Meeting on Accelerating the Raising of Tobacco Taxes and the Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products in the Western Pacific, Manila, Philippines, 27-29 November 2017 : meeting report

27–29 November 2017 Manila, Philippines Meeting Report MEETING ON ACCELERATING THE RAISING OF TOBACCO TAXES AND THE RATIFICATION OF THE PROTOCOL TO ELIMINATE ILLICIT TRADE IN TOBACCO WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC RS/2017/GE/63(PHL) English only MEETING REPORT MEETING ON ACCELERATING THE RAISING OF TOBACCO TAXES AND THE RATIFICATION OF THE PROTOCOL TO ELIMINATE ILLICIT TRADE IN TOBACCO PRODUCTS IN THE WESTERN PACIFIC Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Manila, Philippines 27–29 November 2017 Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines February 2018 NOTE The views expressed in this report are those of the participants of the Meeting on Accelerating the Raising of Tobacco Taxes and the Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products in the Western Pacific and do not necessarily reflect the policies of the conveners. This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Meeting on Accelerating the Raising of Tobacco Taxes and the Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products in the Western Pacific, in Manila, Philippines from 27 to 29 November 2017. CONTENTS SUMMARY .................................................................................................................................. 3 1. INTRODUCTION ................................................................................................................. 3 1.1 Meeting organization ............................................................................................................... 3 1.2 Meeting objectives ................................................................................................................... 3 2. PROCEEDINGS .................................................................................................................... 3 2.1 Opening session ....................................................................................................................... 3 2.2 WHO FCTC Article 6 implementation: key to financing the Sustainable Development Goals......................................................................................... 4 2.3 Tobacco taxation: win–win for public health and government revenues ................................. 5 2.4 State of tobacco taxation in the Western Pacific Region ......................................................... 5 2.5 Scare tactics of the tobacco industry: key hindrance to raising tobacco taxes ......................... 6 2.6 Panel discussion I: raising tobacco taxes ................................................................................. 7 2.7 Panel discussion II: earmarking tobacco taxes for health ........................................................ 8 2.8 Panel discussion III: tobacco industry interference ................................................................ 10 2.9 Breakout session I: coalition-building for successful tobacco tax reform .............................. 11 2.10 Protocol to eliminate illicit trade in tobacco products ............................................................ 11 2.11 Reasons why we need the Protocol: international experiences .............................................. 11 2.12 Panel discussion IV: ratif ying the Protocol ........................................................................... 12 2.13 Tracking and tracing system .................................................................................................. 13 2.14 Panel discussion V: measuring and preventing illicit trade ................................................... 13 2.15 Breakout session II: challenges and opportunities in preventing illicit trade in tobacco products ................................................................................................................ 15 2.16 Next steps ............................................................................................................................... 15 2.17 Closing ................................................................................................................................... 15 3. SUBREGIONAL WORKSHOP ON BETEL NUT AND TOBACCO USE ...................... 15 3.1 Opening .................................................................................................................................. 15 3.2 Evidence on the health impact of betel nut and tobacco use .................................................. 16 3.3 Betel nut and tobacco use in the Pacific islands and selected ASEAN member states .......... 16 3.4 Country presentations ............................................................................................................ 17 3.5 Breakout session: Action planning......................................................................................... 18 3.6 Closing ................................................................................................................................... 18 4. CONCLUSIONS AND RECOMMENDATIONS .............................................................. 18 4.1 Conclusions ............................................................................................................................ 18 4.2 Recommendations .................................................................................................................. 19 ANNEXES Annex 1. List of participants ................................................................................................................. 20 Annex 2. Outcome of breakout session I: coalition-building for successful tobacco tax reform .......... 26 Annex 3. Outcome of breakout session II: challenges and opportunities in preventing illicit trade of tobacco products ................................................................................................................ 37 Annex 4. Outcome of breakout session: action planning (Subregional Workshop on Betel Nut and Tobacco Use) .................................................................................................................. 43 Keywords: International cooperation / Tobacco industry / Tobacco products / Tobacco use – prevention and control / Taxes SUMMARY Tobacco is the world’s leading cause of preventable death, killing 6 million people every year, of which one third are from the Western Pacific Region. To address this global epidemic, the WHO Framework Convention on Tobacco Control (WHO FCTC) was adopted and came into force in 2005, and all Member States in the Western Pacific Region have become parties to it. The WHO FCTC provides a complete package of measures to reduce tobacco consumption and save lives. The importance of tobacco control in promoting development is recognized in the United Nations 2030 Agenda for Sustainable Development, including specific reference to WHO FCTC implementation in target 3.a. In 2012, the Protocol to Eliminate Illicit Trade in Tobacco Products was adopted at the Fifth Session of the Conference of Parties to the WHO FCTC, and it is currently open for ratification or accession by Parties to the WHO FCTC. While progress has been made in many aspects of tobacco control, most Member States in the Western Pacific Region have yet to meet the goals related to Article 6 of the WHO FCTC on price and tax measures to reduce the demand for tobacco. Furthermore, only one country in the Region has ratified the Protocol to date. This Meeting on Accelerating the Raising of Tobacco Taxes and the Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products in the Western Pacific was organized by the WHO Regional Office for the Western Pacific to provide guidance and best practices in both of these crucial areas. Participants from 20 countries and areas in the Region attended the meeting. The importance of multisectoral collaboration in achieving effective tobacco control was emphasized. Furthermore, participants discussed coalition-building as a way to realize successful tax reform and identified country-specific strategies to address the challenges and opportunities in preventing illicit trade in tobacco products. Eight countries and areas also attended the Subregional Workshop on Betel Nut and Tobacco Use to discuss this aspect of tobacco control that is of specific concern to their country/area. The objectives of the meeting were: 1) to brief countries on emerging issues and enable sharing of experiences and lessons learnt on tobacco taxation and the ratification of the Protocol; 2) to identify country-specific challenges and opportunities in raising tobacco taxes and ratifying the Protocol; 3) to develop country-specific actions to raise tobacco taxes; 4) to strengthen coordination and collaboration between the health, finance and foreign affairs sectors to accelerate the raising of tobacco taxes and the ratification of the Protocol; and 5) for the Member States that attended the Subregional Workshop on Betel Nut and Tobacco Use to share experiences and develop key actions for the control of betel nut and tobacco. The meeting participants concluded the following: 1) Tobacco taxation is the most cost-effective measure to help reduce smoking prevalence and thereby reduce deaths due to noncommunicable diseases. 2) Illicit trade is a global problem and ratifying the Protocol is an important step towards a global solution. 2 3) Tobacco industry interference is a cross-cutting issue that affects every aspect of tobacco control. 4) Tracking and tracing systems are an effective tool for combating illicit trade in tobacco products. 5) Multisectoral cooperation and a whole-of-government approach are essential to passing effective tobacco control measures. 6) The negative effects of betel nut and tobacco use are impacting the health of many people in the Region and efforts should be made to address this culturally and economically embedded practice. Member States are encouraged to do the following: 1) Increase tobacco excise tax rates, indexed against inflation, to reduce affordability of tobacco products. 2) Consider ways to secure sustainable funding for health (e.g. earmarking of taxes). 3) Adopt a code of conduct for all government officials in relation to interactions with the tobacco industry to combat tobacco industry interference. 4) Take a whole-of-government approach to strengthening multisectoral collaboration by building a coalition with support from a range of government ministries, civil society organizations and development partners. 5) Design and implement an effective tracking and tracing system as a tool to address illicit trade in tobacco products. 6) Work towards ratifying/acceding to the Protocol. 7) Engage with civil society, youth groups, schools and local governments to raise awareness on the harmful effects of betel nut and tobacco use and actions to prevent their consumption. 3 INTRODUCTION 1.1 Meeting organization The Meeting on Accelerating the Raising of Tobacco Taxes and the Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products in the Western Pacific was organized by the WHO Regional Office for the Western Pacific and held from 27 to 29 November 2017 in Manila, Philippines. Presentations, panel discussions and interactive activities were held, with participants from 20 countries and areas in the Region attending the meeting, some representing ministries of health, finance and foreign affairs, as well as customs agencies. Panel discussants and participants identified the challenges in implementing the raising of tobacco taxes and ratification of the Protocol. Participants were encouraged to develop specific action plans to address these two aspects of tobacco control in their countries. Eight countries and areas1 also attended the Subregional Workshop on Betel Nut and Tobacco Use to discuss this aspect of tobacco control that is of specific concern to their country/area. 1.2 Meeting objectives The objectives of the meeting were: 1) to brief countries on emerging issues and enable sharing of experiences and lessons learnt on tobacco taxation and the ratification of the Protocol; 2) to identify country-specific challenges and opportunities in raising tobacco taxes and ratifying the Protocol; 3) to develop country-specific actions to raise tobacco taxes; and 4) to strengthen coordination and collaboration between the health, finance and foreign affairs sectors to accelerate the raising of tobacco taxes and the ratification of the Protocol. PROCEEDINGS 2.1 Opening session Dr Hai-Rim Shin, Acting Director, Division of NCD and Health through the Life-Course, WHO Regional Office for the Western Pacific, welcomed all participants to the meeting. Dr Shin Young- soo, Regional Director, gave the opening address. He noted the attendance of colleagues from not just the ministries of health but also the ministries of finance and foreign affairs and saw this as a rare honour. It is also crucially important for addressing the problem of tobacco use, which is the world’s number one preventable killer. While progress has been made in the last decade, there is still much to be done. Specifically, the Western Pacific Region is falling behind in two key areas: the raising of tobacco taxes and the ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products. Dr Shin reiterated WHO’s support and commitment towards helping Member States develop concrete plans of action to move forward in these two areas. 1 Cambodia, Lao People’s Democratic Republic, Marshall Islands, Federated States of Micronesia, Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea and Solomon Islands. 