Tobacco Free Pakistan

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Tobacco Free Pakistan
By Dr. Inamul Haq*

This is with reference to the report, Tobacco kills over 160,000 Pakistanis every year. The PM’s aide, Dr. Sultan, quoted this statistic and said that the government would continue to strive to raise awareness and promote a smoke free society by providing a counter-marketing campaign, awareness against nicotine use, and empower young people to engage in the fight against tobacco. This statement was made in an event held on World Tobacco Day while the Ministry of Health and WHO were signing a letter of intent with the Pakistan Red Crescent Society.  

In the same event, Dr. Ziauddin, former head of the Tobacco Control Cell, Pakistan, and country’s former focal person for the World Health Organization’s convention on Tobacco Control (FCTO) said the government should increase the tax on all tobacco products in the upcoming budget. With the same objective, the Pakistan National Heart Association (PANAH) recently arranged a walk to create awareness among the people to quit smoking and adopt a healthy lifestyle to prevent untimely death and disease.

All these efforts of “top experts” are commendable indeed to revive the old “tobacco debate”, that has been a topic of discussion for more than three decades. However, due to lack of any professional and practical approach and knowledge about the work already done in this field in Pakistan and abroad, these efforts have never yielded any positive outcome. What is of conceren is that despite these failures, once again, we are still focusing on counter-marketing and awareness campaigns and contemplating an increase in taxes on tobacco products. These policymakers and advisory experts should have at least tried to apprise themselves of some of the relevant reports compiled in the past on tobacco control, as referenced below, before making any naïve suggestions and recommendations:

1. WHO experts published a report on constituents of cigarettes in developing countries including Pakistan. A test and analysis of 50 brands of cigarettes, as per this report, showed the number of toxic constituents to be the highest in Pakistani cigarettes, as compared to the cigarettes in the other Asian countries in the region. 

2. A report of the Network for Consumer Protection campaign in 1990 titled “Tobacco Free Initiative Pakistan” provides comprehensive details about consumption of cigarettes in Pakistan, the adverse effects of smoking, and mentions ways and means to control it. The report also touches on the weakness and failure of the government in this regard. Being a member of the Board of Directors of this network, I believe that this campaign was perhaps one of the best to make people aware of the hazards of tobacco. 

3. A report of late Hakim M. Saeed published in Pakistan Tibbi Association’s journal (Akhbar Al Tibb) in 1983 giving full details about the consumption of cigarettes per person, the mindless waste of financial and human resources, and the loss of revenue to the government. This report also provides an in-depth analysis of the situation and the means to control it from the beginning. 

The increase in number of smokers in Pakistan and elsewhere, though alarming, is proportionate to the increase in population. However, the drastic increase in deaths and diseases can be attributed directly to lack of sincere professional approach and political will of the government and policy makers. Holding rallies, walks, seminars, and events on World Tobacco Day are the culture of the West, with specific objectives in mind, but in Asian countries like Pakistan, it is limited mainly to self-publicity and political well-being. Obviously, these campaigns have not been able to make the slightest dent on tobacco control during the last four decades.

I have significant experience in dealing with tobacco control on behalf of the governments on various national and international platforms and positions. While holding the charge of the Chief Drug Control and Research Division, N.I.H., from 1975-1986, I established the Tobacco and Smoke testing and analysis laboratory sponsored as a project by the Chief of advisory panel on Smoking and Health of the World Health Organization (WHO), Dr. Roberto Masironi, Geneva. I represented Pakistan on this panel as an expert member for six years and participated in the first Pakistan UICC workshop on smoking, sponsored by the International Union against Cancer (UICC) and Ministry of Health. Being a focal person on tobacco products, I was asked by the WHO in 1985, to collect all the samples of cigarettes marketed in Pakistan in accordance with WHO protocols and guidelines and submitted to their designated Addiction Research Foundation laboratory in Toronto, Canada for test and analysis.

A request was made to the chief of WHO advisory panel on smoking and health, Geneva, who happened to be my bench-mate at Rome University, Italy, to provide me necessary equipment and facilities to enable us to test and analyze cigarette smoke and products at our laboratory in N.I.H. In response, the WHO representative, while deeply appreciating and thanking me for my collaboration and interest in WHO project, sent me the first report of such test analysis.

