Context
The Egyptian Law, specifically Law 1981/52, mandated the inclusion of textual health warnings on all tobacco products, whether locally produced or imported, as early as 1981. This significant development was the result of a prolonged battle led by the health committee of the parliament, spearheaded by a dedicated cardiologist. Violations of this law were subject to penalties such as imprisonment, fines, confiscation of non-compliant products and even the closure of factories or stores where these products were found. Later, Law 2002/85 amended the provisions of Law 1981/52 and specified that the textual health warnings should occupy at least 30% of the main display areas of the tobacco packaging, conveying the message "Beware smoking destroys health and causes death".
Initiative
Following Egypt's ratification of the WHO Framework Convention on Tobacco Control (FCTC), significant advancements were made in the regulation of packaging and labelling for tobacco products. Through Law 2007/154, Egypt explicitly acknowledged its commitments under the WHO FCTC and introduced several changes. The law mandated that the size of textual health warnings be increased to a minimum of 50% of the packaging, and it recommended the inclusion of additional textual warnings and pictorial health warnings, to be determined by a ministerial decree. Furthermore, it amended the provisions in Law 1981/52 to prohibit the use of misleading terms, such as "low tar", "light", "ultra-light" or "mild", which imply that a product is less harmful than others. Additionally, Law 2007/443 required that all tobacco packaging include a clear and visible textual health warning in Arabic, along with specified pictures illustrating smoking hazards on the heart, lungs and during pregnancy. These pictures are accompanied by relevant text, such as "Smoking causes heart problems", "Smoking causes lung cancer", "Smoking harms both smokers and non-smokers" and “Smoking kills and harms your health”.
Egypt achieved notable compliance with Article 11 of the WHO FCTC as early as 2008 and became one of the leading countries in the Eastern Mediterranean Region. In 2008, pictorial health warnings, aligned with the WHO FCTC Article 11 guidelines, were implemented, with a set of four rotating every two years. Since 2012, these warnings have also featured the help line number 16805. Additionally, a collection of 20 customized pictorial health warnings, accompanied by relevant text messages, was developed to meet Egypt's specific requirements. These warnings are available in the WHO FCTC Health Warnings Database. Currently, the selection of warnings is conducted by a panel of experts.
A draft bill proposing amendments to health warning labelling was submitted to the former Minister of Health however, it was not prioritized on the health agenda. The draft bill aimed to enlarge the size of pictorial health warnings and included plans for plain packaging.
Challenges and lessons learnt
The initiative highlighted the valuable lessons gained from close collaboration with WHO and other international organizations to implement evidence-based packaging and labelling for tobacco products. Furthermore, establishing stronger communication channels with the Ministry of Finance proved crucial in countering manipulations by the tobacco industry.
However, there are certain challenges and areas for improvement. The health warnings currently in use are generic and applied to both cigarette and waterpipe packaging, but there is a need for tailored messages specific to waterpipes and other tobacco products. Moreover, there is a lack of more effective requirements for tobacco packaging and labelling, such as placing warnings at the top of the pack and ensuring they are not obscured by any markings or tax stamps. It is also important to clarify that warnings do not absolve or reduce the liability of the tobacco industry. Additionally, there should be a prohibition on the use of figurative signs, misleading terms and descriptors that depict flavours, as well as the display of quantitative information on emission yields and expiry dates on tobacco packaging. Furthermore, due to insufficient financial resources, there is a lack of parallel anti-tobacco mass media campaigns during the launch of new warning sets. Lastly, there is currently no formal mechanism for pre- and post-testing the effectiveness of health warnings.
Impact
According to the Global Adult Tobacco Survey of 2009, nearly all cigarette smokers (98.2%) acknowledged the presence of health warnings on cigarette packs. Among them, almost half (44.6%) considered quitting smoking due to the warning labels. In contrast, 66.4% of current waterpipe smokers had noticed health warnings on waterpipe packs, but only a small percentage (3.0%) of them had contemplated quitting as a result of the warning label. This discrepancy may be attributed to the distinct nature of waterpipe smoking, where the tobacco is prepared away from the smoker in commercial waterpipe establishments.
Next steps
The National Plan for Tobacco Control includes objectives to enhance the size of pictorial health warnings to cover 85% of the pack's surface or potentially introduce plain packaging, if feasible. Additionally, the plan aims to create and execute impactful public awareness campaigns through various channels such as broadcast media (television and radio), print media (newspapers and magazines), and digital media platforms including YouTube, Facebook, Twitter, blogging platforms and mobile applications.
References
Global Adult Tobacco Survey 2009
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.
