British American Tobacco's erosion of health legislation in Uzbekistan

TOPIC

ORIGINAL DECREE ²¹

BAT RESPONSE IN MEETING WITH HEALTH MINISTER²⁴

Health impacts

1. Smoking belongs to the most widely spread bad habits and it is one of the main risk factors related in the development of chronic non-infectious diseases such as chronic bronchitis and emphysema, lung throat, larynx, mouth, gullet, pancreas, urinary bladder cancer, cardiovascular diseases. Smoking can essentially worsen the clinic [sic] course of such diseases as stomach and duodenum [sic] ulcer, chronic gastritis, etc, strongly influence the development of the heart-crowning artery [sic] sclerosis. Smoking has a strong negative influence on the women of fertile age and on the health of their children.

2. In Uzbekistan the number of people suffering from the diseases of breathing system, including those related to smoking, increased from 1.8m people in 1991 to over 2.0m in 1993, the number of people suffering from tumours increased from 106.2 thousand up to 136.8 thousand ……blood circulation system – from 731.1 thousand up to 824.2 thousand people….

3. Retrospective observation of the 40-57 year-old men in different cities of Uzbekistan showed that deaths caused by oncologic [sic] diseases occur 3 times more frequently, and deaths caused by the heart pathology 2.5 times more frequently among the intensive smokers compared to people who never smoke. 75% of the people suffering from the chronical [sic] bronchitis smoke or used to smoke.

4. In Uzbekistan 49% of men and 9% of women smoke. Among the 20-29-year- old-people 60% of men and 11% of women are smokers, among the 30-39-year-old-people – 53% and 15% correspondingly in the recent years the number of smoking children and teenagers tends to increase. …

5. Since recently the sales of tobacco products of foreign production frequently without documents confirming the quality of such products, have become widely spread in Uzbekistan. The Republic of Uzbekistan has no laws which restrict smoking, and the advertising of tobacco products goes on a large scale.

6. Wide advertising of tobacco products through the mass-media makes the sanitary-englighting [sic] work on the harm of smoking inefficient.

7. Almost all developed countries of the world (USA, Canada, Germany, Sweden, Norway, etc) have already taken the preventing measures for the smoking epidemy[sic]. The first results of this work show that smoking among the population can be successfully overcome.

Taking into consideration the above and for the purpose of decreasing the spread of smoking, decreasing the morbidity, disability and lethality caused by the basic chronical [sic] non-infectious diseases related to smoking based o n the Law of the Republic of Uzbekistan "On the State Sanitary Supervision",

I issue the decree as follows:

Mr Iskandarov assumed that BAT accepted this as indisputable fact. Our reply was that the BAT people sitting around the table were not qualified to comment. Nevertheless, our understanding was that these were complex scientific issues and that there was still a controversy about smoking and health. We offered to bring our experts to explain our position in more detail but this was not followed up on by Mr Iskandarov.

Cigarette deliveries

1. From the moment of issuance of this Decree the following shall be permanently prohibited to [sic] the Republic of Uzbekistan:

1.1 Sale of tobacco products without documents confirming their quality and with the content of nicotine exceeding 1mg and tars exceeding 15mg in one cigarette…….

Concerning the upper delivery targets of 1mg nicotine and 15mg tar,

6. This in itself will preclude the manufacture of plain cigarettes and, we believe all current filter brands produced by TTF. In effect TTF will have to close with immediate effect……

7. At present TTF can produce only plain cigarettes due to materials shortages, and that their capacity for filter cigarettes is very small.

8. Before setting targets for delivery reductions it is important to understand the delivery figures of the current domestic products. …

9. Reducing cigarette deliveries is possible but in the case of the domestic tobacco industry will require the installation of new equipment, and may also require the introduction of new tobaccos with low nicotine levels [do we have any measurements of Uzbek tobacco chemistry?] This cannot be achieved with immediate effect but can only be introduced in a phased manner.

