Pacific Workshop on the Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015-2019), Nadi, Fiji, 17-19 November 2015 : meeting report

Meeting Report

Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015-2019)

17–19 November 2015 Nadi, Fiji

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC English only

MEETING REPORT

PACIFIC WORKSHOP ON IMPLEMENTATION OF THE REGIONAL ACTION PLAN FOR THE TOBACCO FREE INITIATIVE IN THE WESTERN PACIFIC (2015–2019) [Report series number: RS/2015/GE/57 (FJI)]

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Nadi, Fiji 17–19 November 2015

Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines May 2016

NOTE

The views expressed in this report are those of the participants of the Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) 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 Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) in Nadi, Fiji from 17 to 19 November 2015.

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CONTENTS

SUMMARY ............................................................................................................................................ 5 1. INTRODUCTION .............................................................................................................................. 9 1.1 Meeting organization..................................................................................................................... 9 1.2 Meeting objectives ........................................................................................................................ 9 2. PROCEEDINGS ................................................................................................................................. 9 2.1 Opening session............................................................................................................................. 9 2.2 Updates from the Convention Secretariat of the WHO FCTC ...................................................... 9 2.3 Global voluntary noncommunicable disease (NCD) monitoring framework and Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019): Where we are now and where we should be in 2019? ................................................................ 10 2.4 Results of the survey on the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) ...................................................................................................... 11 2.5 Panel Session I: National coordinating mechanisms for tobacco control (Article 5.2) and sustainable funding for the implementation of the WHO FCTC ................................................ 12 2.6 Breakout Session I: Progress and challenges .............................................................................. 14 2.7 Building cessation systems in the Pacific (participatory exercises) ............................................ 14 2.8 Protocol to Eliminate Illicit Trade of Tobacco Products: Implication for the Pacific islands ..... 15 2.9 Panel Session II: Progress and advances in WHO FCTC compliant legislation and regulations ................................................................................................................................... 15 2.10 Panel Session III: Taxation (Article 6) ...................................................................................... 17 2.11 Panel Session IV: Tobacco industry interference and legal challenges in tobacco control (Article 5.3) ............................................................................................................................... 18 2.12 Breakout Session II: Recommendations .................................................................................... 20 2.13 Panel Session V: Engaging with partners .................................................................................. 20 2.14 Building alliances for tobacco control....................................................................................... 21 2.15 Panel Session VI: Innovations in tobacco control / Engaging faith-based and youth organizations.............................................................................................................................. 22 2.16 Breakout Session III: Development of actions plans and reporting back.................................. 23 2.17 Recommendations and next steps.............................................................................................. 23 2.18 Closing ...................................................................................................................................... 23 3. CONCLUSIONS AND RECOMMENDATIONS ........................................................................... 24 3.1 Conclusions ................................................................................................................................. 24 3.2 Recommendations ....................................................................................................................... 24 3.2.1 Recommendations for Member States .................................................................................. 24 3.2.2 Recommendations for WHO ................................................................................................ 25 ANNEXES ............................................................................................................................................ 27 Annex 1. Participants list................................................................................................................... 27 Annex 2. Programme ......................................................................................................................... 30 Annex 3. Country action plans .......................................................................................................... 34 Annex 4. Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in Western Pacific (2015-2019) ......................................................................... 53

Keywords: Tobacco use cessation / Tobacco use – prevention and control / Regional health planning

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SUMMARY The sixty-fifth session of the World Health Organization (WHO) Regional Committee for the Western Pacific endorsed the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019). The plan guides Member States in strengthening national policies, programmes and actions to accelerate implementation of the WHO Framework Convention on Tobacco Control (FCTC). To discuss implementation of this plan, the Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) was convened. The objectives of the meeting were: 1) to share experiences among participants on progress in tobacco control and progress in the Tobacco Free Pacific 2025 regional alliance; 2) to identify legislative gaps and options to address them; 3) to identify implementation gaps, including in enforcement, and options to address them; 4) to identify appropriate ways to counter tobacco industry interference; and 5) to identify other priorities for action towards achieving the three strategic objectives of the regional action plan. While there has been progress in implementing the WHO FCTC in the Western Pacific Region, efforts need to be intensified to accelerate implementation. We must continue striving to normalize a tobacco-free lifestyle. To have more comprehensive measures, all partners need to be engaged. Experiences of Member States are valuable and sharing of such experiences must be encouraged. Several challenges remain including inadequate resources for enforcement, tobacco industry interference and lack of urgency to address tobacco control issues. Recommendations for Member States 1) Member States are encouraged to develop and implement comprehensive legal frameworks for tobacco control, strengthen policy enforcement and establish consistent monitoring and evaluation of tobacco control measures. 2) Member States are encouraged to perform impact assessments of tobacco control measures that can contribute to a Pacific evidence base which can be used to advance developments in tobacco control policies and initiatives. 3) Member States are encouraged to secure sustainable mechanisms for funding to support tobacco control such as the earmarking of tobacco tax revenues towards tobacco control efforts. 4) Member States are suggested to consider the implications and gains of ratifying or acceding to the Protocol to Eliminate Illicit Trade of Tobacco Products. 5) Member States are encouraged to develop capacity around cessation services taking into consideration population-based cessation approaches. 6) Member States are encouraged to create awareness on Article 5.3 among selected departments/ministries and nongovernment sectors including communities. 7) Member States are suggested to explore innovative approaches to tobacco control that are inspired, led by communities such as engaging media and leveraging social media and technology. 8) Member States are encouraged to strengthen multisectoral coordination including engagement of non-health sectors and civil society for effective enforcement of legislation. 5

9) Member States are encouraged to participate and support the establishment of the TFP2025 Alliance. 10) Member States are encouraged to pursue the country-specific ways forward summarized in Table 1 (below). Recommendations for WHO 1) WHO is requested to provide and/or coordinate technical assistance to address capacity gaps, particularly on emerging issues in tobacco control such as illicit trade, limited surveillance and impact analyses and use of non-nicotine and electronic nicotine delivery systems (ENDS). 2) WHO is requested to support Pacific island countries in implementing the WHO FCTC by convening capacity-building workshops. 3) WHO is requested to provide and coordinate legal assistance to support development and implementation of legal frameworks for tobacco control. 4) WHO is requested to facilitate communication and coordination and serve as liaison to other regional and global bodies such as the WHO FCTC Secretariat, the Pacific Community (SPC), Framework Convention Alliance (FCA), SEATCA, Cancer Council Australia, Action on Smoking and Health (ASH) New Zealand, McCabe Centre for Law and Cancer and other development partners to strengthen and promote a multisectoral approach in tobacco control and accelerate implementation of WHO FCTC. 5) WHO is requested to provide administrative support to create and maintain a TFP2025 Alliance web-based platform for information, knowledge and publications. 6) WHO is requested to convene the national tobacco control focal points in 2017 for a midterm review of the implementation of the regional action plan towards TFP2025.

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Table 1. Country-specific issues and ways forward: Country/Area American Samoa Cook Islands Fiji Guam Issues and priority actions Training for enforcement and smoke-free educators in schools; increased smoke-free signage; mass media campaigns Smoke-free environments; cessation; strengthen enforcement; awareness campaign Strengthen policies/legislation; continue enforcement; awareness campaign Tobacco tax; taxation of electronic nicotine delivery system (ENDS); media campaign for raising age limit for purchase and sale of all tobacco products (including ENDS) Stakeholder mapping; awareness campaign on smoke-free places; revise legislation; tobacco and youth survey Tobacco taxation; awareness campaign Cessation; mass media campaigns; smoke-free zones and enforcement; graphic health warnings; licensing mechanism National coordinating mechanism for tobacco control; advocacy and awareness campaigns; review tobacco legislation; enforcement Enforcement; community awareness raising; information dissemination; sales to minors Strengthen tobacco control enforcement for smoke-free places; betel nut chewing and regulation of ENDS use in workplaces Articles 9, 10 and 11; graphic health warnings Mass media campaigns; tobacco control legislation; graphic health warnings Amendment of tobacco control regulations including regulating sale of ENDS; enforcement capacity Enforcement; community mobilization; tobacco taxation; Article 5.3 Tobacco control legislation; cessation; tobacco taxation Mass media campaign; cessation; illicit trade; enforcement Global Youth Tobacco Survey; cessation; tobacco taxation Enforcement to control illicit trade, smoke-free compliance; graphic health warnings; community mobilization Sales to minors; awareness raising of second-hand smoke exposure; education campaigns

Kiribati Micronesia, Federated States of Nauru Niue New Caledonia Northern Mariana Islands, Commonwealth of the Palau Papua New Guinea Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Wallis and Futuna

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1. INTRODUCTION 1.1 Meeting organization The sixty-fifth session of the World Health Organization (WHO) Regional Committee for the Western Pacific endorsed the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) to guide Member States in strengthening national policies, programmes and actions to accelerate implementation of the WHO Framework Convention on Tobacco Control (FCTC). To discuss implementation of this plan, the Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) was convened in Nadi, Fiji from 17 to 19 November 2015. 1.2 Meeting objectives The objectives of the meeting were: 1) to share experiences among participants on progress in tobacco control and progress in the Tobacco Free Pacific 2025 regional alliance; 2) to identify legislative gaps and options to address them; 3) to identify implementation gaps, including in enforcement, and options to address them; 4) to identify appropriate ways to counter tobacco industry interference; and 5) to identify other priorities for action towards achieving the three strategic objectives of the regional action plan. 2. PROCEEDINGS 2.1 Opening session The workshop was opened by Dr Liu Yunguo and Dr Vera Luiza da Costa e Silva. This was followed by the nomination of the officers of the meeting by Mr Kelvin Khow: Ms Shra Alik as Chairperson, Mr Petelo Alapati Tavite as Vice-Chairperson and Dr Le'Roy Tatui and Ms Velma Del Rosario as Rapporteurs. This was followed by participant introductions, review of the meeting objectives and an overview of the workshop by Dr Ada Moadsiri. The list of participants is available in Annex 1. The programme of activities is available in Annex 2. 2.2 Updates from the Convention Secretariat of the WHO FCTC Dr Vera Luiza da Costa e Silva shared updates from the Convention Secretariat of the WHO FCTC. The Convention Secretariat was created during the first session of the Conference of the Parties (COP)—the governing body of the WHO FCTC comprised of all Parties to the Convention—and is hosted in WHO headquarters in Geneva. It offers assistance to Parties through regional and/or intercountry workshops, fosters international cooperation and works with nongovernmental and intergovernmental organizations. It maintains a database on treaty implementation and develops and shares communication strategies/platforms, reporting/e-learning tools and needs and post-needs assessments. The Convention Secretariat relies on the experiences and recommendations of the Parties in the Pacific to plan sustainable measures relevant in the Pacific context. The WHO FCTC was entered into force in 2005. Ten years later, 90% of the world's population are covered by the provisions of the treaty. Provisions include general obligations; measures to reduce the 9

