Joshua Kyallo, Director of Africa for Campaign For Tobacco-Free Kids, says a tobacco epidemic is looming. He spoke to John Muchangi
Tell us about Campaign For Tobacco-Free Kids work in Africa
The Campaign For Tobacco Free Kids (CTFK) is based in Washington DC. We work in global health and tobacco control. We were recently successful in getting some strong laws passed in Russia and smoke-free laws in Beijing. Coming to the African region, the TFK, as part of the Africa tobacco control work, supported by the Bill and Melinda Gates and Bloomberg philanthropies around 2005, 2006 and 2007, began by giving grants to African countries to help pass laws. Some of the examples include the tobacco control legislation in South Africa. We have continued through our partners to support South Africa. Around 2010, we also helped Togo, one of the smallest countries in Africa but very strong in tobacco control. We have done work in Ghana, which passed tobacco control law in 2012. Currently, we work alongside all tobacco control actors around the world and in Africa in partnership with the World Health Organisation (WHO), who primarily support the government. We've partnered with the American Cancer Society over the last five years or so and the International Union AgainstTuberculosis and Lung Disease. Within that broader network, the role of TFK in Africa is to build primarily the capacity of civil society organisations to support passage of strong tobacco legislations that are compliant with the WHO Framework Convention on Tobacco Control (FCTC). That work includes Kenya where we helped pass the law in 2007. We also work in Ghana, where there's a law in Togo, Nigeria, Botswana, and Ethiopia among others. We have about 10 countries.
Tobacco use in many parts of the world outside of Africa is going down. How is the situation on the continent?
Compared to the rest of the world, the tobacco prevalence rates in Africa are much lower. That's the good news. The bad news is, we are the primary target of the tobacco industry.
So as the rest of the world tighten their laws in tobacco legislation, the tobacco industry is setting base in Africa. What we are doing in Africa is primarily prevention. We think there's an opportunity to stop an epidemic before it comes to Africa. We have a lot to learn from what has happened in other parts of the world. We know where the science is; we know where the truth is.
There are tools that have proven very successful in Latin America and across the whole world. There's no reason why Africa cannot act now. We have struggled in Africa with infectious diseases. Look at what has happened to the healthcare system with tuberculosis, malaria, HIV and maternal and child health issues. Our health care system has been totally stretched and health workers cannot cope. I do not think myself that Africa has capability to withstand another epidemic.
So the work in Africa, from TFK perspective, is primarily prevention; preventing an epidemic before it hits the continent. So we we take satisfaction in the sense that the epidemic hasn't hit us yet, but we see the threat. Look at BAT for example. It has been in Kenya for 100 years. Across Africa, Philip Morris has built a hub in West Africa. We helped set up legislation in West Africa and continue to work in Senegal and Ghana, where we helped pass laws last year. Philip Morris has set up huge headquarters in Dakar, Senegal, and is the supply hub for the region.
In Kenya, BAT moved from South Africa, and has also taken its offices from Uganda and moved them to Kenya. Africa has become the target of the tobacco industry. I will give you very specific statistics. In 2010, data showed that tobacco industry managed to get profits from cigarettes from only two regions in the world. These were Middle East and Africa. BAT says although they are losing their market in the rest of the world, they have very great prospects in Africa.
Campaign For Tobacco-Free Kids has actively supports tobacco control in Africa. Why this urgency?
Tobacco use is the world's leading cause of preventable deaths today. The science is overwhelming. Tobacco kills six million people a year today. It kills far more people than HIV/Aids, malaria, tuberculosis, accidents and homicides combined. This scares me as a Kenyan because we have spent a lot of time to address these issues. Imagine an epidemic that kills far more people than that? That's what tobacco does. Number two, it is projected if we do not do anything now - for instance if Kenya does not pass the regulations, or implement them - around the world, 8 million people will die a year from tobacco use. 70 per cent of those will be from less developed economies like Africa, Kenya included.
The cost of inaction now to Africa and Kenya, in the long-term, is going to be huge. We are dealing with a product sold by tobacco industry, which kills, causes disease and causes disability. It's the only product we know which when you use consistently as prescribed by the manufacturer, we know for sure, will kill at least 50 per cent of its lifetime users. You can be guaranteed. Therefore there's a an urgency to prevent a looming epidemic and there's a very small window of opportunity. I always tell African and Kenya, you have the science now, the evidence and the opportunity to act. Why wait?
Do you think Kenya has done enough to stop these deaths?
The story of Kenya is an exciting and sad one as well. Exciting because Kenya was one of the first country to ratify the World Health Organisation FCTC around 2005. In 2007, Kenya passed the Tobacco Control Act. That’s the good part.
The sad part is for seven years since then, Kenya did not adopt the regulations to fully implement the 2007 Act. Why is that? One is political leadership. But the biggest barrier has been consistent, deliberate, tobacco industry interference. So we were excited that last December when the Minister of Health issued the tobacco control regulations.