Measurement of deliveries:

It was pointed out that there are internationally accepted instruments and test procedures used to measure cigarette deliveries and that BAT would be happy to advise the government laboratories on this. This was welcomed.

Documents confirming quality:

….. If Mr Iskandarov’s need for documentation cannot be changed then BAT should at least propose a system that is manageable as the Uzbeks appear to have little idea of the practicalities.

Advertising

1.2 Advertisement of the local and foreign brand tobacco products, including the advertisement through the mass media (television, radio, cinema, newspapers, magazines, etc);

10. The decree will seriously interfere with the industry's commercial freedom to market a legal product.

11. World wide experience consistently shows that advertising bans to not reduce consumption.

12. Advertising a mature product like cigarettes is not intended to increase the overall market but to expand company market share. A ban would prevent manufacturers from informing smokers about which cigarettes are available and what their attributes are.

13. The international tobacco industry takes a responsible attitude to the marketing of its products and in many countries works with the government to agree a set of advertising standards (not targeted at young people etc.). In Russia a voluntary code has just been signed.

14. A comprehensive ban on advertising would discriminate heavily against BAT as it is a relative newcomer in the market and would be to the ultimate detriment of the domestic industry.

It was clear from discussion that Mr Iskandarov is concerned about advertising encouraging young people to smoke. BAT made it clear that this was not their intention.

BAT offered to make available a copy of the voluntary advertising code in Russia and Mr Iskandarov was interested to receive this; we already have the Russian version available but will not hand it over until a coordinated approach to this whole issue has been established.

News filtering back via KPMG from Mr Mahsudov indicates that adoption of the Russian code until an Uzbek code can be formulated may be the way forward.

Smoking in public places

1.3 Smoking in the public places, on the transport, at the health care institutions, kindergartens, schools and other institutions for children, colleges and universities. At other institutions and enterprises smoking should be permitted only in specially arranged places.

BAT made the point that scientists do not agree that other peoples cigarette smoke has been proven to be a cause of disease. However, we recognised that cigarette smoke can be irritating to both smokers and non smokers but believe the solution is not necessarily a smoking ban but improved ventilation.

Manufacturing of filterless, high tar/nic cigarettes

2. To ban the manufacturing of tobacco products without filters and with the content of nicotine exceeding 1mg and tars exceeding 15mg in one cigarette, to replace their manufacturing by the manufacturing of harmless cigarettes with more perfect filters.

(See above under cigarette deliveries)

Introduction of health warnings

3. To ban the manufacturing of tobacco products without the warning inscription on the pack as follows: "The Ministry of Health Care of the Republic of Uzbekistan warns: smoking is dangerous for your health."

BAT made the point that there is a community expectation that cigarettes should contain health warnings. As a responsible manufacturer we respond to this expectation by placing health warnings on packs of cigarettes that we produce. This in no way indicates that the company accepts that smoking has been proven to be a cause of disease.

On further discussion it became clear that Mr Iskandarov was only planning that this should apply to locally manufactured cigarettes because he could not control the manufacturers of imported cigarettes. BAT informed him that this was very inconsistent, and that indeed imported cigarettes can and must be treated in the same way as domestic cigarettes.

[In the Uzbek market Marlboro sells at 9 som with a warning in Uzbek and for 15 som without a warning in Uzbek. They are perceived as being different products.]

Ban on unlicensed sales

4. To ban the sale of tobacco products in the places which are not fixed by the hakimates for this purpose.

After much discussion it would appear that Mr Iskandarov [sic] principle concern is to prevent sales of cigarettes to and by persons under the age of 18.. …..

To achieve this he wants to:

- Remove small sellers such as tray sellers because they are often run by young people.

- Only use licensed outlets

And for this to be specifically aimed at tobacco products.

BAT’s concern was expressed at the apparent power this gave city hakim’s to control the distribution of products.