demand and supply of tobacco; liability of the Parties; international cooperation; and reporting and exchange of information. The Convention is administrated by the Secretariat, the COP and the COP Bureau as well as intersessional working and expert groups. The Protocol to Eliminate Illicit Trade in Tobacco Products, a treaty that aims to eliminate all forms of illicit trade in tobacco products through a package of measures to be taken by countries through international cooperation, was adopted by Parties to the WHO FCTC on 12 November 2012. At its sixth session in November 2014 in Moscow, Russian Federation, the COP extended the mandate of the following intersessional groups: working group on Articles 9 and 10 of the WHO FCTC; expert group on Article 19 of the WHO FCTC; and working group on sustainable measures. The COP also decided to establish an expert group to conduct an impact assessment of the WHO FCTC and an expert group to review reporting arrangements under the WHO FCTC. Assessments revealed that the WHO FCTC has decreased smoking rates in countries that have adopted it. However, tobacco industry interference, existing international trade treaties, the emergence of new tobacco products and markets, globalization, and the plight of vulnerable groups (i.e. tobacco farmers) still remain as challenges in the implementation of the treaty. Dr Vera Luiza da Costa e Silva reminded delegates of the obligations of Parties to the WHO FCTC, including voluntary assessed contributions for the FCTC Secretariat to continue funding implementation of its commitments and activities. She also reasserted the need to accelerate implementation of the FCTC. 2.3 Global voluntary noncommunicable disease (NCD) monitoring framework and Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019): Where we are now and where we should be in 2019? Mr Kelvin Khow presented the global voluntary target for tobacco control—a 30% relative reduction in prevalence of tobacco use from 2010 to 2025—and the progress indicators for tobacco control and demand-reduction included in the Global Action Plan for the Prevention and Control of NCDs (2013– 2020). Mr Khow also presented the new Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) and its aim to reduce smoking prevalence in the Western Pacific Region by 10% among young people and adults during this time period. Mr Khow outlined the discussions being held at the United Nations Secretariat level around the issue of NCDs and the Sustainable Development Goals (SDGs), and explained how the work around tobacco control is playing an increasingly important role especially in ensuring sustainable funding for prevention and control of NCDs. Progress on the implementation of the WHO MPOWER measures was also shared during the presentation. National surveillance systems have been established and nine countries in the Region have achieved the highest level of monitoring by the end of 2014. In terms of laws and policies, a lot is being done at the local government level, but hurdles remain. Despite the Western Pacific Region having the highest number of smoke-free laws, some countries still experience very low compliance. As for tobacco taxation, only 2 out of 27 countries have reported a tax value of retail price of over 75%; most countries have tobacco taxes between 51% and 74% of retail price. Efforts are being carried out to further raise taxes.

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Support for smoking cessation is often a neglected measure, but there are countries that have comprehensive cessation programmes with national toll-free quit lines in place. Countries are also starting to leverage the use of mobile technologies in order to develop and provide more efficient cessation services. With regards to mass media and advertising, the Region has been doing really well in developing, adopting and enforcing laws on public health warnings and banning tobacco advertising. Nine countries are reported to have very strong national anti-tobacco mass media campaigns. Overall, substantial progress has been made and there is a downward trend in smoking prevalence in the Region. However, a lot remains to be done. Main challenges to overcome include policy progress consolidation, policy gaps and effective enforcement, regulation of emerging products such as the electronic nicotine delivery system (ENDS) and interference from the tobacco industry (e.g. using trade agreements to undermine tobacco regulation). Mr Khow reminded the Pacific island countries, which are all Parties to WHO FCTC, about their obligation to the treaty. There is a need to continue pushing tobacco control measures and efforts strongly in order to achieve the commitments in the global NCD action plan and ultimately, realize the strategic outcomes of the regional action plan. Discussion In response to a question about who is responsible for amending trade agreements to prevent tobacco industry interference, it was explained that little is known about the implications of trade agreements on WHO FCTC implementation. The lack of enforcement of tobacco control laws and policies in some Pacific islands was recognized. There is a need to identify high impact interventions for tobacco control. It was noted that higher taxes and subsequent increases in tobacco prices have led to substitution with cheaper tobacco, including locally grown tobacco. Countries should consider implementing an excise tax to ensure that taxes are collected on all tobacco products equally including locally grown tobacco. The WHO FCTC reinforces the importance of licensing for trade in all tobacco products, including locally grown tobacco, in order to enhance governments’ ability to regulate. Pacific islands can also use licensing requirements to hold licensees accountable for adhering to tobacco control laws. 2.4 Results of the survey on the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) Ms Mina Kashiwabara shared the results of the preparatory survey. She discussed the major findings as well as the common priority actions of countries in the Region. The survey found that most Pacific island countries and areas have adopted a multisectoral approach to tobacco control (especially with health professionals), but they have different approaches for Objective 1.6 (sustainable cessation services) and Objective 3.3 (Tobacco Free Pacific 2025. Holding tobacco-free mega events and is also a common activity. The top priority actions identified by countries were as follows: 1) regulate ENDS; 2) engage with key health professionals and health professional organizations to ensure their participation in tobacco control policy development and enforcement as well as advocacy against the tobacco industry; 3) regulate the contents and emissions of tobacco products; and 4) create mechanisms for partnership with public health lawyers and policy and regulatory experts' networks.

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2.5 Panel Session I: National coordinating mechanisms for tobacco control (Article 5.2) and sustainable funding for the implementation of the WHO FCTC National NCD coordinating mechanisms and Health Promotion Foundation New Caledonia Mr Patrice Hoarau presented on behalf of the Government of New Caledonia's and shared about the department in charge of the overall coordination of tobacco control policies, and on the government services involved in tobacco control such as the Government Tax Service and the Health Management Service. The government has taken several measures in the last 10 years to mitigate the impact of smoking tobacco. Recent notable measures have been the prohibition of smoking in bars and restaurants (with the exception of open terraces) in August 2012, and the 30% increase in the price of tobacco in October 2015. Such an increase is a milestone since it has never been done before. Projects currently under consideration include the improvement of government-funded nicotine replacement therapy, particularly for pregnant women, introduction of plain tobacco packaging, and better coordination of government measures. Mr Hoarau also presented on the New Caledonian Health and Social Agency (ASSNC). The agency, which is partly funded by tax revenue from the sale of tobacco products and alcohol, aims to fund the hospital system and later establish prevention programmes for drug addiction, cancers affecting women, obesity and diabetes. In order to coordinate policies on tobacco and other addictions, ASSNC was commissioned by the government in 2012 to develop a comprehensive plan that would bring together all relevant institutions and associations in the fields of health, education and justice. However, only a part of the plan was adopted. ASSNC is also the implementing agency of the addiction program that aims to raise public awareness of the effects of tobacco, alcohol and cannabis, and to ensure that users have access to available treatment and services (including psychosocial services). The importance of designating a national coordination mechanism for the WHO FCTC and engaging relevant stakeholders was highlighted. It was recommended to develop youth-targeted tobacco policies and awareness activities. In addition, implementers may consider providing incentives to achieve smoke-free homes and integrating tobacco cessation in drug addiction services. Tonga Dr 'Ofakiokalani Tukia presented on the National Non-Communicable Disease Committee (NNCDC), which was established in 2004 under Section 6(2) of the Public Health Act as the body responsible for policy and programmes relating to NCD prevention and control. The NNCDC is made up of the chief executive officers of major ministries as well as representatives from the civil society, commercial and religious sectors. The key functions of the NNCDC include advising the government on issues pertaining to the prevention of NCDs; informing and making policy recommendations on Tonga’s NCD health

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promotion and prevention strategies, including legislation and regulations; overseeing implementation of activities; and monitoring and reviewing progress. The NNCDC is advised by four risk-factor committees—healthy eating, physical activity, tobacco and alcohol. In order to improve management, the NNCDC delegated responsibility to the TongaHealth Promotion Foundation (TongaHealth), a quasi-government body, for coordination of policy development and implementation processes and progress reporting to NNCDC and Tonga’s cabinet. TongaHealth, in its role as the secretariat of the NNCDC, also liaises closely with the tobacco advisory committee on coordination of the design, implementation and evaluation of tobacco prevention and control strategies. The tobacco advisory committee is composed of representatives from the government, nongovernmental organizations (NGOs) and civil society and is chaired by the GS Tonga Red Cross Society. The advisory committee functions to advise the NNCDC and TongaHealth Board regarding evidence, statistics and policy; lead communication and advocacy for tobacco control; support effective implementation of strategies and work plans; and support the assessment of grant applications. Tonga's new national NCD strategy is close to completion. A key change for NCD prevention and control under the new strategy is the introduction of annual work plans to support strengthened operationalization and progress reporting. Closing the session, Dr Tukia talked about the challenges in tobacco control in low-resource, lowpopulation settings and identified the priority areas that need careful monitoring and evaluation. He also highlighted successes such as the increase in taxation, the establishment of a Tobacco Control Enforcement Unit, the amendment of the Tobacco Act, and the improved networking and partnerships to develop mass media anti-tobacco campaign and cessation services. Discussion   The French territories should consider establishing a link with the Convention Secretariat for support in tobacco control efforts since France is a Party to the WHO FCTC. In response to a question about why people still use tobacco, it was explained that there are numerous reasons, including: availability, affordability, accessibility, acceptability, attractiveness and addictiveness.

