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United Arab Emirates

The 16th World Conference on Tobacco or Health: Not exactly “World”

3 Apr, 15 | by Marita Hefler, News Editor

Wasim Maziak

Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida

Two years ago, I was invited to serve on the scientific committee for the 16th World Conference for Tobacco or Health (WCTOH). I was particularly happy to serve, since this was the first time such an important event was planned in the Middle East, where most of my career has been focused. Over the past decade, several colleagues and I were greatly involved in initiatives aiming at seeding tobacco control research and training of tobacco control professionals from the region, with support from the US National Institute of Health.

The decision to hold the 16th WCTOH in Abu Dhabi (UAE) was only good news for me; a homecoming of years of efforts to seed science and evidence-based tobacco control principles in the Middle East. To build momentum, we started planning events that combine research and capacity building for tobacco control in the region, with conferences held in Abu Dhabi in 2013 and Qatar in 2014. We supported regional researchers to attend these conferences and conducted special research training workshops for junior researchers from the Middle East. This was complemented by a seed-grant program, for pilot studies in tobacco control in different countries in the region. Given the great opportunity presented by WCTOH for those grantees, we organized a special symposium during the WCTOH for our seed grantees to present their research results. This was really going well all around, and personally I was looking forward to a highlight of my career efforts in the region.

My excitement withered as the conference drew closer, when I started receiving worried messages from researchers in the region about a delay in their visa and travel arrangements. It became clear certain countries, not individuals, were the focus of visa denials. These were Syria, Iraq, Tunisia, and Bangladesh. I had a flashback from a year earlier, as I and my wife preparing for the 2014 waterpipe conference in Abu Dhabi, when her visa was denied while I had no problem. My wife is a tobacco control researcher from the University of Miami, and has years of work in tobacco control in the region. The only difference between us is that I had couple of months before received my new US citizenship, while she was still a permanent residence awaiting her citizenship and had to travel with her Syrian passport. When I brought this issue to the attention of one of the WCTOH organizers and warned about its grave potential for the WCTOH, he kept brushing the issue aside as of no concern.

Eventually, about 60 conference participants were denied entry to UAE, including 3 out of 6 participants in my symposium for young researchers in the region (Syria, Iraq, Tunisia). The conference organizers issued a statement that such denial is to be expected, and that it is actually less than previous similar occasions. However, I expect that in most similar occasions in the past visa denial was based on a case by case consideration not nationality, since I travelled to all of them since 2000 on my “cursed” Syrian passport. Still, I would have accepted this as related to the country’s policy with little that one can do about it. The main problem here is that the policy was well known to the local organizers based on previous experience, such as mine, but it was kept hidden from both the international organizing committee and conference participants. In the words of one of the conference Chairs, the local organizers assured everybody that “bona fide delegates would be allowed to enter the country”.

The largest delegation denied visas came from Bangladesh, one of the most active countries in Asia in tobacco control. It is also the home of second largest migrant working population in UAE, and has a lot to do with the construction and development boom of UAE, mostly under appalling conditions. What is worse is that the local organizers kept all participants from “shady” countries waiting even as the conference started (sometimes spending more than a day in the airport or with friends waiting for news) without telling them to go home based on what they knew of the extreme unlikelihood that they will receive a visa. Even two weeks after the conference, no official apology or responsibility declaration has been issued by any of the bodies related to the organization of WCTOH. This is unheard of from a community like ours that aspires to the highest moral values and respect for human dignity.

Tobacco control has been the cause of my life and career. Having a strong tobacco control community and successful international gatherings is vital for international cooperation and collaboration. If we remain silent about such mishandlings we risk repeating them or becoming accomplices in them. This is why I think such an incident requires a clear response from the organizers, and calls on us as community to create a better process for selecting host countries and organizing future World Conferences. Much more say in such decisions should be given to tobacco control activists from developing countries, who are at most risk of being refused visas, to ensure they have the opportunity for full participation.

