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The World Health Organization Framework Convention on Tobacco Control Tenth Conference of the Parties will discuss next generation tobacco control policies, as the incoming New Zealand Government receives strong international condemnation for repealing recent 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.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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It is sad to see people like Alex Wodak, who I am sure strongly support smokefree goals, celebrating the demise of New Zealand’s ground-breaking smokefree measures.
In response to Alex, could he please point me to the evidence that the cigarette black market in soaring in New Zealand? According to the 2022 KPMG report (available here: https://assets.nationbuilder.com/taxpayers/pages/2370/attachments/original/1689202217/New_Zealand_Illicit_Trade_Tobacco_FINAL_31052023.pdf) the size of the illicit black market in tobacco products in NZ reduced from 230 million tons in 2019 to 167 million tons in 2022. That is hardly soaring, plummeting maybe. (NB this is an estimate from a tobacco industry funded report!).
Also, could he explain why a shrinking black market combined with a greatly reduced number of much more secure tobacco retailers (they would have to meet stringent security standards to sell tobacco – currently there are not such requirements) selling denicotinised tobacco products which would be unappealing to people who smoke and hence very difficult to sell on will result in a increase number of violent incidents related to illicit tobacco?
Several lines of evidence, including numerous RCTs of denicotinised cigarettes, anticipated responses to these measures in surveys like our NZ ITC study (a substantial proportion of people who smoke say they will quit or switch to vaping), and logic (people smoke for the nicotine – so if it is removed, they probably won’t smoke) suggest denicotinisation supported by the other NZ smokefree action plan measures would result in a rapid, substantial and equitable reductions in smoking prevalence. They would also complement THR approaches by strongly encouraging people who smoke who can’t or don’t want to quit using nicotine to move to harm reduced vaping products, which are widely available in Aotearoa.
The New Zealand endgame measures would almost certainly have greatly hastened the achievement of the Smokefree Aotearoa goal and, as Sisay Menghasa notes, could have had profound positive impacts on many other countries, particularly LMICs. If these measures are blocked as they appear likely to be in New Zealand due to the stringent opposition of the tobacco industry and its allies (unfortunately supported by some sections of the smokefree community), we will never know whether they are effective or not.
I am Sisay Derso Mengesha, a public health researcher and member of the tobacco control committee in Ethiopia. In light of the discourse put forth by Prof. Gartner, I would like to extend my sincere appreciation for the valuable insights shared. The depth of knowledge and expertise conveyed through the messages is truly commendable and provides a robust foundation for further analysis and exploration.
I am writing to express my profound concerns regarding the recent cancellations of life-saving public health laws by the government of New Zealand. The tobacco control laws in New Zealand have served as a model for several countries, including Ethiopia, which has enacted strong tobacco control bills. The smoke-free policy, in particular, was designed to be robust, aimed at saving millions of lives, preventing premature deaths, chronic illnesses, healthcare costs, and direct and indirect loss of productivity. The economic gains achieved by this policy are substantial and far outweigh the value of the tobacco industry to the country. In 2019, Ethiopia adopted a 100% smoke-free policy, and the tobacco control community leveraged the experiences of developed countries like Australia and New Zealand during advocacy and public hearings. The reversal of such a best practice in public health law by the government of New Zealand will have far-reaching consequences in other countries, especially in resource-limited countries like Ethiopia, which requires more foreign currency to meet development challenges. The tobacco industry operating in low- and middle-income countries will use the repeal of the smoke-free policy in New Zealand as a fertile ground to dilute strong tobacco control laws in developing countries. Hence, as a public health researcher and a tobacco control champion from a developing country, I sincerely request the government of New Zealand to reconsider its decision to repeal the tobacco control bill. The impact of this reversal will be felt beyond the borders of New Zealand and will have a detrimental effect on the health and economies of countries that have modeled their tobacco control laws on those of New Zealand.
Im with Alex. Prohibition is not a viable or progressive policy in a non-totalitarian society, and entrenching a generational divide is not likely to contribute to a more harmonious society.. More power to education / harm reduction.
We already have restriction on smoking laws. Sadly, these Re not adhered to, and almost never kept by whatever authorities exist.
In medical practices, and hospitals, where such smoking restrictions should be an example to our communities, it is a daily scene of smokers standing and sitting right under ” no smoking” signs. Health professionals, patients, and relatives congregate just outside entry points creating a heavy passive smoking zone for those who must enter or exit. Security is never seen, and they are powerless.
Same can be said for shopping areas, and CBD office buildings, although in postCovid Era, number of workers has decreased.
So I ask, in 2024, with lofty rhetoric on no cigarette sales, when are we actually going to review our existing policies. If they do not work, we need to ensure they are reviewed and changed to be successful. In the meantime, yes, let’s have plans for future, but fix the issues of current smoking restrictions first.
As Winston Churchill noted, “However beautiful the strategy, you should occasionally look at the results”. The New Zealand government was quite right to recently drop three tobacco control policies inherited from the previous government. The policy of reducing nicotine levels in smoked tobacco products was in grave trouble after the company supplying low nicotine products began a financial death spiral. Drastically reducing the number of tobacco retailers would most likely have increased the number of violent incidents involving the vigorous cigarette black market. New Zealand and Australia have the most expensive cigarettes in the world as a result of sky high cigarette taxes. This has resulted in soaring cigarette black markets in both countries. Why end tobacco sales to anyone born after 2008 to create a smoke-free generation when smoking rates in young New Zealanders have already plummeted to such low levels after the four major political parties in New Zealand agreed to encourage smokers to switch to vaping? Australia has a lot to learn from New Zealand’s recent support for tobacco harm reduction. Quasi prohibition policies for drugs, including tobacco, are much easier to sell to electorates than pragmatic harm reduction interventions like vaping but tobacco harm reduction, like other forms of drug harm reduction, has consistently achieved unprecedented falls in smoking rates.
We should do what Singapore and certain districts in Tokyo do and make smoking illegal in streets, parks, and public areas. Instead there should be special enclosures (like in Japan) where smokers can go. Surely this would be a huge discouragement due to the inconvenience, but also protect children from both second hand smoke and from smoking being ‘normalised’ due to seeing people do it everywhere in public. Not to mention decrease the colossal amount of litter smokers produce. If you walk down any street the majority of the litter is from smokers. If smoking were confined to small areas they could have easy disposal bins, or at least the litter would be confined to these areas. We don’t let people drink alcohol wherever they want outside, so I find it odd we let people smoke anywhere when there is no safe level of second hand smoke, and it is such a harmful activity.