4 As office bearers, Dato’ Sri Subromaniam Tholasy, Director-General of the Royal Malaysian Customs Department was nominated as Chair of the meeting; Dr Geoffrey Kenilorea, Ministry of Health and Medical Services, Solomon Islands as Vice Chair; and Mr Srey Socheat, General Department of Taxation, Cambodia as Rapporteur. A list of participants is available in Annex 1. Mr Tholasy reiterated the two main goals of the meeting: (1) to accelerate the raising of tobacco taxes and (2) to ratify the Protocol. He encouraged participants to consider the raising of taxes with the goal of reducing affordability of tobacco products. In the Western Pacific Region, only four countries have signed the Protocol and only one country has ratified it thus far. He urged meeting participants to commit to concrete goals with a clear timeline of when to take action. 2.2 WHO FCTC Article 6 implementation: key to financing the Sustainable Development Goals Mr Patrick Musavuli showed a video message from Dr Vera Luisa da Costa e Silva, the Head of the Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC). Dr Da Costa e Silva expressed her deep appreciation to the participants for their work in the important area of tobacco control. She looked forward to the ratification of the Protocol in their countries as it requires ratification by 40 countries in order to enter into force. Combating illicit trade in tobacco products goes hand in hand with this goal. She pointed out that it is only with the added efforts of customs, taxation, police, foreign affairs and other sectors, that the health sector will eventually push this agenda across the Region. Mr Musavuli then introduced the WHO FCTC, which was adopted by the World Health Assembly on 21 May 2003 and entered into force on 27 February 2005. It has been widely embraced with 181 Parties to the treaty. The Conference of the Parties (COP) meets every two years to discuss different measures of the WHO FCTC, having adopted a total of eight guidelines thus far. Guidelines for implementation of Article 6, which covers price and tax measures to reduce the demand for tobacco, were adopted at COP6 in 2014. In September 2015, the UN General Assembly endorsed the Addis Ababa Action Agenda, in which 193 UN Member States recognized that, as part of a comprehensive strategy of prevention and control, price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and health-care costs and that they represent a revenue stream for financing for development in many countries. Evidence has shown that significant tobacco tax increases are the single most effective policy for reducing tobacco use and its negative health and economic consequences. One success story is the case of the Philippines, where the “Sin Tax” covering tobacco products provided a revenue boost that expanded universal health coverage to more than 45 million Filipinos. After years of strong advocacy, the WHO FCTC goals were included in the UN Sustainable Development Goals (SDGs) under target 3.4. Then at COP7 in 2016, the Delhi Declaration was made, calling on Parties “to actively pursue the achievement of SDG Target 3.a and strengthen the implementation of the WHO FCTC”. The WHO FCTC Secretariat was also requested to take the lead in collaborating with different partners to accelerate implementation. Mr Musavuli urged participants to use Article 6 as a tool not only to reduce tobacco consumption and increase funding for tobacco control but also to support the SDGs. 5 2.3 Tobacco taxation: win–win for public health and government revenues Mr Jeremias Paul in his presentation pointed out the deadly health and enormous economic consequences of tobacco consumption, a major risk factor for noncommunicable diseases (NCDs), which contribute to 70% of all deaths. Globally, low- and middle-income countries (LMICs) bear the brunt of the burden, making up 80% of tobacco users. The demand for tobacco is inversely related to price, especially for price-sensitive populations such as young people and the poor. Research has shown that a 10% raise in tobacco taxes will decrease consumption by an average of 5% in LMICs and 4% in high-income countries. Statistics on the United States of America, France, South Africa and the Philippines illustrated how raised taxes have led to lower cigarette sales, reduced smoking by young people, fewer lung cancer deaths and increased revenue. The best practices in tobacco tax policy can be represented by the acronym “STOP”, which stands for Simple tax structures, sufficiently high Tax levels and tax shares, regular adjusting of tax rate to Overcome inflation and implementation of increases as part of a Package. Importantly, an increase in taxes should lead to an increase in prices, or else it will not impact consumption. In some cases, the tobacco industry absorbs part of the tax first so that consumers are less affected. Specific excise taxes are more effective than mixed or ad valorem methods, and a uniform structure is easier to implement than a tiered structure. So-called “sin taxes” are usually supported by the majority of the population, especially if the taxes are earmarked for health or social programmes. Examples of success stories include Viet Nam and Thailand. The Chair remarked that the statistics presented in Mr Paul’s presentations would be helpful to convince ministries of finance to raise taxes on tobacco products in their countries. 2.4 State of tobacco taxation in the Western Pacific Region Among the six WHO regions, the Western Pacific has the largest number of smokers and the highest rate of adult male smokers. In his presentation, Mr Kelvin Khow observed that although there is a downward trend in tobacco smoking in the Region, prevalence is not falling sharply enough to achieve the targeted 30% reduction. Each minute, three people in the Region die prematurely from a tobacco-related disease and the economic costs are substantial, including both direct costs such as health-care expenditure and indirect costs such as loss of productivity from morbidity and mortality. According to projections for China, excise tax increases would avert millions of deaths and millions of catastrophic medical expenditures, especially in the lower-income quintile. To mark World No Tobacco Day in 2017, WHO released a report outlining the impact of tobacco on the environment. Cigarette butts account for 30–40% of all items picked up in international coastal and urban clean-ups, and tobacco farming is damaging to the earth and jeopardizes the lives of workers. Tobacco also has an economic impact at the household level. There is a link between tobacco use and exacerbation of poverty, with income being diverted to tobacco rather than education or social areas, and women and children being especially vulnerable to its harmful effects. Taxation is a cost-effective measure to prevent and reduce tobacco use among vulnerable populations such as young people. While there has been some progress in taxation in the Region, it is the least utilized among the WHO MPOWER comprehensive tobacco control policies (Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; Raise 6 taxes on tobacco). Prices of tobacco products remain too low in this Region. One concerning trend for countries such as Viet Nam and the Lao People’s Democratic Republic is that economic growth resulting in income increase may outstrip tax raises such that tobacco products become even more affordable. Mr Khow emphasized the need to index taxation with inflation in order to keep pace with a country’s economic development. Scenarios modelling the impact of raising tobacco taxes on public health and finance show the substantial potential increase in general government revenues and health budgets if cigarette excise taxes were raised by US$ 0.25 or US$ 0.80 per pack. In the discussion that followed, participants brought up a common belief that raising taxes would result in more smuggling and ultimately a reduction in revenue. Dr Ada Moadsiri from the WHO Division of Pacific Technical Support shared that a WHO-commissioned study about the economic impact of consecutive tobacco tax increases in the Cook Islands found that the tobacco industry front- loaded the import of tobacco in the quarters prior to an anticipated tax increase to avoid paying the higher tax rate, which resulted in the collection of less revenue than forecasted. To prevent the tobacco industry from undermining tobacco tax impacts, legislative measures such as a floor tax could be implemented. Other topics discussed included comparison of the purpose and variable impacts of different kinds of taxation (e.g. import duties, excise taxes, value-added taxes), how to tax informal/local tobacco products, the cost of enforcement measures to control tobacco and tobacco industry interference. 2.5 Scare tactics of the tobacco industry: key hindrance to raising tobacco taxes The biggest hindrance to raising tobacco taxes is the tobacco industry, which uses scare tactics and misinformation to block these efforts, including: claiming that raised taxes will increase smuggling and other forms of illicit trade, threatening legal action, presenting taxes as being anti-poor, and contending that revenues will be reduced and that employment would be affected. Mr Paul addressed these tactics in his presentation. Research evidence does not support the claim that taxes are the cause of tobacco smuggling. Non-tax factors such as weak governance, high levels of corruption, lack of commitment, and ineffective customs and tax administration all play a part. Sometimes the tobacco companies themselves are engaging in illicit trade. The key strategies to combating smuggling and illicit trade are proper enforcement and cracking down on corruption. In the case of the anti-poor rhetoric utilized by the tobacco companies, Mr Paul pointed out that when the health impact of reduced mortality and morbidity from tobacco smoking is taken into consideration, tobacco taxes actually disproportionately benefit lower-income people – who are more sensitive to pricing changes – especially when revenues gained are used for social programmes that target the poor. Evidence has also shown that smoke-free policies do not adversely impact industries such as restaurants and bars. Mr Paul then went on to describe the Philippines’ successful experience in tobacco control, which initially required a paradigm shift in thinking about tobacco taxation, resulting in the Sin Tax Reform Law passed in 2012. A multi-tiered system was eventually merged into a simpler uniform system in 2017 and tax rates adjusted for income and inflation effects to reduce affordability. With political support for earmarking, the increased revenues from tobacco taxes went towards the health budget, which tripled from 2012 to 2016, allowing the national government to pay for health insurance 7 premiums for poor, near-poor and senior citizens. Despite a strong tobacco lobby that mounted legal challenges against the government, the movement had political support at the highest level and strong leadership and coalition partnerships in finance, health and civil society. Mr Paul advocated a multisectoral and whole-of-government approach that builds broad alliances. Some other lessons that can be learnt from the Philippines’ experience include: focus first on health gains of tobacco taxation, for example, by framing the tax increase as being “anti-cancer”; “think technically but act politically” – understand the mindsets of key stakeholders and leverage partnerships to overcome the tactics used by the tobacco industry; anticipate these tactics and apply pre-emptive moves and countermeasures; finally, international cooperation is critical for countries to work collaboratively in combating illicit trade in the Region. 2.6 Panel discussion I: raising tobacco taxes Participants in the panel discussion were representatives from the WHO Collaborating Centre on Tobacco Control and Economics (China), Kiribati, the Philippines and the Southeast Asia Tobacco Control Alliance (SEATCA). 2.6.1 China In China, the State Tobacco Monopoly Administration (STMA) is the pricing authority for all tobacco products and functions as the oversight body of China National Tobacco Corporation, the largest tobacco company in the world measured in terms of revenue. When tobacco taxes were increased in 2009, the STMA absorbed the increases and applied pricing strategies that optimized their profits and interfered with the effectiveness of the government’s tax policy. However, cigarette excise taxes raised in 2015 successfully increased prices, resulting in decreased consumption and increase in government revenue. Some enablers that facilitated implementation of the measure were: use of the WHO analytical framework Tobacco Tax Simulation (TaXSiM) for modelling, simulation, forecasting and industry analysis; the Campaign for Tobacco-Free Kids media campaign; monthly cigarette price surveys to monitor price changes after tax increase; and research results shared with policy-makers to provide support for the measure. Dr Rong Zheng echoed the recommendations of having a simple tax structure, indexing regular tax increases to inflation and income, and making the tax increase part of a comprehensive tobacco control strategy including other policy measures such as smoke-free legislation. 2.6.2 Kiribati Ms Akaaka Kibae from Kiribati presented on the implementation of the conversion of import duty into an excise tax on tobacco products. Challenges to the new system included: the lack of proper standard operating procedures for assessing and monitoring the tax, the need for consistency in policy to align the new rates with international customs reporting guidelines, and rejection of the measure by people who were not used to the new measure. While the measure is still in its infancy, government revenue has increased since 2014. 