Context

Bahrain became a party to the WHO Framework Convention on Tobacco Control (FCTC) on 20 March 2007. The passing of Royal Decree No. 8 of 2009 marked a significant step forward in tobacco control efforts in the country, introducing the first comprehensive tobacco control law in the Kingdom. In line with Article 13 of the WHO FCTC, Bahrain implemented a ban on most forms of tobacco advertising, promotion and sponsorship. This ban aimed to reduce the appeal of tobacco products, particularly among the public and minors. Additionally, it sought to prevent the tobacco industry from exerting influence on tobacco policies and regulations by sponsoring governmental or nongovernmental activities and projects.

Initiative

Since the introduction of Royal Decree No. 8 of 2009, there has been vigilant monitoring to ensure compliance with the ban on tobacco advertising, promotion and sponsorship. While the ban encompassed all media channels including television, radio, newspapers and magazines, enforcing it in social media originating from Bahrain posed particular challenges. Additionally, tobacco brands were prominently displayed during Formula one events hosted by Bahrain. To address these issues, a ministerial decree was issued in 2011 specifically addressing tobacco advertising, promotion and sponsorship. This decree prohibited all forms of sponsorship and eliminated tobacco promotions from sports events. It also barred the tobacco industry from advertising and promoting tobacco products at points of sale, and prohibited the display of brand slogans, brand boxes and price tags. Moreover, free distribution of tobacco products, promotional discounts and offers were banned. Furthermore, the production of dramas by the Ministry of Information Affairs in Bahrain banned the depiction of tobacco consumption scenes, unless for the purpose of raising awareness.

Challenges and lessons learnt

Bahrain achieved the highest level of success in enforcing bans on tobacco advertising, promotion and sponsorship among countries of the Gulf Cooperation Council back in 2011. Subsequently, the compliance level has remained high (8 out of 10), as indicated by the latest WHO Report on the Global Tobacco Epidemic of 2019. The collected compliance data for this report demonstrate effective enforcement of both direct tobacco advertising bans and bans on tobacco promotion and sponsorship in the country. Rigorous monitoring of ban implementation and the referral of violators to public prosecution played a pivotal role in maintaining compliance. However, monitoring social media platforms continues to present a significant challenge. In response, the Ministry of Health has collaborated with the Cyber Crimes Directorate in the Ministry of Interior to address violations occurring on social media. Additionally, the regulation of electronic nicotine delivery systems poses a challenge, as they are classified as electronic devices rather than tobacco products, making the ban inapplicable to them.

Impact

The impact of the ban on tobacco advertising, promotion and sponsorship in Bahrain has not been measured. Nonetheless, data from the Global Youth Tobacco Survey conducted in 2002 and 2015 indicate positive changes. There has been a 10% decrease in the number of young people who reported owning items displaying tobacco or cigarette brand logos, and a 27% decrease in the number of young people who reported observing actors smoking on television.

Next steps

The National Antismoking Committee, led by the Ministry of Health, is advocating for the classification of electronic cigarettes (e-cigs) as tobacco products. This classification would enable comprehensive control measures, including the prohibition of e-cig advertising, promotion and sponsorship.

References

Global Youth Tobacco Survey

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

WHO Report on the Global Epidemic Tobacco 2019

Story originated in 2019.

Context

Bahrain ratified the WHO Framework Convention on Tobacco Control (FCTC) on 20 March 2007. To enhance tobacco control efforts, the issuance of Royal Decree No. 8 of 2009 played a pivotal role as the first comprehensive tobacco control law in the Kingdom.

In line with Article 11 of the WHO FCTC, Bahrain implemented a crucial measure requiring health warnings on all tobacco packages. This requirement was specified under Article 18 of Royal Decree No. 8 of 2009. The legislation mandated that health warnings be applied to various types of tobacco products and adhere to the WHO FCTC's guidelines. The warnings were to be displayed in both Arabic and English languages, providing information on the constituents and emissions of tobacco.