Tobacco taxation supporting tobacco cessation services Cook Islands Mr Valentino Wichman discussed how the Cook Islands uses tobacco taxation to support tobacco cessation. The initiative to increase tobacco taxation was led and driven by the Ministry of Finance and Economic Management (MFEM), and was supported by the Ministry of Health (MoH) through evidence and research. The additional tax revenue has been used to fund tobacco cessation and other tobacco control programmes. In February 2014, the Cook Islands MoH established a smoking cessation programme. To date, more than 50 people have registered and about 34 people have quit smoking. In September 2014, the government launched a smoke-free home programme in Rarotonga to prevent exposure to secondhand smoke in homes. The programme aims to have 1000 homes registered in 2015. 13

Mr Wichman shared plans to further tobacco control in the Cook Islands. These plans include surveys and research; amendments to the Tobacco Act; finalization of the Tobacco Action Plan; expansion of the smoking cessation programme to the outer islands; continued partnership with local stakeholders as well as regional and international agencies; and identification of realistic activities to help decrease the current percentage of smokers to meet the goal of a tobacco-free Pacific. 2.6 Breakout Session I: Progress and challenges The participants were divided into working groups and asked to identify recent progress as well as challenges and obstacles in achieving the three strategic outcomes of the regional action plan in their respective countries. They were then asked to write their successes and challenges on small pieces of paper and tape them on wall posters according to specific objectives. Participants were given time to peruse and review all the entries posted, check on other countries' developments and reflect on whether there are common hurdles. Individual group discussions ensued followed by each group reporting a summary of their discussions to the plenary. 2.7 Building cessation systems in the Pacific (participatory exercises) Dr Annette David presented on population approaches to building a cessation system. The WHO FCTC mandates countries to establish effective interventions to treat tobacco dependence. There is strong evidence to show that three key interventions—tobacco cessation advice incorporated into primary health care services; easily accessible and free quit lines; and access to free or low-cost pharmacological therapy—provide the greatest chance of increasing quit attempts and improving success rates at the population level, when combined with policies such as smoke-free laws, tobacco advertising and sponsorship bans, tobacco tax increases and powerful health warnings. Currently, over 85% of the world's population have no access to cessation services, and the majority live in developing countries, many of which are Parties to the WHO FCTC. As these Parties increasingly enact and implement tobacco control policies, more tobacco users will seek cessation services and support. Building capacity to meet the anticipated rise in cessation demand is considered a key strategy. Tobacco control programme managers need a systematic process to build capacity to address cessation. A comprehensive approach is necessary, but resource and programme limitations require a realistic approach, especially in low- and middle-income countries. The WHO Regional Office for the Western Pacific created simple planning tools for governments to assess and map cessation readiness and capacity in their countries. The tools are based on a theoretical model of cessation capacity as a pyramid with three successive levels of interventions. Participants used one of these tools to assess their current cessation readiness and capacity. Through this activity, participants learnt how to create a foundation through tobacco control policy and community capacity-building that raises the demand to quit from tobacco users, and to match this with interventions that increase the health system’s capacity to provide cessation support. Countries should focus on training all health-care workers and ancillary tobacco cessation stakeholders in delivering brief advice, and linking the advice with existing community resources. Training in intensive cessation counselling and pharmacologic treatment of tobacco dependence can occur later, as demand for cessation increases and resources are made available. Given the global evidence that majority of former tobacco users quit on their own, expanding the capacity to deliver brief advice to ensure maximum population reach can result in significant numbers across a population of tobacco users who have successfully quit. 14

Participants underwent abbreviated training in brief cessation advice and practised this skill among themselves. The consensus was that delivering brief advice is feasible and easy to learn, and is a skill that can readily be acquired by many members of the community. Participants expressed their desire to receive technical assistance in brief cessation advice training, and noted that this type of skill should be mandatory for all health-care workers. Discussion   It was recognized that there is a scope to institutionalize cessation policies in the health sector, communities and workplaces. Countries requested technical assistance from WHO in providing opportunities and resources for training to build foundations for rolling out cessation programmes in their respective countries, territories and areas.

2.8 Protocol to Eliminate Illicit Trade of Tobacco Products: Implication for the Pacific islands Dr Maria Carmen Audera-Lopez presented on the Protocol to Eliminate Illicit Trade in Tobacco Products. This international treaty was adopted after four years of negotiations in Seoul, Republic of Korea in November 2012 with the objective of eliminating all forms of illicit trade in tobacco products, in accordance with the terms of Article 15 of the WHO FCTC. It is the first protocol to the Convention, and once in force, it will be a new legal tool for supply chain control, law enforcement and international cooperation. There is a need to eliminate illicit trade because illegal tobacco products are more affordable and not subject to regulation. Also, it redirects revenues to the hands of criminals instead of the government, strengthens corruption and weakens good governance. The sixth COP called on all WHO FCTC Parties to ratify the Protocol at the earliest opportunity and advocate its entry into force. At the time of the workshop, there were only 11 Parties to the Protocol and 54 signatories. Dr Audera-Lopez outlined the process of becoming a Party and how the Protocol could be entered into force. She also called attention to the self-assessment checklist available on the Secretariat's website to help Parties assess their legal, regulatory and policy frameworks in view of the requirements of the Protocol. Dr Audera-Lopez expressed the need to establish a standard tracking and tracing system for the Pacific and recommended to identify a lead ministry (e.g. customs) for the Protocol to assist the health sector. 2.9 Panel Session II: Progress and advances in WHO FCTC compliant legislation and regulations Development of graphic health warnings (Article 11) Vanuatu Mr Jerry Iaruel discussed the development of graphic health warnings (GHWs) in Vanuatu and the process the MoH will need to go through in order to amend the current legislation. In 2013, Vanuatu passed the Tobacco Control Regulations and began printing GHWs on cigarette packs. However, the warnings were copyrighted. Therefore, in September 2014, the MoH decided to develop original GHWs to avoid copyright issues. The MoH held consultations and conducted focus 15

group discussions with current and former smokers and non-smokers. Since then, health warning messages and corresponding images have been finalized. Mr Iaruel concluded his presentation by enumerating the steps required to amend the legislation and recommended holding an advocacy session with the community to gather their support. Plain packaging (standardized packaging) Cancer Council Victoria Ms Kylie Lindorff shared the objectives of plain packaging and the key features for its standardization. She also gave an overview of how Australia was able to legislate plain packaging and discussed the many challenges that arose for the country after its enforcement. It took Australia many years of advocacy, research and analysis by NGOs to justify the case for plain packaging after its first call through a publication by the Centre for Behavioural Research in Cancer (CBRC) in 1992. This initiative was significantly supported by the recommendations and findings by the government's Preventative Health Taskforce as well as collaboration with international colleagues and the genuine political will to invest in prevention measures. In 2012, plain packaging was successfully legislated and mandated by the government with full implementation from 1 July 2012. Several challenges came up such as opposition from the tobacco industry and retailers, legal issues and conflicts in trade. However, Australia remains confident in its position and there is an overwhelming majority of expert opinion supporting it. Next steps for the country include continuous monitoring and evaluation, publication of findings, provision of assistance to other countries to progress legislation and rigorously defending legal challenges. Ms Lindorff also recognized the need for quality research to determine strategies for plain packaging. Tobacco control enforcement and fixed penalty notice Fiji Mr Nafiz Ali presented on tobacco control enforcement in Fiji. Tobacco control initiatives in Fiji began in 1997. Those led to the passing of the Tobacco Control Act (TCA) in 1998 and Fiji becoming a party to the WHO FCTC in 2003. In 2008, the Tobacco Control Enforcement Unit (TCEU) under the Ministry of Health and Medical Services (MOHMS) was established and officially became a unit. This was followed by the enactment of the Tobacco Control Decree in 2010 and Tobacco Control Regulations in 2012. The core objective of the TCEU is the enforcement of tobacco control laws including the provisions of the WHO FCTC. Important duties of the TCEU include annual licensing of manufacturers and importers of tobacco products; registration of tobacco retailers and suki vendors and collection of registration fees; ticketing and documentation of offenders smoking in public places; initiating and facilitating tobacco-free settings; and reviewing the government's commitment to the WHO FCTC and its requirements. Mr Ali also shared the most frequently violated components of the TCA and regulations such as the sale of single cigarettes, sales to minors, smoking and advertising of tobacco at prohibited places and trading tobacco products without a license. 16

Fiji established a system for licensing of tobacco product manufacturers, importers and retailers, as well as for implementing a fixed penalty for decree violators. A total of FJ$ 2 049 074.25 in revenues have been collected by TCEU over the past five years. Revenues were used by the MOHMS to support tobacco control measures. To date, eight villages and six urban municipalities are now declared tobacco free and 47 villages have tobacco-free community halls. These achievements were made possible through the dedicated support and enforcement training for local city/town health officers provided by the MOHMS. TCEU is currently having a month-long campaign with the Land Transport Authority to prohibit tobacco smoking in public service vehicles. Mr Ali concluded by sharing some lessons learnt by Fiji. The fixed penalty notice system helped make the enforcement process more efficient and effective. The establishment of a unit for tobacco control enforcement and the dedication of the officers were considered necessary, as well as collaboration with local police and other agencies. Mr Ali recommended community empowerment and ownership to achieve sustainable tobacco-free settings. He recognized the need to develop an enabling mechanism and provide legal training for enforcement officers to prosecute, along with the need to recruit enforcement officers of diverse backgrounds. 2.10 Panel Session III: Taxation (Article 6) Dr Tibor Zoltan Szilagyi discussed the development and recommendations of the guidelines for implementation of Article 6 of the WHO FCTC—price and tax measures to reduce the demand for tobacco. Reports by Parties on their implementation of Article 6 showed that the proportion of reporting Parties levying excise taxes has increased, widely using a combination of specific and ad valorem type taxes. In addition, more than two thirds of Parties have increased tax rates since 2012, and the average proportion of all taxes in the retail price of tobacco products has further increased to 67%. However, there are still significant differences between Parties and regions in terms of levels of taxation and prices of tobacco products. It was recommended that the taxation system for each country should be tailor-made according to their unique situations and challenges. Tobacco taxation in the Pacific: Benefits and overcoming challenges Dr Ada Moadsiri presented on the benefits of tobacco taxation in the Pacific and overcoming related challenges. Global research confirms that tobacco tax increases lead to reductions in tobacco consumption. This has led many governments to adopt and increase tobacco taxes with the stated intent of reducing tobacco use. The Pacific is targeting an increase in excise taxes of at least 70% of retail price in order to reduce the affordability of tobacco products. Recommendations include increasing awareness of and building capacity in taxation systems; implementing specific excise taxes, and furthermore, implementing floor taxes and tax stamps to prevent tax evasion; prohibiting loose tobacco and duty-free sales; and strengthening enforcement to ensure tax collection and the regulation of locally grown tobacco. Discussion  The lack of information on the implications of trade agreements on tobacco taxation and import taxes was recognized.

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Countries requested information from WHO on best practices for implementing licensing for the trade (sale, import and manufacture) and taxation systems. Parties were advised to consider the economic and social impact of taxation on income levels in the communities as part of the taxation planning process.

