MENA: A fertile ground for legal and illegal tobacco trade

Illicit trafficking is a global threat.  It concerns a wide range of merchandises including weapons, drugs, pharmaceutical products, software, luxury products, tobacco, in addition to human trafficking. Benefits from illicit products could be partially or, in certain cases, entirely used to fund conflicts and terrorist acts.

Tobacco smoking: A global epidemic

Smoking represents the biggest global public health issue. It is the first preventable cause of mortality, killing worldwide 50% of its consumers (6 million/year, including 600,000 passive smokers), and the principal risk factor of the non-transmissible chronic diseases (cause of 60% of total mortality). Moreover, beside the many physical health pathologies (cancers, chronic obstructive pulmonary diseases, children’s asthma, sudden infant death, infertility…), new studies show that smoking can lead to the development of certain mental illnesses, in particular psychosis and schizophrenia.

The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) was signed in March 2004, with the objective of decreasing tobacco use. It was adopted by 168 countries, and aims for a 30% decrease in smoker’s prevalence by 2025.

Unfortunately, low- and middle-income countries in the Middle East are still at the start point of the strategy, struggling to implement even indoor smoking ban laws.

Moreover, countries in the Middle East (where over 60% of adults are smokers) are today the target of the tobacco industry with a special interest to the vulnerable youth (as young as 16 years), turning them into clients for life.

Illicit Tobacco trade: contraband and counterfeiting

Whether contraband (original products purchased outside the regulated supply chain to avoid taxation) or counterfeiting (products not following the law and the manufacture’s quality norms), illicit tobacco trade (10.7% of global cigarette sales) makes cigarettes cheaper and more accessible, and, as a result, increases its consumption among low-income groups, particularly teenagers and youth.

Beside the health threat, illicit tobacco trade reduces governments’ revenues and funds criminality, terrorism and conflicts. The consequences are an increase in poverty rates and health inequalities in low- and middle-income countries, being the target of smugglers. This is particularly true for the MENA region where state institutions are weak and law enforcement often ineffective.

Article 15 of the WHO Framework Convention on Tobacco Control aiming to combat illicit tobacco trade, led to the adoption, in 2012, of the Protocol to Eliminate Illicit Trade in Tobacco Products and to a worldwide campaign in 2015, on the annual World No-Tobacco Day.

Middle East: the target of legal and illegal tobacco business

Since the adoption of the Framework Convention on Tobacco Control and the regulation of tobacco products, the total number of cigarettes sold in mature markets is in decline. As a consequence, the four major tobacco companies (Philipp Morris International, British American Tobacco, Japan Tobacco International and Imperial Tobacco) expanded their business into emerging markets in MENA, Asia and Eastern Europe, sometimes with the complicity of local “influencers”, local authorities and governments, generating more than a third of their total income.

Also, lobbying by tobacco companies is claiming that illicit trafficking is the iatrogenic consequence of the increase in taxation and the tightening of regulation imposed on tobacco products.

But according to the WHO, illicit tobacco trade is more common in low- (16.8% of the market) and middle-income (11.8% of the market) countries where taxes are low (Pack price: $1.13 and $1.89, respectively), and less common (9.8% of the market) in high-income countries where taxes are high (Pack price: $4.89). This has been also documented in 2015, by studies published in the British Medical Journal that showed that the increase in taxes in the USA, and the introduction of the plain packs in Australia did not increase illicit tobacco trade in these countries.

Thus, the position of the tobacco industry regarding the WHO FCTC is controversial. Moreover, and according to the WHO, tobacco companies are encouraging smuggling in the MENA region, mainly to Iran (44% of total cigarette sales with higher rate (72.5%) among women) and Iraq via Lebanon and Syria. The reasons are multiple: legally sell their brands on the market, increase demand for their brands (a form of marketing), and sell their spoiled or less good products (Iraq). A research paper published in 2008, in Tobacco Control, shows the complicity of British American Tobacco in cigarette smuggling across the poor countries of Africa. (Unfortunately, it is difficult to get accurate data concerning this illicit business in the MENA region).

Recently in Lebanon, the Régie Libanaise de Tabac et Tombac owned by the State, declared a 30% decrease in their cigarettes sale in 2015, compared to the same period in 2014, not because of the implementation of the indoor smoking ban law, which is barely respected, but because of illicit smuggling from Syria. In contrast, the sales of Waterpipe (Narguilé, Hookah, Shicha) tobacco products increased by 60%, because this type of products is not available in Syria, according to the Régie Libanaise de Tabac et Tombac. But, the real reason could be its increasing popularity, in particular among youth, who perceive it as less harmful than cigarettes, thus turning it into the new epidemic of the Middle East.

The Syrian conflict, regional geopolitics, uncontrollable borders, and political and economic instability, contribute to encouraging the smuggling of tobacco products, from Syria to Lebanon, as is also the case with Captagon, the Syrian-made amphetamine. Illicit cigarettes are either sold in Lebanon, in particular to the Syrian refugees and the hosting communities, or transited to other countries of the Middle East.

Tobacco trade, whether legal, regulated or illicit, remains a global major public health threat, in particular for the Middle East, a prime target for the tobacco industry. The increase in chronic diseases related to smoking, with the consequent increase in health expenses, is contributing to maintaining national and individual poverty rates in these countries.

In light of the above, there is an urgent need, in particular with the Narguilé epidemic among youth, to implement and enforce FCTC policies by governments and to raise awareness about the health effects of tobacco as well as to modify the population perception of smoking as a normative behavior.

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