2.6.3 Philippines The Philippines’ Sin Tax Law was implemented in 2012 with a big jump in the tax rate along with a gradual shift to a unitary tax structure regardless of cigarette price or brand. Tax protection for legacy brands was removed and provisions are in place to correct for inflation through an annual increase of 4% every year in perpetuity. The bulk of the revenue collected (85–87% of additional revenue) is earmarked for health programmes and the rest allocated to tobacco-growing districts, especially 8 towards alternative livelihoods. The tax measure was successful despite the anti-taxation efforts of the tobacco lobby, described as the most powerful in the Region. This was achieved through a broad- based coalition consisting of government champions in both the executive branch and congress, and civil society advocates. Mr Filomeno Sta Ana III especially highlighted the role of civil society, which: provided technical assistance, framed the measure as a health issue as opposed to a fiscal one, pressured politicians and pushed for maximum objectives, and shaped public opinion through effective and creative communication strategies. As a result of the Sin Tax, smoking prevalence has decreased, especially in populations vulnerable to price increases, such as young people and the poor, and substantial revenue generated from the law has led to a dramatic increase in budget for the Department of Health. 2.6.4 ASEAN member states Ms Sophapan Ratanachea presented on the status of implementation of tobacco tax measures in member states of the Association of Southeast Asian Nations (ASEAN). The major findings from SEATCA’s 2017 report were that: (1) in most ASEAN countries, the tax rates were not high enough to impact affordability; (2) tax systems need to be made simpler and more effective; and (3) tax administration policies such as licensing, tracking and tax collection were not strong enough to address challenging issues. Ms Ratanachea offered the following suggestions and recommendations: • Use research evidence to advocate tax increases that will impact affordability of tobacco products. • Pay attention to aspects of tax administration such as licensing and regulation, and develop a strong tax collection system. • To combat illicit trade, consider a tracking and tracing or fiscal marking system so that legal and illegal products can be easily differentiated. • Create a so-called code of conduct to prevent the tobacco industry from interfering in the decision-making process and to discourage government officials from giving the industry special treatment such as tax holidays. • Use a simple and uniform tax system to reduce the cost of auditing tax payments and prevent consumers from shifting to cheaper products or brands. 2.7 Panel discussion II: earmarking tobacco taxes for health Dr Peter Cowley introduced the session on earmarking tobacco taxes by commenting that it was an important but often misunderstood tool. On the one hand, earmarking can lead to budget inflexibility; on the other hand, it can be used to protect against encroachments of consolidated funds by other parts of government. The constant battle is to ensure that earmarking for health results in health outcomes. This is an area that might be unfamiliar to the health sector. The panel participants were representatives from SEATCA, Solomon Islands and the Philippines. 2.7.1 ASEAN member states Article 6 of the WHO FCTC recommends that Parties dedicate revenue to tobacco control programmes and thus far, more than 40 countries worldwide have implemented earmarked taxes for health. An example of a success story in this Region is Viet Nam, where an intersectoral management board oversees a unit in the Ministry of Health that distributes 100% of tobacco excise taxes to 9 tobacco control. In her presentation on ASEAN member states, Ms Ratanachea also described Thailand’s best practice in setting up an autonomous state agency, the Thai Health Promotion Foundation, which utilizes the 2% surcharge from alcohol and tobacco products for alcohol and tobacco control programmes and other health promotion activities. Following the principle of “make the polluter pay”, the model uses surcharges paid for by the industry – making it an effective fiscal tool to secure a sustainable and adequate fund for health promotion – while 100% of the excise tax goes to the Ministry of Finance. Ms Ratanachea stated that transparency in fund management is very important as such a system could easily lead to corruption. However, it is a very effective source of funding for health promotion, especially for countries that are reliant on external donor funding, which is not sustainable in the long run. 2.7.2 Solomon Islands Dr Geoffrey Kenilorea presented on the Healthy Lifestyle Promotion Fund (HLPF) in Solomon Islands, established initially through both local and donor funding through the Tobacco Control Act 2010. One challenge is the absence of comprehensive guidelines and regulations to manage the HLPF, which are now being drafted. License fees collected for tobacco manufacturing, import, distribution, wholesale and retail in the past few years have been going into a consolidated fund instead of to the HLPF. However, the goal is for the HLPF to fund most of the NCD activities for 2018, including all tobacco control measures to be implemented. Dr Kenilorea emphasized the importance of receiving support from the permanent secretaries and the technical advisory group. He recommended sensitizing key role players to the issues and having key documents ready as early in the process as possible for smooth implementation. 2.7.3 Philippines In her presentation on the Philippines, Dr Maylene Beltran summarized the key points covered by earlier presenters on the success of the Sin Tax Law. The allocation of the incremental revenue consists of 85% for health and 15% for alternative livelihood of tobacco farmers. Of the 85% allocation for health, 80% is for the Universal Health Care expenditures and 20% for medical assistance and Health Enhancement Facilities Programme. The budget for the Department of Health increased three-fold from 2013 to 2017, with 64% of the contribution derived from the Sin Tax. The increase in budget was used to cover 15.3 million poor and 2.8 million seniors, as well as to provide new health services and health facilities, and increase coverage for other programmes such as infection control. Other tobacco control efforts included graphic health warnings on cigarette packs, a nationwide ban on smoking and development of the Internal Revenue Stamps Integrated System to reduce illicit trade. Dr Beltran concluded her presentation by suggesting that a regional regulatory framework on NCDs can increase political commitment and accountability, present these interventions as a package and accelerate implementation in the Region. In his final remarks, Dr Cowley made the point that ministries of finance are understandably wary of earmarking as it would be fiscally irresponsible if the funds are not wisely spent. The sentiment was echoed by Mr Sta Ana, who recommended that successful earmarking should avoid arbitrariness and have a level of specificity that is not too detailed. From an economic institutional perspective, a case can be made for earmarking for health, as health is a public good. 10 2.8 Panel discussion III: tobacco industry interference Ms Annabel Lyman introduced the two panel presenters: Dr Mary Assunta Kolandai from SEATCA and Dr Ada Moadsiri from the WHO Division of Pacific Technical Support. 2.8.1 Tobacco industry interference index Dr Kolandai reported that in a 2016 report to the COP, Parties identified tobacco industry interference as the biggest obstacle to implementation of the WHO FCTC. Transnational tobacco companies such as Philip Morris International employ many strategies to defeat anti-tobacco measures. Fortunately, Article 5.3 of the WHO FCTC provides sufficient antidotes to these tactics and contains effective tools that can empower governments. The Tobacco Industry Interference Index is a civil society report by SEATCA that assesses the status of countries’ implementation of Article 5.3. The main finding of the report was that only marginal improvements had been made in the Region and most governments do not have procedures in place for disclosing or documenting interactions with the tobacco industry. One notable exception is the Philippines, where the Department of Health has developed a code of conduct that serves as a firewall between civil services and the tobacco industry. Dr Kolandai encouraged all countries to take a whole-of-government approach and to require the tobacco industry to disclose and report all their expenditures related to marketing, retailer incentives, philanthropy, lobbying and political contributions. There is a need to denormalize the industry, which often takes actions under the auspices of corporate social responsibility, but these in fact should be banned. One recent example was when the UN Global Compact delisted four tobacco companies that had previously been participants in it. Dr Kolandai stressed the importance of policy coherence, systematic monitoring of the tobacco industry, operationalizing Article 5.3 at all levels and branches of government, and identifying, engaging and supporting those government sectors that are more vulnerable to influence by the tobacco industry. 2.8.2 Pacific tobacco industry interference index Dr Moadsiri built on the previous presentation to discuss the adaptation of the Tobacco Industry Interference Index for the Pacific, which was inspired by the SEATCA tool and report. She pointed out that the Pacific islands are not too small to be targeted. One common example of tobacco industry interference is the industry making donations to fund post-disaster relief efforts. The industry often targets certain sectors of government that are vulnerable to their influence – such as customs – so measures need to be put in place to prevent interference. In the lively discussion that followed, Dr Yel Daravuth from the WHO Representative Office in Cambodia brought up the goals of the WHO FCTC working group, which recently met to develop a medium-term strategic framework to push hard against tobacco industry interference and work towards taxation in the next 3–4 years. He characterized the current situation as a crossroads with great opportunities ahead for defeating the tobacco lobby. Dr Moadsiri encouraged participants to continue to raise awareness outside the health sector and use that as a catalyst for action. Dr Kolandai described ways to enhance transparency. For instance, the ministries of health in Australia and New Zealand publish information on all their meetings and who are involved so these become a matter of public record. The Philippines’ two-page template for the code of conduct is another example that she offered to make available to anybody who is interested in implementing it. Participants also discussed the importance of working with other international organizations such as the World Customs Organization (WCO) and the Oceania Customs Organisation (OCO) on the issue of illicit trade. 11 In his wrap-up, Mr Kelvin Khow thanked all participants for their lively engagement and encouraged everyone to think about the presentations thus far as a lot of information had been shared. The following two days would consist more of group work. 2.9 Breakout session I: coalition-building for successful tobacco tax reform At the start of the second day of the meeting, the Vice Chair welcomed participants back to the meeting and the Rapporteur summarized the key points from the previous day’s discussions. The morning was devoted to a breakout session focused on facilitating coalition-building between key players within a country for successful tobacco tax reform. Participants were tasked to identify the underlying causes hindering tobacco tax reform in their country, analyse the level of interest and influence of key players in tobacco tax reform, and develop country-specific actions to engage with or address the threats posed. A summary of each country’s outcomes is provided in Annex 2. 2.10 Protocol to eliminate illicit trade in tobacco products Mr Patrick Musavuli presented on the Protocol to Eliminate Illicit Trade in Tobacco Products. The Protocol is based on Article 15 of the WHO FCTC and is a binding international treaty to eliminate all forms of illicit trade in tobacco products. It is estimated that 10% of cigarettes in the global market are from illicit trade, with the percentage higher in LMICs. Mr Musavuli stated that the tobacco industry is involved and there is a clear link between illicit trade and organized crime. Because the Protocol has many parts, his presentation focused on establishment of a tracking and tracing system (Article 8), which can help countries control their supply chain. Implementation of Article 8 allows countries to find out where products were manufactured, their intended market of sale, shipment route and point of distribution. For the system to be effective it is imperative that the tobacco industry does not have any way to control or influence it. Another crucial aspect is law enforcement, which has to be able to hold persons and entities liable for unlawful conduct and include destruction of confiscated goods. International cooperation at both the regional and subregional levels is important in successfully combating illicit trade. In the Western Pacific Region, only four countries (China, Fiji, Mongolia and the Republic of Korea) have signed the Protocol, and among them, Mongolia has ratified it. The Protocol requires ratification/accession by 40 Parties for it to enter into force and was still short by seven at the time of the meeting. Mr Musavuli urged participants to consider accession to the Protocol by 2 July 2018, 90 days before COP8 is convened on 1 October 2018. If this deadline is not met, then the Protocol will not enter into force until 2020. A panel of experts has been established and will be discussing the minimal requirements for tracking and tracing and he encouraged participants to request their assistance in understanding this crucial aspect of the Protocol. The Convention Secretariat also organizes regional and subregional multisectoral workshops to bring together the different ministries such as health, finance, foreign affairs and customs. Participants can find more information at www.who.int/fctc/protocol/activities/en/. 