By Brian Moonga
The smoke was gone but he still bears the brunt of many years of gassing his lungs with the 4,000 chemical containing cigarettes.
James Mvula was only 17 when he became a chain smoker puffing more than 20 cigarettes per day, only to be rewarded with a stubborn, recurring tuberculosis disease whose effects he still struggles with today. He is now 38.
“Nearly 61 per cent of TB deaths in Zambia are attributable to smoking,” says Dr Peter Chungulo, TB control programme specialist at the School Of Medicine of the University of Zambia in Lusaka.
The World Health Organisation says Zambia’s tuberculosis incidence is 10th in the world and that close to 120 per 1,000 people die of the disease each year.
“Smoking is a risk factor for tuberculosis infection and for the development of pulmonary tuberculosis. Passive smoking, especially among children, accelerates the development of active TB. The potency of drugs is highly reduced in a smoker”, says Dr Peter Chungulo, a tuberculosis expert at the University of Zambia School of Medicine.
Zambia’s efforts at curbing indiscriminate smoking to protect public health are threatened to stall because of a strong direct and indirect influence by pro-tobacco advocates, according to tobacco control advocates and health officials.
In addition to several consultative meetings last December between the tobacco industry and health authorities, up to eight officials from different tobacco companies participated in drafting the Tobacco Products Control Bill of 2010, contrary to the Framework Convention on Tobacco Control to which Zambia is party, the treaty prohibits such a level consultation with the tobacco industry.
According to anti-tobacco lobbyists, tobacco industry officials dominated the legislative process to formulate what would be contained in certain parts of the document currently undergoing review with the Justice Ministry.
Some anti-tobacco lobbyists who questioned this development were convinced that industry officials were taking over the meeting to skew the new law in their favour.
“What was the essence of allowing such a high level of participation of the tobacco industry in a process which should result in major restrictions in their activities”, says Chitindi of the Tobacco Free Association of Zambia.
Allegedly outnumbered and overpowered by British American Tobacco officials from Zambia, Zimbabwe and South Africa, anti-tobacco lobbyists could not defend critical clauses of the draft bill such as on the creation of smoking rooms in public places.
“Government health inspectors could not speak against this part of the bill because it appeared they feared reprisal and possible job losses”, she says.
The British American Tobacco feels that they have the right to participate in such consultative processes involving the tobacco industry the country and that stake holders are equal partners.
“The adoption of the Tobacco Control Bill is a reflection of the consensus resolutions made during the said meeting. as an industry, we support balanced regulation thus regulation that takes into account the needs of smokers while protecting non-smokers from exposure to tobacco smoke”, says MuzyambaChibbabbuka the company’s corporate affairs manager in Lusaka.
According to Chitindi, the controversial clause said to have a rich input by tobacco industrialists allows the manager or owner of public places to allocate a smoking area within the premises.
“Smoking in public places means smoking where members of the public become exposed to the secondary smoke. Where such exposure does not exist is not the same as smoking in public places. The issue is not “public places” per se it is where exposure of secondary smoke to members of the public becomes a risk. A smoking booth though in public places takes away this risk and is also legal”, says Knox Mbazima of the Tobacco Association of Zambia.
“Under the Public Indecency Act undressing in public is an offence. Does that mean that if I undress in a booth at a public place I am breaking the law. Would it make sense to remove all the booths that people undress in to try new clothes because the law does not allow undressing in a public place”, says Mbazima
Although the new law in the making generally reduces tobacco industry manoeuvres including advertising and is seen as a step towards a total advertising ban of tobacco products, it still violates Statutory Instrument 39 of2008 of the Ministry of Local Government which bans smoking in public places.
“For me it was such a surprise that the industry was left to get away with reintroducing smoking in public through these rooms, so this decision was in bad taste and unfortunately, we lost out”, she says.
The fact that Zambia is still entangled in actively running a huge tobacco industry and trying to fulfil demands of an international treaty means that both government and the tobacco industry are set to cooperate with each otherfor some time to come.
The Ministry of Health has successfully established a tobacco focal office and passed a law on curbing environmental tobacco smoke, but not much has been done to meet benchmarks of the World Health Organisation’s Framework Convention on Tobacco Control, such as increasing taxation on cigarettes and demand reduction strategies.
The low specific excise duty of 20 per cent per packet of cigarettes which costs ZMK6, 000 gives easy accessibility to the deadly sticks.