They are are not the strongest across Africa, but they are a brave, positive development and we are very hopeful the Ministry of Health, the Government of Kenya and Parliament can stand firm, and have these regulations adopted.
The parliamentary committee on delegated legislation is accused of sitting on these regulations past the 21-day deadline imposed by the law.
I can speak as a global practitioner of public health and tobacco control and also speak as a Kenyan. I think the first thing Kenya should do is get the regulations adopted.
There’s no moment in history better than now to put in place regulations to protect the health and lives of 44 million Kenyans. It’s absolutely priority number one.
Not to do that now will be failure on part of Parliament and government and will potentially mean that for years to come, millions of lives that would have been protected now, will be exposed to the deadly consequences of tobacco use. That for me is priority number one.
WHO director Dr Margaret Chan mentioned tobacco firms have resorted to lawsuits to intimidate governments and their ministries of health. Have you seen this trend in Africa?
Let's just understand the tobacco industry because we need the government and the public to know who we are dealing with. The tobacco industry is not a friend of public health. If you look at the FCTC article 5.3, it says there is an irreconcilable conflict of interest in the commercial interests of the tobacco industry and the public health agenda of governments.
So what's happening in Kenya is a fight between the commercial priorities of the tobacco industry and the responsibility and obligations of the government of Kenya to fulfill its legal mandate as a party to the FCTC. Kenya ratified the FCTC and is legally bound. The Kenyan constitution of 2010 says any international law that Kenya ratifies is enshrined within the constitution of Kenya. So the FCTC is actually a piece within the Kenyan constitutional framework.
But the tobacco industry comes up with a lot of tactics. They will distort evidence and we have seen them do that. They will sometimes discount science even when the evidence is overwhelming. They will intimidate governments, they will try to mislead governments, they will threaten the government. Litigation is one way to do that. I am very familiar with the case of Kenya where the BAT has sued the Ministry of Health. The timing of the lawsuit was to try and intimidate the government in its efforts to adopt the regulations. Within the Tobacco Control Act, the Minister of Health is fully empowered to issue regulations and tell the industry what they can or they cannot do.
So the minister was acting purely within the law of 2007. But the tobacco industry went to the court asking for an injunction to have time to speak with the minister. They were trying to arm-twist the ministry into a negotiation table. The minister, who is actually dedicated and has a great team with a tobacco control board, has taken a very professional, clear stand and said there is no basis for negotiation.
I am aware the Minister of Health has filed defence. The ministry is firm and we urge them to continue to be firm. This is the industry trying to intimidate the government. And the intention is get people scared and Parliament thinks, if we adopt the regulations, we are going to get more lawsuits. We have seen this around the world. There is nothing new in it.
In other parts of the world, in Australia and Paraguay for instance, the industry has sued governments for allegedly flouting trade agreements.
In Kenya too the industry first tried to raise trade arguments and the Attorney General filed a response that the regulations are within the constitution of the country. They were defeated. They went and wrote to Parliament and tried to confuse Parliament. They lost the initial round. I am also aware they wrote to Chief of Staff in the President's office, who in turn wrote to the Minister of Health trying to intimidate the minister, but the minister made a very professional response to the allegations.
Within the East African Community, the industry acts either directly or using camouflages. The EAC business community is the tobacco industry mouthpiece. I am aware letters have gone to EAC headquarters in Arusha accusing Kenya of trying to violate trade agreements. When the people who understand the constitution of Kenya looked at those those accusations, they had no basis.
Inside Kenya, you have the Kenya Manufacturers Association. When you hear the voice of KAM, you are listening to the tobacco industry. I know KAM has sent tonnes of letters to Parliament trying to undermine the adoption of the legislation.
Do you feel the current legislations in Kenya adequately cover new forms of tobacco and nicotine delivery like Shisha and electronic cigarettes?
I can speak as a global practitioner of public health and tobacco control and also speak as a Kenyan. I think the first thing Kenya should do is get the regulation adopted. There's no moment in history that Kenya, Parliament and the government have a better opportunity than now to put in place regulations to protect the health and lives of 44 million lives of Kenyans. It's absolutely priority number one. Not to do that now will be failure on part of Parliament, failure on part of government and will potentially mean that for years to come, millions of lives that would have been protected now, will be exposed to the deadly consequences of tobacco use. That for me is priority number one.
On the issue of Shisha and e-cigarettes, the global evidence is very clear. There is no form or level of tobacco use that is safe. These electronic devices are for transmitting products that are toxic. You have the same level of effect. Currently, the regulations have not regulated them. But in Uganda, the government has already decided they will ban Shisha. So Kenya needs to learn from that. But we say, if governments can ban cigarettes, let them do it. It's within their mandate.
The point is, it's not for us to tell governments what to do. Our work as TFK and other global actors is to present the government with the science and the evidence, which is overwhelming. To remind them of international commitments and obligations and ask them to act consistent with their promises to their citizens. When they ratified the FCTC, they made a commitment not to us but to the citizens of Kenya.