World Conference on Tobacco or Health: keeping the focus on the tobacco industry

1 Apr, 15 | by Marita Hefler, News Editor

 

Anna Nicholson, Menzies School of Health Research

Follow Anna on Twitter @annaknicholson

The 16th World Conference on Tobacco or Health (WCTOH) was held in Abu Dhabi from March 17-21 2015, the first time it has been held in the Middle East. While this did not come without challenges (approximately 60 delegates, the majority from Bangladesh, were denied visas – see http://blogs.bmj.com/tc/2015/03/17/15th-world-conference-on-tobacco-or-health-regional-delegates-refused-visas/), the conference was attended by 2,184 delegates from over 100 countries. In the opening plenary, Dr Margaret Chan, Director General of the World Health Organization (WHO), rallied delegates to “keep the battle lines fresh and vigorous”, setting the tone for a program that focused on curtailing the tobacco industry. Despite many successes, delegates were sobered by the record profits recorded by a number of tobacco companies since the 15th WCTOH in 2012, notably in low income countries.

It is 10 years since the WHO FCTC came into force. So where are we now? Of the 178 countries with available data, about two thirds (125) show declining prevalence, but fewer than one in five (37) countries are on track to meet a 30% reduction by 2025. Country-specific surveillance shows 45 countries have comprehensive smoke free policies, 21 have adequate cessation support, 30 have graphic warning labels (>50% of pack), 24 have total advertising & promotion bans, and 32 have adequate taxation (75% of retail price). Day one of the scientific program focussed on growing evidence of the role of MPOWER, the technical package of technical measures and resources to achieve demand reduction provisions of the FCTC (Monitor tobacco use and prevention policies; Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco).

The conference theme was ‘Tobacco and Non-Communicable Diseases’ (NCDs). It was refreshing to be reminded of the importance to think beyond tobacco, and hear shared learnings from countering food, beverage and alcohol marketing. Delegates were urged to consider strategies that shift responsibility from the individual to industry and government, including product regulation, hard-hitting and sustained campaigns that raise public awareness, and advertising, promotion and sponsorship bans. Underpinning discussions was an awareness that funding available for preventing cardiovascular and other non-communicable diseases is in no way reflective of the scale of the NCD epidemic. Delegates heard about progress toward the World Health Assembly target to reduce tobacco use by 30% as part of the 25×25 global target of a 25% reduction in NCD deaths by 2025, and advocacy efforts to integrate the FCTC with the UN Sustainable Development Goals (SDGs).

The social, economic and environmental impacts of the tobacco industry were also acknowledged: issues such as food and water insecurity, air pollution, deforestation and pesticide use, as well as trade, farming and poverty. Delegates were urged to speak out against these tobacco-related inequalities. A number of symposia featured the heavy burden on low and middle income countries, with a particular focus on ‘best buy’ tobacco control strategies.

Attention was also drawn to many countries failing to provide adequate financial resources to tackle implementation of the FCTC (including high income countries), and the importance of keeping tobacco control efforts free of industry funding and influence. At a national level, delegates heard of the importance of strengthening primary health care systems, improving alliances, and advancing the role of these systems as agents for social change. The role and importance of civil society was also acknowledged, and delegates were encouraged to extend their partnerships and role as tobacco control advocates by including new champions for health reform.

Plain packaging was the focus of one plenary and a number of symposia. Nathan Smyth from the Australian Department of Health welcomed Ireland and the UK, which have both recently voted to introduce plain packaging, to “the greatest fight on Earth”. There was much discussion of lessons learned from current legal battles against the tobacco industry, which aims to slow the diffusion of plain packs by tying up resources, increasing the costs, and countering the evidence base. It was heartening to see the growing number of nations who have plain packaging in their sights despite these battles.

