Tobacco industry killing efforts to cut smoking deaths

Every year on May 31, the world stops and reflects on the millions who have lost their lives to tobacco use and the one billion others who are set to lose their lives to tobacco this century, if current trends are not reversed. Tobacco remains the largest preventable cause of death in the world. 

Every year it kills more people than AIDS, malaria and Tuberculosis (TB) combined. On average, smokers die 15 years earlier than non-smokers.

Tobacco use is set to become the leading cause of death in low and middle income countries by 2030. This vice causes 15 cancers, particularly lung cancer, and is the only common denominator in the non communicable diseases (NCD) epidemic which involves diabetes, heart and respiratory diseases.

This year, the World Health Organization (WHO) has selected tobacco industry interference in tobacco control efforts as the theme of the World No Tobacco Day.

The tobacco industry has been defined as ‘those persons and companies engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products’.

The leading tobacco companies in the world include Phillip Morris, British American Tobacco (BAT) and Japan Tobacco International. In Uganda, British American Tobacco Uganda (BATU) and Mastermind are the leading ones.

The tobacco industry is one of the most lucrative in the world. The Tobacco Atlas last year estimated that revenues from the global tobacco industry were likely to reach half a trillion US dollars, a year. Many tobacco companies are actually wealthier than many developing countries.

“The tobacco industry has historically employed a multitude of tactics to shape and influence tobacco control policy. It has used its economic power, lobbying and marketing machinery, and manipulation of the media to discredit scientific research and influence governments in order to propagate the sale and distribution of its deadly product. Furthermore, the tobacco industry continues to inject large philanthropic contributions into social programmes worldwide to create a positive public image under the guise of corporate social responsibility,” reads a WHO statement.

Because of the economic muscle tobacco companies wield, they hold sway over poor African governments and frustrate national efforts to cut tobacco deaths.

“The entry point for the tobacco industry in Uganda is the overly hyped economic importance of the industry in government tax revenue and tobacco farmers’ livelihoods,” says Dr Sheila Ndyanabangi, the Tobacco Control focal person in the ministry of Health.

But the disease burden and the costs of treating tobacco-related diseases far outweigh the reported economic importance and are not worth any life. The Centre for Tobacco Control in Africa (CTCA), a regional project funded by the Bill and Melinda Gates Foundation, is pioneering alternatives to tobacco farming through pilot projects in the tobacco-growing districts of Arua and Kanungu.

According to information from Uganda Tobacco or Health Forum, the tobacco industry reportedly put Uganda government under pressure not to increase excise duty on cigarettes in the 2008/2009 national budget, yet globally, taxes on tobacco products are said to be one of the most effective deterrents to tobacco use.

Tobacco companies all over the world are known to frustrate national anti-tobacco legislation through instituting stalling lawsuits and sustained media campaigns against proposed legislation.

John Amanya, Deputy Executive Secretary of the Uganda National Tobacco Control Association, observes that in Uganda we have already seen the tobacco industry sponsor press articles to try and punch holes in the proposed tobacco control bill which had its first reading before Parliament recently.

Despite the ban on tobacco advertising in Uganda, tobacco companies still stealthily advertise under the guise of corporate social responsibility sponsorships or indirect advertising, such as glossy job adverts in the print media.

Jackie Tumwine, a tobacco control advocate, recalls that despite the law banning tobacco advertising and promotion, BATU sponsored and chaired the Commonwealth Business Forum in 2007.

“The global tobacco industry kills six million people every year. It does this in a deliberate, systematic manner, complete with business plans, lobbying, political contributions and favours, and cash bonuses to its executives who kill the most people by successfully selling them their deadly cigarettes and other tobacco products,’’ says Dr Thomas Glynn of the American Cancer Society.

Kenya generic AIDS drugs court ruling sets East African precedent

Thousands of people living with HIV and AIDS in East Africa were given new hope last week (25 April 2012), when a High Court judge in Nairobi ruled that Kenya’s anti counterfeit law is unconstitutional in its interpretation of generic HIV drugs as illegal counterfeits.


A generic drug is an identical copy of a brand name, the latter of which are usually manufactured by pharmaceutical giants. Brand drugs such as those manufactured by Pfizer and Norvatis go for prices tailored to Western markets and thus are unaffordable for the majority of patients in sub Saharan Africa. However, many can afford Indian generics, which cost as little as a tenth of the brand price.

