29 July 2021
Talha Khan Burki. Source: The Lancet
The COVID-19 pandemic does not seem to have done much damage to the tobacco industry. “Beyond disruption to supply chains, analysts believe the short-term impact of COVID-19 on the tobacco industry will be relatively limited”, states British American Tobacco (BAT) on their website. They add that “it is likely that key cigarette volumes were only slightly lower than expected in 2020”. Having started the year by worrying about reduced consumption and stock shortages occasioned by factory closures, by the end of 2020 the major tobacco firms were raising their sales and profit targets. Moreover, the industry has keenly exploited the opportunities provided by the pandemic to engage with government bodies and join in with relief efforts. If policymakers, especially in low-income and middle-income countries (LMICs), do not remain vigilant, the tobacco industry might emerge from the COVID-19 pandemic in better shape than it went into it.
The most visible activities over the past 18 months or so have involved so-called corporate social responsibility, largely in the form of donations of equipment or cash. Article 5.3 of the WHO Framework Convention on Tobacco Control (WHO FCTC) recommends that parties reject partnerships with the industry. “When the tobacco industry makes donations or invests in a community, it is not doing so out of generosity; there are always strings attached”, points out Dr Adriana Blanco Marquizo, head of the secretariat of the WHO FCTC (Geneva, Switzerland). “They will try to use corporate social responsibility as leverage and will later pressure countries not to institute strong tobacco control measures.”
Still, it is hard to blame cash-strapped governments from accepting assistance during a crisis of the magnitude of COVID-19, especially given the scarcity of medical supplies in the early days of the pandemic. By the end of May, 2020, Phillip Morris International (PMI) had donated more than US$31 million to countries struggling to contain COVID-19. The company has stated that they expect to continue these efforts through 2021.
“As soon as the pandemic hit, the industry started to capitalise”, explains Tom Hird, research fellow at the Tobacco Control Research Group at the University of Bath (Bath, UK), a research partner in STOP, a global tobacco industry watchdog. “They wanted to burnish their reputation through corporate social responsibility, but they also wanted to protect themselves from any potential fallout from a pandemic driven by a respiratory virus, given the health context of smoking.” Building and strengthening relationships with policymakers and government departments means that tobacco industry executives can subsequently get in touch to lobby for delays in tax hikes or smoke-free legislation.
The scale of activity suggests a concerted global effort. There have been donations of personal protective equipment (PPE) and hand sanitiser in Bangladesh. Testing kits have been distributed in Indonesia. Costa Rica has received face masks. In several countries, including Greece, the industry has donated ventilators. The Romanian Red Cross accepted a substantial financial donation to assist with its response to COVID-19, as did Italy’s state-run National Civil Protection Department, and a Ukrainian charity overseen by a former state secretary of the ministry of health (the money was used to purchase PPE for border guards).
“Some of the countries to have received the most eye-catching donations include those with a large population of smokers, like Brazil, India, and the Philippines, and those with extraordinarily high smoking prevalences for their region, like Greece”, said Hird. “The industry is putting this focus on hospitals and medical supplies, all with the aim of gaining access to policymakers and distracting from the colossal and continuing harm of the tobacco epidemic.” He added that while high-income countries are in a position to turn down donations of money or key medical supplies without facing serious consequences, LMICs cannot do so.
The industry has made direct connections to the offices of high-ranking politicians. Government funds in India, home to 100 million smokers, received over $36 million in donations from tobacco companies. The corporate social responsibility activities were publicised on the Twitter account of the Prime Minister.
“The tobacco industry has a long history of trying to generate favourable public relations out of crisis situations”, said Robert Jackler, principal investigator at the Stanford University Research into the Impact of Tobacco Advertising facility (Stanford, CA, USA). “They claim corporate responsibility, even though they are selling a product that kills more than 8 million people a year, and they do everything they can to undermine tobacco control legislation or to skirt round it.”
