While tobacco use is declining in many parts of the world, especially among high income countries, Africa is one of only two WHO world regions where tobacco use, among the leading causes of preventable cancer death worldwide, is projected to continue to rise. While most countries on African continent have ratified the WHO Framework Convention on Tobacco Control, implementation of effective evidence-based tobacco control measures remains limited and incomplete. Moreover, the tobacco industry is increasingly targeting African countries as a growth market for their products and employing tactics to counter effective tobacco control measures. Given the central role of tobacco control for global cancer control, it is critical to strengthen collaboration between the cancer and tobacco control communities. This session will review the most cost-effective tobacco control measures, strategies for monitoring and countering tobacco industry influence, and how research can enhance implementation and scale up of tobacco prevention and cessation programs. As session Chair, Dr. Parascandola will provide brief opening remarks to outline the rationale for the session and expected outcomes. Dr. Parascandola will also facilitate discussion and summarize results from the Mentimeter poll for audience input.

Smoking prevalence in Africa is generally low but rising. The WHO estimates that the number of tobacco-attributable deaths on the continent will double by 2030. Given the state of the smoking epidemic, focusing on prevalence (as opposed to cessation) is the most effective way to avoid these deaths and the associated costs. The societal costs of smoking are already very high, especially in countries with higher smoking prevalence such as South Africa.
Evidence based tobacco tax policy is the most effective and cost-effective measure to prevent tobacco use and improve health outcomes, especially among youth, while also raising government revenues. However, African countries lag behind in implementing strong tobacco tax policies. African countries need to pay attention not only to the excise tax level, but also to the excise tax structure. Many African countries have an inferior ad valorem excise tax regime and wrong base.
The tobacco industry often exaggerates the potential impacts of higher tobacco taxes, and especially their link to smuggling. However, investigations have revealed that major tobacco companies have benefited from and been directly involved in fuelling the illicit tobacco trade.
Nevertheless, tax evasion from cigarette sale in Africa is tiny compared to other tax evasion. Empirical evidence demonstrates that governments can raise tobacco taxes and gain health and economic benefits from these higher taxes even in the presence of illicit trade. Government efforts to improve tax administration and implementing and enforcing strong measures to control illicit tobacco trade will further increase the impact of higher taxes on health and revenue.

Corporates’ activities have been shown to be associated with disease burden, including cancers. Monitoring tobacco industry activities, particularly those related to its efforts to interfere with the development and implementation of effective tobacco control policies have been associated with effective tobacco control (TC), which in turn has been associated with reduced cancer burden. However, until recently, only limited efforts have been made to systematically monitor and counter tobacco industry interference in TC policy process in the African region.
This presentation will provide the audience with the activities of the only tobacco industry monitoring observatory in Africa, particularly in relation to capacity-building efforts on effective monitoring and countering of tobacco industry interference, including the use of the Africa Tobacco Industry Monitoring App (ATIM app) and other monitoring tools such as sales data. Furthermore, the presentation would provide findings from monitoring efforts that suggest illicit trade is being over exaggerated by the industry. The data also suggest among others, that the launch of the VUSE e-cigarette in March 2021 through the youth-focused ‘inspiration’ livestream concert saw the product take on 9% market share within three months of its launch in South Africa. Oral nicotine pouches are similarly being promoted in Kenya.
It is concluded that the tobacco industry’s continued promotion of novel products and the over exaggeration of illicit trade concerns are tactics to inappropriately engage with government and government agencies outside of Health Ministry. These industry activities are intended to distract and interfere with the implementation of effective tobacco control policy in Africa. It is recommended that tobacco control governance needs to be strengthened through the implementation of an all-of-government (Multi-sectoral) approach. Furthermore, governments should urgently implement the WHO FCTC Article 5.3 guidelines so as to protect tobacco control policy process from the vested and commercial interests of the tobacco industry.