In the end no firm conclusions were reached but we suspect that in practice both sides may not be too far apart. The solution may be to propose that "cigarettes may only be sold in outlets which satisfy government guidelines" and then to specify the guidelines.

ORIGINAL DECREE (the text that is later changed by BAT is highlighted in bold)

AMENDED DECREE (BAT changes are highlighted in bold

1. Smoking can essentially worsen the clinic [sic] course of such diseases as stomach and duodenum [sic] ulcer, chronic gastritis, etc, strongly influence the development of the heart-crowning artery [sic] sclerosis. ….

2. In Uzbekistan the number of people suffering from the diseases of breathing system, including those related to smoking, increased from ….

4. ….There is data that tobacco smoke is more harmful to non-smokers than to smokers.

7. Almost all developed countries of the world (USA, Canada, Germany, Sweden, Norway, etc) have already taken the preventing measures for the smoking epidemy[sic]. The first results of this work show that smoking among the population can be successfully overcome.

Taking into consideration the above and for the purpose of decreasing the spread of smoking, decreasing the morbidity, disability and lethality caused by the basic chronical non-infectious diseases related to smoking based on the Law of the Republic of Uzbekistan "On the State Sanitary Supervision",

1. Smoking has been claimed to worsen the clinic [sic] course of such diseases as stomach and duodenum [sic] ulcer, chronic gastritis, etc, and to influence the development of the…

2. In Uzbekistan the number of people suffering from the diseases of breathing system, including those associated with smoking, increased from ….

4. Sentence removed.

7. …. …

The first results of this work show that smoking among the population can be successfully reduced.

diseases statistically associated with smoking

1. From the moment of issuance of this Decree the following shall be permanently prohibited to [sic] the Republic of Uzbekistan:

1. From the moment of issuance of this Decree the following shall take place in the Republic of Uzbekistan

1.1 Sale of tobacco products without documents confirming their quality and with the content of nicotine exceeding 1mg and tars exceeding 15mg in one cigarette…….

1.1 The sales-weighted average tar level of cigarettes (both domestic and imported) will be reduced to 20 mg over 10 years.

1.2 Advertisement of the local and foreign brand tobacco products, including the advertisement through the mass media (television, radio, cinema, newspapers, magazines, etc);

1.2 Advertising of local and foreign brand tobacco products, including advertising through the mass media (television, radio, cinema, newspapers, magazines, etc); will be restricted according to the attached code.

1.3 Smoking in the [sic] public places, on the transport, at the health care institutions, kindergartens, schools and other institutions for children, colleges and universities. At other institutions and enterprises smoking should be permitted only in specially arranged places.

1.3 Smoking [‘in public places’ and ‘on the transport’ removed] at health care institutions, kindergartens, schools and other institutions for children, [colleges and universities removed] will be prohibited. At other institutions and enterprises, and on public transport, both smoking and nonsmoking areas will be provided.

2. To ban the manufacturing of tobacco products without filters and with the content of nicotine exceeding 1mg and tars exceeding 15mg in one cigarette, to replace their manufacturing by the manufacturing of harmless cigarettes with more perfect filters.

2. The sales weighted average tar levels of manufactured cigarettes, both domestic and imported, will be reduced to 20 mg over 10 years, and filter cigarettes will be introduced into the market.

3. To ban the manufacturing of tobacco products without the warning inscription on the pack as follows: "The Ministry of Health Care of the Republic of Uzbekistan warns: smoking is dangerous for your health."

3. The Sale of tobacco products will be prohibited without the warning inscription on the pack as follows: Ministry of Health [Replaces ‘The Ministry of Health Care of the Republic of Uzbekistan’] warns: smoking is dangerous for your health.

4. To ban the sale of tobacco products in the places which are not fixed by the hakimates for this purpose.

4. The sale of tobacco products will be banned in places which do not satisfy government guidelines aimed at protecting young people.