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NCAS MONTHLY BULLETIN April 2024


NCAS and 55 other Public Health Organisations Issues Formal Complaint Regarding CPD Offerings Sponsored by Philip Morris International(PMI).

NCAS and the public health community of South Africa issued a letter to the  the Health Professions Council of South Africa (HPCSA) voicing concerns involving the sponsorship of CPD activities by Philip Morris International (PMI), a major tobacco company.

 

In November 2023, a registered Independent Practitioner Association (IPA) (the Alliance of South African Independent Practitioners Associations or ASAIPA) hosted a continuing professional development (CPD) programme with sponsorship from Philip Morris International (PMI). This event took place as Parliamentary Hearings were taking place around the country on the Tobacco and Electronic Delivery Systems Control Bill that the Department of Health is hoping to have adopted.


Accepting funding of CPD from a tobacco company is unethical and stands contrary to the provisions of both the Tobacco Products Control Act 83 of 1993 and the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) to which South Africa is a signatory.


The letter calls on the HPCSA:

  • to investigate the circumstances under which ASAIPA held a CME/CPD event sponsored by PMI.

  • to draw up guidelines for CPD accreditors and providers to ensure there is no doubt that any entity linked to the tobacco industry should be precluded from funding any CPD activities that are registered with the HPCSA. CPD accreditors should require a declaration in all applications that there is no subsidisation from the tobacco industry, as is applied by WHO in all their events. 

  • to alert the Minister of Health to the fact that the tobacco industry has been actively attempting to influence doctors’ opinions. through sponsorship of CPD activities.


The HPCSA has acknowledged the letter and have indicated that they will investigate the matter and revert back.




Cigarette Butts and Disposable E-Cigarettes Feature at the Plastic Treaty Talks (INC-4) 

The fourth session of the Plastic Treaty, Intergovernmental Negotiating Committee (INC-4) meeting in Ottawa, Canada which ended on 29 April, presented an opportunity to address cigarette butts and disposable e-cigarettes as sources of plastic waste. 


At the WHO Framework Convention on Tobacco Control (WHO FCTC)’s 10th Conference of the Parties (COP 10), Inger Andersen, Executive Director of the United Nations Environment Programme (UNEP), expressed UNEP's readiness to implement relevant decisions adopted at COP10. This included integrating the FCTC into the global environmental agenda, particularly in ongoing negotiations for the UN Treaty to End Plastic Pollution. The WHO FCTC COP 10, adopted a decision recognising “that plastic cigarette filters are unnecessary, avoidable and problematic, single-use plastics that are widely spread in the environment, killing microorganisms and marine life, as well as polluting oceans.”   


The aim of the INC-4 was to advance the existing treaty text that was developed during the INC-3 in Kenya, so that it can be finalized at the last meeting, to be held towards the end of 2024 in Busan, South Korea. UNEP’s Zero Draft contained promising recommendations, including a proposal to ban or phase out problematic single-use plastics.  


Talks on Cigarette filters and disposable vapes featured at the INC-4 

  • The Stop Tobacco Pollution Alliance, an alliance of over 100 organisations attended the INC-4 of the United Nations Treaty to End Plastic Pollution, keeping the conversation of listing of cigarette filters and disposable e-cigarettes as problematic single-use plastics in the Plastic Treaty alive. 

  • Panama, which hosted the WHO FCTC COP 10 negotiations pushed for the alignment of the Plastic Treaty with the WHO FCTC, at the INC-4 calling for the inclusion of the WHO FCTC in the preamble of the Plastics Treaty. 

  • Peru called for cigarette filters to be banned with Panama quickly showing support.  

  • Switzerland included cigarette butts as a prime example of useless polluting plastics in a submission on dealing with various plastics and plastic products.  

  • Cigarette filters also fit the criteria proposed by Switzerland, for determining which plastics should be banned outright.  