2.11 Reasons why we need the Protocol: international experiences In his presentation, Mr Austin Rowan recounted some of his past experiences as head of investigations at a European antifraud office to illustrate the severity of the illicit tobacco trade. The amount of money involved is staggering and it goes to serious organized crime syndicates that use it 12 for other harmful activities such as drugs. These case examples demonstrate the importance of international cooperation as illicit trade is a global phenomenon that requires a global solution – no matter how good one country’s customs laws are, illicit trade will still be a problem if its neighbouring countries do not also take control of the situation. The Protocol is an international treaty that can be a powerful tool if ratified. As a case study, Mr Rowan described how 120 million cigarettes smuggled as animal feed in a free zone were investigated and seized, and the criminals caught and jailed all due to cooperation among several countries – an example of international cooperation at its best. In response to a question about how to do a gap analysis, Mr Musavuli reminded participants that they can seek assistance from the panel of experts and use the tool available online to assess their country’s current compliance in relation to each article of the Protocol. The panel of experts is working on developing a tracking and tracing system that has global interoperability and is effective for all countries. Participants were urged to ratify the Protocol so they can ensure that any tracking and tracing system developed will fulfil their needs and be appropriate for their specific contexts. 2.12 Panel discussion IV: ratifying the Protocol Mr Musavuli invited representatives from Mongolia and Fiji to share their experiences on how their countries became a Party and a signatory to the Protocol, respectively. 2.12.1 Mongolia Mongolia is the only country in the Region that has ratified the Protocol. Dr Baigalmaa Dangaa related the steps involved in this process, which included translating all materials – fact sheets, plans of action – quickly from English to Mongolian and making these readily available to the decision- makers and policy-makers. A well-informed and active working group was established that involved many sectors; the WHO country office and Regional Office for the Western Pacific provided technical support and worked closely with the working group. Furthermore, the social atmosphere was conducive to tobacco control measures due to a successful advocacy campaign and the influence of a powerful anti-tobacco champion in parliament. The Minister of Health was also very supportive and influential in reaching the public using plain language. While tobacco industry interference was a challenge and there were conflicts of interest even among members of parliament, taking a whole-of- government approach in which many sectors agreed on the same actions overcame these obstacles. The next steps to be taken are development of an effective tracking and tracing system and improving treatment of tobacco dependency and public awareness. Mr Musavuli stated that a best practices document on Mongolia is being drafted to be shared with other parties in the Region. 2.12.2 Fiji Mr Nafiz Ali reported that, having signed the Protocol, Fiji is now progressing towards ratification, with the aim for it to be included as part of the seven Parties needed for the treaty to enter into force. An interim leadership team was created, made up of directors from different sectors headed by the Permanent Secretary for Health and Medical Services. The process is now at the stage of tabling a motion paper. After signing the Protocol, Fiji undertook a self-assessment, with support from WHO, to determine the country’s current compliance with the Protocol. The self-assessment was important for raising awareness among government sector colleagues about the Protocol. One of the key issues 13 identified was the need for legislative amendments to the national tobacco control legislation to ensure that Fiji is fully compliant with some of the mandatory requirements of the Protocol. In his concluding remarks for this panel discussion, Mr Musavuli once again strongly encouraged participants to push for the Protocol so that their countries will be represented, especially during discussions about the tracking and tracing system that can then be developed according to their needs. Dr Moadsiri encouraged the Pacific island countries to be a Party to the Protocol so that their context is taken into consideration. They reminded participants that Parties should implement the tracking and tracing system within five years after entry into force of the Protocol for cigarettes and 10 years for other tobacco products, so countries should not be deterred if they are not yet fully compliant. Since the process takes a long time, the key is to secure political will and begin the process as soon as possible. 2.13 Tracking and tracing system According to Mr Rowan, there are no existing tracking and tracing systems that meet the requirements stipulated by the Protocol. With current technology, tax stamps are of high quality and difficult to counterfeit, but can only indicate whether duties have been paid or not. It is crucial to be able to identify where cigarettes go into the black market. Tracking should begin at the factory where cigarettes should be stamped with a unique code that can be scanned and entered into a computer system to generate information about where they are being sold. It is essential that such a system meet all the requirements of the Protocol and is not controlled by the tobacco industry. Mr Rowan related a case involving 80 million cigarettes originating from RJ Reynolds Tobacco Company that were smuggled on the Black Sea in vessels and trucks that purported to contain toilet paper rolls. Although the contraband was seized, identifying marks on the master boxes had been cut off and RJ Reynolds claimed ignorance as to who the cigarettes were being sold to. While this case occurred 18 years ago, it is still relevant today because it remains difficult to bring the perpetrators of illicit trade to justice. 2.14 Panel discussion V: measuring and preventing illicit trade Though difficult to quantify, one estimate is that illicit trade is responsible for US$ 40-50 billion in lost revenue globally. Speakers for the final panel discussion on measuring and preventing illicit trade were from the Royal Malaysian Customs Department, the Singapore Health Promotion Board and the OCO. 2.14.1 Malaysia In the case of Malaysia, 90% of illicit cigarettes come from Indonesia, Viet Nam, Cambodia and the Philippines. Mr Tholasy shared statistics on the percentage of revenue leakage in Malaysia and listed the five causes as: commercial fraud (misdeclaring), direct smuggling (Malaysia has a long coastline), tax evasion, integrity (includes behaviour of customs officers, port authority, liner authorities and customs brokers) and misuse of free zone facilitation/duty-free island (free zones are usually considered to be outside of customs authority). All major ports have scanners and the Customs Department works with the navy and coast guard to seize ships suspected of smuggling. There is also a tax stamp fiscal marking system in place, but the system is limited as it does not indicate who the buyer is. There is a need to develop a new state-of-the art customs information system that integrates many different agencies. Enforcement is also now being coordinated to combat syndicates that threaten officers in high-risk areas. 14 2.14.2 Singapore In Singapore, the price differential between legal cigarettes and contraband cigarettes is very high, so there is high incentive to smuggle. Most illegal cigarettes come from neighbouring countries; Singapore has very porous borders with Malaysia and Indonesia and is a major trans-shipment port through which lots of goods travel between destinations. Mr Lit Fai Chan presented on the strategies Singapore has taken to tackle illicit tobacco, which include the following: • Customs works closely with the Immigration & Checkpoints Authority (ICA) to identify illicit tobacco that might be concealed among other goods by increasingly complex and organized syndicates. • There is a large penalty for possession of illicit tobacco and individuals who offend could be charged S$ 500 per pack – which could be 40 times the amount of tax evaded – and repeat offenders may even receive a prison term. These are strong deterrents. • Public education on this issue is conducted on different platforms. For instance, Singapore Customs conducts a roadshow with a suite of messages geared towards the large population of foreign workers in Singapore that includes a warning about the consequences of possessing illegal cigarettes. • All legal cigarettes are inscribed with the letters “SDPC” (Singapore Duty-Paid Cigarette) and a series of vertical marks to indicate their legality. This innovative re-engineering solution serves as an easy way for law enforcement to identify contraband and also works as a social deterrent. 2.14.3 Pacific island countries Mr Tevita Tupou from the OCO presented on the situation of illicit trade in the Pacific islands. The OCO represents 23 customs administrations across the Pacific that collectively process more than 95% of regional trade. It works closely with the WCO at the global level. The Pacific islands are physically connected by the Pacific Ocean, but not necessarily commercially connected beyond trade agreements. Therefore, a regional coding system – the Pacific Harmonized Commodity Description and Coding System (PACHS) 2017 – was developed to standardize classification of commodities at the regional level. Cigarette smuggling is linked to transnational crime perpetrated by outlaw motorcycle gangs. Mr Tupou characterized these gangs as being able to work outside the framework of the law and having unlimited resources; in contrast, law enforcement works within the framework of the law and has limited resources. The criminal organizations will collaborate with one another if there is money to be made. In the same way, collaboration among governments and government sectors is a key element to defeating them. The OCO has partnerships with different international agencies and coordinating centres to encourage sharing of information. The ASYCUDA (Automated System for Customs Data) is a computerized system designed by the United Nations Conference on Trade and Development (UNCTAD) that can be used to manage and oversee cross-border trade operations. Mr Tupou stated that context and scalability are key for application of strategies in the Pacific and the bottom line is collective action, leadership and integrity. In her wrap-up, Dr Moadsiri encouraged countries to become a Party to the Protocol. 15 2.15 Breakout session II: challenges and opportunities in preventing illicit trade in tobacco products At the start of the third day, Ms Ashlee Teakle welcomed participants to the last day of the conference and Mr Srey Socheat recounted the highlights from the second day’s discussions. Ms Mina Kashiwabara explained the purpose of the next breakout session, which was an opportunity for participants to focus on: (1) identifying measures to control the illicit trade in tobacco products, (2) determining causes that are hindering these chosen measures from being implemented/ strengthened, and (3) identifying country-specific actions to address these causes. A summary of each country’s outcomes is provided in Annex 3. 2.16 Next steps In the last session of the meeting, Mr Musavuli summed up some key points: • There is a need for self-assessment for some countries to find out where they are in terms of the Protocol, what the next steps are and how WHO can provide support. • Tracking and tracing is one of the agenda items of the experts panel meeting in South Africa in March. The panel will take the issue of cost into consideration and inform parties of their findings. • It is important to take a whole-of-government approach and to work together at the country level – ministries/departments of health should involve all the other sectors. • Collaboration with customs organizations and development organizations like the World Trade Organization (WTO) and the OCO is needed because they are already in the field and can help move the agenda forward. • Political will is paramount, so ratification of the Protocol should be advocated with decision- makers and the WHO FCTC should be followed. Mr Tupou added that it is possible to piggyback on trade facilitation committees in participants’ respective countries as these are very powerful and supported by many development agencies such as the Asian Development Bank and the International Monetary Fund. 2.17 Closing In her closing remarks, Dr Hai-Rim Shin thanked everyone for their participation in the meeting and urged them to think about their top priorities. She encouraged all participants to let the Regional Office know how it may provide support and be of assistance to them. SUBREGIONAL WORKSHOP ON BETEL NUT AND TOBACCO USE 3.1 Opening After the meeting, representatives from Cambodia, the Lao People’s Democratic Republic, the Federated States of Micronesia, the Marshall Islands, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea and Solomon Islands participated in the Subregional Workshop on Betel Nut and Tobacco Use. 16 3.2 Evidence on the health impact of betel nut and tobacco use Dr Anita Das from the United States National Cancer Institute (NCI) explained her role in helping build linkages in the Region and presented evidence on the negative health impacts of betel nut and tobacco use. According to a 2002 study on the global epidemiology of areca nut (colloquially called betel nut/quid) usage, 10–20% of the world’s population chew it, with or without tobacco. It is most prevalent among East, Southeast and East Asian populations. Other studies have looked at chewing rates which are as high as 76% in the Solomon Islands and Palau. In 1987, the International Agency for Research on Cancer (IARC) concluded that chewing areca nut with tobacco was carcinogenic to humans, and in 2004 this was revised to carcinogenic with or without tobacco. Studies have shown that areca nut is a precursor of oral malignant disorders that can cause oral cancers. It also has negative effects on almost all the organs in the human body and interferes with the immune system. Because of its harmful and addictive nature, its use should be tightly regulated Unlike the WHO FCTC for tobacco, there is currently no global policy on areca nut use. Cessation programmes or interventions present a multidisciplinary challenge because they have to take into account the social/cultural norms and traditions in which areca nut chewing is embedded. In 2016, the NCI and its partners convened an international conference on betel nut use with scientific and public health leaders in the Region to identify research needs and discuss opportunities to reduce its use. An article defining a global research and political agenda is forthcoming in the medical journal Lancet Oncology. 