Framework Convention on Tobacco Control: Progress Update
October 26, 2000: Framework Convention on Tobacco Control
Tom Novotny, MD, MPH, Director, Office of International and Refugee Health
By way of introduction to the FCTC, Dr. Novotny indicated that it is important to understand the background of this unusual activity. As a treaty process, it involves people in multiple disciplines and not just public health. The FCTC is the first treaty authorized by WHO under its constitution. Ministries of foreign affairs (typically, the treaty negotiating body for a country) for each of the 191 member states are participating in the effort. In the case of the United States, the State Department has delegated the lead to HHS. In turn, HHS insists that health should be the primary focus of the treaty.
A number of components need to be considered in negotiating a multilateral action on tobacco control. As a result, Dr. Novotny indicated, preparations have been complex. Work on the FCTC in the United States is guided by the Domestic Policy Council (DPC) at the White House, which has called for a broad involvement of federal agencies. Participating agencies include the U.S. Department of Treasury, the U.S. Trade Representative's Office, the U.S. Department of Commerce, the U.S. Department of Agriculture (USDA), the U.S. Environmental Protection Agency, the U.S. Bureau of Alcohol, Tobacco and Firearms (ATF), the U.S. State Department, the U.S. Agency for International Development, several parts of HHS including CDC and the Office on International and Refugee Health, and others. The projected completion date for the negotiation process is 2003.
Work on the FCTC has been extensive and includes public involvement as well as keeping Congress informed. In fact, on five separate occasions, the group working on the FCTC has met with representatives of the House of Representatives and the Senate Foreign Relations Committee to discuss health issues. The Committee appears to be very interested in this effort. A staff member for Senator Jesse Helms (R-NC) attended the first round of Geneva negotiations.
Public comments have been obtained in writing and through a public hearing held March 15, 2000. Attendees at the session included governmental and non governmental organizations (NGOs), professional groups, and the tobacco industry. In addition, WHO held another well-attended public hearing before the negotiations in Geneva. The U.S. delegation has met with the tobacco industry and tobacco growers to obtain their input, although they are not part of the delegation.
In terms of history, WHO-related activities began a year and a half ago through the World Health Assembly (WHA), the governing body of WHO. Through the efforts of WHA staff led by Derek Yach, Neil Colishaw, and others, this FCTC process has moved forward. Two working group meetings were held over the last year. At that time, issues were laid out for further discussion and negotiations. At the first negotiation, member states began to outline their positions and discuss the content of the FCTC.
The Framework Convention is meant to be a broad document that can be signed by many countries. The United States has supported a general document so many countries can sign it. Subsequent protocols should then be more substantive and detailed.
In addition to the various consultations mentioned, the U.S. delegation has met weekly for a year and a half with the DPC group. Everyone's views have been heard and used to help shape the U.S. position. The negotiating positions of the United States were cleared by all the relevant departments, truly a great accomplishment.
In terms of the negotiations in Geneva, two days were spent trying to decide on the procedural approach. The United States then lobbied successfully to be part of the Bureau, the small management group that will help conduct the negotiations, and will be the Bureau representative for the Americas, one of WHO's Regions. The Chairman of the three-year process will be Celso Amorim, Ambassador to Geneva from Brazil, who has already provided a steady hand and good leadership. The negotiation participants also discussed direct involvement by NGOs. As is standard for WHO, NGOs will participate through organizations in official relations to WHO. A coalition called the Alliance (led by the Campaign for Tobacco-Free Kids) will work with the officially recognized organizations. The U.S. delegation met with NGOs and others every evening to discuss issues of concern.
The U.S. delegation for the first round of negotiations consisted of Dr. Novotny as the lead delegate, Ripley Forbes from HHS, Larry Green from Office on Smoking and Health, John Sandage and Lynn Lambert from the U.S. State Department, Tami Light from ATF, Gene Philhower from USDA (Geneva), and Linda Vogel from the U.S. Mission (Geneva). The next session will be held starting April 30. At that session there will be three working groups: one will deal with health issues, another with deal with economic issues, and a third will deal with the treaty-making process.