Noticing Pakistan’s keen interest and enthusiasm in solving the international problem of increasing smoking and deaths and diseases, the coordinator of WHO Smoking and Health program, Dr. R. Masironi, felt pleasure in enclosing copies of technical services agreement between the WHO and the National Institute of Health Drugs Control and Research Division, Islamabad, Pakistan (vide WHO letter dated December 06, 1983) in respect of monitoring of harmful constituents of cigarettes and tobacco in Pakistan. Under this agreement, the amount given was $23,000 USD of which up to $3000 to be used for my visit to the Addiction Research Foundation in Toronto for orientation, which I did for 15 days in 1985. A smoking machine was also provided to us by the WHO in this regard. On return I trained two assistants in test and analysis of cigarettes in the Drug Control Research Division laboratory. The WHO coordinator, Dr. Masironi wrote a letter dated August 16, 1985, Geneva, to the Director General Ministry of Health, Islamabad, Pakistan, stating that the WHO has supported the establishment of a cigarette analysis laboratory at the Drug Control division of the National Institute of Health, Islamabad, under the supervision of Dr. Inam Ul Haq, “the scope of this laboratory is to allow monitoring of tar and nicotine levels in cigarettes being marketed in Pakistan. Hopefully, in future, this laboratory may be likely to assume the role of a reference analytical center for the Eastern Mediterranean region of WHO. In order to acquaint Dr. Inam Ul Haq in the analytical methodology specific for this operation, WHO intends to sponsor his visit to Toronto, Canada for approximately 2 weeks during October-November 1985”. Vide this letter, dated July 26, 1985, addressed to me by name, Dr. Masironi also directed the head of the Biomedical Research, WHO under him to prepare copies of the standards which they follow in doing cigarette analysis for tar, nicotine, and carbon monoxide in the WHO reference laboratory at Addiction Research Foundation, which I received. To enforce these WHO standards, it was felt necessary to involve the stakeholders of Pakistan Tobacco industry by forming a committee.

Since I was compiling the Pakistan Pharmacopoeia, the then Pakistan Standards Institution appointed me as Chairman Tobacco Product Subcommittee. With the support of the chief, executives of the tobacco industry who first reacted to the idea of laying down standards and specifications of cigarettes later yielded to the pressure of the government. We laid down standards and specifications according to international specifications after about one-year deliberations, which were published in a booklet form in 1990, which might be available with the then Pakistan Standards Institution.

As this agreement between WHO and NIH Islamabad to establish Tar, Nicotine, and Carbon Monoxide testing laboratory at the Drug Control and Research Division of NIH Islamabad in 1983, much progress was made according to the terms and conditions of the agreement by 1985 and 1990. It is not known what is the fate of this laboratory established by WHO in agreement with Drug Control and Research Division NIH Islamabad, the scope of which was to monitor the levels of Tar and Nicotine in cigarettes marketed in Pakistan. Hopefully this laboratory, according to WHO was likely to assume the role of a reference analytical center for the Eastern Mediterranean region of WHO.

The above situation analysis provides enough evidence to prove that we have failed to control or limit cigarette smoking, which, on the contrary, is increasing every year due to our wrong policies and unscientific approach. If we are sincere to save the lives of millions of cigarette smokers in Pakistan, one of the practical and feasible options with the existing infrastructure would be to start testing and analyzing the cigarette samples being marketed and smuggled to monitor the toxic elements like Tar, Nicotine, and Carbon Monoxide against the laid down standards and specifications. This could easily be done in the cigarette smoke analysis laboratory that was established at N.I.H. in the 1990’s. Those exceeding the prescribed limits be prosecuted under the law which should provide licensing system for sale of all kinds of cigarettes being marketed. The rules and regulations under this law should prohibit sale of cigarettes to children, ban their sale in canteens of educational institutions, airport lounges, and put restrictions on advertisement of tobacco products. The Ministry of Health Services and the DRAP has the power under the DRAP Act 2012 to make rules and regulations. The penalties should be like these of violations of drug laws, for example, imprisonment and fines.

The WHO will be most willing to help and facilitate if Pakistan takes the lead and sets an example in South Asian countries to control and contain cigarette smoking. Now that we have the political will, especially the will of the Prime Minister, who is making all the efforts to make “Naya” Pakistan, we should sincerely implement this scheme professionally for which we have means, infrastructure, expertise, and the background to achieve this noble cause.

Dr. Inamul Haq
Ex Drugs Controller and Chairman Quality Control Authority,
Ministry of Health, Govt. of Pakistan.

Cell: 0304 1363349

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