The next generation of tobacco control measures

In November, the Tenth session of the Conference of the Parties (COP10) of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was to occur in Panama. Significantly, COP10 marks two decades since the adoption of the WHO FCTC. Disappointingly, COP10 was delayed to February 2024 due to security concerns around (unrelated) large-scale protests in Panama City. At the time that COP10 was due to meet, global tobacco control experienced additional setbacks in Aotearoa New Zealand and Malaysia, which are likely to be heavily discussed at COP10 in February.

What happened to New Zealand’s smoke-free laws?

On 24 November 2023, Aotearoa New Zealand’s National Party announced it would repeal the country’s world-leading smoke-free law as part of a deal with two minor parties (ACT and New Zealand First) to enable it to form a coalition government following the October election. The law, passed by the former Labour-led government, would denicotinise smoked tobacco products (reducing their addictiveness), reduce the number of tobacco retailers by 90% (reducing tobacco availability and triggers to purchase), and end tobacco sales to anyone born after 2008 (creating a smoke-free generation). These measures are considered key to achieving the country’s goal of less than 5% smoking prevalence by 2025 for both Māori and non-Māori citizens alike. The laws commenced in 2023, but the measures would not take effect until mid-2024.

The smoke-free goal and the laws to achieve it were the culmination of public health efforts initiated by Māori leaders in 2005, who called for returning Aotearoa New Zealand to its original tupeka kore (tobacco-free) status, which would eliminate inequities in tobacco-related diseases experienced by the Māori population due to the introduction of tobacco smoking through colonisation. Modelling indicates the smoke-free laws would achieve enormous health and economic benefits for citizens in Aotearoa New Zealand and would be particularly pro-equity for Māori. By 2040, over 8000 premature deaths would be averted. Those who quit smoking because of the laws would cumulatively gain 56 590 health-adjusted life-years and US$23.2 billion from greater income due to less tobacco-related disease and savings from not buying tobacco.

Instead of prioritising these health and economic benefits for citizens, the new centre-right government focused on lost tobacco tax revenue, ignoring the value of human lives that would be saved by reducing smoking. The government intends to use this tobacco tax to fund income tax cuts for middle- and high-income earners. Although the smoke-free laws would have boosted the finances of people predominantly on low incomes, among whom smoking is concentrated, the repeal of the laws will largely benefit those who are less likely to smoke. Health and medical experts internationally urged the Prime Minister and the Health Minister, a former general practitioner, to retain the laws.

The impact on smoking laws in other nations

In 2023, two other countries (Malaysia and the United Kingdom) also looked set to implement the smoke-free generation law. In June, the Malaysian Health Minister, Dr Zaliha Mustafa, tabled the Control of Smoking Products for Public Health Bill 2023, which included preventing tobacco and vaping product sales to anyone born after 2006. However, the smoke-free generation provision was removed from the final version of the bill that passed into law on 30 November. This now leaves the UK as the front-runner in terms of progressing this policy, with Prime Minister Rishi Sunak holding firm on the proposal to end tobacco sales to anyone born after 2008. Although, his leadership on this measure is being tested through intense tobacco industry lobbying.

If the Aotearoa New Zealand and Malaysian governments had stayed the course on implementing their planned measures, they could have expected to be lauded as tobacco control world leaders at COP10, rather than the strong criticism they are receiving. Nevertheless, several lessons from the recent events in Aotearoa New Zealand, Malaysia and the UK are likely to inform constructive dialogue on two priority topics scheduled for discussion at COP10: tobacco product regulation (eg, denicotinisation of tobacco products) and forward-looking measures beyond minimum requirements (eg, retailer reduction and smoke-free generation laws), which are supported by FCTC articles 9 and 2.1 respectively.

The value of innovative tobacco control

Countries that innovate in tobacco control policy can inspire others, even if they themselves fail to follow through. The bold leadership shown by Aotearoa New Zealand’s previous Labour-led government, spearheaded by the former Health Minister, Ayesha Verrall, created momentum to look beyond the mainstay of demand reduction approaches to address the more fundamental drivers of the tobacco epidemic. Notably, Australia’s world-leading tobacco plain packaging law was first proposed in Aotearoa New Zealand in 1989 and considered by Canada in 1994 (here). In the decade since it was implemented in Australia in 2012, the policy spread to 22 countries, demonstrating once a new policy is implemented by one country, it can quickly become mainstream.

However, interference from the tobacco industry and its allies should not be underestimated. Even when a policy is evidence-based and widely supported, politicians are still vulnerable to lobbying and may be willing to sacrifice public health for political expediency.

A strength of Aotearoa New Zealand’s smoke-free laws was their combined potential to benefit everyone regardless of race or age. Governments should be encouraged not to focus solely on the smoke-free generation policy, but to combine this policy with innovative measures that will also benefit current adults who smoke (such as denicotinisation of smoked tobacco).

Bold measures required for progress

Tobacco kills 8 million people worldwide annually. We have known tobacco is highly addictive and deadly for over 60 years. Yet, after two decades of sustained effort in implementing the FCTC’s core demand reduction measures, progress remains slow and regulation of tobacco is not commensurate with how other harmful and addictive products are regulated. Global smoking prevalence only declined an average of 0.4 percentage points per year from 2007 to 2021, and tobacco remains the leading cause of preventable death.

It is imperative that governments prioritise health and wellbeing over commercial profits by progressing bold measures to rapidly and permanently end the commercial tobacco epidemic. With Aotearoa New Zealand’s new government appearing set to abandon the country’s world-leading smoke-free laws, the upcoming COP10 discussions provide an opportunity for other countries, such as the UK, Canada or Australia to step up and demonstrate global leadership on these next generation tobacco control policies.

Professor Coral Gartner is a Professor of Public Health at the School of Public Health at the University of Queensland, Director of the National Health and Medical Research Council Centre of Research Excellence on Achieving the Tobacco Endgame, an Australian Research Council Future Fellow, and President of the Society for Research on Nicotine and Tobacco Oceania Chapter.