2.11 Panel Session IV: Tobacco industry interference and legal challenges in tobacco control (Article 5.3) Addressing legal challenges by the tobacco industry: A country perspective Solomon Islands Dr Geoffrey Kenilorea presented on tobacco industry interference and legal challenges in tobacco control in Solomon Islands. The tobacco industry has been employing various strategies to work around the provisions in the Tobacco Control Act and protect its interests. With reference to the first principle of Article 5.3, i.e. there is a fundamental and irreconcilable conflict between the tobacco industry's interests and public health policy interests, it was established that the industry is all about profitability and commercial gain. A pressing issue is that despite scientific evidence proving the lethal nature of the industry's products, it has continued to retain and even entice more customers. A WHO FCTC assessment was done in May 2012 in Solomon Islands. The results showed that ministries and civil servants lacked awareness of Article 5.3 and its guidelines, and that policies and measures were not in place to implement it. Recommendations included information dissemination and revision of the terms of reference of the Tobacco Control Task Force (TCTF). Initiatives identified to enforce Article 5.3 in Solomon Islands were shared by Dr Kenilorea to the plenary. Some of the lessons learnt in effectively battling the industry include adequate preparation, getting legal counsel and strengthening alliances. Papua New Guinea Ms Ellie Dekine Winge discussed the current prevalence of tobacco smoking in Papua New Guinea and the challenges the country is facing in terms of tobacco control. Papua New Guinea has one of the highest smoking prevalence rates in the world. About 60% of males, 56% of females and 43.1% of young people are found to be consuming tobacco products. Enforcement of tobacco control policies has been a challenge due to lack of capacity and funding. Also, the tobacco industry has been intervening with tobacco control. The industry is appealing to the Attorney General to revisit the revised Tobacco Bill, arguing that the bill is not enforceable and threatening legal actions. Ms Dekine Winge identified initiatives and ways to move forward to combat tobacco smoking. These include forging partnerships, e.g. the NCD Unit of the Department of Health partnering with the Department of Education and target schools to make them smoke-free environments; establishing a task force on tobacco control; creating a separate tobacco control fund apart from the fund approved by the Department of Treasury; holding tobacco-free sports and mega-events; prioritizing tobacco control in the NCD strategic plan and roadmap; negotiating for a portion of tobacco tax revenues be allocated to the tobacco control fund; and pushing for the approval of the revised Tobacco Bill. The benefit of an economic impact assessment in relation to tobacco control was also acknowledged. 18

Tobacco Industry Interference Index Southeast Asia Tobacco Control Alliance (SEATCA) Ms Bungon Ritthiphakdee presented on the Tobacco Industry Interference Index, SEATCA's initiative to assist countries to assess their implementation of Article 5.3, and gave insights into how to assess and tackle interference. The index was developed based on the eight recommendations of the Article 5.3 guidelines and was divided into 20 sub-recommendations. SEATCA works with civil society organizations from seven countries to collect information through questionnaires. All answers are given a score and are justified by information and/or evidences. An overall lower score means better performance (implementation) by a country. SEATCA aims to conduct a report annually to monitor progress. Main findings from the last index revealed that most governments continue to receive contributions in kind from the tobacco industry and/or endorse industry-led corporate social responsibility (CSR) activities. Findings also showed that governments still accept or endorse offers of assistance from the tobacco industry in implementing tobacco control policies, and most governments do not have a procedure for disclosing interaction with the industry. In order to strengthen implementation of the Article 5.3 guidelines, SEATCA recommended to raise awareness of the Article 5.3 guidelines and the industry tactics among other sectors; adopt and implement a code of conduct for government officials dealing with the tobacco industry; disclose all interactions by the government with the industry and raise transparency; ban all CSR activities and publicity performed by the industry; and require tobacco companies to disclose and report on all expenditure on marketing, retailer incentives, philanthropy, lobbying and political contributions. In conclusion, Ms Ritthipakdee shared SEATCA's other initiatives in the Association of Southeast Asian Nations (ASEAN) region, which include a regional network to monitor the tobacco industry; a toolkit to develop preventive measures; a CSR regional report; capacity-building workshops and meetings; and a regional campaign on tobacco industry denormalization. Capacity-building and legal training to counter industry interference McCabe Centre for Law & Cancer Ms Daiana Buresova presented on the capacity-building workshops and legal training to counter tobacco industry interference offered by the McCabe Centre for Law & Cancer such as the Intensive Legal Training Programme (ILTP). The ILTP is an intensive three-week course conducted in Melbourne twice a year that builds capacity in the use of law for cancer prevention, treatment, supportive care and research. The programme focuses on legal challenges to tobacco control measures and it has sessions about the negotiation of regional, international trade and bilateral investment agreements exploring options for preserving public health policy space. Opportunities and challenges in establishing national systems to address NCDs in broad terms and the associated risks of having industry groups at the policy/legislation formulation and implementation stages are also covered. Moreover, the scope and implementation of Article 5.3, common tobacco industry tactics and arguments based on firsthand experience, countermeasures to industry interference and best country models on the application of Article 5.3 of the WHO FCTC policies are also discussed in the ILTP.

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How to implement Article 5.3 of the WHO FCTC and avoid industry interference without encountering difficulties from having not consulted them, where there may be state obligations under an investment law (for example the industry may claim "fair and equitable treatment") can be a challenge for tobacco control policymakers and enforcers. The McCabe Centre for Law & Cancer is recognized by the convention secretariat as a knowledge hub for WHO FCTC. 2.12 Breakout Session II: Recommendations The participants reconvened in their respective working groups. They were asked to provide recommendations to other countries, WHO and/or other partners to overcome the identified challenges and obstacles in the implementation of the regional action plan. They were also asked to decide on recommendations that could benefit their countries. 2.13 Panel Session V: Engaging with partners Strengthening NGO and government collaboration for NCDs including tobacco control Guam Ms Elizabeth Guerrero presented on the Guam NCD Consortium, which was established in response to the declaration of a regional state of health emergency to the epidemic of NCDs in the United States-affiliated Pacific islands. The Guam NCD Consortium, which includes the Tobacco Control Action Team, is a group of stakeholders that work to empower young people and adults to be physically active, eat healthy and make healthy choices that are tobacco, alcohol and drug free. To date, there are more than 200 members that make up the Consortium, representing over 50 different agencies in Guam. Framework Convention Alliance (FCA) Ms Annabel Lyman presented on the FCA in Pacific island countries. The FCA, a founding member of the NCD Alliance, was set up in the late 1990s by global civil society organizations. Today, it is made up of nearly 500 civil society organizations from more than 100 countries. It brings together health, consumer, human rights, environmental, religious and other groups and serves as a powerful voice in the negotiation processes of the WHO FCTC. The alliance's mission is to help strengthen the WHO FCTC as the basis for effective global tobacco control and to support its full and accelerated implementation worldwide. Today, the FCA represents an extensive network of tobacco control experts and advocates at country level. It provides advocacy and technical support to members and governments and gives updates on opportunities in tobacco control around the WHO FCTC process and other relevant issues. Upon request, it assists with reporting, identifying funding opportunities and writing applications. Moreover, it conducts capacitybuilding and networking at regional and global events. Civil society in the Pacific islands has been supporting WHO FCTC implementation. It mobilizes public support for tobacco control measures; exposes tobacco industry practices; builds capacity; advocates for stronger tobacco control measures; and holds governments accountable on their tobacco control commitments.

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To conclude her presentation, Ms Lyman shared tips and recommendations on how to engage with civil society. These include inviting NGOs to participate in needs assessment missions and consultations; providing support to civil society colleagues in the way of skill building on the treaty and industry interference; including members of civil society in coordinating mechanisms and task forces; organizing "World No Tobacco Day" (WNTD) activities jointly with civil society groups; and identifying areas where capacity-building is needed and joining efforts with civil society to mobilize available resources. New Zealand Mr Sefita Hao'uli gave a brief presentation on Action on Smoking and Health (ASH) New Zealand and the importance of networking and building strategic alliances for tobacco control. He encouraged Pacific islands to continue collaboration and to engage the media in building public support for tobacco control. 2.14 Building alliances for tobacco control History and mandate of SEATCA Ms Bungon Ritthipakdee highlighted the programme strategies (the “4Fs”) and objectives of SEATCA in response to the current smoking prevalence and the challenges in tobacco control in the ASEAN region. SEATCA's mission is to save lives by accelerating effective implementation of the WHO FCTC in ASEAN countries. The alliance is mandated to form a supportive base for government and nongovernmental tobacco control workers in their efforts to promote the implementation of effective evidence-based tobacco control measures; foster more active cooperation between tobacco control workers at national and regional levels and act as a regional leader on issues which affect all countries in the region; fight tobacco industry tactics and interference that undermine effective tobacco control; and facilitate information transfer and sharing of experience and knowledge, coordinate national and regional initiatives in tobacco control, and bring South-East Asian issues into the international tobacco control arena. These make up SEATCA's programme strategies—the “4Fs”: form, foster, fight and facilitate. As for the objectives for 2015–2018, the alliance aims to foster south-to-south collaborations to achieve national targets on strengthening tobacco control laws, increasing tobacco taxes and developing a sustainable financial mechanism for tobacco control. SEATCA develops and produces policy recommendations and progress reports for each country in the region and has contributed to the critical achievements by the ASEAN member states in terms of tobacco control laws. It also promotes best practices on smoke-free environments through the provision of technical support; capacity-building and facilitation of the Smoke-free Cities ASEAN Network; collaboration with the WHO Regional Office for the Western Pacific on Smoke Free World Heritage Sites in ASEAN; and partnerships with the ASEAN Secretariat on a Smoke Free ASEAN. SEATCA serves as a regional hub for tobacco control information in the ASEAN region and has resources such as publications and reports available.