Of 12 the million people in Zambia then, the global youth tobacco survey conducted in various districts by the University of Zambia Institute for Research in 2007 indicated that 21 per cent of men and 5 per cent of women are smokers, now 28 per cent of Zambian men and -2 of its women are smokers, according to the Zambia Health and Demographic Survey of 2007.
“We are not really a smoking country if you compare us to Greece where an individual smokes about 1,600 cigarettes compared to Zambia where one only smokes an average of 20 per month”, argues Knox Mbazima, general manager of the Tobacco Association of Zambia.
According to an online version of a third edition of the Tobacco Atlas, global cigarette consumption has been steadily rising and there are now a billion smokers globally,35 per cent are in high income countries and 50 per cent in low income countries.
Although Zambia no longer manufactures cigarettes, it exports nearly 120 million kilograms of tobacco per year, more than 60 per cent of which is produced by peasant farmers.
Moist and dry sniff, oral smokeless tobacco, roll-your own, traditional smoking pipes and manufactured cigarettes are common in many parts of Zambia.
National tobacco statistics are less shocking on paper but the dent on public health is strongly evident although disputed by the tobacco industry.
“A lot of people talk about cancer, there are many reasons for that, 4,000 chemicals yes, some of them are suspected to be carcinogenic, but the same chemicals are found in food”, says Mbazima.
Zambia’s respected health experts warn of grave danger caused by smoking.
“We are seeing more asthmatic attacks, bronchitis, poor TB recoveries and other respiratory illnesses”, says Dr Fastone Goma, an ardent tobacco researcher and professor of physiological sciences at the University of Zambia School of Medicine.
“Cigarettes contain 50 cancer causing chemicals, the radioactive polonium 210, hydrogen cyanide, carbon monoxide, cadmium, butane including the internationally banned synthetic pesticide dichlorodiphenyltrichloroethane and other dangerous chemicals harmful to health”, says Dr Fastone Goma.
Professor Groesbeck Parham, a gynaecological cancer surgeon at the University Hospital in Lusaka points out that cervical cancer is also triggered by smoking tobacco.
“Tobacco is responsible for some cases of cervical cancer through reduced immunity which results from loss of essential immune cells, the CD4s which are killed by tobacco chemicals. These make the bodies of women who smoke susceptible to cervical cancer”, he says.
Dr Tuckson Lambert, a respected surgeon who in the mid-1990s shared an operating table with American renowned neurosurgeon Ben Carson, strongly advisesagainst smoking.
“When the patient is now coughing blood in the ward and you tell him this is cancer of the lung, that’s the time he says I wish I did not smoke, it’s too late, the cancer is wide spread, the body is gone”, he says.
Because of serious damage to health caused by tobacco, increased litigation has seen tobacco companies establish in developing countries where anti-tobacco laws are lax.
Global statistics from the Washington based Campaign for Tobacco Free Kids website indicate that between 2002-2008 over 283 law suits were pending in courts of law against the giant tobacco company Phillip Morris and its affiliates.
But such kind of litigation in Zambia is something unheard of; instead the tobacco industry threatens to sue people like Muyunda Ililonga, an anti-tobacco campaigner heading the Zambia Consumer Association which has been on the offensive.
Ililonga was earmarked for a lawsuit by the British Tobacco for a denting story he had authored in the press, but later the company reversed its decision and dangled a carrot by asking him attend a meeting in the United States of America and to help the company implement an anti-smoking campaign for young people.
In tobacco politics, it’s a big taboo for anti-tobacco advocates and the industry to even exchange views or ideas let alone plan together.
“The industry is securing new markets and Africa happens to be one of them”, says Lutgard Kagaruki the head of Tanzania’s Tobacco Control Forum who recently visited Zambia.
According to Kagaruki, countries like the United States have in the last four decades significantly reduced tobacco production by about 70 per cent while in Tanzania, production has increased by 85 per cent.
“So If they know that tobacco productions hazardous, they shouldn’t dare practise what they cannot in their own countries”, says Kagaruki whose organisation has managed to help 70 tobacco farmers in Tanzania grow alternative crops.
“If we made a law under article 19 of the Framework Convention on Tobacco Control, many tobacco companies would be sued and that can kill the industry”, says John Mayeya the tobacco focal person at Zambia’s ministry of health headquarters in Lusaka.
But a World Health Organisation report of 2004 warns that: “if current trends persist, about 500 million people alive today will eventually be killed by tobacco, half of them in productive middle age and in Africa, each losing 20 to 25 years of life”.