Generic drug manufacturers such as CIPLA of India imitate the exact formulas used in brand antiretrovirals (ARVs) drugs through a process called ‘reverse engineering’. The drugs are understood to be as effective as the brand names.

Justice Mumbi Ngugi ruled that intellectual property rights do not override the right to life and health. She found the definition of a ‘counterfeit’ in the Kenya Anti-Counterfeit Act of 2008 to be too broad leading to generic HIV drugs being bundled together with other counterfeits. Justice Mumbi said this vagueness is posing a grave threat to the right to life and health for thousands of Kenyans who depend on life-saving generic ARVs.

The High Court judge has now instructed the Kenyan parliament to review the Anti Counterfeit Act of 2008 and amend the offending articles, which can lead to arbitrary seizures of generic HIV drugs under the pretext that they are ‘counterfeits’, as happened at a Dutch port last year.

Under common law, a high court ruling in Kenya sets a precedent for countries such as Uganda and it is now thought that human rights activists in Uganda and the rest of East Africa will invoke the ruling in any potential suits.

The news will also comes as a welcome development for Ugandan pharmaceutical companies such as the Quality Chemicals Plant in Luzira, most of whose products are generic drugs

While testifying before a Ugandan parliamentary committee last month, Moses Mulumba, a human rights lawyer and intellectual property rights expert, revealed that the Uganda Counterfeit Bill 2010 regards generic AIDS drugs as ‘counterfeits’ and would render 90 % of HIV drugs in Uganda illegal should the bill be passed by parliament and assented to by President Museveni.

With efforts to deepen East African regional integration taking centre stage, the Kenya High Court ruling becomes even more instructive for Uganda and the rest of members of the East African community (EAC).

“A vast majority of people in Kenya rely on quality generic drugs for their daily survival. Through this important ruling, the High Court of Kenya has upheld a fundamental element of the right to health,” said UNAIDS Executive Director Michel Sidibé.
“This decision will set an important precedent for ensuring access to life-saving drugs around the world.”

“The court has correctly interpreted the Constitution and guaranteed the right to health. This ruling speaks against any ambiguity that serves to undermine access to generic medicines and puts the lives of people before profit”, Patricia Asero, one of the three petitioners, was quoted as saying.

Last week also marked the successful passage of the East Africa HIV/AIDS Prevention and Management Bill 2012 by the East African Legislative Assembly (EALA), a timely milestone as the assembly’s term of office expires in June this year.

Is the world economy a patient that has developed drug resistance?

The news is gloomy. The United Kingdom's economy contracted by 0.2% in the past quarter of 2012. Today, the BBC announced that the US economy has had a negative economic growth of 2.3% which is worse than many analysts that predicted. Spain announced that it was officially back in recession with 25% of its population official designated as unemployed.

Since 2008, western economies have adopted fiscal stimulus packages one after the other but the economies cant still turn the corner. Its like a patient in intensive care who doesn't show signs of real recovery but only allows a few flashes of hope.

To be fair, Obama's stimulus packages saved the US auto industry and the auto giants have now turned a profit and paid off US government loans but still...

No matter what strategies economists devise to revive western economies, the results are still feeble.

And the political repercussions are clear. Ruling parties in  Greece,Netherlands,  and recently in France are feeling the wrath of main-street. And had Obama had a more formidable opponent, the economy would have done him in at the next elections

The IMF has come up with a rescue package fund of over $ 400 billion to bail out countries in need- a sure certainty.

Kampala engulfed in secondhand tobacco smoke epidemic

You enter a Kampala bar, late in the evening and the entire place is engulfed in smoke - the whole atmosphere is colored with the grey of cigarette smoke. You venture out of the bar momentarily and you smell your clothes and hair and the scent of tobacco pollutes your nose. Now, imagine how absorbent your lungs are, compared to the cotton fabric of your cloth.

Secondhand smoke, also known as passive smoking or environmental tobacco smoke, is a mixture of sidestream smoke from the burning tip of the cigarette and mainstream smoke exhaled by a smoker.