Indeed, in countries under lockdown, the industry lobbied strenuously to have their products included on rosters on essential goods. They have appealed against restrictions on production and manufacture of cigarettes in Argentina, Bangladesh, and the Russian Federation. In Brazil, PMI simply disregarded a ban on non-essential manufacturing and continued to produce cigarettes. BAT’s South African affiliate raised a court case, which proved successful, against the 5-month-long prohibition of tobacco sales enforced by the country last year.
As the pandemic took hold, vast amounts of research were generated. Much was published before peer review, under the assumption that the readership would highlight shortcomings and methodological flaws in the comments section. The so-called nicotine hypothesis, which contended that nicotine was protective against COVID-19, has its roots in preprint papers. Although there is no suggestion that these papers have been funded by the tobacco industry, a co-author on one publication received substantial funding from the industry-backed Council for Tobacco Research in the 1990s.
A prominent proponent of the nicotine hypothesis, Konstantinos Farsalinos, co-authored an editorial on the subject in Toxicology Reports with a former member of PMI’s scientific advisory board. Konstantinos Poulas, another co-author on the editorial, has received a grant from the PMI-funded Foundation for a Smoke-Free World (FSFW). Earlier this year, the European Respiratory Journal retracted an article co-written by Farsalinos and Poulas after discovering that Poulas and another author had failed to disclose conflicts of interest involving the tobacco industry. The retracted article was on risk factors for COVID-19. One of its conclusions was that “current smoking was not associated with adverse outcomes”.
The FSFW has called for research proposals to explore the link between nicotine use and COVID-19. “It serves the tobacco industry’s interest to promote the nicotine hypothesis, regardless of how weak the evidence may be”, said Hird. “It takes attention away from the terrible respiratory damage done by smoking.” The nicotine hypothesis could also help drive demand for heated tobacco products.
Late last year, several US lawmakers wrote to BAT and PMI. The authors accused the tobacco industry of using the COVID-19 pandemic “to unethically—and perhaps illegally—promote the sale of their tobacco and e-cigarette products, often on social media platforms primarily used by children and young adults”. They cited a research paper co-authored by Jackler, which outlined the ways in which manufacturers have aggressively marketed e-cigarettes during the pandemic. These included offering free gifts of items such as sanitisers, providing discounts to health-care professionals and essential workers, and implying that their products have health benefits. Face masks emblazoned with company logos have turned consumers into walking billboards.
Adverts for e-cigarettes have co-opted public messaging associated with the pandemic: “stay home and vape”, reads one; “keep calm and stay home”, reads another, illustrated with plumes of vapour. They have been placed on social media sites such as Instagram, which are extremely popular with teenagers and young adults. “This attempt to profit off the back of a global health crisis, reminiscent of decades of false and misleading advertising about cigarettes by tobacco companies, represents a callous indifference to the lives and well-being of millions of people across the world”, wrote the politicians.
Jackler notes that ever since the tobacco industry started marketing its products, it has attempted to hitch them to key trends and events. Adverts during World War One associated tobacco with victory. The industry would subsequently deploy the rhetoric of the suffragette movement with the “torches of freedom” campaign. Virginia Slims introduced the tagline “you’ve come a long way, baby” in the late 1960s, playing on the feminist themes of the era. “Today, we see the industry paying influencers on social media to push e-cigarettes, which they claim are harmless and cool, when in fact the whole point is to get a new generation addicted to nicotine”, said Jackler. “As soon as COVID-19 arrived, they recognised the opportunity that the pandemic presented.”
In which case, perhaps tobacco control advocates should follow suit. After all, the post-pandemic recovery will offer plenty of opportunity to tackle tobacco use. Governments could focus on tobacco taxes, for example. “Raising taxes reduces the consumption of tobacco, generates government revenues, and protects health systems from the strain of dealing with tobacco-related illnesses”, said Blanco Marquizo.
More broadly, policymakers could continue to emphasise the interlinked nature of health and economics, something the COVID-19 pandemic has made abundantly clear. “I hope countries will realise that there are measures in the WHO FCTC that will help them to have a healthier population and be more resilient for when the next pandemic arrives”, said Blanco Marquizo. “We need to keep in mind the connection of the events of the previous 2 years with public health; the single thing that would make the biggest difference to public health is ending the tobacco epidemic.”