Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: roadmap of actions to strengthen the implementation of the WHO Framework Convention on Tobacco Control in the European Region 2015–2025: progress report

Regional Committee for Europe 72nd session Tel Aviv, Israel, 12–14 September 2022 EUR/RC72/17(H) Provisional agenda item 14 9 August 2022 | 220592 ORIGINAL: ENGLISH Roadmap of actions to strengthen the implementation of the WHO Framework Convention on Tobacco Control in the European Region 2015–2025 Progress report This report describes progress made since 2018 on the Roadmap of actions to strengthen the implementation of the WHO Framework Convention on Tobacco Control in the European Region 2015–2025, in line with resolution EUR/RC65/R4. This progress report is submitted to the 72nd session of the WHO Regional Committee for Europe in September 2022. EUR/RC72/17(H) page 2 Contents Context .................................................................................................................................................... 3 Focus area 1: Strengthening implementation of the WHO FCTC and supporting innovation ........... 4 Focus area 2: Responding to new challenges .................................................................................... 5 Focus area 3: Reshaping social norms ................................................................................................ 6 Supporting area 1: Assessing progress, gaps, gradients, trends and impact ..................................... 6 Supporting area 2: Working together: partnerships and international cooperation ........................ 7 Collaborating centres .............................................................................................................................. 7 Conclusions and future plans .................................................................................................................. 8 EUR/RC72/17(H) page 3 CONTEXT 1. The Roadmap of actions to strengthen the implementation of the WHO Framework Convention on Tobacco Control in the European Region 2015–2025 draws on and is aligned with the articles of the WHO Framework Convention on Tobacco Control (WHO FCTC), as well as the guidelines for their implementation and the policy options and decisions of the Conference of the Parties. The Roadmap considers existing global and regional policy frameworks, including the action plans for the prevention and control of noncommunicable diseases adopted at both the global and European regional levels. 2. The Roadmap helps achieve the strategic objectives of the European Programme of Work, 2020– 2025 – “United Action for Better Health in Europe”, further contributing to delivering the WHO Triple Billion targets and supporting countries in implementing the commitments made under the 2030 Agenda for Sustainable Development and the Global Action Plan for Healthy Lives and Well-being for All. 3. By adopting the Roadmap at the 65th session of the WHO Regional Committee for Europe, Member States of the WHO European Region confirmed their commitment to taking further steps to accelerate full implementation of the WHO FCTC across the Region. By implementing the Roadmap, Parties in the Region will be able to reduce the devastating consequences of tobacco use on health, lives and economies and achieve the voluntary global target of a minimum 30% relative reduction in the prevalence of current tobacco use in persons aged 15 years and over by 2025. 4. Tobacco use remains the single most preventable cause of illness, disability and death in the Region. The dangers extend beyond the physical health of individuals to include their social and economic well-being. Of the 53 WHO European Member States, 51 have ratified the WHO FCTC, thereby committing to protecting public health. 5. Since 2015, a reduction in overall tobacco use has been observed across the Region (from 27.2% in 2015 to 25.3% in 2020). The rate of this reduction has, however, been relatively slow, and the Region continues to have one of the highest rates of tobacco use globally. The age-standardized prevalence of current tobacco smoking among individuals aged 15 years and older varied between 5.9% and 40.3% across Member States in 2020, demonstrating significant inequalities within the Region. Current trends suggest the Region is moving towards a 19% relative reduction between 2010 and 2025, and only 11 out of 53 countries in the Region are likely to meet globally agreed targets. 6. This slow progress can be partially explained by the slow implementation of the WHO FCTC, due to insufficient financial resources, limited staff and technical capacity in countries, the new challenges posed by the emergence of novel nicotine and tobacco products, continuous tobacco industry interference and the COVID-19 pandemic. 7. The Roadmap, adopted by the Regional Committee in 2015, envisions a Region free of tobacco- related morbidity, mortality and addiction. Implementation of the Roadmap would help implement resolution EUR/RC64/R4 on the Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 and ensure that no Member State is left behind. 