Secondhand smoke is a complex mixture of some 4,000 chemical compounds, including almost 70 known or probable human carcinogens (cancer-causing agents).

Second hand smoke kills children and adults who don’t smoke. It causes lung cancer and heart disease in people who have never smoked. Even brief exposure can damage cells in ways that set the cancer process in motion. According to the WHO, nonsmokers exposed to secondhand smoke at home or at work increase their heart disease risk by 26% to 30% and lung cancer risk by 20 to 30 percent.

“The evidence is now indisputable that secondhand smoke is an alarming public health hazard, responsible for thousands of premature deaths among nonsmokers each year”

Richard Carmona, the US Surgeon General said in 2006.

Uganda banned smoking in public places through regulations passed in 2004 by then Environment Minister Kahinda Otafire called the National Environment (control of smoking in public places) regulations.

The regulations were passed as an off shoot of a Uganda High ruling in December 2002 which declared that smoking in public places was a violation of non-smokers’ constitutional right to a clean and healthy environment.

The High court instructed NEMA to formulate a law against public smoking which was enacted in 2004 and states that: “No person shall smoke a tobacco product or a lighted cigarette in an enclosed, indoor area of a public place.”

Public places here include bars, restaurants, shopping centres and public transportation .But we all know that Ugandans make some of the best laws in the world but trail in enforcing the same very laws.

A study I recently conducted on Uganda’s compliance with the regulations on control of public smoking in in bars and restaurants in Kampala, in the wake of the ban on smoking in public, however tells a tragic public health story of thousands of people in Kampala unwittingly involved in involuntary smoking.

The majority of bars in Kampala blatantly break the law by allowing public smoking on their premises contrary to Ugandan law. In fact, of the 23 bars I sampled in Kampala, only four enforce the ban on public smoking. Ironically, even in bars and restaurants where the ‘no smoking sign’ was prominently displayed, smoking continued unabated at the premises.

The study was conducted in five areas of Kampala including in Kisementi, Kabalagala and the sampled bars including the most popular bars frequented by middle class Ugandans.

The study, made possible by the US-based Campaign for Tobacco Free-Kids, shows that the law against public smoking in Kampala remains on the books with no enforcement to speak of. With the passing out of environmental police, by the Uganda police last year one can only hope the situation will be ameliorated.

Even with the proposed 2010 Tobacco control bill having had its first reading in parliament and a Tobacco Control policy awaiting cabinet consideration, enforcement of the tobacco control law will remain critical to the health of millions of Ugandans.

Respiratory symptoms among bar workers in Scotland decreased by 26 percent after

Smoke-free legislation was implemented in 2006 and asthmatic bar workers experienced

reduced airway inflammation and reported an improved quality of life.

In Uruguay, the enforcement of a 100% some-free law has reduced hospital admissions for heart attacks by 22 percent.

Many think that as long as they don’t smoke they will escape the now scientifically proven 15 cancers associated with cigarette smoking. But sadly, it is not enough not to smoke.

Why Jeffrey Sachs should be next World Bank President

Going by an op-ed article authored by Prof Jeffrey Sachs last week, he is interested in taking the reins at the World Bank.

For people in the west, the World Bank is no sacred cow and it is another of the myriad of US concerns, which is why then US president,George W Bush, chose Deputy Defence Secretary Paul Wolfowitz as World Bank President -which ended in disaster.

Robert Zoellick has been a more agreeable President but he was only a safe' substitute' drafted in after the Wolfowitz shipwreck. He was formerly a US trade negotiator. Clearly, the US's quality of choices of World Bank Presidents in the last ten years betrays an attention deficit disorder.

It so happens that by virtue of being the majority shareholder at the Bank and by virtue of an old pact, it gets to pick the President.

The World Bank could really change the poor world. Although it was set up after the second world war to help a battered Europe, in the last decades it has set its sights on the 'bottom billion' to borrow a Paul Collier term.

There are few candidates in the world who are better suited to be World Bank President ahead of Prof Jeffrey Sachs- a man with a true passion and heart for eradicating world poverty and disease.

I actually took to him belatedly-after reading his Bestseller 'The End of Poverty' in 2005, a book I borrowed from the US Embassy Library in Kampala.