Although Zambia has successfully documented tobacco use statistics like Tanzania where 42,000 new cases of cancer occur annually as a direct result of tobacco use, there is a general understanding of the dangers tobacco can cause to human health.
Tobacco Association of Zambia feels that smoking is a legal activity that anyone who understands its consequences chose to or not to part take.
Zambia’s total annual health care expenditure is USD68 per capita, which is about half of the World Health Organisation’s African regional average and makes up about 4.8 per cent of gross domestic product.
Last year, the health sector was allocated 30.1 per cent of the total national budget or ZMK 1,772.9 billion for 2011, but expenditure on tobacco control for the health ministry is a meagre ZMK30 million per annum.
Given the strong financial muscle and influence of the tobacco industry, in Zambia, anti-tobacco lobbyists feel tobacco control measures will not succeed at bringing about desired control of the dreaded crop.
“Tobacco is an important industry that last year generated close to $100million or ZMK500 billion”, says Mbazima.
But according to the tobacco atlas, the tobacco industry globally is said to drain about $500 million, a large amount of money which is said to exceed the total annual expenditure on health in low income countries.
The industry contributes 3 per cent of the country’s gross national domestic product.
The tobacco industry is still supported by government as evident on many occasions and recently when about ZMK36 billion was earmarked to pay tobacco farmers.
Michael Mwale (not real name) who sought anonymity grows tobacco on an 18 acre farm in Chipata. He also sponsors peasant farmers with fertiliser harvesting 40 bales of 3,800 kilograms of tobacco each year.
“Tobacco has a small profit, but it pays in only about two days compared to maize where you get paid after two months. I will continue growing as long as buyers are out there”, he says.
Mwale yields 100 kilograms from each bag of fertiliser he sponsors a grower, and last year he bought 10 such bags at the cost of ZMK1, 850,000 earning $3,000 or ZMK13 million after selling his produce, but he feels that transportation and input costs eat deep into his profits.
Knox Mbazima’s association supports about 60 such farmers and in 2010 gave out ZMK1 billion to help them buy inputs.
“The industry is very important to the economy and it also employs over 450 thousand people, so calling for its closure would result in huge job loses”, he says.
With Zambia’s huge unemployment problem and poverty levels at 70 per cent according to the World Bank, the industry sees this as a huge opportunity for many to earn a living.
Mbazima is appalled by anti-tobacco lobbyists who he says perceive the industry as criminal.
“Some nongovernmental organisations are overboard, it surprises me that all these nongovernmental organisations talk about stopping smoking, but how many have gone to the rural areas to ask people to stop smoking roll-your-own, they have never.”, he says.
Amidst trying to implement stringent measures to control tobacco, the ministry of health seems empathetic with tobacco companies for now, an indication that the tobacco industry in Zambia still has its sun shining.
“Action to instantly cease the tobacco industry, it would be catastrophic, economically, so we need to strike a balance for now”, says Mayeya of the Ministry of Health.
The Zambia Consumer Association is worried of the seemingly warm and accommodative relationship between government and the tobacco industry which is prohibited under article 5.3 of the Framework Convention on Tobacco Control.
With a $130 thousand grant in 2008 from the Michael Bloomberg Foundation, the association helped train over 30 health inspectors and magistrates to help with enforcing anti-tobacco laws, but the enforcement of such laws has not seen the light of the day.
“The tobacco industry has been convincing officials that tobacco contributes significantly to the economy in form of taxes and jobs and that it also undertakes various corporate social responsibility activities in order to look like a good corporate citizen”, says Ilionga.
A new study published in Tobacco Control shows that British American Tobacco which controls 17 per cent of the global cigarette market used several strategies, including cultivating relationships with tobacco-friendly governments, to try to weaken the Framework Convention on Tobacco Control before its ratification, including the use of free-trade agreements, to undermine the treaty since its ratification.
The report also says that the company claims that the tobacco industry should be consulted when developing tobacco control policies to ensure effective regulation.
“British American Tobacco Zambia believes that all stakeholders should be consulted in the formulation of legislation, indeed public consultation is key part of the Zambian legislative process. We are of the view that regulation should be sensible and proportionate and based on scientific evidence to reduce the impact of tobacco on public health”, says Muzyamba Chibbabuka, the corporate affairs manager in Lusaka.