  

Industry Influence -  The Centre for Environmental International law (CIEL) reported that 196 lobbyists for the fossil fuel and chemical industry registered for the INC-4, a 37% increase from the 143 lobbyists registered at INC-3. Civil society requested for the INC to apply “Article 5.3 of the FCTC and use it as a minimum standard to set up policies and procedures to protect the negotiations and implementation of the plastics treaty from conflicts of interest and adopt codes of conduct consistent with those policies. Article 5.3 should then be used by the Secretariat and the INC as a model for policies that protect against other conflicts of interest from the petrochemical and plastics industries.” 





New Research Alert.

Malone, Ruth E. "Stop Industry Sponsorship of Continuing Medical Education."

British Medical Journal  385 (2024). 385:q950.


The research highlighted a concerning development on PMI’s attempts to embed itself within medical education. The research reveals how Medscape, a platform offering continuing education for healthcare professionals, was found to be promoting a series on smoking cessation sponsored by the tobacco company Philip Morris International (PMI). This revelation sparked criticism due to the stark incongruity of educational initiatives for medical professionals being financially supported by a tobacco giant responsible for an estimated one million deaths annually. 

  

Following backlash from clinicians and healthcare professional organizations regarding course content—such as the omission of smoking cessation as a suggested option for patients seeking to reduce their lung cancer risk—Medscape removed the content and now claims to have implemented a policy against accepting tobacco industry funding for educational programs. However, the company also asserts that the content complied fully with accreditation standards set by the Accreditation Council for Continuing Medical Education. If accurate, this underscores the urgent need for an upgrade in accreditation standards. 



Swarnata, Arya, et al. "The Impoverishing Effect of Tobacco Use in Indonesia."

Nicotine and Tobacco Research (2024): ntae088. 


The study highlights that tobacco consumption in Indonesia is not only crucial for public health but also for poverty reduction. The findings highlight that tobacco expenditure diverts resources away from essential commodities, leading to a decrease in the standard of living for smoking households, particularly in rural areas. 

To combat this issue, policymakers should implement comprehensive tobacco control measures aimed at reducing smoking prevalence and tobacco-related health care costs. This could include increasing tobacco taxes, implementing smoke-free policies, and funding public health campaigns to raise awareness about the harmful effects of tobacco use. 

  

Study Results.

Accounting for unproductive spending related to tobacco use, Indonesia’s headcount poverty ratio in March 2021 would rise by 3.22 percentage points, equivalent to an additional 8.75 million people living below the poverty line. In addition, the poverty gap index would increase by 0.77 percentage points. The impoverishment effect of tobacco is larger among rural populations than their urban counterparts. Moreover, the impoverishment is mainly driven by direct tobacco spending rather than tobacco-attributable health care expenditure. 


Significant portions of Indonesia’s population are exposed to secondary poverty due to tobacco use. A high level of cigarette spending among smoking households is the major source of the impoverishing effect of tobacco use. 



Ernesto M Sebrié, et al, “Tobacco packaging and labeling policies in the WHO African Region: Progress 15 years after adoption of the WHO Framework Convention on Tobacco Control Article 11 Implementation Guidelines 

Nicotine & Tobacco Research, 2024; ntae080.

  

The study highlighted the need for concerted efforts to strengthen tobacco packaging and labelling policies in the WHO African Region (AFRO) in alignment with the WHO Framework Convention on Tobacco Control (FCTC) Article 11 and its Implementation Guidelines. It highlights the progress made by several AFRO countries in adopting tobacco packaging and labelling policies consistent with the WHO FCTC guidelines. However, it also underscores the disparities between countries, particularly in terms of income level, with higher-income countries generally having stronger policies. 

  

Study Results.

Forty (of 47) AFRO countries adopted national laws, of which a majority adopted large rotating pictorial HWLs and banned misleading descriptors; only Cote d’Ivoire and Mauritius adopted standardized packaging. The higher a country is in the World Bank’s income-level group, the stronger their packaging and labelling policies are. This observation was not present in the sub-policy area of HWLs. Prior to approving the WHO FCTC Article 11 Implementation Guidelines, only 23 countries adopted text-only HWLs whereas 26 countries adopted pictorial HWLs after the approval. 


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