Tobacco remains the biggest public health threat, killing more than seven million people globally every year. The World Health Organization has recognised progress in Nigeria, but concerns remain about effective implementation, write researchers Catherine O Egbe, Stanton Glantz and Stella A Bialous for The Conversation.
Nigeria is a key tobacco industry market in Africa because of its population size and access to other markets in the region. One of the largest publicly traded tobacco companies in the world, British American Tobacco, built a state-of-the-art manufacturing plant in the country in 2003 to service West African countries. In 2016, BAT opened its new West Africa Head Office in Lagos.
A Global Adult Tobacco Survey done six years ago estimated that 4.5 million Nigerian adults smoked. The country has an estimated population of 198 million. Nearly a third of the adult population was exposed to second-hand smoke.
Nigeria started trying to regulate tobacco smoking in the 1970s. But it only enacted its first tobacco smoking control decree in 1990. This made Nigeria one of the first African countries to regulate tobacco. But the decree became less and less relevant because the government didn’t raise public awareness or prioritise implementation.
Nigeria’s 2015 National Tobacco Control Act was an improvement on the 1990 Act because, among other things, it:
- Regulated the interaction of government and industry.
- Regulated e-cigarettes, and other tobacco products.
- Established the National Tobacco Control Committee (a multi-sectorial coordinating mechanism) and a Tobacco Control Fund.
- Stipulated more stringent measures for violating the law.
But the law had lots of loopholes. And three years later it still hasn’t been implemented.
Why implementation is moving so slowly
The non-implementation of the 2015 tobacco law is due to problematic clauses slipped in late in the process of passing it.
In particular, the act includes the unprecedented requirement that regulations prepared by the federal ministry of health must be approved by the National Assembly. This additional step slows down the process. It also provides another opportunity for the tobacco industry to block progress.
The regulations have not yet been submitted to the National Assembly.
The law also requires the Standards Organisation of Nigeria, a body that regulates products, to issue guidelines for regulating tobacco products.
A major problem with the organisation is that the tobacco industry dominates its processes. For example, tobacco industry representatives outnumber those from other agencies on the committee that writes the guidelines.
The Standards Organisation has defended this situation by saying it is mandated by law to include the industry. But having the tobacco industry on the committee is a serious impediment to developing effective regulations.
Another problem with these guidelines is that they only cover cigarettes at present, not all tobacco products. This leaves snuff, hookah, pipe, and e-cigarettes without any regulatory guidelines.
The tobacco industry in Nigeria is aware of every move the government makes even before new measures are introduced. This is because it has representatives on the regulatory committee as well as through membership of the National Tobacco Control Committee. This means that the industry is in a position to mobilise against any new regulations.
These situations represent clear conflicts of interest and violate Article 5.3 of the WHO’s framework which commits parties to insulate public health policy making process from the tobacco industry’s interference.
Fresh efforts have been made to close the loopholes in the 2015 law by getting an updated law through the Senate. This includes ensuring that there is zero industry interference
Because of its size, Nigeria has the potential to boost the global anti-tobacco movement. But this requires it to have comprehensive laws in place that are compliant with the Framework Convention on Tobacco Control. And that are properly implemented and evaluated.
Advocates and policy-makers in other African and low- and middle income countries should learn from Nigeria’s experience and focus on making laws that are strong from the outset.
And since the tobacco industry is a major threat to comprehensive and effective tobacco control policies, countries should ensure strict compliance with the framework to ensure non-interference – direct or indirect.
The other step the Nigerian government needs to address is the fact that tobacco control is massively underfunded. Tobacco control is mostly funded by international donor agencies rather than the government. It’s time the government took responsibility for the lives of its people and adequately fund tobacco control activities.
* Catherine O Egbe, PhD, is a Specialist Scientist in the Alcohol Tobacco and Other Drug Research Unit at the South African Medical Research Council. Stanton Glantz is professor of Medicine at the University of California, San Francisco. And Stella A Bialous is an Associate Professor in School of Nursing and Center for Tobacco Control Research and Education at the University of California, San Francisco.
Role of stakeholders in Nigeria's tobacco control journey after the FCTC: lessons for tobacco control advocacy in low-income and middle-income countries.
Catherine Egbe, Stella A Bialous and Stanton Glantz.
Nigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. Tobacco control advocates in Nigeria achieved some success in countering tobacco industry interference to implement the FCTC.
We triangulated interviews with key informants from local and international organisations who worked in Nigeria with documentation of the legislative process and Nigerian newspaper articles. Data were analysed and interpreted using the Policy Dystopia Model and WHO categories of tobacco industry interference that had been developed mostly based on experience in high-income countries.
As in high-income countries, the tobacco industry continued to oppose tobacco control policies after Nigeria ratified the FCTC, including weakening Nigeria's 2015 National Tobacco Control Act. Both tobacco control advocates and industry used discursive (argument-based) and instrumental (activity-based) strategies.
The industry argued self-regulation and the economic importance of tobacco. They exploited legislative procedures, used front groups and third parties to push for pro-industry changes. Advocates, with help from international organisations, mobilised prominent Nigerians and the public.
Advocates pre-empted and countered the industry through traditional and social media, monitoring and exposing tobacco industry activities, and by actively engaging lawmakers and citizens during the legislative process.
The Policy Dystopia Model and WHO categories of industry interference provide a helpful framework for understanding tobacco control debates in low/middle-income countries (LMICs) as in high-income countries.
One difference in LMIC is the important role of international tobacco control advocates in supporting national tobacco control advocates. This partnership is important in pushing for FCTC-compliant legislation and countering industry activities in LMIC.
The vector of the tobacco epidemic: Tobacco industry practices in low and middle-income countries.
S Lee, PM Ling and Stanton Glantz
To understand transnational tobacco companies' (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use.
Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries.
TTCs' strategies used in low and middle-income countries followed four main themes-economic activity; marketing/promotion; political activity; and deceptive/manipulative activity.
Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment.
TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts.
TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.
[link url="https://theconversation.com/nigeria-isnt-doing-enough-to-reduce-tobacco-use-heres-why-108695?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20January%208%202019%20-%201206311070&utm_content=Latest%20from%20The%20Conversation%20for%20January%208%202019%20-%201206311070+CID_2e80cc1ed68feabafef98b51e6c0ea62&utm_source=campaign_monitor_africa&utm_term=explain"]Nigeria isn’t doing enough to reduce tobacco use. Here’s why[/link]
[link url="https://www.ncbi.nlm.nih.gov/pubmed/30045974"]Role of stakeholders in Nigeria's tobacco control journey after the FCTC: lessons for tobacco control advocacy in low-income and middle-income countries.[/link]
[link url="https://www.ncbi.nlm.nih.gov/pubmed/22370696"]The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries.[/link]