The company’s global profits hit over $5billion in 2006 and in 2010,its taxes to the Zambian government soared by 3.1% to $25.71 million from $24.93 million in 2009, which coincides with a lead in smoking males from 21% to 26% in 2010.
Such attractive numbers seem to have convinced authorities that the tobacco industry should be allowed to participate in legislative processes.
“Government can’t legislate in hiding because this process is the same as a constitution making process where all interested parties participate, if we went ahead to make laws against the tobacco industry without their presence, such laws would not be effective”, he says.
The Tobacco Control cites tobacco companies of using corporate social responsibility programs to counter their negative image and enhance their credibility as responsible corporate citizens.
In 2008, Zambia’s Local Government minster then Sylvia Masebo who is also the architect of the law banning smoking in public officiated at a British America Tobacco handover of anti-smoking campaign materials for young people.
Her step contravened the Framework Convention on Tobacco Control, causing heads amongst anti-tobacco organisations to roll.
Proponents are also said to avoid effective Tobacco Control Policies through directly influencing draft legislation by submitting public or private comments and offering “technical assistance” to governments.
Such interference has been cited in the Zambian scenario, according to Chitindi of Tobacco Free Association of Zambia.
“The draft bill is weak because the tobacco industry was allowed to actively take part in drafting a new law.” says Chitindi.
Tobacco lobbyists and the ministry of health want tobacco control legislation formulation to be a consultative process.
“Yes industry participated, mostly listening in to what we were discussing and at some stage, they were contributing here and there”, says Mayeya in contradiction to what Chitindi says was a full participation by the tobacco industry players.
But Mayeya insists that stakeholders should not be kept away from such strategic meetings.
“Government policy acceding to guidelines from cabinet are that when one is developing legislation or policy, stakeholders for and against should meet and reach consensus, consensus is more healthier”,
Previously top government officials have said their government was committed to implementing the tobacco control agenda, but critics like Chitindi feel that government is deliberately dragging its feet to domesticate the Framework Convention on Tobacco Control treaty.
“The government is wearing two jackets one of health another for tobacco, it does not want to injure the interest of the tobacco industry because of the money it gets from them, but its allowing the health of its citizens to be injured”, she says.
Chitindi’s claims are based on visible evidence such as the lack of arrests and convictions since Zambia banned smoking in public places, although many people have simply chided this law.
In 2009, the then minister of agriculture and renowned medical doctor who is also one of the longest former serving ministers of health, Brian Chituwo called for a leap of tobacco production from 30million to 100 million kilograms o per annum.
“You will appreciate that an increase volume of tobacco will has a high multiplier effort on growth of tobacco industry”, Brian Chituwo.
His successor in the ministry of agriculture Dr Eustarckio Kazonga expressed worry last year when he met with foreign ambassadors attached to Zambia.
“Government is worried over the anti-tobacco spirit that is mushrooming in the region in which most of the countries rely on tobacco for their economies”, he said.
Zambia is expected to enforce price and tax measures to reduce the demand for tobacco, curb illicit trade in tobacco products and protect the environment and public health from tobacco smoke.
There is a serious clash national and global interest.
“Zambia signed the Framework Convention on Tobacco Control because it’s a member country of the World Health Organisation, it was just obligatory that we also be part of the Framework Convention on Tobacco Control”, says Mayeya.
“The tobacco industry contributes to the economy of the country, compared to economies in the North that are resilient, the tobacco industry is just a small portion of the income of those countries but here, tobacco alone contributes close to $90 million dollars”, he adds.
The Tobacco Association of Zambia is which says it recognises and supports the treaty feels it’s bent on eliminating the existence of the tobacco industry.
“Under the FCTC we are not even supposed to talk with government, so you see how wrapped this law is, we must strike a balance and support that which is legal”, he says.
But poor financial resources and a strong tobacco industry has made some lobbyists feel they are going against the big wave.
Between 2008 and 2011 Zambia Tobacco Control Consortium comprising Tobacco Free Association of Zambia, Zambia Consumers Association and others only had less than $400 thousand to fight the tobacco industry.
“The industry has huge financial resources and is better is organised compared to anti- tobacco campaigners thus government tends to listen more to the tobacco them”, says Iilonga.
In 2010, the Bill and Melinda Gates foundation which has been building alliances between international nongovernmental organisations to wage war against the tobacco industry gave a staggering $5.6 million dollars to leading tobacco organisations, but compared to the $90million generated by the tobacco industry in one year in Zambia means the fight in far from over.