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Building a Tobacco Free Pacific 2025 Alliance Dr Ada Moadsiri presented on the Tobacco Free Pacific 2025 Alliance. The alliance, inspired by the Pacific's Healthy Islands vision and SEATCA, aims to bring together governments, NGOs and technical agencies and provide a platform to share best practices on tobacco control. It also aims to offer advocacy and technical support and facilitate building of the Pacific evidence base for tobacco control interventions. Priorities for action include supporting the Pacific islands to develop and implement WHO FCTC compliant legislation—GHWs; advertising, partnership and sponsorship bans, and smoke-free public places; increase taxes on tobacco products; prevent tobacco industry interference; and prevent illicit trade of tobacco products. The alliance also offers an online platform where members can post and retrieve resources, information, and publications on various tobacco control initiatives and issues. 2.15 Panel Session VI: Innovations in tobacco control / Engaging faith-based and youth organizations Global Youth Leadership Nexus Mr Geoffrey Alacky presented on the Global Youth Leadership Nexus (GYLN), a faith-based organization that engages young people in raising awareness about tobacco. One advocacy activity was a singing competition wherein the winners became role models for other young people. GYLN held an interfaith conference to collect the views of church leaders and establish an alliance with the Ministry of Health and Medical Service (MHMS). GYLN also advocates for health promotion for NCD prevention. It helps build partnerships between churches and the MHMS and link churches with communities in order to promote health through settings-based approaches. Tobacco Free Generation Mr Kelvin Khow presented on the Tobacco Free Generation (TFG), a social movement that seeks to educate and encourage teenagers to be part of a generation on non-smokers and its potential to significantly contribute to the tobacco endgame. The tobacco endgame concept suggests moving beyond tobacco control toward a tobacco-free future wherein commercial tobacco products would be phased out or their use and availability significantly restricted.1 Contributions to the endgame pertain to initiatives designed to change/eliminate permanently the structural, political and social dynamics that sustain the tobacco epidemic, in order to end it within a specific time.2 TFG is proposing to deny access to tobacco for those born from the year 2000 onwards even after they reach 18 years old in order to eliminate tobacco use. TFG believes that if there is no longer an age at which tobacco can be legally obtained, it will cease to be a "rite of passage" for young people

1

McDaniel PA, Smith EA and Malone RE. The tobacco endgame: A qualitative review and synthesis. Tob Control. 28 August 2015. 2 McDaniel PA, Smith EA and Malone RE. The tobacco endgame: A qualitative review and synthesis. Tob Control. 28 August 2015.

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and they will no longer be lured to smoke. Smoking will no longer be perceived as a right of the adult that young people want to emulate. At the 2015 World Conference on Tobacco or Health, Dr Margaret Chan, Director-General, World Health Organization, expressed her strong support for TFG. The conference also recognized and commended jurisdictions, including the Australian state of Tasmania, which are advancing initiatives to create tobacco-free generations. Social media to support monitoring and enforcement Ms Mina Kashiwabara emphasized the need to strengthen monitoring of implementation and compliance through the use of mobile technology and social media. As an example, Ms Kashiwabara presented on the Tobacco Action Patrol (TAP), a mobile application that is used to crowdsource price monitoring of tobacco products in the Philippines, thereby addressing the need to strengthen the monitoring of the Sin Tax Law. Users of this app are able to monitor the price of cigarette brands through crowdsourcing; report the location and time of tobacco sales; upload photos of tobacco products to ensure proper labelling, tax stamps and marketing; mobilize people through social networks; assist in regulating the consistency of prices and ensuring the Sin Tax Law is properly implemented; and deter illicit tobacco sales. Successful piloting of the application through student volunteers resulted to 5000 entries and the unearthing of unknown brands. Data analysis is ongoing. Discussion There is an opportunity for Pacific island countries, territories and areas to use social media and mobile technology as children are more technologically savvy and the world is becoming more dependent on technology. There was also broad agreement that the work on youth engagement should be strengthened and that the TFG concept is an interesting one that might actually gain some traction in some of the smaller settings such as those found in the Pacific islands. It was also well aligned with the movement around the Tobacco Free Pacific 2025. 2.16 Breakout Session III: Development of actions plans and reporting back As a final activity, participants were asked to reconvene in their groups to identify the most feasible country action and plan the activities that will support the implementation of the identified action in 2016, taking into consideration the resources available and technical assistance required. The participants then shared their action plans to the plenary. Country action plans are available in Annex 4. 2.17 Recommendations and next steps Dr Ada Moadsiri shared the recommendations made during the meeting in the form of an outcome statement. The outcome statement is available in Annex 5. 2.18 Closing Mr Kelvin Khow gave closing remarks and acknowledgments and formally closed the meeting.

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3. CONCLUSIONS AND RECOMMENDATIONS 3.1 Conclusions There has been much progress in implementing the WHO FCTC in the Western Pacific Region. Yet efforts need to intensify to accelerate implementation and we must continue striving to normalize a tobacco-free lifestyle. Tobacco control measures are uneven within countries and across the Region. To have more comprehensive measures, we need to bring all partners on board as multisectoral engagement is a critical aspect of successful tobacco control implementation. Member State experiences are valuable and sharing of such experiences must be encouraged. Several challenges remain including inadequate resources for enforcement, tobacco industry interference and a lack of urgency to address tobacco control issues. 3.2 Recommendations 3.2.1 Recommendations for Member States 1) Member States are encouraged to develop and implement comprehensive legal frameworks for tobacco control, strengthen policy enforcement and establish consistent monitoring and evaluation of tobacco control measures. 2) Member States are encouraged to perform impact assessments of tobacco control measures that can contribute to a Pacific evidence base which can be used to advance developments in tobacco control policies and initiatives. 3) Member States are encouraged to secure sustainable mechanisms for funding to support tobacco control such as the earmarking of tobacco tax revenues towards tobacco control efforts. 4) Member States are suggested to consider the implications and gains of ratifying or acceding to the Protocol to Eliminate Illicit Trade of Tobacco Products. 5) Member States are encouraged to develop capacity around cessation services taking into consideration population-based cessation approaches. 6) Member States are encouraged to create awareness on Article 5.3 among selected departments/ministries and nongovernment sectors including communities. 7) Member States are suggested to explore innovative approaches to tobacco control that are inspired, led by communities such as engaging media and leveraging social media and technology. 8) Member States are encouraged to strengthen multisectoral coordination including engagement of non-health sectors and civil society for effective enforcement of legislation. 9) Member States are encouraged to participate and support the establishment of the TFP2025 Alliance. 10) Member States are encouraged to pursue the country-specific ways forward summarized in Table 1 (below).

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3.2.2 Recommendations for WHO 1) WHO is requested to provide and/or coordinate technical assistance to address capacity gaps, particularly on emerging issues in tobacco control such as illicit trade, limited surveillance and impact analyses and use of non-nicotine and electronic nicotine delivery systems (ENDS). 2) WHO is requested to support Pacific island countries in implementing the WHO FCTC by convening capacity-building workshops. 3) WHO is requested to provide and coordinate legal assistance to support development and implementation of legal frameworks for tobacco control. 4) WHO is requested to facilitate communication and coordination and serve as liaison to other regional and global bodies such as the WHO FCTC Secretariat, the Pacific Community (SPC), Framework Convention Alliance (FCA), SEATCA, Cancer Council Australia, Action on Smoking and Health (ASH) New Zealand, McCabe Centre for Law and Cancer and other development partners to strengthen and promote a multisectoral approach in tobacco control and accelerate implementation of WHO FCTC. 5) WHO is requested to provide administrative support to create and maintain a TFP2025 Alliance web-based platform for information, knowledge and publications. 6) WHO is requested to convene the national tobacco control focal points in 2017 for a midterm review of the implementation of the regional action plan towards TFP2025.

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Table 1. Country-specific issues and ways forward: Country/Area American Samoa Cook Islands Fiji Guam Issues and priority actions Training for enforcement and smoke-free educators in schools; increased smoke-free signage; mass media campaigns Smoke-free environments; cessation; strengthen enforcement; awareness campaign Strengthen policies/legislation; continue enforcement; awareness campaign Tobacco tax; taxation of electronic nicotine delivery system (ENDS); media campaign for raising age limit for purchase and sale of all tobacco products (including ENDS) Stakeholder mapping; awareness campaign on smoke-free places; revise legislation; tobacco and youth survey Tobacco taxation; awareness campaign Cessation; mass media campaigns; smoke-free zones and enforcement; graphic health warnings; licensing mechanism National coordinating mechanism for tobacco control; advocacy and awareness campaigns; review tobacco legislation; enforcement Enforcement; community awareness raising; information dissemination; sales to minors Strengthen tobacco control enforcement for smoke-free places; betel nut chewing and regulation of ENDS use in workplaces Articles 9, 10 and 11; graphic health warnings Mass media campaigns; tobacco control legislation; graphic health warnings Amendment of tobacco control regulations including regulating sale of ENDS; enforcement capacity Enforcement; community mobilization; tobacco taxation; Article 5.3 Tobacco control legislation; cessation; tobacco taxation Mass media campaign; cessation; illicit trade; enforcement Global Youth Tobacco Survey; cessation; tobacco taxation Enforcement to control illicit trade, smoke-free compliance; graphic health warnings; community mobilization Sales to minors; awareness raising of second-hand smoke exposure; education campaigns

Kiribati Micronesia, Federated States of Nauru Niue New Caledonia Northern Mariana Islands, Commonwealth of the Palau Papua New Guinea Samoa Solomon Islands Tokelau Tonga Tuvalu Vanuatu Wallis and Futuna

