Tobacco plain packaging momentum continues worldwide with 38 countries and territories moving forward with regulations

New international report also shows 134 countries and territories now require graphic picture warnings on cigarette packages

TORONTO, Nov. 9, 2021 /PRNewswire/ -- An international report released today by the Canadian Cancer Society (CCS) shows there is tremendous momentum worldwide for tobacco plain packaging. There are now 38 countries and territories moving forward with plain packaging, with 21 having adopted the measure, 3 having it in practice, and 14 working on it. The CCS report, Cigarette Package Health Warnings: International Status Report, documents global progress on plain packaging, ranks 206 countries and territories on the size of their health warnings on cigarette packages, and lists the 134 countries and territories that now require graphic picture warnings.

Plain packaging accelerating globally

"There is a strong, unstoppable global trend for countries to implement plain packaging," says Rob Cunningham, Senior Policy Analyst, CCS. "Australia was the first country to implement plain packaging in 2012 and now the pace of implementation is accelerating. These developments are very encouraging as plain packaging is a key measure to protect youth and to reduce tobacco use."

While there are now 21 countries and territories that have adopted plain packaging, in 2018 only 9 countries had done so.

Guidelines under the international tobacco treaty, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), recommend that countries consider implementing plain packaging. Plain packaging includes health warnings on packages and prohibits tobacco company branding such as colours, logos and design elements. It also requires the brand name to be a standard font size, style and location on the package and the brand portion of each package to be the same colour such as an unattractive brown. Finally, the package format is standardized. Plain packaging regulations put an end to packaging being used for product promotion, increase the effectiveness of package warnings, curb package deception and decrease tobacco use.

Plain packaging has been implemented in Australia (2012), France (2016), United Kingdom (2016), Norway (2017), Ireland (2017), New Zealand (2018), Saudi Arabia (2019), Turkey (2019), Thailand (2019), Canada (2019), Uruguay (2019), Slovenia (2020), Belgium (2020), Israel (2020), Singapore (2020), Netherlands (2020), Denmark (2021), and Guernsey (2021), and will be implemented in Hungary (2022), Jersey (2022) and Myanmar (2022). Plain packaging has been implemented in practice in 3 countries where packages are imported from a country with plain packaging: Monaco (from France), Cook Islands (from New Zealand), and Niue (from Australia). Plain packaging is under formal consideration in at least 14 countries: Armenia, Chile, Costa Rica, Finland, Georgia, Iran, Malaysia, Mauritius, Mexico, Nepal, South Korea, South Africa, Spain, and Sri Lanka.

The number of countries requiring plain packaging is expected to increase even further because of the World Trade Organization (WTO) appeal decision on June 9, 2020, that Australia's plain packaging requirements are consistent with WTO's international trade agreements.  The tobacco industry had been opposing plain packaging arguing the measure infringed WTO trade agreements, but that argument can no longer have any credibility.

Graphic picture warnings continue to increase

The report found that 134 countries and territories now require picture health warnings on cigarette packages, an increase from 117 in 2018. This represents 70% of the world's population. Canada was the first country to require picture health warnings in 2001.

"There is unrelenting international momentum for countries to use graphic pictures on cigarette packages to show the lethal health effects of smoking," says Cunningham. "It is extremely positive for global public health that more than 130 countries and territories have required picture health warnings and have increased warning size and that so many are moving toward plain packaging," says Cunningham. "The international trend will reduce global tobacco industry sales and will save lives lost to cancer and other tobacco-related diseases."

In total 122 countries and territories have required warnings to cover at least 50% of the package front and back (on average), up from 107 in 2018 and 24 in 2008. There are now 71 countries and territories with a size of at least 65% (on average) of the package front and back, and 10 with at least 85%. The top countries ranked by warning size as an average of the front and back of the package are:

1.  92.5% East Timor (Timor-Leste) (85% of front, 100% of back)
1.  92.5% Turkey (85%, 100%)
3.  90% Maldives (90%, 90%)
3.  90% Nepal (90%, 90%)
3.  90% Vanuatu (90%, 90%)
3.  90% Benin (90%, 90%) (2022)
7.  87.5% New Zealand (75%, 100%)
8.  85% Hong Kong (S.A.R., China) (85%, 85%)
8.  85% India (85%, 85%)
8.  85% Thailand (85%, 85%)

In the 2018 report, East Timor was top ranked at 92.5%, and has now been matched by Turkey.

Cigarette package warnings are a highly cost-effective way to increase awareness of the negative health effects of smoking and to reduce tobacco use. Picture-based warnings convey a more powerful message than a text-only warning and the effectiveness of warnings is known to increase with size.

Guidelines under the FCTC recommend that warnings should:

• be as large as is achievable;
• include a rotated series of graphic pictures;
• be at the top of both the front and back of packages.

Picture warnings are especially valuable for low- and middle-income countries where there are higher rates of illiteracy and where governments may have few resources. Health departments determine the content of warnings and the tobacco industry is responsible for printing the warnings on packages. Examples of graphic picture warnings include a diseased lung or mouth, a patient with lung cancer in a hospital bed and a child being exposed to second-hand smoke.

The report was released today in conjunction with the 9th session of the Conference of the Parties to the WHO FCTC being held virtually November 8-13, and hosted in Geneva, Switzerland. The report supports the implementation of the FCTC. The FCTC has an obligation for parties to require health warnings that "should be 50% or more of the principal display areas but shall be no less than 30% of the display areas" and may be in the form of, or include, picture warnings. There are now 182 parties to the FCTC.

This is the 7th Canadian Cancer Society international report on cigarette package health warnings. Previous reports were published in 2008, 2010, 2012, 2014, 2016 and 2018.

Cigarette Package Health Warnings report in English
Cigarette Package Health Warnings report in French

About the Canadian Cancer Society

The Canadian Cancer Society works tirelessly to save and improve lives. We fund the brightest minds in cancer research. We provide a compassionate support system for all those affected by cancer, from coast to coast and for all types of cancer. As the voice for Canadians who care about cancer, we work with governments to establish health policies to prevent cancer and better support those living with the disease. No other organization does all that we do to improve lives today and to change the future of cancer forever.

Help us make a difference. Call 1-888-939-3333 or visit cancer.ca today. 

Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society, Phone: +1-613-762-4624, Email: [email protected]