Jordan successfully bans waterpipes, adapts smoking cessation services and establishes partnerships during COVID-19

Introduction

jor_tob_covid_2020 The Jordanian National Epidemics Committee and Ministry of Health are leading the efforts to respond to the COVID-19 pandemic. Jordan’s Ministry of Health is focusing on three main areas within tobacco control: enforcing a ban on waterpipe use in public places, adapting smoking cessation services and establishing partnerships to provide nicotine replacement therapy.

Ban on waterpipes in public places

His Excellency Mr Omar Razzaz, the Prime Minister of Jordan, on 14 March 2020, issued a decision banning waterpipes in restaurants and cafés. Following this decision and within 48 hours, a full lockdown was announced, which helped implement the decision fully. The ban has continued indoors in public places till the restrictions due to the pandemic relaxed towards the end of April and internal tourism began to pick up.

The Ministry of Health, as of 25 June 2020, requested from ministries of interior, local administration, tourism and antiquities, environment, trade and industry, and the Mayor of Amman to ensure that smoking in all forms is banned 100% indoors in all public places according to Articles 52 and 53 of the Public Health Law.

The Ministry of Tourism and Antiquities has issued the Guide for Health and Safety Precautionary Measures in Touristic Establishments. The guide includes, amongst other measures for touristic establishments, standards to serve waterpipes in touristic establishments. These standards include serving waterpipes outdoors, sanitizing the waterpipe, use of personal or disposable waterpipes and ensuring that staff and workers are wearing appropriate protective gear and are free of COVID-19 through checking their temperature daily. Establishments which do not meet these standards are faced with grave penalties, while establishments which meet all standards are recognized by a sticker displayed in a prominent place. His Excellency the Prime Minister has directed the formation of the Joint Committee for Awareness, Guidance and Monitoring of Touristic Establishments, with a number of ministries represented and supported by the tourism police. The Joint Committee is tasked with monitoring and ensuring that touristic establishments meet the various standards outlined in the tourism law. In addition, the Ministry of Health has established a separate Committee for non-touristic establishments which serve waterpipes and are not categorized as touristic establishments to ensure that all establishments are covered by inspections.

Currently, the use of waterpipes indoors is still banned; however, they are being served outdoors and in open places. The Joint Committee has formed five teams tasked to carry out daily inspections across the Kingdom. The teams inspect and check that general health and safety precautions are in place including the use of waterpipes. Where the teams identify violations, they tackle them immediately and impose fines and closures as needed.

Adapting smoking cessation services

Jordan’s Ministry of Health in cooperation with the World Health Organization (WHO) has established a hotline for smoking cessation counselling. The hotline serves as a hub where phone inquiries are addressed by physicians from the Ministry of Health. These physicians have been trained by WHO on counselling and treatment for cessation. The hotline has been publicized widely on the Ministry of Health’s website and its social media platforms. Linked to this, the Ministry of Health launched a huge campaign for health awareness in the week prior to World No Tobacco Day 2020 on social media and television and promoted the hotline widely.

Establishing partnerships to provide nicotine replacement therapy

The Ministry of Health in collaboration with WHO has secured a donation of 80 000 Euros worth of nicotine replacement therapies. The partnership—currently in the process of approval by His Excellency the Jordanian Prime Minister—with Johnson & Johnson Consumer Health will secure 37 800 nicotine patches for the Ministry of Health cessation centres and clinics. This donation will help 5400 people quit smoking. It will be extended to partner centres and clinics such as universities which—in spite of having trained physicians—are unable to provide nicotine replacement therapy due to its high cost. The Ministry of Health is working closely with WHO to develop an implementation plan for this partnership. The plan will cover how best to work with different stakeholders: universities, nongovernmental organizations, and, UN agencies such as UNRWA and UNHCR to maximise the benefits from the partnership and extend into different groups in the society such as Palestinian and Syrian refugees.

WHO, on 10 July 2020 in Geneva, held a live press conference to launch WHO Access Initiative for Quitting Tobacco. In this press conference, Jordan was recognised and presented as the first pilot country with an innovative programme to quit smoking and reduce the risk during COVID-19. Jordan was the first country in the world to receive the donation from Johnson & Johnson Consumer Health during the time of COVID-19.

In addition, the Ministry of Health in collaboration with WHO, together with the Spanish Cooperation have managed to secure funds to integrate cessation services into primary health care.

Way forward

The Jordanian National Plan for Preparedness and Response to COVID-19 includes tobacco control with a focus on cessation, awareness and communication activities. The Ministry of Health together with a team of WHO experts and consultants (tobacco, mental health and noncommunicable diseases), are working together to ensure that all essential health services will be functioning properly after the pandemic subsides and also in the unlikely event of another outbreak.

The Ministry of Health, supported by WHO, is looking at ways to utilise effectively 15 trained family physicians from the King Hussein Cancer Centre. Currently, there are five clinics and the Ministry of Health is looking at ways to further expand clinics and services and integrate them into primary health care.

Future plans include the close coordination between WHO and the Ministry of Health to clarify the position of smoking indoors in regulations, as currently, waterpipes are the only tobacco product banned indoors. This continues to represent a challenge for effective tobacco control. The Ministry of Health has approved the implementation plan for the WHO Framework Convention on Tobacco Control (FCTC) 2030 project. The FCTC 2030 project supports Parties eligible to receive official development assistance to achieve the Sustainable Development Goals by accelerating the implementation of the WHO FCTC. In addition, a study has been completed to propose changes to the General Health Law.