8. The Roadmap comprises three focus areas, underpinned by two cross-cutting supporting areas (Box 1). Each of these areas includes a set of recommendations for Member States and a set of actions for the WHO Regional Office for Europe (WHO/Europe). EUR/RC72/17(H) page 4 Box 1. Focus areas and cross-cutting supporting areas Focus areas: 1. Strengthening implementation of the WHO FCTC and supporting innovation 2. Responding to new challenges 3. Reshaping social norms Supporting areas: 1. Assessing progress, gaps, gradients, trends and impact 2. Working together: partnerships and international cooperation 9. This report describes and illustrates progress made by Member States and WHO/Europe from 2018 to 2021 in each area. Focus area 1: Strengthening implementation of the WHO FCTC and supporting innovation 10. Since 2018, important progress has been made towards the implementation of the WHO FCTC across the Region. In the past four years, several countries have strengthened their tobacco control measures, with new policies being introduced, better enforcement mechanisms put in place, and high compliance with tobacco control laws achieved.1 These countries include Armenia, Kyrgyzstan and Ukraine, which have recently introduced strong tobacco control measures. 11. The Roadmap prioritizes strengthening the implementation of price and tax measures, as outlined in Article 6 of the WHO FCTC. Currently, 28 countries in the Region tax tobacco products at the level recommended by WHO (compared with 25 in 2018), ensuring that these products are less affordable, particularly for vulnerable populations. WHO/Europe organized a workshop on tobacco taxation (held in Kazakhstan in 2021), provided technical support to Member States (Ukraine in 2020), and contributed to the development of the WHO technical manual on tobacco tax policy and administration and its translation into Russian (due to be published in 2022). 12. Prevention of illicit trade in tobacco products, pursuant to Article 15 of the WHO FCTC, is another priority under focus area 1. To date, 30 Member States in the European Region and the European Union have ratified or signed the Protocol to Eliminate Illicit Trade in Tobacco Products. In collaboration with the Convention Secretariat, WHO/Europe provided a platform for Parties and observers to the Protocol to collaborate and prepare for the Second Meeting of the Parties, which was held in November 2021. 13. Relatively slow progress in the adoption of tobacco control measures outlined in Articles 6 and 15 of the WHO FCTC can be partially explained by the tobacco industry’s extensive lobbying and a lack of intersectoral collaboration on tobacco control at the country level. Significant efforts remain to be made to reduce the affordability of all tobacco products through higher taxes and to scale down illicit trade. 14. Important progress has been made in implementing Article 8 of the WHO FCTC. Since 2018, five more countries2 have adopted a comprehensive ban on smoking in indoor places or widened the list of public places covered by the ban. Legislative measures have also been extended to cover novel and emerging nicotine and tobacco products. 15. Substantial progress has been achieved in meeting obligations under Article 11 of the WHO FCTC. Forty-five countries now require graphic images to be used on packaging, and 10 have passed legislation on 1 See https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021. 2 Countries that have adopted a comprehensive ban on smoking in indoor places or widened the list of public places covered by the ban: Armenia, Georgia, Kyrgyzstan, Tajikistan and Ukraine. EUR/RC72/17(H) page 5 plain packaging.3 Member States of the European Union and the Eurasian Economic Union are strong contributors to the legislative progress under this article. Israel has also made noteworthy progress, becoming the first country in the world to implement plain packaging for electronic nicotine delivery systems. 16. To support governments in developing comprehensive tobacco control legislation and strengthening enforcement mechanisms, WHO/Europe conducted workshops for newly independent and south-eastern European countries (Bulgaria and Georgia) in 2019. Training workshops have also been held for central Asian countries, including a workshop on tobacco control leadership (in Kyrgyzstan in 2019) and a series of nine online workshops on enforcement of tobacco control legislation (2020–2021). 17. Since 2018, WHO/Europe has provided an annual regional platform for discussing country successes and lessons learned in implementing the WHO FCTC (Portugal in 2018, Turkmenistan in 2019 and virtually in 2021). 18. Continued efforts are needed to implement and enforce robust tobacco taxation policies, protect tobacco control policies against the commercial and other vested interests of the tobacco industry, and warn about the dangers of tobacco through mass media campaigns. Strengthening the implementation of time-bound measures – such as smoke-free policies and bans on all forms of tobacco advertising, promotion and sponsorship (including cross-border and internet advertising and promotion), as well as helping individuals to give up smoking – require urgent attention; these are the policy areas in which the European Region lags behind other WHO regions. Focus area 2: Responding to new challenges 19. The landscape of nicotine and tobacco products is evolving constantly. A great diversity of designs, types and variants of these products, as well as their aggressive promotion by the tobacco industry, create big challenges for regulators. The use of these products has evolved differently in different countries, depending on the regulatory environment. National surveys show that the rates of e-cigarette use among young people vary from 2.8% in Kyrgyzstan (2019) to 41% in Monaco (2019).4 Those that have data from two survey rounds have recorded a significant increase in the use of these products over time.5 To support Member States, WHO/Europe has developed information briefs and materials for both policy-makers and the general public and conducted a number of workshops for various groups of countries (Ukraine in 2018, Denmark in 2019, Hungary in 2020 and virtually in 2020–2021). 