3.3 Betel nut and tobacco use in the Pacific islands and selected ASEAN member states Dr Ada Moadsiri summarized the status of betel nut chewing in the Pacific islands based on data from the WHO STEPwise Approach to Surveillance (STEPS) surveys. Prevalence ranged from 2.2% in the Marshall Islands in 2006 to a high of 90.2% in Yap (Federated States of Micronesia) in 2009.2 Some national and local governments have made headway in regulating betel nut; for instance, banning sales to minors, banning use in public places and posting health warnings at the points of sale. However, there are limited resources to enforce these laws. Growing and exporting betel nut is a lucrative business, so it is difficult to deter people from trading it as a source of income. Many people have misconceptions about chewing betel nut; for instance, some people think it improves oral hygiene or that it controls blood sugar. Therefore, awareness interventions are imperative to reducing demand for betel nut. Dr Moadsiri shared that one effective strategy is to frame the betel nut control measures as actions to protect future generations, an approach similar to that used in tobacco control. Other examples include preventing the public display of betel nut. There is currently a bill in the Commonwealth of the Northern Mariana Islands to tax betel nut. Other enforcement options include establishing a registration process for betel nut retailers. Development of a course about betel nut for the Pacific Open Learning Health Network (POLHN) is under way. 2 These values differ from the ones presented earlier due to differences in how the questions were worded in different surveys. 17 3.4 Country presentations Representatives from Papua New Guinea, the Marshall Islands and the Federated States of Micronesia gave presentations on betel nut control efforts in their countries. 3.4.1 Papua New Guinea Tobacco and betel nut chewing are a major problem in Papua New Guinea, where this can be a social or ceremonial practice. Prevalence rates are high in men, women and young people. Ms Rosemary Robert summarized current prevention and control measures, which include population-based health awareness interventions and banning of betel nut by the National Capital District Commission in Port Moresby. As a result of these measures, Port Moresby has become cleaner, yet challenges remain. Betel nut has become a commercial commodity and awareness of its health impact is still low. There is a need to change the cultural practice and curb the trend in young people taking up betel nut chewing. Interestingly, the governor’s initiative to regulate betel nut is based on environmental reasons, however it also indirectly promotes healthy lifestyles. 3.4.2 Marshall Islands Ms Leilani Peren presented on the engagement of civil society to address betel nut and tobacco use in the Marshall Islands. The Marshall Islands has a Tobacco Control Act (2006) and a Betel Nut Prohibition Act (2010) which include a ban on sale of tobacco and betel nut to minors. As a way to involve the community in the anti-tobacco effort, a popular nongovernmental organization (NGO), Kumit Bobrae (Kumit), is working with the Ministry of Health and Human Services to enforce compliance of the ban. It has a strong connection with the police force, both nationally and locally, and Kumit compliance officers are deputized to use the citation forms that include the ban. This successful collaboration has resulted in an 18% retail violation rate (RVR), which is lower than the targeted 20% or lower RVR. Kumit is also part of a multisectoral working group on tobacco control consisting of various agencies and government sectors. In August 2017, the group reviewed tobacco, betel nut and alcohol legislation, identifying loopholes and potential amendments. One example was that the betel nut law previously allowed for import of betel nut for personal consumption without imposing any limits. Ms Peren outlined plans made by the working group: to work with the judicial branch to develop a mechanism that makes it easier to cite lawbreakers; to identify NGO partners to work with in raising awareness; to establish a process whereby a portion of money received from fines is dedicated to enforcement; and to consult multiple sectors when drafting legislation to avoid loopholes. 3.4.3 Federated States of Micronesia Mr Ari Skilling explained that betel nut chewing is a deeply embedded cultural practice in Yap, where it was traditionally used in the “men’s houses” for calm deliberation. In the late 1990s, the practice spread and became popularized in the other states of the Federated States of Micronesia (Chuuk, Kosrae and Pohnpei). A few regulations have been instituted, such as requiring a licence to sell betel nut (Tafunsak municipality in Kosrae) and ban of sale to minors (state law in Pohnpei), which were passed with the help of passionate members in legislature. One big challenge is pushback from the private sector as betel nut is heavily relied upon as a cash crop. Other challenges include policy- makers themselves being users and fragmented data that make it difficult to convince lawmakers to risk re-election with a measure that might be considered polarizing. Some schools and hospitals have started prohibiting betel nut use on their property but interventions are still in their infancy. Efforts are now under way to identify persons of influence and/or local NGOs to champion the cause. Having a 18 better informed community and leadership and making use of local/cultural hierarchy structures would result in the most effective interventions. All the participants in this breakout session expressed their appreciation to the WHO Regional Office for the Western Pacific for bringing them together. The sharing of data, information, challenges and strategies was very useful and beneficial to everyone’s efforts to address the epidemic of betel nut and tobacco use in their countries. 3.5 Breakout session: Action planning Ms Mina Kashiwabara facilitated the final activity of the day, which was a breakout session for action planning by countries. The participants identified existing activities for the prevention and control of betel nut and tobacco use within six strategic areas introduced in the Review of Areca (Betel) Nut and Tobacco Use in the Pacific: A Technical Report. The six strategic areas were: (1) legislation and policies; (2) governance and local enforcement; (3) public awareness, education, communication and advocacy; (4) alliance and partnership; (5) cessation services or dependence treatment; and (6) surveillance and knowledge management. The participants were then asked to identify potential future activities that they can introduce in each strategic area. Due to the time constraint, countries stopped after the brainstorming of future activities and were asked to reflect on those ideas upon returning home. A summary of the outcomes is provided in Annex 4. 3.6 Closing Ms Kashiwabara, Ms Teakle and Dr Moadsiri thanked everyone for their active participation, enthusiasm and commitment to addressing the issue of betel nut and tobacco use in their countries. CONCLUSIONS AND RECOMMENDATIONS 4.1 Conclusions It was concluded that: 1) Tobacco taxation is the most cost-effective measure to help reduce smoking prevalence and thereby reduce deaths due to noncommunicable diseases. 2) Illicit trade is a global problem and ratifying the Protocol is an important step towards a global solution. 3) Tobacco industry interference is a cross-cutting issue that affects every aspect of tobacco control. 4) Tracking and tracing systems are an effective tool for combating illicit trade in tobacco products. 5) Multisectoral cooperation and a whole-of-government approach are essential to passing effective tobacco control measures. 6) The negative effects of betel nut and tobacco use are impacting the health of many people in the Region and efforts should be made to address this culturally and economically embedded practice. 19 4.2 Recommendations 4.2.1 Recommendations for Member States Member States are encouraged to do the following: 1) Increase tobacco excise tax rates, indexed against inflation, to reduce affordability of tobacco products. 2) Consider ways to secure sustainable funding for health (e.g. earmarking of taxes). 3) Adopt a code of conduct for all government officials in relation to interactions with the tobacco industry to combat tobacco industry interference. 4) Take a whole-of-government approach to strengthening multisectoral collaboration by building a coalition with support from a range of government ministries, civil society organizations and development partners. 5) Design and implement an effective tracking and tracing system as a tool to address illicit trade in tobacco products. 6) Work towards ratifying/acceding the Protocol. 7) Engage with civil society, youth groups, schools and local governments to raise awareness on the harmful effects of betel nut and tobacco use and actions to prevent their consumption. 4.2.2 Recommendations for WHO WHO is requested to do the following: 1) Continue supporting Member States by providing advocacy and educational materials about the harms of tobacco use to be used for presentation to government officials and on social media. 2) Further support Member States in identifying and combating tobacco industry interference in all areas of tobacco control. 3) Provide opportunities for Member States to share experiences and learn best practices from one another, such as through regional meetings and workshops. 4) Encourage and facilitate partnerships between Member States and international development agencies and trade organizations to build technical capacity for monitoring and surveillance of tobacco use. 5) Facilitate sharing of information among Member States about existing and future efforts to address betel nut and tobacco use. 20 21 ANNEXES Annex 1. List of participants 1. PARTICIPANTS BRUNEI DARUSSALAM Dr Siti Rosemawati Binti HJ MD YUSSOF, Senior Medical Officer Health Promotion Centre, Ministry of Health Bandar Seri Begawan BB3910 Tel. no.: +673 2384247 Email: rosemawati.yussof@moh.gov.bn CAMBODIA Dr Sovann SIN, Deputy Director, National Center for Health Promotion No. 03 National Road 6A, Russey Keo, Phnom Penh Tel. no.: +855 23 432 051 Email: sovann@nchp.gov.kh Mr Srey SOCHEAT, Deputy Chief, Excise Tax Bureau General Department of Taxation, Sangkat Toek Laak1, Khan Toul Kork, Phnom Penh Tel. no.: +855 12 556 686 Email: srey_socheat@yahoo.com FIJI Mr Nafiz ALI, Manager, Ministry of Health and Medical Services Dinem House, Amy Street, Toorak, Suva Tel. no.: +679 8905 049 Email: nafiz.ali@govnet.gov.fj Mr Peni SUVEINAKAMA, Principal Foreign Service Officer Ministry of Foreign Affairs, BLV Complex, Nasese, Suva Tel. no.: +679 9906 355 Email: p.suveinakama@gmail.com HONG KONG SAR (CHINA) Dr YUEN Ka-yiu, Medical and Health Officer, Tobacco Control Office Department of Health, Room 1801-1803, 18/F, Wing On Kowloon Centre 345 Nathan Road, Hong Kong Tel. no.: +852 3901 4106 Email: mo3_tco@dh.gov.hk KIRIBATI Mr Enoka ARABUA, Health Promotion Officer, Ministry of Health and Medical Services, P.O. Box 268, Nawerewere, Tarawa Tel. no.: +686 28100 Email: enoka.arabua2@gmail.com Ms Akaaka KIBAE, Acting Deputy Commissioner of Taxes Ministry of Finance and Economic Development, Bairiki, Tarawa Tel. no.: +696 21806/ +696 73099388 Email: kibae@mfep.gov.ki LAO PEOPLE’S DEMOCRATIC REPUBLIC Dr Khattanaphone PHANDOUANGSY, Head, Health Promotion Division National Tobacco Control Secretariat member, Hygiene and Health Promotion Department, Ministry of Health, Simuang Road, Vientiane Tel. no.: +856 21 214010 Email: tphandouangsy@yahoo.com Mr Anosack PHENGTHIMMAVONG, Deputy Permanent Secretary Ministry of Finance, 23 Singha Road, P.O. Box 046, Vientiane Tel. no.: +856 20 55405028 Email: anosackph@gmail.com 22 MALAYSIA Mdm Noor Azliza ABDUL AZIZ, Assistant Director, Enforcement Division Intelligence Section, Royal Malaysian Customs Headquarters, Level 3 North Block 2G1B, Ministry of Finance Complex, No. 3, Persiaran Perdana Precinct 2, 62596 Putrajaya Tel. no.: +60 38882 2848 Email: azliza.aziz@customs.gov.my Dr Norliana ISMAIL, Senior Principal Assistant Director, Tobacco Control Unit & FCTC Secretariat, Disease Control Division, Ministry of Health Level 2, Blok E3, Ministry of Health, Parcel E, 62590 Putrajaya Tel. no.: +60 38892 4414 Email: norliana.ismail@moh.gov.my Mr Subromaniam THOLASY, Director General of Customs, Royal Malaysian Customs Department, Royal Malaysian Customs Headquarters, Level 10 North, Ministry of Finance Complex, No. 3, Persiaran