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ANNEXES Annex 1. Participants list Mrs Farrah N. Lesa, Tobacco Team Leader/Quitline Counselor, Tobacco/Diabetes Prevention Programs, Department of Health, American Samoa Government, P.O. Box 6222, Pago Pago 96799. Telephone: +684 633 7475, Facsimile: +684 633 1377, Email: farrah.lesa@doh.as Mr Valentino Wichman, Manager, Policy, Research, Monitoring and Evaluation Ministry of Health Administration Office, Tupapa, Rarotonga, Telephone: +682 29664, Facsimile: +682 23109, Email: valentino.wichman@cookislands.gov.ck Mr Nafiz Ali, Acting Manager, Tobacco Control Enforcement Unit, Ministry of Health, Dinem House, Toorak, Suva,Telephone: +679 890 5049; +679 331 4988, Facsimile: +679 331 9346, Email: nafiz.ali@govnet.gov.fj Ms Elizabeth Guerrero, Program Coordinator III, Department of Public Health and Social Services, 123 Chalan Kareta, Mangilao, Guam. Telephone: +671 735 7303, Facsimile: +671 735 7500, Email: elizabeth.guerrero@dphss.guam.gov Mr Enoka Arabua, Health Promotion Officer, Ministry of Health and Medical Services, P.O. Box 268, Nawerewere, Tarawa, Kiribati. Telephone: +686 28100, Facsimile: +686 28152, Email: enoka.arabua2@gmail.com Ms Shra Alik, Tobacco Control Program Manager, Department of Health and Social Affairs, Box P.S. 70, National Government, Palikir, Federated States of Micronesia. Telephone: +691 320 6982, Facsimile: +691 320 6798, Email: salik@fsmhealth.fm Ms Nerida-Ann Hubert, Diabetes Support Officer (NCDs), Nauru Department of Health, Anabar District, Anabar, Nauru. Telephone: +674 558 1392. Email: annsteshia22@gmail.com Mr Claude Gambey, Project Manager, Department of Health, Government of New Caledonia, BP P4 Noumea Cedex 98851. Telephone: +687 970 289, Email: claude.gambey@gouv.nc Mr Patrice Hoarau, Responsable Programme de Prevention et de Soin en Addictologie, L'Agence Sanitaire et Sociale de la Nouvelle-Caledonie BP P4 Noumea Cedex 98851. Telephone: +687 250 442, Email: patrice.hoarau@ass.nc Dr Le'Roy Tatui, Principal Dental Officer, Niue Foou Hospital, Niue Public Service Commission, Niue Public Service Building, Fonuakula, Alofi, Niue. Telephone: +683 7638, Email: leroy.tatui@mail.gov.nu Ms Velma Del Rosario, Program Coordinator, DPH Non Communicable Diseases Bureau, Commonwealth Healthcare Corporation, P.O. Box 506479, Chalan Kanoa Saipan 96950 Commonwealth of the Northern Mariana Islands. Telephone: +670 236 8727, Facsimile: +670 236 8700, Email: vdelrosarioncdb@gmail.com Ms Israella Yaoch, Data Technician, Ministry of Health, P.O. Box 6027, Koror, Palau. Telephone: +680 488 8114, Email: eleosreklai@gmail.com Ms Ellie Dekine Winge, Technical Officer, Cancer Control and Prevention Program, National Department of Health, P.O. Box 807, Waigani, Port Moresby, Papua New Guinea. Telephone: +675 301 3773, Facsimile: +675 325 0568, Email: ellie-winge@health.gov.pg

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Mr Faaifoaso Moala, Senior Health Promotion Officer, Health Promotion Section Ministry of Health, Private Bag (Matootua), Apia, Samoa. Telephone: +685 68131, Email: faaifoasom@health.gov.ws Dr Geoffrey Kenilorea, National Director (Focal Point), Non Communicable Diseases Unit, National Focal Point, Tobacco Free Initiative/Tobacco Control, Ministry of Health Headquarters, P.O. Box 349, Honiara, Solomon Islands. Telephone: +677 28199, Facsimile: +677 20085, Email: gkenilorea@moh.gov.sb; gkenilorea@gmail.com Mr Petelo Alapati Tavite, National Public Health Advisor/NCD Coordinator, Tokelau Health Department, Health Head Office, Nukonunu, Tokelau. Telephone: +690 4211; +690 4212, Email: alapatitavite@gmail.com Dr 'Ofakiokalani Tukia, Medical Officer Special Grade and Head, NCD-Health Promotion Unit and Tobacco Control Unit, Ministry of Health, P.O. Box 59, Nuku'alofa, Tonga. Telephone: +676 23200; +676 24291, Email: o.tukia@gmail.com Mrs Avanoa Moeli Homasi-Paelate, Senior Health Promotion Officer, Health Education & Promotion, Ministry of Health, Princess Margaret Hospital, Funafuti, Tuvalu. Telephone: +688 20989, Email: mysabs@yahoo.com Mr Jerry Iaruel, National Mental Health Focal Point, Public Health Office Ministry of Health, PMB 9009 Port Vila, Vanuatu. Telephone: +678 548 5811, Email: ijerry@vanuatu.gov.vu Dr Laurence Joelle Marais, Medecin Conseiller Technique, BP 244, Vice Rectorat, Mata'Utu 98600, Wallis and Futuna. Telephone: +681 722 828, Email: médecin@acwf.wf; laurence.marais@acwf.wf Mr Geoffrey Alacky, Coordinator, Tobacco Free Pacific 2025 Network, West Kola Ridge, P.O. Box R251 Honiara, Solomon Islands. Telephone: +677 747 6551, Email: rim@solomon.com.sb Ms Daiana Buresova, Pacific Islands Coordinator, McCabe Centre for Law and Cancer, Suva, Fiji. Email: dburesova@gmail.com Dr Annette David, Director, Consulting Services, Health Partners, LLC, P.O. Box 9969, Tamuning, Guam 96931 United States of America. Facsimile: +1 671 646 5226, Email: amdavid@guam.net Ms Bungon Ritthiphakdee, Executive Director, Southeast Asia Tobacco Control Alliance, Thakolsuk Place, Thod-dumri Road, Phayathai, Bangkok 10200 Thailand. Telephone: +66 81 255 1280, Facsimile: +66 02 241 0082, Email: bungon@seatca.org Professor Robert Beaglehole, Chair, Scientific and Technical Expert Group, Public Health Division, Secretariat of the Pacific Community, BP D5 98848 Noumea, New Caledonia. Email: r.beaglehole@auckland.ac.nz Mr Sefita Hao'uli, Executive Board Member, Action on Smoking and Health New Zealand, 6 Mitchelson Street, Ellerslie, Auckland 1051 New Zealand. Telephone: +64 9 525 4288, Facsimile: +64 9 579 2659, Email: sefita.haouli@gmail.com Ms Kylie Lindorff, Chair, Tobacco Issues Committee, Public Health Committee, Cancer Council Australia, Level 14, 477 Pitt Street, Sydney NSW 2000 Australia. Telephone: +61 2 8063 4100, Facsimile: +61 2 8063 4101, Email: kylie.lindorff@cancervic.org.au Ms Annabel Lyman, Coordinator – Pacific Island Countries, Framework Convention Alliance, P.O. Box 4097 Koror, Palau PW 96940. Telephone: +680 488 4223, Email: lymana@fctc.org 28

Dr Si Thu Win Tin, Advisor, Secretariat of the Pacific Community, BP D5 98848 Noumea, New Caledonia. Email: sithuw@spc.int Mr Kelvin Khow Chuan Heng (Responsible Officer), Technical Officer, Tobacco Free Initiative (TFI), WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000 Philippines. Telephone: +63 2 528 9979, Facsimile: +63 2 521 1036, Email: khowk@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. Telephone: +63 2 528 9894, Facsimile: +63 2 521 1036, Email: kashiwabaram@who.int Dr Ki-Hyun Hahm, Technical Officer (Legislation and Regulation), Noncommunicable Diseases, WHO Regional Office for the Western Pacific, United Nations Avenue, Ermita Manila 1000 Philippines. Telephone: +63 2 528 9870, Facsimile: +63 2 521 1036, Email: hahmk@who.int Dr Liu Yunguo, WHO Representative, Director Pacific Technical Support, Level 4 Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Telephone: +679 3304600, Facsimile: +679 3234116; Email: Liuyun@who.int Dr Wendy Snowdon, Team Coordinator, Pacific NCD and Health through the Life Course, WHO South Pacific, Level 4 Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Telephone: +679 3304600, Facsimile: +679 3234166, Email: snowdonw@who.int Dr Ada Moadsiri, Technical Officer, NCD/Tobacco Free Initiative (TFI), WHO South Pacific, Level 4 Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Telephone: +679 3304600, Facsimile: +679 3234166, Email: moadsiria@who.int Ms Pushpanjali Padayachi, Special Service Agreement, Tobacco Free Initiative (TFI), WHO South Pacific, Level 4 Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Telephone: +679 3304600, Facsimile: +679 3234166, Email: padayachip@who.int Mr Koorio Tetabea, Special Service Agreement, Tobacco Free Initiative (TFI), WHO Kiribati, Bikenibeu, Tarawa. Telephone: +686 28231, Facsimile: +686 28188, Email: tetabeak@who.int Mr Richard Moufa, Special Service Agreement, Tobacco Free Initiative (TFI), WHO Federated States of Micronesia, Department of Health and Social Affairs, 1/F Mogethin Building, National Capital Complex, Palikir. Telephone: +691 320 2619, Facsimile: +1 866 868 3940, Email: moufar@who.int Ms Kolisi Lomialagi Thelma Viki, National Professional Officer, WHO Solomon Islands, Ministry of Health Building, Chinatown, Honiara. Telephone: +677 23406, Facsimile: +677 21344, Email: vikik@who.int Dr Vera Luiza da Costa e Silva, Head, WHO FCTC Secretariat, World Health Organization, 20 Avenue Appia CH-1211 Geneva 27 Switzerland. Telephone: +41 22 791 1561, Email: dacostaesilvave@who.int Dr Maria Carmen Audera-Lopez, Technical Officer, WHO FCTC Secretariat, World Health Organization, 20 Avenue Appia CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3246, Email: auderalopezc@who.int Dr Tibor Zoltan Szilagyi, Technical Officer, WHO FCTC Secretaria, World Health Organization, 20 Avenue Appia CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 2417, Email: szilagyit@who.int 29

Annex 2. Programme Day 1, Tuesday 17 November 08:30–09:00 09:00–09:20 Registration Welcome remarks Dr Liu Yunguo WHO Representative WHO Division of Pacific Technical Support (DPS) Dr Vera Luiza da Costa e Silva Head of the Convention Secretariat WHO Framework Convention on Tobacco Control (FCTC) 09:20–09:35 09:35–09:45 09:45–10:15 10:15–10:45 10:45–11:15 Self-introduction of participants and nomination of officers of the meeting Overview of the workshop Mr Kelvin Khow Acting Coordinator, TFI, WPRO Dr Ada Moadsiri Technical Officer, NCD/TFI, DPS

Group photo and healthy break Updates from the Convention Secretariat of the WHO FCTC Global voluntary NCD monitoring framework and Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019): Where we are now and where we should be in 2019 Results of the survey on the TFI regional action plan 2015 Discussion Dr Vera Luiza da Costa e Silva

Mr Kelvin Khow

11:15–11:30

Ms Mina Kashiwabara Technical Officer, TFI

12:00–13:30

Lunch

I. Sustainable institutional capacity for WHO Framework Convention on Tobacco Control implementation 13:30–14:30 Panel session I: national coordinating mechanisms for tobacco control (Article 5.2) and sustainable funding for the implementation of the WHO FCTC  National NCD coordinating mechanisms and Health Promotion Foundation - New Caledonia - Tonga  Tobacco taxation supporting tobacco 30 Moderator: Dr Geoff Kenilorea, National Director NCD, Solomon Islands Ministry of Health and Medical Services

cessation services - Cook Islands  Discussion 14:30–15:30 15:30–16:00 Breakout Session I: Progress and challenges Healthy break and information product market place Kelvin Khow, Mina Kashiwabara, and Ada Moadsiri Dr Annette David, Health Partners Limited, Guam

