps people using tobacco products, even when they want to stop. Millions of other Nigerians are in that trap. A 2019 study titled “Current prevalence pattern of tobacco smoking in Nigeria: a systematic review and meta-analysis” estimated that “one out of ten Nigerians still smokes daily.”
How the law regulates tobacco industry
Concerned by the problem, Nigeria has enacted tough regulations against cigarette advertising and consumption. Some of the regulations that were designed to check the industry include Nigeria’s National Tobacco Control (NTC) Act which was signed into law on 10 June 2015 covers several areas of tobacco control including regulation of smoking, the prohibition of tobacco advertising, promotion and sponsorship, regulation of tobacco products, contents and product packaging, licensing, and protection from tobacco industry interference, among others.
Regulations for implementing the Act, which came four years after and is now known as the National Tobacco Control (NTC) Regulations 2019, provide more clarity on stakeholders’ obligations for effective tobacco control.
Nigeria is also a signatory to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) which entered into force on January 18, 2006.
Exceptions in the law
But there are exceptions in the law regulating tobacco entities, the most notable of which can be found in Section 12(2) of the National Tobacco Control Act, 2015. The section states, among others, that the provisions of subsection (1) do not apply to communication between manufacturers, retailers of tobacco or tobacco products and any consenting person who is 18 years of age or above.
Tobacco Industry Interference Index 2023
The tobacco industry seems to have found and is exploiting these loopholes to undermine efforts to check the tobacco problem.
Some of its tricks were exposed last November in the Tobacco Industry Interference Index 2023, published by Pan-African transparency watchdog Corporate Accountability and Public Participation Africa (CAPPA) with support from Bloomberg Philanthropies through the Centre for Good Governance.
‘Whilst Nigeria’s National Tobacco Control Act and its Regulations have largely checked the activities of tobacco corporations and entities, the industry has exploited some weaknesses in these laws and gaps in the system to interfere in tobacco control,” said CAPPA’s Executive Director, Akinbode Oluwafemi at the launch of the report in Lagos.
One such tactic, Akinbode noted, “is the tobacco industry’s use and loud celebration of its Corporate Social Responsibility (CSR) activities in the media and on social platforms as a way of enhancing its image to attract unsuspecting individuals, thereby creating a perception of the industry and its products as responsible and desirable. These CSR initiatives are further promoted by the endorsement of state authorities, who associate and collaborate with the industry to execute socio-economic empowerment programs.”
The report, the third in the series, shows a marked deterioration in Nigeria’s rating from 53 points in 2021 to 60 in the period under review. It noted that the main deterioration was the government’s failure to adhere to transparency mechanisms, especially relating to demands it is supposed to make of the industry or disclosure of exchanges with the industry as mandated by the National Tobacco Control Act 2015 and the National Tobacco Control Regulations 2019. These breaches are exploited maximally by the industry to interfere in public health policy.
This report x-rays industry interference in policy development in Nigeria, their misleading Corporate Social Responsibility (CSR) activities, benefits the tobacco industry enjoys, unnecessary interactions between the industry and public officials, transparency mechanisms in government dealings with the industry that are not strictly adhered to, conflict of interest and preventive measures, among others. The report reinforces the importance of Parties adhering to the WHO FCTC guidelines which requested Parties to protect their tobacco control policies from commercial and other vested interests of the tobacco industry (Article 5.3).
An industry’s tricks
According to the report, the main deterioration in tobacco industry interference in 2023 is manifest in the Nigerian government’s challenges and failure to adhere to transparency mechanisms, and disclosure of exchanges with the industry as mandated by the National Tobacco Control Act 2015 and the National Tobacco Control Regulations 2019. These breaches, the report noted, are exploited maximally by the tobacco industry to interfere in public health policies and deliberations. The report also flagged other areas of concern which include:
“The unnecessary and unhealthy interaction between the tobacco industry and public officials, mostly in the agriculture sector where top government officials have been documented in several instances, participating in the industry’s activities and openly lauding them.
“The tobacco industry’s use and loud celebration of its Corporate Social Responsibility (CSR) activities in the media and on social platforms as a way of enhancing its image to attract unsuspecting individuals, thereby creating a perception of the industry and its products as responsible and desirable. These CSR initiatives are further promoted by the endorsement of state authorities, who associate and collaborate with the industry to execute socio-economic empowerment programs.
“The weak enforcement of preventive measures, including ambiguities in the National Tobacco Control Act (NTCA) 2015 and its Regulations of 2019. These challenges inadvertently allow the tobacco industry to operate without accountability in certain instances. For instance, while the NTCA mandates the tobacco industry to submit annual reports on tobacco and tobacco products, it also retains that the Minister may choose to either disclose or withhold this information from the public. This optional transparency makes it difficult for public health advocates to verify whether compliance is being enforced or not.