Perdana, Precinct 2 62596 Putrajaya Tel. no.: +60 19277 5881 Email: Subromaniam.tholasy@customs.gov.my MARSHALL ISLANDS Ms Leilani PEREN, Tobacco Control Coordinator, Ministry of Health and Human Services, P.O. Box 16, Majuro 96960 Tel. no.: +692 625 3355 Email: leilaniperen@gmail.com Mr Itibo Puta TOFINGA, Consultant / Acting Assistant Secretary of Finance, Ministry of Finance, P.O. Box 29, Majuro 96960 Tel no.: +692 625 5722 Email: tofinga54@hotmail.com MICRONESIA (FEDERATED STATES OF) Mr Ari SKILLING, Acting Program Manager, FSM National Tobacco Prevention and Control Program, Department of Health and Social Affairs P.O. Box PS70, Palikir 96941 Tel. no.: +691 320 1570 Email: askilling2@fsmhealth.fm MONGOLIA Ms Lkhamjav DAANSRAN, Specialist of Revenue , Division of Financial Policy and Planning Department, Ministry of Finance, 119, 43B Telmuun 3rd Khoroo, Kahn Uul District, Ulaanbaatar Tel no.: +976 88025405 Email: lkhamjav_d@moh.gov.mn Dr Baigalmaa DANGAA, Senior Office for NCD Prevention and Control Public Health Department, Ministry of Health, Government building VIII Olympic street-2, Sukhbaatar district, Ulaanbaatar Tel no.: +976 99153926 Email: baigalmad@yahoo.com Ms Uyanga GANBOLD, First Secretary, Department of Foreign Trade and Economic Cooperation, Ministry of Foreign Affairs, Peace Avenue 7A Ulaanbaatar Tel. no.: +976 99117638 Email: dep07-10@mfa.gov.mn NEW ZEALAND Ms Scarlett STORR, Senior Advisor, Tobacco Control Ministry of Health, P.O. Box 5013, Wellington Tel. no: +64 4 4962390 Email: scarlett_storr@moh.govt.n 23 NORTHERN MARIANA ISLANDS (COMMONWEALTH OF) Ms Samantha Kim BIRMINGHAM-BABAUTA, Research Associate Commonwealth Healthcare Corporation, P.O. Box 500409 Saipan Tel. no.: +670 285 7264 E-mail: sami.birminghambabauta@chcc.gov.mp PALAU Ms Candace KOSHIBA, Program Manager, Substance Abuse Prevention Unit Ministry of Health, P.O. Box 6027, Meyuns Road, Koror 96940 Tel. no.: +680 488 8119 Email: ckoshiba@gmail.com PAPUA NEW GUINEA Ms Rosemary ROBERT, Technical Officer, Alcohol and Substance Abuse National Department of Health, P. O. Box 807, Waigani, Port Moresby National Capital District Tel. no.: +675 3013773 Email: rosemary_robert@health.gov.pg PHILIPPINES Dr Maylene BELTRAN, Director IV, Bureau of International Health Cooperation, Department of Health, Building I, San Lazaro Compound Rizal Avenue, Sta Cruz 1003, Manila Tel no.: +63 2 711 9502 Email: bihcfctcdesk.dohph@gmail.com Ms Donna Celeste FELICIANO-GATMAYTAN, Director Socio-cultural Security Division, Office of the United Nations and International Organizations, Department of Foreign Affairs 2330 Roxas Boulevard, Pasay City Tel. no.: +63 2 834 4567 Email: donna.gatmaytan@dfa.gov.ph SAMOA Mr Isaia LAUTASI, Foreign Service Officer, Ministry of Foreign Affairs and Trade, Level 3 Fiame Mata'afa, Faumuina Mulinuu II Building, Apia Tel. No.: +685 21171 Email: isaia@mfat.gov.ws Mr Christopher LEI SAM, Finance Manager, Ministry of Health P.O. Box 2268, Apia Tel. No.: +685 7211440 Email: leisamchristopher@gmail.com Ms Siufofoga SEKUINI, Senior Revenue and Taxation Office Ministry of Finance, Private Bag, Apia Tel.no.: +685 34360/ +685 7672297 E-mail: siufofoga.sekuini@mof.gov.ws SINGAPORE Mr Lit Fai CHAN, Assistant Director , Health Promotion Board Substance Abuse, Adult Health Division, 3 Second Hospital Avenue Singapore 168937 Tel. no.: +65 6435 3177 Email: chan_lit_fai@hpb.gov.sg Ms CHNG Chee Yeong, Senior Deputy Director (Substance Abuse) Health Promotion Board, Substance Abuse, Preventive Health Programmes Division, 3 Second Hospital Avenue, Singapore 168937 Tel. no.: +65 6435 3705 Email: chng_chee_yeong@hpb.gov.sg SOLOMON ISLANDS Dr Geoffrey KENILOREA, National Director (Focal Point) Noncommunicable Diseases, National Focal Point for Tobacco Free Initiative/Tobacco Control Ministry of Health and Medical Services, P.O. Box 349, Honiara Tel. No.: +677 28199 Email: gkenilorea@moh.gov.sb Mr Rictor LUABOE, Chief Analyst, Revenue and Business Regulation Finance and Treasury, Economic Reform Unit, P.O. Box 61, Honiara Tel. no.: +677 23122 Email: rluaboe@mof.gov.sb 24 VANUATU Mr Alberick Jean Jacques RORY, Manager, Health Promotions Focal FCTC, Ministry of Health, Private Mail Bag 042, Port Vila Tel. No.: +678 7745450 Email: jrory@vanuatu.gov.vu Mr Harold TAROSA, Acting Manager, Customs Revenue Customs and Inland Revenue, Private Mail Bag 9012, Port Vila Tel. No.: +678 7752384 Email: htarosa@vanuatu.gov.vu VIET NAM Ms TRAN Thi Nguyet Tu, Senior Specialist, Department of Taxation Policy Ministry of Finance and Trade, 28 Tran Hung Dao Str., Hoan Kiem Dist. Hanoi, Tel. No.: +84 24 22202828 Email: tranthinguyettu@mof.gov.vn Ms VU Thi Hau, Official, Planning-Finance Department, Ministry of Health 138A Giang Vo, Ba Dinh, Hanoi Tel. no. +84 24 62732215 Email: hauv.khtc@moh.gov.vn 2. TEMPORARY ADVISERS Dr Mary Assunta KOLANDAI, Policy Advisor, Tobacco Industry Interference Southeast Asia Tobacco Control Alliance, Thoddamri, Road, Dusit City Bangkok, Thailand Tel. no.: 612 80634115 Email: mary.assunta@cancer.org.au Ms Kathleene LANNAN, Legal Officer, United Nations Commission on International Trade Law, Vienna International Centre, Vienna, Austria Tel. no.: +43 6991 820 9331 Email: kate.lannan@uncitral.org Ms Ji LIANG, Professor, Research Institure for Fiscal Science Ministry of Finance, P.R. China, Xinzhi Plaza 1228, Fucheng Road A28 Beijing, China Tel. no.: +86 1369 150 3777 E-mail: liangji99@126.com Mr Austin ROWAN, Head of Operations, Task Group Cigarettes The European Commission Anti-Fraud Office, Brussels, Belgium Email: austin.rowan@telenet.be Mr Filomeno STA. ANA III, Coordinator, Action for Economic Reform Unit 1403 West Trade Center, 132 West Avenue, Quezon City 1104 Philippines Tel. no.: 632 426 5626 Email: filomenoiii@yahoo.com Mr Tevita TUPOU, Operations Manager, Oceania Customs Organization (OCO), Private Mail Bag, 84 Harris Road., Suva, Fiji Tel. no.: 679 3313110 Email: tevitat@ocosec.org Dr Rong ZHENG, Head, WHO Collaborating Centre on Tobacco Control and Economics, School of International Trade and Economics University of International Business and Economics, No. 10 Huixin Dongjie Chaoyang District, Beijing, China Tel. no.: +86 64493332 Email: rosezheng@uibe.edu.cn 25 3. OBSERVERS/REPRESENTATIVES DEPARTMENT OF FINANCE Atty Willie SARMIENTO, Attorney III, Customs Department Department of Finance, Legal Services, Bureau of Customs, Gate 3 South Harbor, Port Area, Manila, Philippines Tel. no.: +63 2 527 0216 Email: w_speed7@yahoo.com FRAMEWORK CONVENTION ALLIANCE Ms Annabel LYMAN, Coordinator, Pacific Island Countries Framework Convention Alliance, P.O. Box 4097, Koror, Palau Email: lymana@fctc.org INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE (IUATLD) Ms Hanbing GUO, Project Officer, Tobacco Control, International Union Against Tuberculosis and Lung Disease, 1 Xindong Road 6-1-151/152 Tayuan Diplomatic Office Building, Beijing, China Email: hguo@theunion.org NATIONAL CANCER INSTITUTE Dr Anita DAS, Consultant for Leidos Biomedical Research, Inc. and Southeast Asia Liaison In support of: Center for Global Health, U.S, National Cancer Institute 6116 Executive Blvd., Suite 300 Bethesda, MD 20892-9322 United States of America Tel. no.: 858 568 6265 Email: anita.das@nih.gov SOUTHEAST ASIAN TOBACCO CONTROL ALLIANCE (SEATCA) Dr Edgardo Ulysses DOROTHEO, FCTC Program Director Southeast Asian Tobacco Control Alliance (SEATCA) 115 Thakolsuk Place Thoddamri Rd, Dusit Bangkok, Thailand 10300 Tel. no.: 662 241 0082 Email: ulysses@seatca.org Ms Sophapan RATANACHEA, Tobacco Tax Program Manager Southeast Asian Tobacco Control Alliance (SEATCA) 115 Thakolsuk Place Thoddamri Rd, Dusit Bangkok Thailand 10300 Tel. no.: 662 241 0082 Email: sophapan@seatca.org Dr Domilyn VILLAREIZ, Smoke-free ASEAN Program Manager Southeast Asian Tobacco Control Alliance (SEATCA), 115 Thakolsuk Place Thoddamri Rd, Dusit Bangkok, Thailand 10300 E Tel. no.: 662 241 0082 mail: domilyn@seatca.org 4. SECRETARIAT WHO Regional Office for the Western Pacific (WPRO) Dr Hai-Rim SHIN (Responsible Officer), Acting Director Division of NCD and Health through the Life-Course (DNH) WHO Regional Office for the Western Pacific, United Nations Avenue Ermita, Manila 1000, Philippines Tel. no.: +63 2 528 9860 Email: shinh@who.int Ms Mina KASHIWABARA, Technical Officer, Tobacco Free Initiative (TFI) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Tel. no.: +63 2 528 9894 Email: kashiwabaram@who.int 26 Ms Mary Jocelyn ALAMPAY, Consultant , Tobacco Free Initiative (TFI) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Email: alampaym@who.int Dr Peter COWLEY, Coordinator, Health Policy and Finance (HPF) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Email: cowleypet@who.int Mr Ramon DE GUZMAN, Consultant, Tobacco Free Initiative (TFI) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Tel. no.: 632 5289098 Email: der@who.int Dr Ki-Hyun HAHM, Technical Officer (Legislation and Regulation) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Tel. no.: +63 2 528 9826 Email: hahmk@who.int Ms Ashlee TEAKLE, Consultant, Tobacco Free Initiative (TFI) WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000, Philippines Tel. no.: 632 5289979 Email: teaklea@who.int WHO Cambodia Dr YEL Daravuth, National Professional Officer, WHO Representative Office in Cambodia, P.O. Box 1217, Phnom Penh, Cambodia Tel. no.: +855 12 880461 Email: yeld@who.int WHO China Mr Kelvin KHOW CHUAN HENG, Technical Officer, WHO Representative Office in the People's Republic China, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie, Chaoyang District Beijing 100600, China Tel. no.: +86 10 65327189 Email: khowk@who.int WHO Division of Pacific Technical Support Dr Ada MOADSIRI, Technical Officer, WHO Division of Pacific Technical Support, P.O. Box 113, Suva, Fiji Tel. no.: +679 323 4143 Email: moadsiria@who.int WHO Headquarters Mr Jeremias PAUL, Coordinator, Tobacco Control Economics, Prevention of Noncommunicable Diseases, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland Tel. no.: +41 22 791 2094 Email: paulj@who.int Dr Robert TOTANES, Technical Officer, Tobacco Control Economics Prevention of Noncommunicable Diseases, World Health Organization 20 Avenue Appia, CH-1211 Geneva 27, Switzerland Tel. no.: +41 22 791 2234 Email: totanes4@who.int Secretariat of the WHO Framework Convention on Tobacco Control Mr Patrick Luhindi MUSAVULI, Technical Officer, Secretariat of the WHO FCTC, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland Tel. no.: +41 22 791 2656 Email: musavulip@who.int 27 Annex 2. Outcome of breakout session I: coalition-building for successful tobacco tax reform ACTION PLANS BY COUNTRY/AREA Brunei Darussalam Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Workshop on illicit trade of tobacco with relevant stakeholders Ministry of Finance (customs), Ministry of Health, Police department, Attorney General’s Chambers, Narcotics, Internal Security Department Convention Secretariat, illicit trade expert Strengthen international collaboration – ASEAN meeting Director General of Customs (Malaysia) Cambodia Goal: Increase excise tax rate on tobacco products from 20% to 30% with tobacco tax base from 90% to 100% Selected priority cause: Lack of stakeholder’s awareness and understanding of tobacco tax, less commitment on tobacco tax and administration Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Organize planning strategic meetings for coalition’s activities on tobacco tax General Department of Taxation (GDT), Ministry of Economic and Finance (MoEF) Ministry of Health (MoH) WHO Organize meetings with relevant departments within MoEF to raise awareness about the evidence of increasing tobacco tax GDT, General Department of Customs and Excise of MoEF National Centre for Health Promotion, MoH NGOs Provide with technical and budget support Organize Tobacco Tax Working Group (TTWG) meetings to propose the establishment of coalition to support for tobacco tax rate and tax base increase TTWG members Provide with technical and budget support Raising awareness to Inter- Ministerial Committee (IMC) for Tobacco Control on tobacco tax IMC members and relevant stakeholders Provide with technical and budget support Workshops with media agencies and other relevant stakeholders on the benefit of tobacco tax Media agencies and relevant stakeholders Provide with technical and budget support 28 Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Start social media campaign on the effect of smoking and the benefit of tobacco taxation MoH, MoEF NGOs, WHO Provide with technical and budget support Letter from MoH to counteraction about tobacco industry complaint MoH Provide with technical and budget support Letter from MoEF to counteract tobacco industry complaint MoEF Provide with technical and budget support Support NGOs to monitor and denormalize TI activities MoH WHO Provide with technical and budget support China Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Assess the cost of smoking in China to persuade high-level policy-makers that tobacco industry is negative to China’s economy Ministry of Health (MoH) Research institutes Technical support Funding support Media campaign to win public support WHO MoH NGOs Media Develop advocacy toolkit Organize stakeholder meeting MoH Ministry of Finance Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Disclose tobacco industry pricing strategy to interfere with tax policy Research institutes Technical support Funding Media campaign WHO MoH NGOs Media Develop advocacy toolkit 29 Fiji Goal: Increase tax by 20–30% Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Stronger coordination and implementation is required – entrance leadership Ministries of Health, Economy, Fiji Revenue and Customs Service (FRCS), Foreign Affairs, Trade, Defence Put together guidelines for intersection with industry Ministries of Health, Economy, FRCS, Trade, Foreign Affairs Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Awareness and education Ministries of