Tuesday, May 28, 2013
Every year on May 31st, the world stops to reflect on the millions of lives lost to tobacco use around the world and the one billion set to lose their lives to tobacco use this century unless current trends are reversed. Uganda already has AIDS and malaria to worry about and yet a perfectly preventable epidemic of tobacco-use associated diseases is brewing. Tobacco use is the most preventable cause of death globally and is currently responsible for killing one in 10 adults worldwide. Globally, tobacco use kills more people every year than AIDS, malaria and Tuberculosis combined. This year, the World Health Organization (WHO) has selected theme of the ban on tobacco advertising, promotion and sponsorship. Scientific studies unequivocally show that a comprehensive ban on tobacco advertising has been followed by a reduction in cigarette consumption and that children and young people are more vulnerable to deceptive tobacco advertising. On 24th June 2007, Uganda became a signatory to the first global public health treaty in history known as the Framework Convention on Tobacco Control (FCTC) part of which commits countries to institute a comprehensive ban on tobacco advertising, promotion and sponsorship (TAPS) under article 13. Last year between June and August, I was principal investigator in a survey to investigate Uganda’s compliance with the ban on tobacco advertising, sponsorship and promotions made possible by a grant from the Geneva-based Framework Convention Alliance (FCA). Our research team scoured four key streets in each of the survey towns of Kampala, Gulu and Mbarara ,to reflect three strategic parts of Uganda, to collect data on Uganda’s compliance on the ban on tobacco advertising, promotion and sponsorship. As we commemorate World No Tobacco Day, it is an opportune moment to disseminate the findings of this study. First the good news: Our research team did not come across any billboard advertising tobacco in the streets of Kampala, Gulu and Mbarara we visited which suggests that direct tobacco advertising has reduced considerably. And now, the not so good news: The tobacco industry in Uganda has changed strategy from direct to indirect advertising in response to advertising restrictions. It circumvents the ban on advertising through innovative indirect forms of advertising such as ‘corporate social responsibility schemes’, product launches and promotions, branding and more recently, cigarette price increases in the print media. Violations at retail outlets are widespread in Uganda and considerable pictorial evidence was compiled for this report in the three towns visited. Point of Sale violations were abundant at super markets, kiosks and stalls, bars, gas stations .The violations are in form of posters, umbrella shades, branded display cases and branded tobacco company vehicles. Ugandan youth have been especially targeted by the industry as the tobacco posters we came across were placed in places favored by youth such as night clubs. Tobacco promotional events happen in youth hang outs. A 2002 Global Youth Survey revealed that almost 60% of Ugandan youth had seen pro-cigarette ads in newspapers and magazines in the past 30 days.. The industry especially targets youth because they are impressionable and therefore more susceptible to acting on tobacco messages, an irresistible lure of recruiting life-long clients to replace half of their clientele who eventually die from tobacco use. Additionally, countries like Uganda have very young populations compared to say Europe with the majority under the age of 30 and therefore a potentially lucrative market. In low and middle income countries, a third of young people own an object with a cigarette logo-according to the International Union against Tuberculosis and Lung disease. Unsurprisingly, the Tobacco Atlas (2012) lists Uganda among countries with a ‘complete absence of the ban on tobacco advertising’. The WHO 2009 report card on Uganda indicates that is no national ban on tobacco advertising, With the tobacco control bill (2012) coming before parliament soon, Uganda needs to follow in the footsteps of Kenya which instituted a ban in 2007, South Africa in 1999 and Ghana in 2012, to legislate for a comprehensive ban on tobacco advertising, promotion and sponsorship in all its forms, both direct and indirect.