“The industry’s continued participation in policy development in Nigeria such as its enjoyment of invitations from the government interagency bodies and agencies to meetings where classified resolutions on public health are reached.”
Tobacco industry promoting `false evidence’, says WHO
Barely a month after CAPPA’s report, the WHO accused the tobacco industry of even worse conduct: spreading misinformation and deliberately recruiting children when marketing e-cigarettes.
The industry “funds and promotes false evidence to argue that these products reduce harm,’’ the UN agency said in Geneva on December 14, 2023, and called for stricter regulations for such products.
WHO chief Tedros Adhanom Ghebreyesus warned in a statement that, “Kids are being recruited and trapped at an early age to use e-cigarettes and may get hooked to nicotine.’’
The WHO wants countries to make e-cigarettes less attractive by banning flavours, reducing the nicotine content and levying taxes on the products.
E-cigarettes are advertised by tobacco companies as nicotine products that can reduce health risks compared to conventional cigarettes.
The WHO points out that the use of electric nicotine vaporizers also produces toxic substances that can cause cancer and increase the risk of cardiovascular disease.
In addition, unborn children could be harmed in the womb and the mental development of underage consumers could be impaired, it said.
The organisation said children ages 13 to 15 are using e-cigarettes at a higher rate than adults in all WHO regions.
The group noted that in Canada, the rates of e-cigarette consumption among teens ages 16 to 19 doubled between 2017 to 2022.
In England, the number of young users has tripled in the past three years.
The WHO says that e-cigarettes are not a suitable alternative for reducing the consumption of tobacco, but rather increase the likelihood of users turning to conventional cigarettes due to their addictive effect.
Disastrous tobacco consumption consequences in Nigeria
No fewer than 26,800 tobacco-related deaths are recorded annually in Nigeria, the Federal Government disclosed last May.
The National Coordinator, Non-Communicable Diseases Division of the Federal Ministry of Health, Dolapo Sanni, who spoke in Abuja at the launch of a research report on tobacco taxation and health financing in Nigeria, described the tobacco epidemic as one the biggest public health threats the world has ever faced.
The research, conducted by the Civil Society Legislative Advocacy Centre and Tax Justice Network Africa, was titled, ‘Tobacco taxation and health financing in Nigeria beyond COVID-19 era’.
The findings largely corroborate a 2021 study by the Centre for the Study of Economies of Africa (CSEA) which put the annual deaths at 28,876.
CSEA’s research further found that smoking-related ailments burden the Nigerian healthcare system with a direct annual treatment cost of N526.45 billion, which was equivalent to 0.36 per cent of the Nigerian GDP in 2019, and 9.63 per cent of the country’s annual healthcare spending.
Chronic obstructive pulmonary disease (COPD) was the top cause of smoking-attributable mortality, followed by ischemic heart disease, stroke, passive smoking, lower respiratory tract infection, and cardiovascular deaths of non-ischemic cause.
Adding up productivity losses due to illness, early deaths and informal caregivers, tobacco-related diseases represented 0.44 per cent of the GDP in 2019, according to the study.
Another study on the estimated benefits of increasing cigarette prices through taxation on the burden of disease published in 2022 in the PLOS ONE journal, found that tobacco’s total economic burden accounts for ₦634 billion annually, considering direct treatment costs, productivity losses (due to early mortality and disability) and informal caregiving cost. It added that in Nigeria, the tax revenue generated by the sale of cigarettes (and other tobacco products) was around ₦36 billion in 2019, which covered only 6.9% of the direct medical costs of smoking, or 5.7% of the total financial burden.
Solving the problem
To address tobacco industry interference challenges, the report urged the Nigerian government to implement the National Tobacco Control Regulations 2019 fully, and also review ambiguities in the law so they do not provide revolving doors that the tobacco industry can exploit to interfere in public health and other government policies.
“The Nigerian government must work to ensure that public officials in relevant ministries, departments and agencies sign conflict-of-interest forms periodically to remind them of commitments or obligations that may compromise their office and operations,’’ said Zikora Ibeh, Policy and Research Officer of CAPPA.
Additionally, the report also tasked state authorities to build intergovernmental synergy at all levels by establishing clear protocols for the full disclosures of minutes and proceedings from meetings and interactions with the tobacco industry. To begin, it advised relevant Ministries, Departments and Agencies (MDAs) to consistently update their websites and other information platforms to facilitate the easy dissemination of information and engender transparency.