Dr. Satcher, on behalf of the United States has come out strongly supporting a Framework Convention that includes a number of protocols and makes strong points. At the negotiations, each country had an opportunity to state its position relative to a number of issues presented by WHO. The United States, for example, supported restricting sales to minors; reducing exposure to secondhand smoke; regulating tobacco products, contents, and disclosures; and tobacco taxes. The delegation offered additional language on secondhand smoke that would support prevention of exposure to children in particular and in public places in general. The United States also made a strong statement on advertising restrictions, paying attention to messages that appeal to children and not just messages that are directly targeted to children. The United States supported the elimination of smuggling. The delegation also supported sharing scientific and technical information around the globe.
Litigation was discussed at the negotiation sessions. The United States supports domestic court actions. In terms of compliance with the treaty, the United States does support reporting requirements on the activities with which we agree. However, there should not be a compulsory dispute resolution process, arbitration, or litigation for non compliance; instead, there ought to be diplomatic solutions to disagreements based on the treaty.
One final item discussed during the negotiations was the removal of subsidies to farmers and ways to deal with the economic impact on farmers whose livelihood is in jeopardy. Dr. Novotny indicated that a White House Commission is considering the economic impact of reduced tobacco production and public health issues. He also indicated that the United States informally met with Malawi, Zimbabwe, and Brazil to begin to brainstorm this issue.
Dr. Novotny mentioned that a number of negotiating positions are privileged and have not been shared with the public. Between now and April, however, the public will be asked to provide comments on the FCTC. Public hearings will be scheduled on the West Coast and other venues. He encouraged everyone to participate and share their point of view. Finally, he indicated that a Chairman's report will be issued from the Geneva meeting. It will outline the interests and activities of the various nations. He believes the United States already has a number of agreed-on negotiating positions but mentioned that work remains to be done to agree on issues related to trade and agriculture.
Relative to the farmers'plight, Dr. Chaloupka, a professor of economics at the University of Illinois, stated that currently there are about 1.2 billion smokers in the world, and in 25 years that estimate will go up to 1.6 billion if no changes are made. Therefore, even if we are successful, current tobacco farmers will not go out of business. The lack of impact on current farmers is particularly true if tobacco control efforts focus on reducing youth smoking because the effects of these efforts on overall demand will not be seen for many years. Dr. Novotny added that the United States has already adopted a policy that guarantees the welfare of farmers in this country (through price supports and other means).
Dr. Satcher told the group that in many countries it is actually the government that profits from tobacco growth. Dr. Novotny added that in a number of countries, like China, the government is the largest consumer and producer of tobacco.
To a question about support for FDA legislation, Dr. Wilkenfeld from the Campaign for Tobacco-Free Kids responded for the NGO community and indicated there is widespread support.
Dr. Novotny indicated that the Administration also strongly supports the regulatory approach proposed by the FDA.
A participant asked if the outcome of the Presidential election will have any effect on the U.S. interest in pursuing the WHO negotiations and Dr. Novotny responded that he hoped it would not. Another question related to the treaty's role in economic measures and taxation schemes and Dr. Novotny said those issues are considered sovereign policy of national governments and out of the purview of this initiative. However, the United States already has established government policy that taxes are an important and effective way to reduce consumption of tobacco.
A participant asked if the delegation has spoken to the International Monetary Fund (IMF) about removing the tobacco industry from their list of industries to be privatized. The rationale is that when industries are privatized there is increased competition leading to increased consumption. Dr. Novotny indicated that they have not spoken to IMF. Dr. Chaloupka added that privatization does not automatically lead to increases in consumption. He cited Poland as an example and said that their government became much more interested in tobacco control once they left the tobacco production business. The World Bank has issued guidelines on privatization.
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