Health, Education Funding Capacity building and technology transfer WHO, Academia, OCO, FRCS, Ministries of Health, Defence, Economy Capacity-building and technology transfer procurement Financing Hong Kong SAR (China) Goal: To increase the proportion of tobacco tax to cigarette retail price to 75% or above Selected priority cause: In view of low smoking prevalence, there is insufficient incentive to set tobacco tax increment as the priority Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Organize internal meetings with Finance Bureau to seek their support, and explain to them that it is an investment in health which can reduce medical costs in the future Health Bureau/Health Department Finance Bureau Liaise with Legislative Council members to support our proposal Legislative Council members/Health Bureau/Health Department Provide funding to academia to conduct local research to show the effectiveness of tax changes in decreasing smoking prevalence Academia/Health Department Work with NGOs to implement social media campaign Health Department/subvented NGOs/other NGOs 30 Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Conduct media briefings and present the effectiveness of raising tax in decreasing smoking prevalence Health Bureau/Health Department/Academia Work with NGOs to promote smoke-free culture in the community Health Department/NGOs Invite academia to conduct media briefings to counter the industrial-funded and biased research Academia/Health Department/Doctor Associations Kiribati Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Carry out consultations to increase support for increasing excise taxes on tobacco Ministry of finance Work with traditional leaders to continue to promote smoke- free public places Village leaders Travel support Amend legislation to require stronger health warnings on tobacco products Attorney General’s Office Support to work with Attorney General’s Office to draft amendments Lao People’s Democratic Republic Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Establish the Tobacco Tax Working Group (TWG) Ministry of Finance (MoF) - leader, Ministry of Health (MoH), National Assembly, Ministry of Justice (MoJ), Prime Minister Office (PMO), NGOs e.g. SEATCA, WHO Technical and financial support Organize series of meeting to develop plans for excise tax law enforcement, specific tax increase and simplification of tax structure TWG Information, evidence and good practices from other countries Prepare official tax reform proposal (tax roadmap) to enforce excise tax law, increase specific tax and simplification of tax structure TWG Review and provide comments to tax reform roadmap Dissemination of tax reform information through media Media and TWG Assist in the dissemination events 31 Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Establishment of Investment License Agreement (ILA) focal points/working group Chair: Ministry of Planning and Investment (MPI) Vice Chair: MOH and MOF Members: Ministry of Industry and Commerce (MIC), MOJ, Council of lawyers, National Assembly (NA), PMO Focal Points: MOH, MPI, MOF TA (Observers –TBC): WHO, SEATCA, Council of lawyers of Laos Technical assistance Development of action plan Working group members, WHO, SEATCA, Council of lawyers of Laos Development of concept note/proposal on ILA amendment Working group members, WHO, SEATCA, Council of lawyers of Laos Provide information and experience of other countries, review the ILA and propose options for ILA amendment Increase awareness on ILA for high level decision makers Working group members Get approval from NTCC and PM on proposal for amendment of ILA Working group members, WHO, SEATCA, Council of lawyers of Laos Inform the TI on enforcement of government decision National Tobacco Control Committee led by MPI and MOH In case of noncompliance by TI, proceed with litigation (2nd phase) Working group members, WHO, SEATCA, Council of lawyers of Laos Provide litigation assistance Malaysia Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Organize individual meetings with different ministers to raise awareness about evidence of lobbyist groups interfering with tobacco control policy Ministry of Finance (MoF), Ministry of Health (MoH), Ministry of Economy (MoE), NGOs, Local Authority, Sport Ministry, etc. Utilize and share SEATCA Report to other ministry Strengthen the taskforce on tobacco control (FCTC Steering Committee) MoF, MoH, NGOs, all the 10 ministries in FCTC Steering Committee Provide information especially valid data on illicit cigarettes consumption across the world Prepare a media brief on the establishment of the coalition MoF, MoH, Ministry of Multimedia and Communication NGOs, media Provide info and example of good practice in coalition building 32 Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Using and utilize the existence of existing social media groups on the effects of smoking and benefits of tobacco taxation NGOs, social media groups, MoH Support and training in media campaign and relation Support civil society/NGOs establish Tobacco Industry Monitoring (TIM) team to monitor tobacco industry interference MoH, media, social media groups Marshall Islands Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Luncheon meeting for all supporters to seek feedback/comments Ministry of Health and Human Services (MoHHS), NGOs, Ministry of Finance (MoF), Malgov’t Attorney General (AG) Office Nitijela champion Information on tobacco-related evidence Identify champion to re- introduce during Nitijela Session Nitijela champion MoHHS, AG Provide any examples Public hearing sessions MoHHS, AG MoF, Malgov’t Public Provide evidence-based information on tobacco industry interfering across region Work through traditional leaders to raise awareness of the danger and consequences of tobacco use Businesses, users, public Traditional leaders Evidence of health issues Micronesia (Federated States of) Goal: Increase to at least 70% of retail price – tobacco products Selected priority cause: Stronger pro-stakeholders; increased “informed community” buy-in Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Organize steering committee meeting to assess coalition compilation Department of Health and Social Affairs; Department of Finance (DoF); Department of Transportation, Communications & Infrastructure; Department of Justice; Department of Resources & Development (DoR&D); Congress – Health Committee Conduct tobacco industry interference workshop Steering Committee; WHO; DoF (customs tax); DoR&D (trade and investment) Yes, facilitation; technical assistance (course and support/supply) 33 Mongolia Goal: 47% Selected priority cause: Weak knowledge and information Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Government working group (to inform data) Establish working group on economic costing of tobacco tax Law initiators Ministry of Finance Media Research institute NGO Patients Ministry of Health
hospitals Research needs dedicated to tobacco-related disease HR Information access management (IT data) Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Media Outcome of research Media NGO Ministry of Health FCTC Collection of evidence on tobacco New Zealand Goal: Earmark the tax Selected priority cause: Not a government priority Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Identify where the money would be best spent Ministry of Health Treasury Policy developers Health-care workers Identify potential champions for change Tobacco control sector NGOs Health-care welfare Inform the public, influence their views Health promotion agency (HPA) Politicians Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Organize ind. meetings with relevant stakeholders to gauge reaction and sentiment to proposed policy Treasury NGOs sector Organize ind. meetings with potential champions to lobby for change Politicians NGOs sector Start campaign to form movement/group HPA NGOs sector Start social media campaign to inform public of potential and media HPA Politicians Media 34 Northern Mariana Islands (Commonwealth of) Action/activities to build/strengthen coalitions Legislators – use champions of health, health committee; get them to introduce bill/amendment; support letters; fiscal figures (projection reports, other countries ); appeal to emotion (graphic health images) Northern Mariana College/Cancer Coalition – letters of support; public education; graphic image display Distributors/small businesses – outcry these guys with public education Customs – support letters; roundtable discussions; earmark public funds to help with enforcement Department of Finance – taxation plan; projection reports; tracking money from tobacco settlement fund (use projection reports to negate failing economy arguments) Commerce – fiscal reports; internal support from Alcoholic Beverage &Tobacco Control Division (enforcement; letter of support; roundtable discussion in bill drafting; influence commerce to support) Palau Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Conduct mini-workshop for all identified support groups (1 or 2 reps) All the supporters Yes, funding and resources Develop communication and media plan Media org/public health/Ministry of Health (MoH)/Tobacco coalitions/Omellemel Me a Ulekerreuil a Bedenged Yes, technical on-site communication Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Develop media campaign to raise awareness Media org/NGOs/MoH/Council of Chiefs (COC) Yes, technical and funding Conduct taxation workshop for policy-makers NGOs/MoH/Olbiil er a Kelulau/COC Yes, technical on-site consultation Papua New Guinea Goal: To increase excise tax on tobacco (20% annually to meet the WHO target of 70%) Selected priority cause: Multisectoral working group; advocacy Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Establish a working group WHO/Pacific Community (SPC)/UNDP Capacity-building Assist in advocating at the leadership level Increase human resource capacity PNG Government/SPC WHO Assist implementation of the national multisectoral strategic plan PNG Government /SPC UNDP WHO 35 Philippines Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Conduct a Sin Tax Advocacy Forum led by Department of Health Sin Tax Coalition Department of Finance Department of Education Participation of Jeremias Paul Dissemination of NTCS 2017– 2022 All relevant government agencies/civil society organizations Technical assistance Strong media advocacies Same as above Supportive statements Samoa Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Establishment of a subcommittee specifically for tobacco taxation enforcement Ministry of Health (MoH), Ministry of Finance (MoF), Police, Ministry of Commerce, Industry and Labour, Ministry of Revenue, Ministry of Foreign Affairs and Trade, donors/Council of Chiefs (COC) Capacity-building, information, TAs Proposal for licensing fees of local tobacco growers – follow traditional healers pathway MoH, MoF, Police, NGOs, COC Funding assistance, support proposal, awareness, TAs Strengthen health awareness focusing on the effects of tobacco Media outlets, MoH, Community/Women’s, Ministry of Education, Sport & Culture, NGOs, MoF/donors, Police More mass media campaign funding, MOH staff capacity- building on tobacco awareness Singapore Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Working group on taxation Ministry of Finance (MoF), Customs, Ministry of Health (MoH) Evidence of the impact of tax on prevalence Transparency when assessing proposals between agencies MoF, Customs, MoH High level engagement between stakeholders MoF, Customs, MoH Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Media statement/Press release on the impact of tax increases and benefit to society MoF Provide inputs to budget speech on the rational for increasing taxes MoF 36 Solomon Islands Goal: Increase excise tax Selected priority cause: Increase political advocacy Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Tobacco Control Taskforce to meet with Parliamentary Standing Committee for Health Parliamentarians clerk Executive of the ruling coalition Finance and Treasury Development of key messages, including evidence-based case about the benefit of increasing tobacco tax Development of concept paper Minister of Health Minister of Finance Technical assistance Submission of concept paper to Cabinet Minister of Health Minister of Finance Action/activities to offset threats posed by some stakeholders Partners to engage Support needs from WHO (if any) Endorse the national guidelines to avoid tobacco industry interfering or presenting their case to Cabinet Cabinet Ministers Minister of Health Support on FCTC guidelines on tobacco industry interference Vanuatu Goals: (1) Convert ad valorem duty rate of 55% to specific duty of 20 VT/stick (2) Increase excise tax rate from 16 VT/stick to 26 VT/stick Priority cause: Lack of coordination Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Briefing with Director-General of Health, present Executive Paper – Current tax structure – Western Pacific targets (30% increase) – SDG 3 2030 – WTO Doha Declaration on trips – Agreement and public health – Revenue consequences on proposal to increase tax (+/–) Ministry of Health, Ministry of Finance and Economic Management, Department of Finance and Treasury, State Law Office (SLO) Revenue analysis Prepare communication paper Instruct SLO to draft bill 37 Viet Nam Goal: reduce prevalence from 47.4% to 39% by 2020 Selected priority cause: Cheap price of tobacco products Action/activities to build/strengthen coalitions Partners to engage Support needs from WHO (if any) Prepare summary report on implementation of tobacco tax law Ministry of Finance (MoF), consultant, research institute - International experience in raising tobacco tax & reducing tobacco consumption Prepare impact assessment report (revenue, illicit, job…) Ministry of Finance (MoF), consultant, research institute - International experience in mixed or specific on world smoking prevalence & tobacco taxes - WHO high level leader letter, communications, dialogue, request to high level leaders of Viet Nam to raise tax on tobacco and other harmful products like alcohol, soft drink Prepare summary report on tobacco harm, smoking prevalence MoH, NGOs Organize meetings with all related stakeholders on tax increasing proposals, and above reports