20. The COVID-19 pandemic created an opportunity for the tobacco industry to spread misinformation about the link between tobacco use and the disease and to position itself as an economic and development partner for national COVID-19 recovery efforts. To address this issue, WHO/Europe produced information and communication materials, both for the general public and for policy-makers, regarding the connection between COVID-19 and tobacco use, with recommendations at the population and individual levels. WHO/Europe has been working closely with all WHO offices to provide the necessary support to Member States to counter misinformation. Some countries in the Region have used the COVID-19 pandemic to strengthen tobacco control action (Malta and the Russian Federation, among others). 21. The COVID-19 pandemic has led to millions of tobacco users wanting to give up tobacco and nicotine use. In a year-long campaign, “Commit to Quit”, launched by WHO, WHO/Europe supported six Member States (Germany, Kazakhstan, Poland, the Russian Federation, Türkiye and Ukraine) in strengthening their tobacco cessation services and launching new initiatives to help encourage people to successfully give up tobacco and nicotine use. 3 Countries that have passed legislation on plain packaging: Belgium, France, Hungary, Ireland, Israel, the Netherlands, Norway, Slovenia, Türkiye and the United Kingdom of Great Britain and Northern Ireland. 4 See Annex 11.4 of the WHO report on the global tobacco epidemic 2021: addressing new and emerging products: https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021. 5 See https://www.ncbi.nlm.nih.gov/pubmed/34694383. EUR/RC72/17(H) page 6 22. Another priority under focus area 2 is to tackle tobacco consumption, exposure to tobacco smoke, and nicotine addiction among vulnerable populations. In view of the high prevalence in the Region of tobacco and nicotine use among women (the highest globally), young people, people with mental health conditions and people living in prison settings, WHO/Europe produced reports and information materials highlighting the issue and suggesting regulatory options in line with the WHO FCTC to ensure that no one is left behind by tobacco control policy. 23. Threats of litigation in international trade and investment tribunals continue to emerge, and several Member States have upheld legal battles against the tobacco industry. Given the emerging tactics of the industry, WHO/Europe and the Norwegian Cancer Society co-organized a 2019 workshop in Denmark to support legal work related to tobacco control by sharing information on legal issues at the domestic, European Union and international levels. Focus area 3: Reshaping social norms 24. Member States in the Region are taking decisive steps in reshaping the social norms around tobacco use. Schools play an important role in educating students about nicotine- and tobacco-free lifestyles and providing enabling environments that protect against exposure to tobacco smoke. In 2021, WHO provided support to pilot the nicotine- and tobacco-free school guide in Kazakhstan, Kyrgyzstan and Ukraine. The same toolkit has been piloted in Turkish universities. All pilots have been successfully implemented and considered for roll-out at the subnational or national levels. 25. One of the priorities under focus area 3 is to advance health literacy, communication and education on the dangers of tobacco. To inform the public, WHO/Europe launched Russian podcasts that feature various aspects of tobacco control, including smoke-free environments, marketing of tobacco, cessation, and environmental consequences of tobacco use. Furthermore, WHO/Europe continues to examine some of the historical and cultural contexts of tobacco control in the Region. A publication on this topic was launched at a webinar in 2020. 26. Another priority is to promote the integration of tobacco cessation treatment and smoking prevention in the training of all health professionals. To that end, WHO/Europe conducted a training workshop on tobacco cessation services from the health system perspective for Baltic countries (Estonia in 2019). 27. The interference of tobacco and related industries in tobacco control efforts constitutes a major barrier to reshaping social norms. To rectify this, WHO/Europe has provided training on the implementation of Article 5.3 of the WHO FCTC to several Member States (Ukraine in 2018, Denmark in 2019, Hungary in 2020 and virtually in 2020–2021). 28. Still, much needs to be done to reshape social norms in the Region. According to the WHO report on the global tobacco epidemic 2021: addressing new and emerging products,6 only nine countries have enforced a ban on all tobacco promotion, 28 have no national (reported) mass media campaigns, and 39 have yet to implement the recommended smoke-free policies. Supporting area 1: Assessing progress, gaps, gradients, trends and impact 29. Monitoring implementation of tobacco use and prevention policies is the foundation for effective tobacco control. Member States in the European Region have done well in that regard; according to the eighth WHO report on the global tobacco epidemic, 42 countries have recent, representative and periodic data for both adults and youths.7 6 See https://www.who.int/teams/health-promotion/tobacco-control/global-tobacco-report-2021. 