Current warning labels on Indian tobacco products ineffective¬¬ – concludes an international expert on tobacco control

India’s new warning labels on tobacco products fall short of the international standards for strong warning labels, according to Professor Geoffrey Fong, of the University of Waterloo in Canada, who is in India with his research team to meet with researchers at the Healis-Sekhsaria Institute for Public Health.

A world expert in tobacco control, Professor Geoffrey Fong made this conclusion based on research that he and his international team of experts have conducted on the impact of warning labels in a massive project across 20 countries.

“Warning labels that include graphic and clear images of the devastating diseases due to tobacco use are known to increase thoughts about quitting and to be used by smokers,” Professor Fong, whose research on warning labels has examined the impact of graphic warnings in Canada, Thailand, Malaysia, Brazil, Uruguay, and Australia, compared to text-only warnings in the other countries, including United States, China, France, Germany, Netherlands.

In July 2006, India introduced new warnings on cigarette and bidi packs and on packages of Gutkha and on tins of loose tobacco used for paanmasala. The original law for picture warnings was passed in 2003 and called for graphic photos of mouth cancer due to tobacco use. The new warnings would also include skull and crossbones, which is an international sign of poison.

“The skull and crossbones is a universal warning sign that the substance or product is very dangerous,” said Professor Fong. “And this is true of tobacco products. For example, we know that between one-third and one-half of all regular smokers will die of a smoking-related disease. It is the only product that kills people when used as intended.”

However, due to extreme pressure from the tobacco industry in India, especially the bidi industry, the implementation of the law was delayed 6 times over 5 years.

Then in March 2008, in an unprecedented move, the strong graphic warnings that had already been notified by the Government in 2006 and 2007 were changedto be weaker. The widely understood symbol of Skull and Crossbones was replaced by a scorpion. The vivid colour photos of real examples of mouth cancer due to tobacco use were changed to a fuzzy image of a chest x-ray.

“Healis has been one of the dedicated organizations in India that has been actively involved in research to facilitate implementation of much more effective warning labels on tobacco products.” said Professor Fong.

But even these new weakened warnings were delayed in their introduction. And they were made smaller (from 50% to 40%), limited (from both sides of the pack to just the back of the pack).

Professor Fong commented on the power of graphic warnings in other countries: “Countries such as Canada, Brazil, Singapore, and Mauritius have introduced very powerful warnings that have helped motivate smokers to quit and prevent young people from starting to smoke.”

“The tobacco industry knows how effective the warnings are, and that’s why they try their best to prevent warnings, weaken them, and delay their introduction.” The fact that the warnings have been so attacked by the tobacco industry in India is a sure sign that they are afraid of the impact of graphic warnings, Professor Fong says.

Close to one million people in India will die this year because of tobacco use. And since the graphic warnings were originally proposed and approved by the Government 6 years ago, about 5 million people have died.

Professor Fong commented on these delays. ”We know that strong graphic warnings are effective in increasing knowledge, motivating quitting, and preventing young people from tobacco use. How many of those that died could have been saved by the knowledge and vivid displays on the warnings that show what tobacco really does to people?”

GoM meet on tobacco pack warnings: Will pack warnings miss the deadline again?

The GoM on tobacco warnings is meeting on April 8, 2009 and further dilution or delay to pictorial warnings is expected. This is a great concern before the nation when the implementation on pictorial warnings is long due now and the deadline is very close i.e. May 31, 2009. This meeting is scheduled at the time when in the previous month General Election 2009 for Lok Sabha were announced and the Election Commission of India has passed the model code of conduct to ensure that  no impression is given or created by any political party  to influence the electorate in their favour. Hence, any kind of politically motivated decision resulting out of this meeting at this crucial hour is the violation of the this model code of conduct.

Also, considering the Honourable Health Minister, Dr. Anbumani Ramadoss has resigned; convening such a meeting by the GoM will certainly have no one representing the concerns of public health and can result into giving likeminded outputs. The non-representation of the health sector in this decisive meeting will lead to biased decisions and favours to the tobacco industry. According to Monika Arora, Director HRIDAY, “The GoM in its earlier 8 meetings has either delayed or diluted the effective pictorial health warnings notified by Ministry of Health and Family Welfare (MoHFW) on July 2006. The implementation of current mild warnings is continuously being delayed due to GoM’s intervention. This is a breach of right to information about the health hazards of the consumption of a deadly product.”

Further, the issue of implementation of Packaging and Labeling rules 2008 is subjudice before our Supreme Court. This case was filed before the apex court seeing the lack of executive will to implement the said rules. Therefore, further interference in the implementation of the rules by GoM would lead to legislative interference when the said matter is pending. According to Bhavna Mukhopadhyay, Senior Director, VHAI, “Any decision emerging out of the GoM meeting tomorrow that is likely to delay or dilute the existing rules will be a serious violation of the election code of conduct as it will gift windfall benefits to the tobacco industry and political gains to certain members of the GoM, who have lakhs of tobacco workers in their constituencies”.

Whereas, the Indian Tobacco Control Law (COTPA 2003) and Global tobacco control treaty signed by India, the Framework Convention on Tobacco Control (FCTC) mandates that all tobacco products, including bidis, must display effective pictorial health warnings. Also, a survey conducted in four Indian States by Healis Sekhsaria Institute for Public Health and Voluntary Health Association of India reports 98% of public supporting the pack warnings and 99% supporting government action to strengthen health warnings requiring them to be large and including pictures of all tobacco products. At this juncture, any of the Government’s decision in further deferring the pack warnings will not only dishonor its international commitment and people’s will but also undermines the health of its 1 billion citizens. According to Dr. Prakash C Gupta, Director, Healis Sekhsaria Institute for Public Health, “Pictorial warnings on tobacco products are intended to increase consumer knowledge of the deadly health effects of tobacco consumption, to encourage cessation and to discourage uptake.  In India they also break the linguistic and cultural barrier, in addition to informing the illiterate population (a large proportion of this segment smokes bidis) about the harmful effects of tobacco use.”

The issue of pictorial warnings has time and again affected the people working in public health as the persistent delay in enforcing the law to display pictorial warnings on tobacco products has resulted in no forward movement. It is ironical that the very same Government that has vehemently supported the guidelines on Article 11 of the FCTC (pack warnings) for the global community at the Conference of Parties meeting in November 2008 at Durban, South Africa is delaying its implementation on different pretexts in its own country.