to improve awareness of tobacco harms and increasing tax Ministries & Agencies: International organisations NGOs, consultants, experts MoF is preparing to propose government to revise ET law (to apply mixed ET: beside ad valorem, adding specific tax) Government office, Ministries and Agencies, National Assembly Committees and office 38 Annex 3. Outcome of breakout session II: challenges and opportunities in preventing illicit trade of tobacco products ANALYSIS OF CAUSES AND COUNTER-MEASURES BY COUNTRY/AREA Brunei Darussalam Problem Causes Counter-measures Support needed Problem with porous border • Lack of data collection • Unclear on methods of data collection • Weak enforcement mechanism • Weak law/penalty and guideline of payments • Weak multisectoral collaboration on illicit trade of tobacco in the country • Source of illicit trade possibly from non- ratified country • Lack of international collaboration • Learn from other countries • Amendments to current law/order • Training of law enforcement officer • Implementation/mon itoring of the law • Raise awareness • Strengthen collaboration • Set up multisectoral collaboration (army/navy?) • International collaboration • Ratification of Protocol • Support from WPRO and the Convention Secretariat Cambodia Problem Causes Counter-measures Support needed • Why is there no establishment of licensing on tobacco • Not a top priority of government • Lack of expertise on tobacco licensing • Experts (international – WHO, WB) • In-country training/workshops • Overseas study tours • Collect experiences from other countries • Draft sub decree China Problem Causes Counter-measures Support needed No incentive to control illicit trade • State Tobacco Monopoly Administration (state monopoly) • Official data show limited exports • Domestic advance tracking and tracing system • International society needs to provide data and evidence • Encourage China to be a leader of global health • WHO and FCTC Secretariat can help coordinate evidence gathering 39 Kiribati Problem Causes Counter-measures Support needed Lack in controlling supply chain (tobacco originally imported] • Legislation needs to include • Lack of resources • Cabinet still needs more clarification regarding the Protocol • Limited funding • No proper tools for tracking and tracing system • Relevant ministries’ weakness • Weak enforcement • Lack of political will • Existing laws to be amended • Ensure assistance for funding partners • Communicating/con vincing/conducting awareness regarding the Protocol • Enforce strong penalties • Assistance to do capacity-building • Strong lobby to politician Lao People’s Democratic Republic Problem Causes Counter-measures Support needed Information exchange among relevant ministries (MOIC, MOF and MPI) at national and provincial levels on establishment of tobacco factories • No leaders in the coordination of information exchange • Lack of proactive action (solve the problem only when it happens, no prevention mechanism) • Tobacco factories find regulation loophole to produce illicit cigarettes • Decree penalty not fully enforced • No exchange of data in the region • Awareness raising among relevant ministries • Seeking support for national tobacco committee • Collecting evidence of illicit cigarettes and factories 40 Malaysia Problem Causes Counter-measures Support needed • Misuse of free zone facilitation/duty-free islands • Cigarette retailers are not licensed • Too many retailers (LKTN – the tobacco industry) • Accessibility of the tobacco industry to the policy-makers • Weakness of the enforcement and monitoring system • Lack of intergovernmental agencies collaboration • Free zones – not under customs authority • Manipulation by the tobacco industry (rely on their data) • Legislation: amendment of (1) Custom Act, (2) Free Zone Act • Implementation of import license in free zone • Cooperation with other law enforcement agencies (NBOS) • Collaborated border management • Advocacy • Code of conduct Marshall Islands Problem Causes Counter-measures Support needed Suspecting duty-free goods are being sold in retail • Limited duty-free allowance • Fishing vessels • Limited enforcement
cultural barrier • Not government top priority • Limited resources Micronesia (Federated States of) Problem Causes Counter-measures Support needed Lack of tobacco licensing regime • Lack of political will/buy-in • Unique government setup (national vs. states) • Tax – jurisdiction • No comprehensive tobacco legislation 41 Mongolia Problem Causes Counter-measures Support needed Tracking and tracing system • Poor official information • Poor customs control • Limited budget • Lower interest of relevant ministry • Low interest of political parties • Increase customs control (IT-based) • Target high-level officials • Improvement needed in legal system • HR • Seeking support ADB/WB Philippines Problem Causes Counter-measures Support needed No full tracking and tracing system • Not a government priority • Lack of awareness of the Protocol • Limited funding • No leadership on the issue • Resume multisectoral engagement (DOF, BIR, BOC, DOH, DOJ, DFA, DTI, CSOs) • Technical support in terms of tech paper development, including exposure trips to parties who will share good/best practices Samoa and Commonwealth of the Northern Mariana Islands Problem Causes Counter-measures Support needed Lack of enforcement • Lack of resources/training • No financial assistance
staff turnover • Poor execution of existing trade penalties • No actions taken by responsible ministries
other ministries to review old legislation • Lack of sectoral coordination • Poor communication and data sharing • Good coordination between ministries and NGOs • Strong support from the government • Strengthen relationship with WHO/OCO and other donor partners Singapore Problem Causes Counter-measures Support needed Why is there illicit trade through the borders • Organized networks • Price differential – incentive • Demand • Influx of workers – mechanism • Intelligence • Education • Deterrence • Enforcement 42 Solomon Islands Problem Causes Counter-measures Support needed • Tracking and tracing • Screening issues • Government priority? • Interest? • No actions from relevant ministry • Old legislation • Corruption
lack of leadership/integrity • Incompetence
limited understanding • Lack of equipment
lack of funds Vanuatu Problem Causes Counter-measures Support needed Lack of licensing • Not included in Tobacco Control Act • Limited funding • Limited resources • Limited understanding • Not a priority with NTFC • Advocacy and engage with traditional chiefs/NGOs • Engage technical partners (AUSAID, NZAID, WB, ADB, WHO, etc.) • New policy initiative • Education and awareness to all stakeholders • MOUs/Collaboration – customs, health, state law, etc., finance and department of external affairs • Customs to engage their partners and include on NTFC agenda • Technical assistance 43 Viet Nam Problem Causes Counter-measures Support needed Weak control of illicit trade on tobacco products (border, domestic market) • Weak coordination between provincial authorities and market controlling agencies • Cigarettes in Cambodia are cheaper than in Viet Nam (Jet, Hero…) • Controlling the supply chain is not effective (retailers have no license, easy to buy) • Many areas between Viet Nam and Cambodia have no related forces such as customs, offences • Limited understanding of people living around the borders (poverty, unemployment) • Strengthen coordination between (meetings, regulate…) • Establishing full supply chain from producers to retailers • Strengthen effectiveness of related agencies • Create more jobs • Communication • Participation in international organizations for anti-smuggling and illicit trading • Seeking support from international organizations (technique, finance) 44 Annex 4. Outcome of breakout session: action planning (Subregional Workshop on Betel Nut and Tobacco Use) Existing activities Future activities Legislation and policies Lao People’s Democratic Republic • National tobacco control law • Advertising ban Micronesia (Federated States of) • Pohnpei betel nut law • Betel nut free public places • No sale to minor Northern Mariana Islands (Commonwealth of the) • Betel nut can be fined as litter • Import tax on betel nut: $3 per pound (bill passed in house) • Ban on betel nut display for sale on counters Palau • Individual voluntary policy on “no chewing” • Ministry of Health policy (chewing betel nut and tobacco) • Ministry of Education policy on “no chewing” • License to sell betel nut Papua New Guinea • National Capital District Commission betel nut ban Solomon Islands • Ordinance – not allowed to sell betel nut within 7 metres from house • Banned betel nut sale at the central market Cambodia • Use existing regulation on tobacco control Lao People’s Democratic Republic • Develop guidelines to ban smokeless tobacco Marshall Islands • Amendment to betel nut prohibition 2017 Micronesia (Federated States of) • Expand policy interventions to sister states Papua New Guinea • Establish a network with the National Capital District Commission • PNG Code of Conduct (DSGO) • Multiple voluntary policy Solomon Islands • Work with Ministry of Environment and Sports for cleaner Honiara towards 2023 South Pacific Games • Increase freights on ships transporting nuts Vanuatu • Awareness in schools • Cultivate a social awareness on adverse health impact Governance and local enforcement Lao People’s Democratic Republic • No enforcement Marshall Islands • Synar programme Micronesia (Federated States of) - Pohnpei • Betel nut law enforcement (citation form) Northern Mariana Islands (Commonwealth of the) • No betel nut sales to minor (18 y/o) Cambodia • Use tobacco control structure at national and subnational Lao People’s Democratic Republic • Policy brief on tobacco-chewing situation for local governments Micronesia (Federated States of) • Enforcement training of current laws Northern Mariana Islands (Commonwealth of the) • Enforce betel nut display and fine betel nut as litter • Betel nut sales license? Vanuatu • School curriculum • Teach young generation on betel nut and health impact • Restrict sales in market 45 Public awareness, education and advocacy Marshall Islands • NCD Coalition • Cancer programme • Ministry of Health awareness Micronesia (Federated States of) - Pohnpei • Betel nut law signage Northern Mariana Islands (Commonwealth of the) • Cancer Coalition produced “Chew” documentary for education • MCHC healthy mother/healthy baby programme Papua New Guinea • Communication and government education Solomon Islands • Healthy settings approach, e.g. schools/churches Cambodia • Mass media campaign Lao People’s Democratic Republic • Mass media Marshall Islands • Mass media Micronesia (Federated States of) • Mass campaign • Uniform messaging; toolkits Palau • Health promotion • Educational campaigns on betel nut and chewing Solomon Islands • Campaign on health effects of betel nut use Vanuatu • Mass media education Alliance and partnerships Cambodia • Inter-ministerial Committee Marshall Islands • PPTFI • NCD Coalition • NGOs Micronesia (Federated States of) • National Tobacco and DM Coalition • Pohnpei SNERT • KSA Tobacco-Free Coalition Northern Mariana Islands (Commonwealth of the) • Free oral health screenings via public health dental clinic • University of Guam and NMC- CREES (BENIT trials) Solomon Islands • Honiara City Council • Women’s group • MOH • Ministry of Education Cambodia • Use the Inter-ministerial Committee Lao People’s Democratic Republic • Advocate local governments to re- enforce tobacco control laws Micronesia (Federated States of) • Seek coalition/NGO buy-in to be “the face” • Expand coalition membership Solomon Islands • Increase partnerships/network • Rope in: Ministry of Environment, Home Affairs Vanuatu • Alliance • Women • Youth • Education • Agriculture Cessation services or dependence treatment Micronesia (Federated States of) • Utilize brief tobacco intervention Northern Mariana Islands (Commonwealth of the) • University of Guam BENIT trials Papua New Guinea • Multiple NGO partners Lao People’s Democratic Republic • Include tobacco chewer in cessation service Marshall Islands • Pilot brief tobacco intervention in betel nut Micronesia (Federated States of) • Request WHO technical advice • Cessation checklist 46 Surveillance and knowledge management Cambodia • National prevalence data among adults • Global Youth Tobacco Survey Lao People’s Democratic Republic • National Adult Tobacco Survey • Global Youth Tobacco Survey Marshall Islands • NCD and Risk Factor Hybrid Survey Report • Global Youth Tobacco Survey Micronesia (Federated States of) • Global Youth Tobacco Survey • BRFSS Rapid H.S. Survey Northern Mariana Islands (Commonwealth of the) • NCD and Risk Factor Hybrid Survey Report Palau • Pregnant women
breastfeeding report • NCD and Risk Factor Hybrid Survey Report Papua New Guinea • Global Youth Tobacco Survey • STEPS Solomon Islands • STEPS • Global Youth Tobacco Survey • Global School-based Student Health Survey Cambodia • Conduct regular surveys o Adults o Global Youth Tobacco Survey o Qualitative study Lao People’s Democratic Republic • Engage women’s association in the activities to control tobacco chewing Micronesia (Federated States of) • NCD and Risk Factor Hybrid Survey • Brief tobacco intervention registry Northern Mariana Islands (Commonwealth of the) • NCD and Risk Factor Hybrid Survey Report Papua New Guinea • Cessation services on dependence treatment Solomon Islands • KAP surveys (schools/community) Vanuatu • Global Youth Tobacco Survey • Global School-based Student Health Survey • STEPS www.wpro.who.int