16:00–17:15 17:15–17:30 17:30–19:30

Building tobacco cessation systems in the Pacific (participatory exercise) Wrap-up Reception and cultural show case

Day 2, Wednesday 18 November II. Effective legislation and regulations for WHO FCTC implementation 08:30–10:00 Protocol to Eliminate Illicit Trade of Tobacco Products: Implications for the Pacific islands Healthy break Panel session II: progress and advances in WHO FCTC compliant legislation and regulations  Development of graphic health warnings (Article 11) - Vanuatu  Plain packaging (standardized packaging) - Cancer Council Victoria  Tobacco control enforcement and fixed penalty notice - Fiji  Discussion Moderator: Nauru Dr Carmen Audera-Lopez Convention Secretariat WHO FCTC

10:00-10:15 10:15–11:30

Ms Kylie Lindorff, Chair Tobacco Issues Committee, Cancer Council Australia

11:30–12:30

Panel session III: Taxation (Article 6)  Article 6 Guidelines adoption and main recommendations  Tobacco taxation in the Pacific: Benefits and overcoming challenges Lunch Panel session IV: Tobacco industry interference and legal challenges in tobacco control (Article 5.3)  Addressing legal challenges by the tobacco 31

Tibor Szylagyi Ada Moadsiri

12:30–13:30 13:30–15:00

Moderator: Dr Ki-Hyun Hahm Technical Officer, NCD

industry: A country perspective - Solomon Islands - Papua New Guinea  Tobacco Industry Interference Index - Overview - Adaptation and results  Capacity-building and legal training to counter industry interference - McCabe Centre for Law and Cancer 15:00–15:15

Ms Bungon Ritthiphakdee, Director, Southeast Asia Tobacco Control Alliance and Ada Moadsiri Ms Daiana Buresova McCabe Centre

Healthy break

15:15-17:00

Breakout session II: Recommendations

Kelvin Khow Ada Moadsiri Mina Kashiwabara

Day 3, Thursday 19 November III. Engaging constituencies for enforcement 08:30–10:00 Panel session V: Engaging with partners  Strengthening NGO and government organization collaboration for NCD including tobacco control - Guam - Framework Convention Alliance (FCA) Moderator: Mrs Avanoa Moeli Homasi Paelate, Senior Health Promotion Officer, Health Education & Promotion, Ministry of Health, Tuvalu Ms Annabel Lyman, Pacific Island Countries Coordinator, FCA - Action on Smoking and Health (ASH) New Zealand Mr Sefita Hao’uli, ASH New Zealand 10:00–10:15 10:15–11:15 Healthy break Building alliances for tobacco control  History and mandate of SEATCA  Building a Tobacco Free Pacific Alliance Panel session VI: innovations in tobacco control/Engaging faith-based and youth organizations   

Bungon Ritthiphakdee Ada Moadsiri Mr Petelo Alapati Tavite, National Public Health Advisor/NCD Coordinator, Tokelau Health Department Pastor Geoffrey Alacky, GYLN, Solomon Islands Kelvin Khow and Ada Moadsiri Mina Kashiwabara

11:15–12:15

Global Youth Leadership Nexus (GYLN) Faith-based organization Tobacco Free Generation Social media to support monitoring and 32

enforcement 12:15 –13:30 13:30–15:00 15:00–15:15 15:15–16:00 16:00–16:15 Resources in the Western Pacific Region 16:15–16:45 Recommendations and next steps 16:45–17:00 Closing remarks Kelvin Khow Ada Moadsiri Lunch Breakout session III: development of country action plans and report back Healthy break Resources from the Convention Secretariat and Reporting on WHO FCTC implementation Tibor Szilagyi Mina Kashiwabara Kelvin Khow, Mina Kashiwabara and Ada Moadsiri

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Annex 3. Country action plans

Country: American Samoa Objective: To engage our SFEA law (Smoke free Environment Law) Country action: Deputizing training for our enforcers (village mayors, police securities, environment inspectors)

Activities Deputizing training for our enforcers (police securities + inspectors, village mayors..) Smoke free educators in schools- day cares, elementary, high schools. Smoke free signs to public places. Healthy lifestyle physical activities - Zumba, walking, cycling. Massive media campaign. Advertisements, TV, newspapers, magazines, websites/Facebook, radio talk shows.

Timeline 2016; 3 weeks.

Stakeholders Village mayors, Department DPS, Department of DOE.

Resources Finance, lawyers.

Expected outcome Enforcement officers and trained in the fields.

6 months

6 months

On going, yearly. Yearly.

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Country: Cook Islands Strategic outcome: Healthier population Objective: Work towards 2025 Tobacco Free Pacific Country action: Action plan Country indicator: Activities planned/achieved

Activities Smoke free environments expansion.

Timeline 2015/2016

Stakeholders RAC, Koutu Nui, Sports Association, Sports Clubs, House Committees. As above

Resources

Expected outcome De-normalising smoking.

Expand cessation plan.

2015/2016

More people quitting. Informed people making the right choice. Actions for 2025 smoke free pacific. Confident officers.

Health promotion awareness campaign. Start planning for new action plan. Enforcement needs to be addressed.

2015/2016

As above + media, NCD committee. Dec 2015 RUOH/WHO Rope in Nao's to be enforcers. Make community report.

2015/2016

2015/2016

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Country: Fiji Strategic outcome: To achieve a 25% reduction in premature mortality in Fiji from the 4 key NCD's by 2025 Objective: 1: Reduce prevalence of current tobacco use among adolescents by 10% by the year 2019. 2: Reduce prevalence of current tobacco use among person's aged 18 years + by 10% by 2019. 3: Increase in the number of settings-based TF policies by 20% by 2019. Country action: Strengthen efforts to enforce existing TC policies (smoke-free places), restriction on sales to minors, advertising, increased staff in TCEU. Country indicator: Reports given on enforcement activities and new positions created Activities Close gaps/loopholes in the policies/legislation, continue enforcement, continue awareness community based schools and workplaces. Timeline Ongoing; 5 years. Stakeholders MOUs. TCEU + wellness team. Resources Government budget. Expected outcome Productive in reducing smoking prevalence rate and closer to TFP2025.

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Country: Guam Strategic outcome: 2 Objective: 2.1 Raise tobacco taxes and use a percentage of revenues for tobacco control and NCD prevention Country indicator: Public law established

Activities Develop draft bill with specific tobacco tax, inclusion of language to make progressive (at least $3 per pack by Dec 2016 and $11 per pack every year after for no less than 10 years). Include specified percentage of tobacco tax revenue to be allocated to TPCP and NCD Consortium. Develop draft bill with policy measures to establish tax rate (progressive and annual) for ENDs and accessories. Bill 141.33 media campaign and education on raising the legal age from 18 to 21 for purchase and sale of all tobacco products (including ENDs and accessories).

Timeline Dec 31, 2016.

Stakeholders DPHSS, community, legislators.

Resources DPHSS, WHO, SPC.

Expected outcome PL specifically far. Marking funds to be used by DPHSS BCHS- TPCP and NCD Consortium.

Dec 31, 2016.

Community, DPHSS, legislators.

WHO, SPC, CDC.

Dec 31, 2016.

Community, DPHSS, legislators.

WHO, SPC, CDC, youth groups, and media. Sister island who is already implementing (Palau).

PL est. tax rate (progressive and annual) for all ENDs and accessories- for allocation to TPCP and prevention. PL est. increase minimum age for purchase and bale tobacco products (includes ENDs and accessories).

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Country: Kiribati Objective: To get tobacco regulation passed

Activities To identify our key partners from different universities, church groups, youth groups, 2 other NGO's. Promote health awareness program on smoke free places. To revise the regulation and submit. Tobacco youth survey.

Timeline 1st quarter 2016

Stakeholders Women, public servants, church leaders, youth peer group, and NGO's. General population.

Resources MHWs.

Expected outcome Develop Kiribati Tobacco Alliance Team.

1-4th quarter 2016. First half of 2016. 1-4th quarter

IEC materials. Policy paper. T.A (WHO) + Tobacco focal point.

To increase the number of smoke free places. Regulation submitted to cabinet for approval. Needs to complete youth survey for tobacco date in Kiribati.

Kiribati Tobacco Alliance Team Youth

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Country: Micronesia, Federated States of Strategic outcome: Tobacco products are less affordable to youth. Objective: Raise tobacco prices bi-annually at national and state by 50% from baseline. Country action: Develop legislation. Country indicator: Enforcement mechanism to assess the compliance in place and impact on tax report.

Activities Do research on tax impact. Utilize the McCabe fellow for drafting of bill. Awareness campaign.

Timeline Jan 2016.

Stakeholders Finance, business.

Resources WHO, McCabe.

Expected outcome Report on impact.

Jan 2016.

AG.

McCabe/WHO One final bill law on tobacco price. MOH, WHO, CDC. 80% of population understand the law.

March 2016.

MOH,TCAC,NGO, Business community.

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Country: Nauru Strategic outcome: National awareness on TCA/R and advocacy and smokers reduced by 10% Objective: Reviewed and enforced tobacco regulations. Country action: Educational awareness on tobacco control and tobacco free environment. Country indicator: Number of persons who quit/wanting to quit.

Activities Orientation on tobacco control regulations/ FCTC cessation programs. Mass campaign WDD, WNTD.

Timeline FebMarch

Stakeholders NCBO, CLOs, Pioneers, NNYC, Education, Rotary club. Education/UN office, Digicel, NCBO, Media, Health departments, NNYC. NCBO, Health, NNYC, CLOs.

Resources Demand to quit.

Expected outcome More awareness, generate interest in cessation, more reports on black markets. 50% increase pap smear tests, national participation, local ownership. Policies in place and endorsed by MPs.

May-Nov

Community policy development on smoke free zones and enforcement. Lobby private sectors to import graphic packaging. Licensing mechanism developed.

June

Feb-July

Private sectors, DFAT, NCBO, Health. Finance, justice, health, border control customs.

Agreement to import graphic packaging only. License in place and enforced, revenue income directed to tobacco free program budget.