Bahrain's decision to implement health warnings on tobacco packages was driven by the evidence-based recommendations of the WHO FCTC. By adopting these recommendations, the country aimed to raise public awareness about the dangers of tobacco use and mitigate the appeal of tobacco products. However, it was recognized that a more comprehensive adoption of the guidelines outlined in Article 11 of the WHO FCTC was necessary to further amplify the impact of these measures and reduce tobacco consumption.

Initiative

In pursuit of its objectives, Bahrain, along with other Gulf Cooperation Council (GCC) countries, formulated GSO 246/2011 for the labelling of tobacco product packages through the GCC Standardization Organization in 2011. The process of adopting this GSO involved extensive meetings and discussions to establish unified specifications for pictorial health warnings on tobacco products that would comply with the requirements of the WHO FCTC for all GCC member countries. The GCC Tobacco Control Committee, the Standards and Specifications Committee, and the Ministries of Trade and Commerce collaborated continuously to achieve this goal. The GSO aligned with a broader set of guidelines within Article 11 of the WHO FCTC, particularly those concerning pictorial health warnings.

Consequently, Bahrain officially implemented pictorial health warnings for the first time through Decision No. 16 of the Ministry of Industry in 2012. Starting in August 2011, suppliers of tobacco products were prohibited from introducing any items with the old packaging. The Ministry of Health, the Ministry of Interior (Customs Directorate), and the Ministry of Industry and Commerce worked together to oversee this process. Suppliers were granted a grace period of six months to sell the existing stock in stores. From February 2012 onwards, only tobacco products carrying pictorial health warnings were available for sale at point-of-sale locations in all GCC member countries. In 2014, another GSO was issued by the GCC Standardization Organization, which established the permissible and impermissible tobacco additives.

Challenges and lessons learnt

Since the implementation of pictorial health warnings on tobacco packages, Bahrain has faced a significant challenge in the form of interference from the tobacco industry. The industry has employed manipulative tactics to impede or prolong the implementation of this measure. Additionally, during the initial stages of implementation, there were a few incidents of illicit sale of tobacco products without the mandated health warnings. However, the Ministry of Health and the Ministry of Interior (Customs Directorate) effectively addressed these occurrences.

While GSO 246/2011 was aligned with the guidelines of Article 11 of the WHO FCTC, there were certain requirements that were not explicitly incorporated. These include:

Placing the warning at the top of the primary display areas of the package and ensuring its presence on every package and any external packaging and labelling used in retail sales.

Prohibiting the use of figurative signs, colours, numbers and descriptors depicting flavours as substitutes for misleading terms and descriptors on tobacco packaging and labelling.

Banning the display of quantitative information on emission yields (such as tar, nicotine and carbon monoxide), even when used as part of a brand name or trademark, as well as the display of qualitative information on relevant constituents and emissions of tobacco products on packaging and labelling.

Establishing or mandating fines for violations related to health warnings on packages.

Restricting the display of expiry dates on tobacco packaging.

Requiring the inclusion of the quit line number on packaging or labelling.

Mandating plain packaging.

These aspects highlight additional areas where further attention and consideration may be necessary to enhance tobacco control measures in line with the WHO FCTC guidelines.

Impact

Although there has been no specific measurement of the direct impact resulting from the implementation of pictorial health warnings on tobacco products, data obtained from the Global Youth Tobacco Survey conducted in 2015 provides valuable insights. According to the survey, approximately 44.6% of youth who were current smokers reported contemplating quitting as a result of the warning labels. This suggests a positive influence on young smokers' attitudes and intentions towards tobacco use.

Next steps

Bahrain has formulated a plan to increase the coverage of pictorial health warnings on tobacco product packaging, aiming to encompass 70% of both the front and back display areas. Ongoing efforts are being made to progress towards this objective. However, in light of Saudi Arabia's initiation of plain packaging implementation and the evolving circumstances within the GCC, other GCC member countries, including Bahrain, are shifting their focus towards directly adopting plain packaging measures. The implementation of plain packaging is currently under negotiation within the GCC Committee of Standards and Specifications, indicating a proactive approach towards advancing tobacco control efforts in the Region.