Jeff Sachs is an authentic development economist who is unflinching in his belief that the basket countries of the world can rise up with western aid and support. Another illustrious economist,William Easterly, famously doesn't agree( on the role of Aid) but you cant fault Jeff Sachs for putting forth a feeble case.

Jeff Sachs, President of the Earth Institute at Columbia University and Advisor to the UN Secretary General on the Millennium development goals(MDGs) has been a persistent critic of the World Bank for its misguided policies in Sub Saharan Africa and at one accused the World Bank of intellectual dishonesty in its prescriptions for the 'Bottom Billion' countries. His writings partly inspired me to write an article in Kampala's leading daily 'The World Bank/IMF have failed poor nations' which was published literally the next day after I emailed it to the Editor.

I argued in the article that the World Bank's one model fits all approach was disingenuous and an economic tragedy for the intellectually lazy African economic policy authorities. Jeff Sachs in his book 'The End of Poverty' proposes a fascinating approach called 'clinical economics' an antithesis of traditional development economics.

Jeff Sachs is a man with the most eminent of qualifications. He is a highly published academic with real-life economic management experience serving as Economic Advisor to developing countries ranging from post-soviet Poland to Kenya and has written several Best sellers since 'The End of Poverty'.

He has been one of the brains behind the MDGs and the model millennium villages including one near my home district. I had the rare opportunity of meeting Jeff Sachs at a Public Debate when he rolled into town in Kampala about two years ago during the tenure of Dr Ezra Suruma as Uganda's Finance Minister.

The World Bank faces many challenges including its relevance and the need to 'get it right' in Sub Saharan Africa; the emergence of new players in Africa such as China which is now widely reputed to lend more money to the continent, some say three-times as much.

President Obama can do one good thing for Africa before the end of his first term-nominate Jeff Sachs as the US government's choice for World Bank President.

Why ‘Made in China’ is a problem for Uganda

Over the last festive holidays I strolled through my home town of Mbarara and was astonished at the number of Chinese immigrants in retail outlets selling commodities such as Chinese mobile phones in outfits which in Kampala-speak would be called emidaala.

I know it is not unusual in today’s Uganda to find Chinese immigrants in retail businesses as we have seen in Kikuubo in Kampala and I occasionally shop at a Chinese-run supermarket in the suburb of Wandegeya. But Mbarara was new for me.

Now, this is no homophobic treatise but I was struck me by what these developments say about the changing character of Ugandan commerce and how Chinese industry in Uganda has truly come full circle by completing the supply chain.

Products are made in China, imported by Chinese traders in Uganda, through an efficient export machine and are now directly sold in Uganda by Chinese retailers.

If you have shopped at any local supermarket in any town in Uganda, you will be forgiven for thinking that everything is ‘made in China’ these days. Chinese products have an irresistible lure. They are cheap.

They typically cost less than any other similar product (including Ugandan- made ones). But there is a catch.

Chinese industry has made many products seem cheap and affordable and many Ugandans have bought their first TV set or electric fan because of cheap Chinese products but this may come at the expense of the local manufacturing sector.

It now seems few Ugandan manufacturers can produce goods locally at prices that rival Chinese products. And this is why.

The cost of doing business in Uganda is not terribly competitive. Commercial bank loans interest rates in Uganda are as high as 30%. The cost of energy is prohibitive and recently, a 40% hike in electricity tariffs was announced. Many businesses have to do with expensive thermal generators during regular and prolonged power cuts. Uganda can’t even compete with China on labour cost.

Chinese engineers and construction companies typically bid lower than Ugandan construction forms for civil works and deliver that project faster than Ugandan contractors.

But there are some exogenous variables working in favour of Chinese businesses in Uganda and elsewhere.

The Chinese government subsidizes Chinese businesses in Africa and in many cases offers very low interest loans to businesses willing to set up shop in Africa. You have heard the Americans perennially complain that the value of Chinese currency is kept artificially low, making Chinese products seem cheap to importers.

Then Senator Barack Obama while visiting Kenya in 2007 pitted Kenyans for thinking that they would compete with Chinese industry saying even the Europeans and Americans had given up. When ever I return from Europe, I am amazed at how many souvenirs and Items I bring in from ‘Europe’ that are actually ‘made in China’.

