Tobacco should be considered a pandemic – a slow-motion pandemic – that adds its lethal features to the ongoing COVID-19 outbreak.
The harmful effects of tobacco on human health have been well documented, but people are not often aware of the extent of that harm. It is widely known that tobacco causes lung cancer and, to some extent, heart disease. But other effects, such as strokes, diabetes and impotence – just to name a few – are less well known. And, more recently, people have begun to understand that the harmful effects of tobacco are not limited to those who smoke, but also to those around them.
Indeed, tobacco affects much more than human health; it is a development issue. Tobacco cultivation and manufacturing impact the environment through deforestation, desertification, soil degradation, and water and soil pollution. Cigarette butts are among the top plastic polluters. There are also enormous economic consequences of tobacco use and production on individuals, families, communities and countries. Tobacco use costs the global economy over US$ 1 trillion annually in medical expenses and lost productivity. In other words, the tobacco epidemic represents a threat to both global health and sustainable development.
Tobacco use is a common risk factor for noncommunicable diseases (NCDs), such as cardiovascular diseases, chronic respiratory diseases, diabetes and cancers. These pre-existing conditions leave those who contract coronavirus disease 2019 (COVID-19) at risk of developing more severe forms of the disease. Also, available research suggests that smokers have worse outcomes if they become infected by the SARS-CoV-2, the virus that causes COVID-19.
How tobacco control may support development?
Tobacco control is important to development and can help countries mitigate the COVID-19 pandemic and build sustainable communities. Even during these difficult times, the global tobacco control community is working tirelessly to contribute to the building-back-better processes at the global, regional and country levels. The Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC), led by Dr Adriana Blanco Marquizo, a medical doctor and public health professional from Uruguay, is an important member of this community.
The WHO FCTC was developed in response to the globalization of the tobacco epidemic and is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. It is the first international treaty negotiated under the auspices of the World Health Organization (WHO). It was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005, having now 182 Parties. The Convention represents a milestone for the promotion of public health and provides new legal dimensions for international health cooperation. Drawing on Article 15 of the Convention, which focuses on eliminating illicit trade in tobacco products, worldwide negotiations led to a new legally binding international treaty – the Protocol to Eliminate Illicit Trade in Tobacco Products. The Protocol entered into force in September 2018, marking yet another important milestone in the history of tobacco control and global public health. Sixty-two Parties to the WHO FCTC also have become Parties to the Protocol, and the number is growing.
Strengthening implementation of the WHO FCTC has been included in the Sustainable Development Goals (SDGs) as Target 3.a, as it contributes to the achievement of SDG 3, which calls for health and well-being for all at all ages, and more specifically to SDG 3.4, which calls for a reduction in premature mortality from NCDs. The inclusion of this specific target in the SDGs is further evidence of the importance of tobacco control as key contributor to sustainable development.
And the evidence is staggering: without adequate investment in tobacco control, it is estimated that up to 1 billion people could die from tobacco-related disease during this century. The number of tobacco-related deaths has been following an ascending curve, with more than eight million people dying annually due to tobacco-related diseases worldwide.
“Tobacco also should be considered a pandemic – a slow‑motion pandemic – that adds its lethal features to the ongoing COVID‑19 outbreak.”
A small group of committed people making a difference
The Convention Secretariat is a small but highly agile and committed team of 28 staff members, representing over 25 nationalities, dedicated to serving Parties to implement both the WHO FCTC and the Protocol. This is accomplished through direct technical cooperation to Parties to help them implement specific provisions of the treaties, including through the FCTC 2030 project and by assessing progress (through reporting systems) and sharing knowledge (success stories, tobacco-control knowledge hubs), serving the treaties’ governing and subsidiary bodies, raising awareness, mobilizing resources and promoting international cooperation.
The work of the Convention Secretariat is ruled by the decisions of their respective governing bodies: the Conference of the Parties to the WHO FCTC and the Meeting of the Parties to the Protocol.
The Convention Secretariat is also an independent member of the United Nations Inter-Agency Task Force on the Prevention and Control of Non-communicable Diseases and currently chairs the Task Force’s thematic group on tobacco control. In that group, the Convention Secretariat has led the development and promotion of a Model Policy on preventing tobacco industry interference among United Nations agencies, which was endorsed by the United Nations Economic and Social Council in 2017 and 2018.
The Convention Secretariat is a small but highly agile and committed team of 28 staff members, representing over 25 nationalities, dedicated to serving Parties to implement both the WHO FCTC and the Protocol.
There is much more work to do…
In October 2018, the Eighth Session of the Conference of the Parties adopted the Global Strategy to Accelerate Tobacco Control 2019–2025, which calls upon all relevant stakeholders to intensify efforts to work together to accelerate action and support implementation of the WHO FCTC by its Parties.
Also, there are new challenges, chiefly novel and emerging nicotine and tobacco products that are aggressively marketed by the tobacco industry in the same way it promoted cigarettes. The industry says they are targeting adult smokers, but the introduction of flavours and other attractive features seem to suggest that the more likely target population is young people. The diversity of these products is enormous, but they can be broadly divided in two groups: electronic nicotine (and non-nicotine) delivery systems that heat a liquid with or without nicotine; and tobacco heated products that consists of an electronic device that heats a tobacco stick. The Conference of the Parties has reviewed these developments on many occasions and has taken strong action. The Eighth Session of the Conference of the Parties in 2018  defined heated tobacco products as it would any tobacco product, therefore subject to the provisions of the Convention. Also, it recommended to countries “to regulate, including restrict, or prohibit, as appropriate, the manufacture, importation, distribution, presentation, sale and use of novel and emerging tobacco products, as appropriate to their national laws, considering a high level of protection for human health”.
…even during a pandemic
Tobacco control remains crucial during the COVID-19 pandemic, and it will be after the pandemic subsides. In fact, tobacco also should be considered a pandemic – a slow-motion pandemic – that adds its lethal features to the ongoing COVID-19 outbreak. A tobacco pandemic that was here before COVID-19 and will remain here after COVID-19 needs to be halted. Therefore, developing, sustaining and strengthening population-level interventions for tobacco control during the COVID-19 pandemic are vital.
Given the links between tobacco use and COVID-19, any recovery plan for the pandemic should be aligned with the WHO FCTC, and the Convention should be part of building-back-better strategies. Increasing tobacco taxes, for example, is a measure that can provide multiple wins: decrease tobacco consumption; increase government revenue; and save future costs to the health systems by preventing the onset of more NCDs. There has been never a better time than now to support tobacco users in their efforts to quit, since the COVID-19 pandemic has made nearly everyone in the world more aware of health in general.
The challenge ahead may, at times, seem insurmountable; however, the Convention Secretariat will keep working, in close partnership and collaboration with partners, especially the United Nations community, to help Parties “to protect the present and future generations from the devastating health, social, environmental and economic consequences of the tobacco epidemic”.
 The Convention Secretariat is the global entity responsible for supporting Parties in the implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) and the Protocol to Eliminate Illicit Trade in Tobacco Products (the Protocol).