References

Global Youth Tobacco Survey

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

Story originated in 2019.

Context

Egypt ratified the WHO Framework Convention on Tobacco Control (FCTC) on 25 February 2005. However, Egypt had already initiated national surveys as early as 2000, as part of the Global Tobacco Surveillance System, to assess the prevalence of tobacco use at a national level and develop suitable interventions. In 2007, Egypt emerged as one of the pioneering countries in the Region in terms of effectively monitoring tobacco use.

Initiative

In line with Article 20 of the WHO FCTC, the Ministry of Health and Population has taken the lead in conducting regular national surveys. Egypt has made significant efforts in research and surveillance related to tobacco control. Each survey received financial and technical support, along with training for key personnel in survey methodology, implementation and analysis. Collaborations between the Ministry of Health and Population and local/international partners such as WHO, the Centers for Disease Control and Prevention, and the Central Agency for Public Mobilization and Statistics (CAPMAS) facilitated the execution of national tobacco control studies.

Egypt has implemented surveys as part of the Global Tobacco Surveillance System, including:

The Global Adult Tobacco Survey (GATS). The first nationwide GATS was conducted in 2009.

The Global Youth Tobacco Survey (GYTS). Egypt conducted four rounds of GYTS, with the first round in 2001 and subsequent rounds in 2005, 2009 and 2014.

The Global Health Professions Student Survey (GHPSS). The GHPSS was conducted in medical schools in 2005.

A significant accomplishment was the incorporation of Tobacco Questions for Surveys (TQS) in other national surveys, such as the WHO STEPwise survey for noncommunicable disease risk factors conducted in 2005, 2011/2012 and 2017, and the national Household Income and Expenditure survey by CAPMAS conducted in 2012/2013 and 2017/2018.

Additional national surveys that included TQS were the National Egypt's Health Issues Survey 2015 and the National Health Accounts 2008/2009. The Ministry of Health and Population collaborated with WHO and academic professionals for three national studies in 2014, which examined health costs of tobacco use, assessed illicit tobacco trade and investigated shisha and smokeless tobacco use among youth in universities. Furthermore, in 2016, the Ministry of Health and Population, together with WHO and nongovernmental organizations, conducted a study on tobacco use among secondary school students.

Challenges and lessons learnt

Acquiring official approvals for national surveys involves time-consuming procedures. Nonetheless, a significant accomplishment has been the integration of TQS into regular national surveys, which serves as a valuable step towards addressing the need for specific tobacco-related surveys.

Impact

The information gathered through surveillance provides valuable insights for assessing the necessity of interventions, evaluating initiatives and guiding future policy measures. However, there is a lack of extensive research on evaluation studies that examine the effectiveness of interventions in reducing the prevalence of tobacco use.

Next steps

Conduct regular national surveys on tobacco use, in particular, the Global Youth Tobacco Survey and the Global Adult Tobacco Survey. These surveys will monitor the prevalence and trends of tobacco use in the country, including the emerging use of novel products like electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS).

Collaborate (Ministry of Health and Population) with the Central Agency for Public Mobilization and Statistics (CAPMAS) and WHO to ensure the integration of specific questions related to ENDS/ENNDS in the Tobacco Questions for Surveys as part of ongoing national surveys.

Incorporate tobacco-related questions into the National Health Information System for comprehensive data collection.

Develop performance indicators for all tobacco-related services and prevention policies, and regularly report on these indicators to policymakers and the health committee in the Egyptian parliament. This will help measure the effectiveness of interventions in tobacco control.

Disseminate information and research findings to relevant national stakeholders, ensuring widespread awareness and knowledge.

Provide (Tobacco Control Department) an annual progress report on the implementation of these strategies to the Higher Committee on Tobacco Control.

Reference

Global Tobacco Surveillance System

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

Story originated in 2019.