7 See footnote 5. EUR/RC72/17(H) page 7 30. In collaboration with the Centers for Disease Control and Prevention and the CDC Foundation, WHO/Europe has helped Member States conduct global adult and global youth tobacco surveys and to incorporate tobacco questions into national STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) surveys. The Global Adult Tobacco Survey has been conducted in Kazakhstan, Romania and Türkiye, while the Global Youth Tobacco Survey has been conducted in 11 countries in the Region.8 31. WHO/Europe continues to strengthen countries’ capacities to use data effectively: five European countries attended the global workshop in August 2019 on Global Youth Tobacco Survey analysis and data to action. Two workshops on effective use of Global Adult Tobacco Survey data were conducted in September 2019 in Romania. 32. One of the priorities under supporting area 1 is to support efforts for research and evidence. WHO/Europe has produced a report on summary results of the Global Youth Tobacco Survey (2020)9 and a scientific paper on the trends in use of electronic nicotine delivery systems among young people in selected countries (2021).10 33. Furthermore, efforts have been made to pilot a key informant survey to enhance the methodology for assessing compliance data on smoke-free and tobacco advertising, promotion and sponsorship legislation and policies. WHO/Europe supported these surveys in Romania (in 2019) and Albania (in 2020). Supporting area 2: Working together: partnerships and international cooperation 34. In an interdependent world, and given the global and regional forces challenging people’s health, it is increasingly important for countries to act together. Since 2018, WHO/Europe has worked closely with several nongovernmental and civil society organizations both at regional and national levels, including the Smoke Free Partnership, the European Network for Smoking and Tobacco Prevention, and Stopping Tobacco Organizations and Products, to build capacity and support countries in strengthening national legislation. 35. The role of supranational organizations, such as the European Union and the Eurasian Economic Union, becomes more prominent in tobacco control, as membership in such unions enables harmonization of various domestic policies and law and implies a high level of cooperation between Member States. At the request of the Eurasian Economic Commission, WHO/Europe delivered four workshops on the regulation of novel nicotine and tobacco products to the Commission’s Member States (virtually in 2020 and 2021). 36. WHO/Europe is also working with the Interparliamentary Assembly of Member Nations of the Commonwealth of Independent States and has developed a draft model law on tobacco and nicotine control for Commonwealth of Independent States countries, which is currently under review. COLLABORATING CENTRES 37. WHO collaborating centres for tobacco control in Germany, the Netherlands and Spain have contributed to the implementation of the Roadmap. The collaborating centre in the Netherlands provided expertise on novel products at regional workshops. The collaborating centre in Spain conducted webinars on tobacco-related topics and organized the fifth ICO-WHO Symposium, Tobacco endgame in COVID-19 times (2020). The collaborating centre in Germany supported communication and information activities related to World No Tobacco Day. 8 See https://www.who.int/teams/noncommunicable-diseases/surveillance/data. 9 See https://www.who.int/europe/publications/i/item/WHO-EURO-2020-1513-41263-56157. 10 See footnote 4. EUR/RC72/17(H) page 8 CONCLUSIONS AND FUTURE PLANS 38. Despite the significant progress in implementing the Roadmap, much remains to be done to achieve the vision of a tobacco-free European Region. While some countries in the Region are considered global tobacco control leaders, and their implementation of the WHO FCTC can be cited as examples of good practice, others have made little or no progress. 39. Since the last Roadmap implementation report, the following achievements can be highlighted: increased country capacity to address the challenge posed by novel products through the provision of training workshops and the development of briefs on novel products; increased awareness of tobacco use among vulnerable populations (factsheets and information materials); and the elaboration of a draft model law on tobacco and nicotine control for Commonwealth of Independent States countries. 40. WHO/Europe will continue to implement the Roadmap under the guidance of Member States and will ensure coordinated support across all three levels of WHO. WHO/Europe will continue to offer technical support to countries in line with their particular needs, assist with capacity-building and share best practices, along with other supportive activities. One of the next priority areas is to provide support to countries that are having difficulties in enforcing tobacco control laws. WHO/Europe is developing an online training course to address this issue. Furthermore, WHO/Europe is producing a toolkit to support implementation of nicotine- and tobacco-free school policies in the Region and communication materials on cross-cutting topics (such as tobacco use and the environment). = = =