Despite the rains, the air in the meeting room was stifling when Celine Awuor arrived at 9am.
From her estimation, half of the people present were visibly drunk youths. The venue was the National Industrial Training Authority (NITA) centre in Athi River, Machakos County, on Wednesday last week. Awuor was here for a public participation forum called by the Ministry of Health to discuss new graphic health warnings on tobacco and nicotine products.
Tobacco kills at least 9,000 Kenyans every year while the highly addictive oral nicotine products come with their own toxicity.
They harm foetuses, causing permanent effects on lung structure and function. They also impair the brains of children and adolescents who use them.
The Ministry of Health has now proposed new graphic warnings (GHWs) on all these products to warn Kenyans of their dangers.
The proposal has pitted the ministry against the tobacco industry, a term that refers to manufacturers, distributors, and retailers of tobacco and nicotine products and the lobbies they sponsor.
Awuor is the CEO of Nairobi-based legal think tank, the International Institute for Legislative Affairs (IILA).
“In the room you could see the face of masters and slaves. Bar owners and tobacco retailers were not hiding. Whenever their representative rose to speak, they would start by shouting ‘Smokers Hoyee,’ and the drunk youths would shout back in unison. You could easily tell they were paid to do this,” Awuor said.
The public participation engagements on the proposed health warnings commenced on May 2 in Kisumu and Nyeri, followed by submissions in Kakamega and Embu. The forums moved to Mombasa and Eldoret on May 6, before concluding in Machakos and Kajiado counties two days later.
The new warnings are a set of 13 images, some showing that using tobacco causes cancer, death, impotence and harms foetuses.
There is also a warning indicating nicotine pouches are not a safe alternative to cigarettes.
The law requires that for such warnings to be effective, they should be changed frequently.
There is evidence graphic health warnings on tobacco products are cost-effective and actually discourage users.
But the warnings on the highly addictive nicotine products are bitterly opposed by the multibillion-shilling tobacco industry, which is hanging on them as its lifeline.
Tobacco use is going down fast around the world and cigarettes are being banned in some countries, including Britain, to fight cancer.
The World Health Organization says for decades, the tobacco industry has employed devious tactics to keep generations of men, women and children addicted to its products.
“The industry’s success in undermining and defeating government efforts to control tobacco has led to an epidemic that continues to take eight million lives each year,” the WHO says.
The activities in the Kitengela meeting brought Awuor to tears. “Some of the sponsored youths were shouting, ‘We smoke by choice and it is our life.’ Some retailers had placards saying, ‘We only sell to adult consumers’. You could tell it was the tobacco industry misusing naïve people.”
The proposed graphic health warnings will replace the current warnings, initiated in 2016.
Awuor says the existing GHWs fall short of the WHO benchmark. “Their size on cigarette packets is too small, the cigarette makers have distorted the quality and they are not effectively rotated. Some regions have not seen certain images. They should be rotated such that even a batch of cigarette packets should have all the messages.”
The law currently says a combined picture and text health warning must occupy at least 30 per cent of the front and 50 per cent of the back of smoked tobacco products.
“We support the proposed graphic health warning because they have been improved. The size should also be improved. Graphic health warnings have been proven to be effective when they are of good quality, large and well rotated,” she said.
Joel Gitali, who in 2022 won the WHO Africa award for leading tobacco control campaigns in Kenya, attended a public participation forum in Eldoret last Monday.
“I also encountered drunk youths, who tried to disrupt the forum,” he says. Gitali is head of the Kenya Tobacco Control Alliance, the umbrella body for organisations involved in tobacco control in the country.
“But we still made our presentations despite protests from the industry,” he says. Gitali advised the government should ban nicotine pouches.
“We cannot allow the industry to experiment on our children. These are targets of these new products. If they have to be in the market, the novel nicotine products must be strongly regulated with graphic warnings covering more than 80 per cent of the packet,” he said.
Nicotine pouches are subject to a variety of regulations around the world, from outright bans to partial or selective regulation.
In France, nicotine is classified as a poisonous substance, subject to regulation. They are banned in Belgium, The Netherlands, Germany, Australia, New Zealand and several high-income countries, forcing the industry to push them aggressively in low and middle-income countries.
Samuel Ochieng, the CEO of the Consumer Information Network, a leading consumer watchdog, attended the public participation exercise in Kisumu on May 2.
“The exercise was held hostage for two hours by groups opposed to the new regulations. We nevertheless made important contributions in the forum. The GHW must now cover the emerging products such as oral nicotine pouches and e-cigarettes,” he said.
Crispin Achola, managing director of BAT-Kenya, attended the public participation forum in Embu on May 3. He said the cigarette manufacturer prefers written warnings instead of images on nicotine pouches.
“For cigarettes, we do concur that given their risk profile as a result of their combustible nature, graphic health warnings are appropriate for the category, and this has been the case for the last couple of years. However, when we look at what we are calling novel nicotine products, scientifically, these have been proven to be reduced-risk products for consumers. As such, we believe that graphic health warnings are not appropriate as this treats them the same as higher-risk products such as cigarettes," he said.
The industry position during the forums was restated many times through a flurry of press statements it sent, sometimes three times a day, through agencies.
KETCA national coordinator Thomas Lindi calls this desperation. “What we have witnessed during the nation wide public participation on the graphic heath warnings for tobacco products is how desperate tobacco industry is getting. The exhibition has demonstrated that emerging products like nicotine pouches and e-cigarettes might be the last kicks of the fading tobacco industry,” he said.
Before Awuor left the forum in Kitengela, she warned of the language used to promote the highly addictive nicotine products.
“They are not ‘safer alternatives’. And less harm doesn’t mean harmless. The government should apply extreme precautionary measures and control these products,” she said.