June

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Country: Niue Strategic outcome: Engagement of constituencies for enforcement = implementation. Objective: Work with mayors (including MOH, top management), local government authorities, community leaders. Country action: Fast-track the passing of the Tobacco Control Bill. Country indicator: Pass and adopt tobacco Control Bill - implementation of WHO FCTC.

Activities Establish TFI Taskforce or working committee/national coordinating mechanism. Advocacy and awareness campaign on TFI (community consultation). Draft (update) and reintroduce Tobacco Bill to Parliament. Needs assessment and compliance review. Enforcement.

Timeline 2016

Stakeholders Health, Faith base, customs, NGO's, community leaders. TFI working committee, communities. TFI working committee, CLO, MOH. TFI taskforce, WHO secretariat, health, law, customs. MOH, law, customs, TFI taskforce, WHO.

Resources

Expected outcome Take lead on WHO FCTC implementation. Prompt government to prioritise Tobacco Control Bill. Passing of Tobacco Bill- implementation of WHP FCTC.

2016-2017

2016

2016 (urgent) 2017-2018

Ensure sustainable institutional capacity.

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Country: New Caledonia Strategic outcome: Enforcement. Objective: Work with community leaders.

Activities Release an information booklet for community leaders.

Timeline January 2016.

Stakeholders 3 provinces, health agency, custom senate.

Resources Social and medical centers, churches, schools.

Expected outcome Increase the community participation and decrease the consumption.

Develop an internet website about tobacco. Achieve signs prohibiting sales to minors.

January 2016.

Associations, schools. Industrial federation, agency (SHA). Retailers and Stop the sale to gas stations. minors.

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Country: Northern Mariana Islands, Commonwealth of Strategic outcome: Objective: Country action: Country indicator:

Activities

Timeline

Stakeholders Police, Justice, Health

Resources

Expected outcome

Strengthen tobacco 2016 control enforcement of policy for no smoking, chewing betel nut, no ecigarettes in the workplace Expand cessation services 2016

Health

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Country: Palau Strategic outcome: Objective: 100% compliance with provision of the Framework Convention on Tobacco Control Article 9.10 and 9.11.

Activities Draft proposed legislation (articles 11 and include 9 and 10). Research issues specific to articles 9,10 and 11. Organise and carry out focus group on graphic images and health warnings. Draft proposed legislation of amendments of existing legislation. Submit proposed legislation/amendments and focus group results to OEK.

Timeline PEB. 01, 2016.

Stakeholders

Resources McCabe center, INHD, CTFK.

Expected outcome

Dec 2015.

WHO

Palau appropriate graphic warnings.

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Country: Papua New Guinea

Activities Mass media, pictorial information, call meetings, planning differently, make sure availability of finance, write letters - follow up, consider availability time.

Timeline

Stakeholders Partnership (Solomon). Churches (20), stakeholders, youths/women's, schools, Kumul Petroleum, oil search, Exon Mobil.

Resources AIPGovernment, SPC-donor, WHOtechnical, ask stakeholders for sponsorship, NDOH budgetadvocacy.

Expected outcome

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Country: Samoa Strategic outcome: 2 x 3 Objective: Effective legislations and regulations. Country action: Amend tobacco control regulation/improve enforcement.

Activities

Timeline

Stakeholders MOH, NHS, AG, MP, MJCA, MUKSP, Samoa, Tobacco Control Committee. AG, MJCA, MP and MOH.

Resources Stationery, legal advisor and TA fees.

Expected outcome Cabinet briefing paper on the amendment is submitted.

Conduct internal and 2016-2017 external consultations on the amendment of tobacco control regulations to regulate the sale of ENDs. Prepare more briefings 2017 for the cabinet and table to parliament session for endorsement. Conduct capacity 2016 building for enforcement officers, adopt Fiji mechanism.

Stationery, legal advisor and TA fees. TA fee, stationery.

Amended tobacco control regulation 2017. Smoking cessation services is available for people wanting to quit smoking.

Ministry of Police, village leader reps, MOH staff, teachers.

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Country: Solomon Islands

Activities "Enforcement implementation -roll-out enforcement compliance strategic plan --> legislative amendments to cater for fixed penalty"

Timeline

Stakeholders

Resources

Expected outcome

Feb-Dec 2016

AG, Finance/customs, GYLNs PC, WHO, Honiara City Council

"Declare state of emergency for NCDs Increase communitybase/network in tobacco control --> establish endorsed sentiment" SICA, SIFGA, GYLN, women and youth, tourism, MHMS.

"Increase tax to excise reaching 70% Percent of tax to fund the Foundation " Article 5.3: amend 5.3 Bill and submit (ban CSR) Dec- April Finance, MCH, AG.

Dec-Dec

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Country: Tokelau Strategic outcome: Objective: Country action: Country indicator:

Activities Develop national tobacco control policy/legislation -Continue consultations with traditional leaders Engage health workers and community groups in developing a tobacco cessation plan and system Develop a tobacco tax plan to increase taxes on tobacco products and possibly reduce supply of tobacco imported into Tokelau over time

Timeline 2016

Stakeholders MOH, Traditional leaders, community groups MOH, community groups

Resources

Expected outcome Approval and support for the proposed tobacco control legislation Capacity built for providing cessation services Increased taxes on tobacco to reduce demand and decreased supply of tobacco products

2016

2016

Customs, Finance, political leaders, MOH, Traditional leaders, community groups

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Country: Tonga Strategic outcome: Decrease incidence and prevalence of premature deaths and disability from tobacco related harm. Objective: Tobacco related harm. Country action: Decrease demand for products, exposure, and supply. Country indicator: Decreased supply of tobacco.

Activities Mass media campaign on tobacco.

Timeline Feb 2016.

Stakeholders

Resources

Expected outcome Decrease demand (use), decreased uptake, increased awareness. Increase quitters, decrease prevalence, decrease harm of smoking exposure. Data available for decision/policy making, decreased supply. Decrease illicit trade and illegal practices.

Cessation services to support smokers to quit.

Feb 2016.

MOH, TongaHealth, Money, TAC, media. temporary media creative TA. MOH, Digicel, Quitline, TCC, TH. Health, NRT. MAFFF, MIA, community leaders, labour and commerce. Crown Law, Ministry of Rev and customs, TH, Police department, MOH. Police department, crown law, retailers, labour and commerce, revenue and customs. TA (WHO).

Assess extent of growing sales of Tapaka Tonga

2017

X to the protocol to eliminate illicit trade of tobacco. Tobacco act is strongly and effectively enforced this through strong partnership with involved agencies.

2017

Ongoing.

Human resources, vehicle.

Decreased demands and decreased availability/supply.

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Country: Tuvalu

Activities Global Youth Tobacco Survey

Timeline August 2016 September

Stakeholders MOH, MOE

Resources

Expected outcome

BTI cessation training

MOH

2016 Increase taxes on tobacco products

2016

Customs, Finance, MOH

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Country: Vanuatu

Activities Enforcement: Work with customs and police to control illicit tobacco, protect from exposure to secondhand smoke in the work place and public places. GHW gazetted and enforcement: finalise the commendment of regulation for GHW. Community mobilization: continue with the media engagement on advocacy, certify non smoke free village during WNTD, engage NGO's and other community networks in advocacy.

Timeline 2016

Stakeholders MOH, municipality, police, customs.

Resources Need budget for operation.

Expected outcome

2016

MOH, SLO.

Technical assistance, budget. Budget, technical assistance.

2016

MOH/community.

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Country: Wallis and Futuna Strategic outcome: Objective: Country action: Country indicator:

Activities Enforce no sales to minors and no single cigarette sales Education and awareness about dangers of tobacco use and second-hand smoke A letter from the Health Minister to inform customs about illicit trade Education campaigns in school and villages

Timeline 2016

Stakeholders Health agency

Resources

Expected outcome

2016

Health agency

2016

Health agency

2016

Health agency

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ANNEX 4. Pacific Workshop on Implementation of the Regional Action Plan for the Tobacco Free Initiative in Western Pacific (2015-2019) Outcome statement

There has been much progress made in implementation of the WHO Framework Convention on Tobacco Control in the Pacific. While we celebrate our successes, obstacles and challenges remain. Efforts need to be intensified if we are to achieve a Tobacco Free Pacific by 2025. To ensure comprehensive measures, we need multisectoral engagement. Experiences of Pacific islands are valuable and sharing of such experiences and building of a Pacific evidence base must be further encouraged and supported. Tobacco industry interference remains a problem in the Pacific. The tobacco industry should not be allowed to impede tobacco control measures.

We, the participants of this workshop reaffirm our commitment to: (1) Full implementation of the WHO FCTC; (2) Contribute towards attainment of the voluntary global NCD targets; and (3) Achieving the Tobacco Free Pacific 2025 goal

Towards these ends, we commit to the following actions:           Strengthen multisectoral coordination including engagement of non-health sectors and civil society; Develop and implement comprehensive legal frameworks for tobacco control, including enforcement; Establish sustainable mechanisms in place to support tobacco control such as dedicating tobacco tax revenues towards tobacco control efforts; Establish consistent monitoring and evaluation of tobacco control measures and their impact which will contribute to a Pacific evidence base; Take action to counter tobacco industry interference through vigilant monitoring and raising awareness among government and non-government sectors including communities; Consider the requirements and implications of ratifying or acceding to the Protocol to Eliminate Illicit Trade of Tobacco Products; Develop capacity around cessation emphasizing population-based cessation approaches; Engage media as a conduit for strengthening tobacco control; Promote and support the establishment of the Tobacco Free Pacific 2025 Alliance; and Explore innovative approaches that are inspired, led, and driven by communities including strategic use of social networks and technology.

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We request WHO to:  Provide and/or coordinate technical assistance to address capacity gaps, particularly on emerging issues involving tobacco and tobacco control such as trade, illicit trade, surveillance, impact analyses, and electronic nicotine and non-nicotine delivery systems; Provide and/or coordinate legal assistance to support development and implementation of legal frameworks for tobacco control; Facilitate communication and coordination with other regional and global bodies such as FCTC Secretariat, SPC, FCA, SEATCA, Cancer Council Australia, ASH New Zealand, McCabe Centre for Cancer and Law, development partners, and others as appropriate; Support Pacific islands in implementation of strategies of the WHO FCTC; Provide administrative support to maintain the TFP2025 Alliance web-based platform; and Reconvene the national tobacco control focal points in 2017 for a mid-term review of the implementation of the regional action plan and progress towards TFP2025.

 

  

Dated: 19 November 2015

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