Lack of an evidence base was a key argument the tobacco industry used to fight Australia when it became the first country to introduce plain packs in 2012. Professor Melanie Wakefield used the analogy of a train leaving the station, collecting evidence from stops en route to the destination of reduced prevalence. Hot off the press of the April 2015 Tobacco Control supplement on plain packs, Professor Wakefield, Dr Michelle Scollo and other Australian researchers shared their ‘en route’ findings of the benefits of plain packs to reduce appeal and brand differentiation, focus attention on warning labels and reduce the ability to mislead consumers. Several presentations discussed the influence of pack shape and branding on consumer interpretations of attractiveness and harm, particularly for slim varieties, further highlighting the usefulness of standardised packaging. Delegates were also reminded of the synergistic effects of policies. Plain packs are not a magic bullet; rather they work together with complementary policies such as total bans on other forms of tobacco industry advertising and promotion. (For more about the supplement and the implications of the research findings, see http://blogs.bmj.com/tc/2015/03/18/blockbuster-special-issue-evaluation-of-the-australian-tobacco-plain-packaging-policy/).

Perhaps the most divisive debate was whether e-cigarettes should be viewed as a friend or foe of tobacco control. While the WHO urged caution, presenters in other symposia challenged the need for tight regulation, arguing this may stifle the emergence of potentially safer technologies. Experts appeared unanimous in their agreement that e-cigarettes produce metabolites known to cause disease such as lung cancer, emphysema, pulmonary fibrosis and cardiovascular events. However, the harm is greatly reduced compared to combustible cigarettes, and may be reduced further in new generations of e-cigarettes, particularly if new technologies can eliminate heating altogether. Delegates learned that some youth are using e-cigarettes before smoking cigarettes; however, no strong evidence of a “gateway effect” was reported. Nonetheless, delegates and presenters voiced concern over the appeal of flavours, the need to ban sales to minors, and the need to monitor effects of vaping in public. Given that e-cigarettes are an increasingly popular form of cessation assistance, the issue of how to best regulate them presents a pressing challenge. Professor Ken Warner reminded delegates to keep the focus on evidence-based tobacco control, look to more enlightened regulation (that does not discourage innovation) and continue to reduce the attractiveness of combustible cigarettes.

After four days of stimulating science, the conference ended with a rousing vision from the youth pre-conference delegation on their campaign “No More Tobacco in the 21st Century” (#NMT21C on Twitter), the prioritisation of which featured in one of the conference resolutions. Other conference resolutions centred on the FCTC: increasing signatories, achieving its recognition in the SDGs, and targets towards additional specific measures. There were also resolutions to treat tobacco uniquely in trade agreements, strengthen the Protocol to Eliminate Illicit Trade in Tobacco Products, and for a UN high level meeting to address the threat to humanity caused by the tobacco industry. Interestingly, despite the discussions and presentations throughout the conference, other broad action on NCDs was not featured in the conference resolutions.

The conference closed with the announcement that South Africa had won the bid for the 17th WCTOH, the first time the conference will be hosted by an African nation. The challenge was set with the words of Nelson Mandela: “I have walked that long road to freedom. I have tried not to falter; I have made missteps along the way. But I have discovered the secret that after climbing a great hill, one only finds that there are many more hills to climb”.

Related:

16th World Conference on Tobacco or Health: regional delegates refused visas

17 Mar, 15 | by Marita Hefler, News Editor

Simon Chapman, University of Sydney

(Editor update: at the time of this post being published, we were able to confirm 38 delegates had been refused visas. The organisers subsequently issued a statement with an estimate that approximately 60 delegates were refused visas. To read the statement click here.) 

Every three years, the world tobacco control community convenes for a world conference to hear the latest research, discuss strategy and train young researchers and advocates in how to get potent legislation adopted by governments. There have been 15 conferences since the 1967 meeting in New York, opened by Robert Kennedy.

This week the 16th is running in Abu Dhabi in the United Arab Emirates. The host countries are selected by a panel of leading international agencies and past conference hosts. There has never been a conference in the Middle East and with heavy smoking rates among men in particular, and generally immature tobacco control policies in place, a strong case weighed heavily in the voting for this weeks’ gathering.

One argument was that the conference would provide a global stage for regional leaders to make announcements about how the Middle East was moving ahead in tobacco control. Another was that the meeting would inspire regional delegates and help them network with global leaders.