Staunch tobacco industrialists like Mbazima believe that the World Health Organisation and developed economies are being unfair by asking young economies like Zambia to start killing off the industry
“If you go to the US, many states developed through tobacco, but someone in an air conditioned office wants us to stop growing tobacco after they have developed from it”, says Mbazima.
Now Zambia’s new law to come-The tobacco products control bill of 2010 seeks to control and regulate the production, manufacturing, packaging, labelling, sale and advertising of tobacco products to prohibit or restrict smoking in public places.
If signed into law, this could result in significant control of the industry as it will seal some of the loopholes like corporate social responsibility which advocates say want to see immediately disappear.
“We want to see a balance, the industry should export, even the Framework Convention on Tobacco Control does not say we should stop growing tobacco because it’s a legal product”, says
The new law is expected to compliment the public health and other existing laws against smoking in public.
The lack of enforcement of anti-smoking laws is also attributed to poor capacity to of law enforcement agencies.
“Tobacco is such a nuisance, but we are failing to implement the anti-tobacco law because we lack resources, we lack the money and capacity to do that”, says Wilson Nyirenda, head environmental inspector at Lusaka City Council.
From Nyrienda’s vantage point, a new fund and section in his department created for the sole purpose of enforcing anti-smoking laws is what would yield positive results.
Although Zambia generally has good laws on controlling tobacco, but the Tobacco Levy Act mandates the Tobacco Board of Zambia to collect revenues from tobacco sales.
The fact that such a law is still in force makes it difficult for any meaningful measure by health authorities to control tobacco.
“All what is required is political will to put resources towards this life- saving work. In fact even a mere pronouncement by the president would move things”, says Ililonga.
It’s doubtful if such political will shall come forth anytime soon given the fact that Zambia is deep in the tobacco industry and its president Rupiah Banda a couple of years ago at a press briefing expressed concern with the low prices at which tobacco was fetching.
Illicit tobacco trade costs in Zambia have not been documented but globally, 600 billion cigarettes are smuggled and this results in revenue loss by government of $50 billion.
The tobacco farmer Mwale from Chipata was several times denied license to transport his tobacco to Lusaka because authorities suspected that he and many other farmers were engaged in smuggling tobacco from Malawi.
“There is urgent need to up-scale efforts and strategies to fight this threat otherwise the legitimate players in the market, and government, stand to lose all that which has been achieved so far”, says Mbazima.
BAT in Zambia wants government to devise mechanisms that will curb illicit trade of cigarettes.
“Illicit trade, in the form of inflows of duty-not-paid cigarettes into the Zambian market, is on the increase. Duty-not-paid cigarettes are sold cheaply and this is negatively affecting our sales and the revenue dues for the government. ”, says Chibbabbuka.
Anti-tobacco lobbyists claim that the tobacco industry is trying to use African bodies like Common Market for East and Southern Africa, East African Commission, Southern African Development Community
“They hide behind these bodies claiming to be speaking for farmers and we all know that our local farmers are very poor”, says Kagaruki who with other members of the African Tobacco Control Consortium were in Lusaka to lobby the 20 member regional trade to recognise certain provisions of the Framework Convention on Tobacco Control.
Last year Common Market for East and Southern Africa at its 14thSummit in Swaziland asked its members to reject the Framework Convention on Tobacco Control and called on the World Health Organisation to put in place proper consultation mechanisms for all affected parties.
“Prior to our meeting, Common Market for East and Southern Africa had only been meeting with the tobacco industry and therefore listening only to one side. Although the main goal of our meeting was to clarify matters regards guidelines on implementation of article 9 of the Framework Convention on Tobacco Control”, says Ililonga who hosted the delegation.
Article 9 of the Framework Convention calls on members to regulate contents of tobacco products.
“The conference of the parties, in consultation with competent international bodies shall propose guidelines for testing and measuring the contents and emissions of tobacco products”, its reads in part.
Unlike countries like Nigeria that have successfully passed effective tobacco laws, Zambia is still struggling and according to anti-tobacco lobbyists, this state of affairs points to the government’s relationship with the tobacco industry.
A watchful eye on tobacco industry interferences with legislation and other tobacco control measures will significantly help reduce the power of the tobacco industry and shrink its revenue contribution to government, but a government that drags its feet will pay an ultimate price of spending big on health care as a result of an expected increase on tobacco induced diseases.