Friday, May 24, 2013
The lives of thousands of Ugandans enrolled on HIV treatment hangs in the balance if an application by poor countries to extend the deadline for manufacture of generic AIDS drugs indefinitely, is rejected by the World Trade Organization (WTO), in on-going negotiations under a treaty known as Trade Related Aspects of Intellectual Property (TRIPS) . Over 90% of HIV drugs in Uganda are generic drugs manufactured mostly in India, according to Denis Kibira, a pharmacist and Medicines Advisor at HEPS-Uganda. Generic drugs are identical copies of drugs manufactured by brand names. Quality Chemicals, a Ugandan pharmaceutical company also manufactures generic drugs. Generic drugs which go for only about a tenth of the cost of brand drugs, were a major enabling factor for the acceleration in access to HIV treatment to the over six million currently on treatment. More than 1.6 million Ugandans live with HIV with an estimated 300,000 currently enrolled on antiretroviral treatment in Uganda. “The ability to access cheap medicines on the market will be curtailed and the fight against HIV/AIDS in Uganda may be lost if expansive trade laws are adopted without improving the incomes of Ugandans.” said Joshua Wamboga from TASO The initial deadline for the manufacture of generic HIV drugs was set to end in 2016 but an application by Haiti in November last year ,on behalf of all poor countries, to extend it indefinitely, has met with stiff opposition at the World Trade Organization which is dominated by rich industrialized countries where most patents for HIV drugs are held by large western multilateral giants such as Norvatis and Pfizer. The US,Europe and other developed country groups are reportedly behind the move to oppose the indefinite extension. Sources with in The World Trade Organization insists it would only be receptive to an extension of the ban on generic drugs for 5-7 years which poor countries are opposed to arguing that they can not build local pharmaceutical capacity for manufacturing original drugs with in that period. “This is unacceptable as the TRIPS Agreement states that upon a duly motivated request, the TRIPS council shall grant an extension. LDCs to which Uganda is categorized are justified in seeking an unlimited extension for so long as they are so classified because the suggested 5-7 years will not give us adequate time to overcome capacity constraints to develop a viable and competitive technological base.” States Mulumba Moses, Director at the Center for Health, Human Rights and Development (CEHURD). Civil society organizations in Uganda working in the area of intellectual property rights and access to medicines argue that the WTO is beholden to western interests. They have issued a letter to the WTO Council chair and Developed country Missions in Uganda to express their disapproval of the manner in which negotiations for the request to extend the time with in which Least Developed Countries (LDCs) can enforce Trade Related Aspects of Intellectual Property (TRIPS) is being handled. ‘’It is infuriating to note that over the past few months, (WTO) has been chairing informal meetings between developed countries and least developed countries where LDCs have been pressed to agree to a shorter term of 5 - 7.5 years’’ says Primah Kwagala a lawyer with CEHURD. About a quarter of the Ugandan population lives under the poverty line, according to the Uganda bureau of Statistics, and the majority can not afford to buy brand drugs manufactured by western pharmaceutical companies to treat AIDS, malaria and Tuberculosis-the three most important diseases in the developing world. With over 90% of Ugandans dependent on Indian generic drugs, outlawing these drugs would jeopardize millions of lives. An extension of 5-7 years is not a long enough period to nurture the local pharmaceutical industry and for companies such as Quality Chemicals to develop original drugs and meet the local demand for medicines in Uganda. Millions of lives depend on the decision to extend this deadline and the WTO should exercise restraint by balancing the interests of western pharmaceutical giants with the public health and development needs of poor countries. In a land mark Kenyan court ruling last year, Justice Mumbi Ngugi ruled that intellectual property rights do not over ride the right to life and health.