The three day conference started on the 17th and as I write, at least 38 registered delegates we know of, many whose presentations had been accepted by the conference and some who were to chair sessions, are still waiting for their visas to be issued.  These are from Bangladesh (29), Iraq, Tunisia, Nigeria and Syria. They have a combined experience of  over 200 years in tobacco control.

This email is typical of the anguished emails we have seen or received directly:

I am writing to you in a situation when I am waiting at a friend’s house, packed up all my bags and posters for presentation and checking email every 6 secs.

I was invited as a speaker for sessions to be held today and tomorrow at the WCTOH. With a full scholarship I was assured about participation and thence I cleared all my appointments for these days.

I live in a distant town, 120 km away from the airport, and when I was leaving my house, my only daughter (8 months old) was sick and this stress was increased when I was waiting at the airport yesterday for hours with an expectation that I will get a visa.

Before that, I had to cancel my flight and it was so uncertain that I have never had such a thing in my travel history. Further, I couldn’t stop myself writing to the logistics people and got a little number of responses in the last few days.

The thing is I have never had the chance to show my travel history and I have two USA visas including one multiple entry valid for several years. I also have visas from Singapore, Malaysia, Turkey, Netherlands, Germany, Japan, China, Indonesia and South Africa on the same passport.

This is seriously awful when I have prepared  my speech and I have not yet  got the visa to fly. With my 12 years of  professional career I got opportunities to lead a number of  platforms on health and tobacco control. [lists his international experience]

However this experience has made my disappointment so terrific that I am truly faded up on choosing a country which doesn’t respect the professionals, experts and researchers who are leading people’s health and well-being issues in this region and worldwide.

Today is the last day when I am waiting for a visa and if I don’t get this by 3PM UAE time, I will surely miss my speech. So I may not go at all to this conference if it is not today.”

A Facebook page set up by a high ranking UAE public health official to facilitate  pre-conference discussions and news transfer was suddenly switched to secret status on Monday and later closed down.

The same person had earlier responded to frustration from delegates still waiting for their visas: “UAE hosts sponsored 400 scholars from low and middle income countries. Some are still awaiting visas and it elicits abuse of the hosts. “No good deed goes unpunished.” This is a small developing country that faces manpower challenges. Yes. The delays for a few have been long and disruptive. I am sorry for that. Thousands of others will enter without hindrance. Hopefully all who want to attend will be admitted and they will enjoy the conference in safety.”

This ‘small developing country’ has the world’s 7th highest GDP per capita.

Prof Wasim Maziak is a Syrian now working in the USA and a distinguished tobacco control researcher. As a member of the conference Scientific Committee he has withdrawn in protest from the Conference. Maziak was a key organizer of the largest collection of research yet assembled on health aspects of waterpipe use, published open access in Tobacco Control in time for the conference. Waterpipe is a major public health problem in the Middle East in particular.

He wrote to us:

I have since years been conducting regular training opportunities for researchers in the Middle East and have established last year a seed grants program (funded by my grant from NIH) to junior tobacco control researchers in the region. I gave 6 of these grants, and I organized a symposium at WCTOH for them, and sponsored them to attend in order present their data from the seed grants for the first time.
Three out of six participants in my symposium were denied visa (Syria, Iraq, Tunsia). Needless to say that these young researchers are devastated because they had such great hope to be on such international theater.
 
I have been warning the organizers for more than a year about this issue, because I know that UAE has discriminatory visa policy, but finally I had to make a stand being a member of the Scientific Committee in hope to elicit some actions to help denied participants” .
 
I was very enthusiastic that the conference came to the region, thinking that it will boost tobacco control in a region in much need for that. My disappointment is utter.”

The Abu Dhabi conference is the first that I have missed since the 5th meeting in Winnipeg, Canada in 1983. I had no expectation of what has now happened. I am very glad I did not attend and hope the international organisers will be highly critical of what has happened, apologise to those excluded and  ensure that all their expenses are met.

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