Statistics show that in 2008, Ugandan exports to China that include cotton, coffee, leather and fish amounted to $20m while imports such as mechanical and electrical appliances stood at $202m.

Uganda’s trade deficit with China has more profound effects on the economy. Besides turning Uganda into a net importer of Chinese products and rendering local manufacturing uncompetitive with losses in manufacturing jobs, the repercussions extend to the value of the Ugandan shilling and imported inflation from China, among many ills.

An economic report shows that Chinese textile imports have caused 80% of Nigerian factories to shut down, resulting in 250,000 workers losing their jobs.

In response to these challenges, South Africa has introduced a quota system for Chinese textiles that limits entry of Chinese textiles. Joint ventures between Chinese and Ugandan entrepreneurs is another alternative middle round.

But the Chinese have built us a football stadium, a city hospital, a twin-tower president’s office and our foreign affairs ministry office block. Should we then be surprised at their benevolence?

And I am typing this on a lap top made in China, while wearing my made in China slippers, drinking coffee out of a mug made from China.

African NGOs petition US government over Cape Town IP summit

Over one hundred human rights NGOs, including some from Uganda, have petitioned the US government to stop a three-day Intellectual property summit set to take place in Cape Town, South Africa in April 2012.

The summit has been called to discuss intellectual property enforcement on the continent and could be a critical meeting affecting millions of poor Africans.

Intellectual property touches on issues such as banning Indian generic AIDS drugs by enforcing patents for western pharmaceutical giants, outlawing extensive photocopying of educational materials published by western multinationals, limiting access to newly developed disease-resistant agricultural seeds for poor farmers or cracking down on counterfeit Microsoft computer programmes.

Intellectual property refers to exclusive rights held by inventors and innovators of new drugs, books, plant seeds, software developers etc. These rights are enforced by international law and unlawful access to them attracts penalties.

The Cape Town summit , billed as ‘ Africa Intellectual Property Forum: Intellectual Property, Regional Integration and Economic Growth in Africa’ is organised by the US Department of Commerce. It has been hyped as the first Africa-wide ministerial-level event of its kind. The summit is jointly organized by World Intellectual Property Organisation (WIPO) and several US multinational companies including PfIzer, Dolby,Caterpillar and Microsoft.

The summit has drawn the ire of human rights NGOs in Africa , partly because of a disturbing conflict of interest, it is sponsored by US multinationals in collaboration with western governments such as US,France and Japan who own most of the intellectual property rights and seek to enforce them in African countries where the majority of people live on less than a dollar.

''It’s a shame that the Africa IP Forum is putting emphasis on IP enforcement agenda. One would expect the continent to be discussing the Development Agenda in light of its social economic challenges in the areas of health, education and agriculture. Over emphasis on IP enforcement is iniquitous of the continent's population that still badly needs to utilise the policy space provided for by the TRIPS Agreement" said Mulumba Moses of the Center for Health, Human Rights and Development, a Ugandan human rights NGO.

The summit is being castigated by human rights activists because it appears to reverse gains made by African governments in securing exemptions from enforcing intellectual property rights of multinationals in poor countries,such as the 2006 TRIPS agreement in Doha which granted poor countries a grace period until 2016 to consume cheap generic AIDS drugs manufactured in India.

It is feared that the summit may trigger new intellectual property legislation in African countries in a compliance move that my curtail access to products, in some cases, life-saving drugs such as AIDS or Tuberculosis (TB) drugs.

The irony of the South African government playing host to a summit ,on African soil, seeking to perpetuate western multinational interests by curtailing access to life-saving drugs or educational materials to poor African students is not lost on African and global human rights NGOs.

The sentiments of the petitioning African NGOs are aptly captured by Sangeeta Shasikant, Legal Advisor of the Third World Network: '' The US is well known for pressuring developing countries to adopt TRIPS plus standards. The Africa IP Summit is another attempt by the US to advance its aggressive agenda on IP protection and enforcement such as Anti-Counterfeit Agreement (ACTA), that favours the interests of certain powerful multinational companies. The US concept paper and programme totally disregards the numerous developmental and socio-economic challenges facing Africa. Issues of access to affordable medicines, access to knowledge, misappropriation of genetic resources and associated traditional knowledge, farmers' rights are totally disregarded''.