Saturday, May 11, 2013
Why tobacco companies target your teenage child and why an advertising ban is an imperative for Uganda
When I was growing up as a child in the 1980s and the 1990s, the back pages of TIME and Newsweek magazines were almost always adorned with a surreal image of a trim, middle-aged white man. He was often riding on horse back with a cowboy hat as he puffed away on a cigarette, often in rugged terrain. He was known as the ‘Marlboro man’. We all wanted to be like the Marlboro man. He was cool, macho and assured. I remember plastering some of my adolescent walls with the pictures of the cool ‘Marlboro man’. It was only much later that I realized that the ‘Marlboro man’ was actually a deceptive tobacco advert aimed at getting me to buy cigarettes- an easy prey to ‘Big tobacco’s sophisticated advertising machine. But the adverts worked. They made smoking appear cool and alluring to an impressionable teenager like me at the time. And that’s the trouble with tobacco advertising, it is an ‘everyone is invited’ sport. Teenagers and young smokers are however, by far, the most sought after demographic. Tobacco advertising is about making money. Before the ‘Marlboro man’ was conceived in the US in 1955, tobacco sales were $ 5 million. In 1957, when the ‘Marlboro man’ was introduced, tobacco sales were up $ 20 million. Imagine you were launching a new soda or beer product in which and you had invested millions. Advertising and promotions are vehicles you can’t ignore. The trouble is that tobacco products are not like any other commercial product. ‘’When used exactly as intended by the manufacturer, tobacco products kill half of all their users’’ says Dr Sheila Ndyanabangi, the tobacco control focal person in the Ministry of Health. Ironically, Wayne McLaren who portrayed ‘the Marlboro man’ in print and television did eventually succumb to lung cancer in real life, on 22nd July 1992 at the age of 51. The World commemorates World No Tobacco day this month and WHO has selected this year’s theme as the ban on tobacco advertising, promotion and sponsorship. Tobacco advertising has been defined as ‘any commercial effort to promote tobacco consumption, including the display of trade marks, brand names and manufacturer logos, marketing of tobacco products and other methods’. On 24th June 2007, Uganda signed a global agenda to, among other things, institute a comprehensive ban on tobacco advertising under a treaty called the Framework Convention Alliance (FCTC) which has force of international law in 186 countries, including Uganda. ’’In the last few months we have seen unprecedented tobacco industry advertising in Uganda. It would seem this advertising is regulation-free. Companies have announced cigarette price increase in glossy full page adverts’’ says John Amanya of Uganda National Tobacco Control Association (UNTCA) ‘The tobacco industry in Uganda continues to advertise, promote and sponsor activities aimed at increasing demand for tobacco products in contravention of the ministerial directive of 1995 with no known regulatory regime to bring them to account. There have been some gains registered as tobacco advertising is less explicit than it was in years past, for instance, there are virtually no billboards advertising tobacco products. Point of sale (POS) violations do however stand out prominently’ reads the Tobacco Control Shadow report compiled by UNTCA which will be launched on 31st May 2013. The report was compiled from field research conducted in Kampala, Mbarara and Gulu to represent strategic regions of Uganda between June and August 2012. The shadow report also reveals that tobacco advertising ban violations are more rife among non-mainstream tobacco companies. The violations become more pronounced in the outskirts of towns. Tobacco advertising is especially targeted towards young people because of the opportunity of recruiting life-long clients enticed through ads that associate smoking with glamour and aroused curiosity in experimenting with things new. Unsurprisingly, scientific evidence shows that children and young people are more receptive to tobacco advertising than adults and that adolescents exposed to advertising are more likely to smoke which is why the most sought after demographic is teens and young smokers. Action on Smoking and Health’s website reveals that studies commissioned by the UK government show that ‘The balance of evidence supports the conclusion that advertising does have a positive impact on consumption” (i.e. it increases consumption). The same review also found that in countries that had banned tobacco advertising the ban “was followed by a fall in smoking on a scale which cannot reasonably be attributed to other factors’. The tobacco industry continues to find innovative ways of side-stepping the restrictions on advertising through non-traditional avenues including’ brand-stretching’ on such items as matches, lighters and key holders in the shape of cigarettes or the use of brand logos without reflecting a company name. ’’Tobacco companies in Uganda circumvent the ban on advertising through setting up events for product launches for new cigarette brands or open and blatant promotional events at recreational places such as night clubs specifically targeting teenagers and adolescents. We have also observed that tobacco companies have become increasingly reliant on displays at the point of sale to draw attention to their products and stimulate sales.’’ says John Amanya of UNTCA. Although tobacco advertising was banned in Kenya in 2007, in South Africa in 1999, the 2012 Tobacco Atlas lists Uganda among countries with a ‘complete absence of a ban on tobacco advertising’. The Uganda tobacco control bill (2012) proposes to ban tobacco companies from conducting free product giveaways, undertaking brand-stretching marketing to other products, or sponsoring events or individuals: all methods by which the tobacco industry seeks to attract new smokers. Point-of-sale displays will also be banned, which will further limit the potential for tobacco advertising. ‘’This is really about an industry that survives, and profits, from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system’ said Judge Gladys Kessler in a US court ruling in August 2006.