Indonesia, torn between anti-tobacco fight and lobbying influence

Indonesia, which has long been very supportive of the tobacco industry, is now considering what direction to take and is considering various strong measures, such as restricting advertising, promotion and sponsorship or extending health warnings on cigarette packets. However, the divergence of views within the government remains very strong.

While the number of smokers worldwide is declining (1 billion smokers in 2017, compared to 1.1 billion in 2007), it is still increasing in Indonesia, with nearly one million additional smokers each year (from 61.4 million in 2011 to 70.2 million in 2021). The use of electronic cigarettes has increased from 0.1 % in 2011 to 3 % in 2021. The increase in health expenditure caused by tobacco is now pushing Indonesia to consider stricter measures in the fight against tobacco.

Anti-smoking advocacy struggling to gain traction

Tobacco is a major contributor to Indonesia's economy, which remains the world's second-largest producer. Long torn between economic demands and public health, the country is preparing to initiate a review of its 2012 law governing tobacco products, under the leadership of the Minister of Health.

In an online debate organized on September 5 by the Indonesian Institute for Social Development (IISD), Tjandra Yoga Aditama, professor of medicine and former director of the World Health Organization (WHO) for Southeast Asia, advocated in particular the banning of all advertising, promotion and sponsorship of tobacco products.[1], and not a simple restriction, as envisaged, in a country where these advertisements are still present on television.

During this debate, a speaker revealed that the Minister of Health was currently carrying out advocacy work with his fellow Ministers of Industry and Economic Affairs, in order to successfully revise the 2012 law.[2]. He is also leading a campaign to raise public awareness about the revision of the law and the dangers of smoking. Beyond restrictions on advertising, promotion and sponsorship, this revision could include regulation of electronic cigarettes, an extension of the size of health messages on cigarette packets, a ban on the sale of cigarettes in bars and a strengthening of health surveillance. A previous attempt to revise the 2012 law had previously been rejected, reflecting the divergence of views on this subject within the government.[3] and strong pressure from the tobacco industry. An article published in early 2022 insisted on Indonesia's interest in ratifying the Framework Convention on Tobacco Control (FCTC), since it is one of the few countries in the world not to have done so.[4].

A textbook case of pro-industry lobbying by a public health expert

Dr. Tikki Pangestu intervened in the public debate in an attempt to introduce the topics of heated tobacco, electronic cigarettes and nicotine pouches (pouches), in the name of risk reduction[5]. While Dr. Tikki Pangestu is systematically cited as a former director of the WHO, which he left in 2012, it is much rarer for his links to the Foundation for a Smoke-Free World (FSFW, exclusively funded by Philip Morris International) to be mentioned. However, Tikki Pangestu has appeared since 2020 in a podcast available on the FSFW website[6]. He also organized a webinar in August 2020 on the fifteenth anniversary of the FCTC, whose sole participant was to be Dr. Sudhanshu Patwardhan, Director of the Centre for Health Research and Education (CHRE), a British organization that received US$2 million from FSFW in 2019 and 2020.[7] ; this webinar was however cancelled the day before it was to be held, without explanation.[8].

In 2018, Tikki Pangestu still castigated the interference of the tobacco industry in Southeast Asia, particularly in Indonesia, and criticized the strategy of cigarette manufacturers seeking to introduce heated tobacco in this region.[9]. It seems to have evolved since then, in a direction favorable to Philip Morris. Tikki Pangestu is also part of the advisory board of the Roche laboratory[10] and members of the Fight Against Smoking Commission, an organization that advocates for a harm reduction strategy to quit smoking and brings together other experts affiliated with the tobacco industry[11].

The poaching of medical experts by the tobacco industry, preferably specialized in tobacco, public health or WHO issues, has been quite common for about thirty years. It allows tobacco companies to give credibility to often unfounded claims (e.g.: passive smoking has no impact), to sow doubt within the scientific community and public opinion, and to maintain controversy on sensitive subjects, all in order to curb public health policies. The field of research on tobacco industry interference is precisely aimed at revealing the links of interest that may unite certain actors in the public sphere (scientists, journalists, economists, etc.) with tobacco companies. Some websites, such as that of Tobacco Tactics, powered by the University of Bath's Tobacco Control Research Group, brings the fruits of this work to the public.

Keywords: Indonesia, public policies, lobby, interference, tobacco industry, tobacco control, public health©Tobacco Free Generation

M.F.

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[1] Triferna P, Adji R, Need stricter regulation against cigarette ads, promotion: expert, Antara News, published September 5, 2021, accessed September 7, 2022.[2] Triferna P, Ruhman F, Ministry moves to gather support for smoking regulation revision, Antara News, published September 5, 2022, accessed September 7, 2022.[3] Policy fragmentation a major obstacle to tobacco regulation in Indonesia, Tobacco-Free Generation, published August 30, 2021, accessed September 7, 2022.[4] Ahsan, A., Tandi, R., Amalia, N. et al. FCTC ratification, smoking prevalence, and GDP per capita: lessons for Indonesia and the rest of the world. Global Health 18, 11 (2022).[5] Need intervention strategies to reduce smoking prevalence: expert, Antara News, published September 3, 2022, accessed September 7, 2022.[6] Dr. Tikki Pangestu, FSFW Global Health Perspectives, 2020.[7] Center for Health Research and Education (CHRE), Tobacco Tactics, published November 24, 2021, accessed September 7, 2022.[8] Canceled - The Framework Convention on Tobacco Control - the Policy and Practice Gap, Lee Kuan Yew School of Public Policy, webinar scheduled for August 26, 2020.[9] Amul G, Pangestu T, Big Tobacco's smoke and mirrors in ASEAN, Asia & The Pacific Policy Forum, published February 28, 2018, accessed September 7, 2022.[10] Atlas of the Diagnostic Pathway, Roche Diagnostics, accessed September 7, 2022.[11] Our Commissioners, Fight Against Smoking, accessed September 7, 2022.National Committee Against Smoking |