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      Plain packaging of tobacco products: Lessons for the next round of implementing countries

      editorial

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          Abstract

          Australia was the first country in the world to implement tobacco plain and standardized packaging, with plain packs appearing on retailer shelves in December 2012. Plain packaging laws standardize the appearance of packs by prohibiting all design features (including colours, shapes, images, logos, textures/ finishes, scents, and promotional text) other than those explicitly permitted. A brand and variant name in a plain font may appear on the pack, and the packs are also required to carry health warnings labels plus other required consumer information. Packs must appear in standard colours, with Pantone 448C, a drab green/brown colour, as the main background colour of the pack 1 . In June 2020, the final remaining legal challenge to Australia’s tobacco plain packaging laws was decided in favour of Australia. The World Trade Organization’s (WTO’s) Appellate Body found that tobacco plain packaging contributed to its objective of reducing tobacco use and exposure, that it was not more traderestrictive than necessary to achieve that public health objective, and that it did not infringe any intellectual property rights under the WTO Agreements 2 . The Appellate Body’s decision ends a decade of litigation against Australia’s tobacco plain packaging laws. This litigation included a challenge by tobacco companies in the High Court of Australia (decided in Australia’s favour in 2012) 3 , an investor–state dispute brought by Philip Morris Asia (PMA) under a bilateral investment treaty with Hong Kong (dismissed in 2015 on the grounds that PMA had abused its rights under the treaty) 4 , and a challenge brought in the World Trade Organization, which was decided in Australia’s favour at the first instance in 2018 5 and has now been confirmed on appeal. Unsuccessful legal challenges were also launched against plain packaging in the UK 6 , France 7 , Norway 8 , and Ireland 9 . These legal challenges formed part of a broader campaign by the tobacco industry to stop or delay the implementation of plain packaging. The challenges have now been definitively ended by the WTO Appellate Body, whose status as the final appeal mechanism for the multilateral trading system should give other countries the confidence to move ahead with the measure without fear of challenges under trade or intellectual property law. In addition to litigation, the tobacco industry has used other tactics to oppose plain packaging legislation such as: lobbying; PR/media campaigns in both print and online media (using familiar arguments such as the ‘Nanny state’); threatening manufacturing plant closures, claiming increased illicit trade and increased stealing from retailers; and using third-party front groups to make its arguments 10,11 . When it cannot prevail in stopping the implementation of plain packaging, the tobacco industry ensures it exploits any loopholes, for example by introducing brand names with colour or concept descriptors 12-14 . Australia conducted rigorous and extensive research to inform the specifics of their plain packaging requirements and most other countries that subsequently introduced plain packaging legislation adopted or adapted similar requirements 15 . However, while there are many similarities, there are also differences in countries’ specific plain pack requirements, such as differences in the products covered (e.g. most countries exclude e-cigarettes), pack dimensions, and pack edges. In 2019, Thailand was the first low-to-middle income country (LMIC) to introduce plain packaging and its experiences may be helpful to other LMICs. Due to intense lobbying by the tobacco industry, with Philip Morris International and various front groups arguing that plain packaging was a violation of trademark and intellectual property rights, the Thai legislation was delayed for seven years. When the WTO finally found in favour of plain packaging in June 2018, Thailand moved quickly. The Thai plain packaging regulation was drafted over the next few months and came into effect by September 2019. As of October 2020, 17 countries have adopted plain packaging: Australia, Canada, France, Ireland, Israel, New Zealand, Norway, Saudi Arabia, Singapore, Slovenia, Thailand, Turkey, UK, Uruguay, Belgium, Hungary, and the Netherlands. Many more have progressed plain packaging laws and regulations to varying extents. Conclusions Plain packaging addresses the obligations to implement effective packaging and labelling measures under Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and to comprehensively ban tobacco advertising, promotion and sponsorship under FCTC Article 13. There is no need for countries to reinvent the wheel; they can follow the example of other countries with regard to the wording of their legislation as well as arguments and strategies to counteract tobacco industry opposition. There are also valuable resources that countries can use, including plain packaging evidence summaries and toolkits such as the Campaign for Tobacco-Free Kids’ Plain Packaging Toolkit 16 , WHO’s report on the evidence, design and implementation of tobacco product plain packaging 17 , and Cancer Council Victoria’s Plain Facts 18 . While legal challenges against plain packaging have been unsuccessful, great care is nonetheless required in drawing up legislation. Those involved in drafting plain packaging legislation should work with lawyers and others with experience in countries that have already enacted plain packaging to ensure that their plain packaging legislation is strong and that potential loopholes are minimized. Plain packaging has great potential globally to change societal perceptions and thereby denormalise use of tobacco products especially among youth, who are vulnerable to tobacco industry marketing strategies. This is particularly important in LMICs where the tobacco industry is aggressively marketing their products. Many LMICs therefore have a unique opportunity to prevent further growth of the tobacco epidemic through plain packaging along with other evidence-based tobacco control measures. It is now time for all countries to move forward with tobacco plain packaging to help save lives by reducing tobacco-related death and disease.

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          Most cited references15

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          Tobacco product developments in the Australian market in the 4 years following plain packaging

          This paper aimed to identify continued and emerging trends in the Australian tobacco market following plain packaging implementation, over a period of substantial increases in tobacco taxes. Since 2012, our surveillance activities (including review of trade product and price lists, ingredient reports submitted by tobacco companies to government and monitoring of the retail environment) found several trends in the factory-made cigarette market. These include the continued release of extra-long and slim cigarettes and packs with bonus cigarettes, particularly in the mainstream and premium market segments; new menthol capsule products; other novel flavourings in cigarettes; filter innovations including recessed and firm filters; continued use of evocative and descriptive product names; the proliferation of the new super-value market segment; and umbrella branding, where new products are introduced within established brand families. Several similar trends were also observed within the smoking tobacco market. While not all of these trends were new to the Australian market at the time of plain packaging implementation, their continued and increased use is notable. Plain packaging legislation could be strengthened to standardise cigarette and pack size, restrict brand and variant names, and ban features such as menthol capsules and filters innovations that provide novelty value or that may provide false reassurance to smokers.
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            Tobacco product developments coinciding with the implementation of plain packaging in Australia.

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              Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations

              By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Differences between countries include the terminology used (either 'plain', 'standardised' or 'plain and standardised'), products covered and transition times (ranging from 2 to 12 months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts) and warning content (eg, inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation and permitting cigarettes that are designed to be dissuasive. Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco-control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy.
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                Author and article information

                Journal
                Tob Induc Dis
                Tob Induc Dis
                TID
                Tobacco Induced Diseases
                European Publishing on behalf of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID)
                2070-7266
                1617-9625
                17 November 2020
                2020
                : 18
                : 93
                Affiliations
                [1 ]Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
                [2 ]McCabe Centre for Law and Cancer, Melbourne, Australia
                [3 ]Health Promotion Department, World Health Organization, Geneva, Switzerland
                [4 ]Centre for Global Health, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
                Author notes
                CORRESPONDENCE TO Joanna E. Cohen. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 4th Floor, Baltimore, Maryland 21205, United States. E-mail: jcohen@ 123456jhu.edu
                Article
                94
                10.18332/tid/130378
                7670849
                33209102
                b7367dae-992b-4d71-9cf9-b04ce3684d3a
                © 2020 Cohen J.E. et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License.

                History
                : 12 November 2020
                : 12 November 2020
                Categories
                Editorial

                Respiratory medicine
                plain packaging,tobacco products,standardized packaging,tobacco control policy,low and middle income countries

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