Generating and compiling data and evidence

Data and evidence were perceived as vital to pre-empt or counter industry arguments; “as long as you press them [tobacco industry] using evidence,(…) they are defeated” (P12). Data were seen as useful for informing decision-makers directly and exposing tobacco industry misinformation in the media. A participant shared how a small-scale study on illicit trade conducted by his organisation, helped rebut industry claims during policy consultations:

It was like a game-changer during the public hearing meeting when we said it’s not true. Our illicit trade is not [more significant figure] [as the tobacco industry claimed] it is only [less significant figure]. Then it changed the mentality of the parliamentarians. (P2)

Interviewees reported lacking up-to-date and reliable context-relevant data, especially on illicit trade, tobacco farming and cultivation, tobacco taxation, employment in the tobacco industry and on the environmental impact of tobacco. They emphasised the need for robust financial and economic data from sources independent of the tobacco industry. They found it difficult to obtain concrete evidence on TII, given that such activities were often hidden.

Beyond country-specific data, evidence detailing, for example, industry strategies and activities in similar countries, especially from the same region, was perceived as important. Other more generic information and resources such as factsheets, provided by the WHO or tobacco control organisations, were seen as useful. Still, they would often need to be translated to the local context, which required time and skill from advocates.

Interviewees also recognised limitations of evidence and data in countering TII: First, emotional narratives were said to matter as much as evidence since “having human stories is also very, very effective for policymakers and for […] the public” (P15). Using such narratives would also mirror industry behaviour: “for the industry it’s not about being precise, accurate, it’s about bringing the emotion, making people believe the industry and not the advocates” (P18). Second, data and evidence need to reach the key people who need to act on them:

so much has been written about TII… among the tobacco control community, the knowledge is there. This knowledge is, however, absent in the people there to make decisions. (P22)

Accessing policymakers and restricting tobacco industry access

For countering TII, advocates saw establishing and sustaining direct access to policymakers as crucial. It enabled them to inform policymakers of tobacco industry conduct and misinformation, thereby, empowering them to make informed decisions.

However, participants agreed that access to policymakers, particularly those in Ministries of Finance, Trade and Agriculture and their respective parliamentary committees, was challenging. Informal links between the tobacco industry and policymakers from outside the health sector, who often believe the industry brings financial benefits, were a key hindrance. A participant recalled an informant telling them:

…the industry is in bed with [Ministry of] Finance, and with the committee in Parliament […] they [policymakers] have completely blacklisted tobacco control; they don’t come to any meetings, they don’t want to be told anything, nothing. Because […] the industry gives them lots of money. What is tobacco control going to offer? Nothing. That’s where the challenge is. (P12)

In some countries, policymakers were reported to have direct conflicts of interest, including via the revolving door phenomenon or having a direct personal or family stake in a tobacco company. In a few countries, such a conflict of interest existed alongside a formal government commitment to tobacco control, for example, “the Prime Minister would like to make [country name] tobacco-free 2040 and at the same time, [the] government is the owner of the tobacco company in [country name]” (P8).

Interviewees also reported issues which enabled industry access to policymakers while constraining the tobacco control community’s access. These included state agendas to promote tobacco as a cash crop, the establishment of a public body with this mandate and investor agreements between a tobacco company and a public entity.

While a formal implementation of FCTC Article 5.3 would help address this, policymakers outside the health sector were often said to be unaware of FCTC Article 5.3. Policies to domesticate this provision lacked in all eight countries. In some, the health ministry was not seen as sufficiently authoritative to introduce such a policy: “health ministry guys are feeling that ‘we are not such an authority to prepare a policy on Article 5.3 for the whole government’…” (P17). Limited state capacity was identified as a barrier to any future FCTC Article 5.3 policy implementation and enforcement.

Working with media

Working with the media was seen as key to obtaining and disseminating data and evidence, exposing and countering tobacco industry conduct, convincing policymakers and the public, and building public pressure on policymakers:

They [tobacco industry] wrote something in the newspaper, we go against, whenever we see any report, we respond to that with media, with publications and also, we use media to aware our community about their tactics, their influence and so on. (P20)

Key activities included building relationships with media executives, editors and journalists, organising press conferences and disseminating public statements. Where advocates were unable to carry out in-depth investigative work, they sought close collaboration with journalists who could “get [missing] information” (P22);

We regularly get some intelligence from them [journalists] on what has been happening regarding tobacco, in that particular ministry. That is one source of information. The main source, I would have to say. (P17)

One participant reported that the “[media] did play a very strong role in ensuring that the correct evidence was presented to the public […] that way media had a strong contribution to getting the [policy]” (P15). In another case, the relationship with influential editors and reporters was crucial:

We knew all the content of the industry’s opinion pieces before they came out on the newspaper. We had to inform the Chair of the [parliamentary] Committee and the Minister of Health that this thing is coming from the industry through the [third party]. We had a reporter investigating for us, who provided the content before the publication […] that was really successful. (P1)

Some in-country CSOs also offered training on tobacco control and industry monitoring for journalists, which was perceived as strengthening the national tobacco control network.

However, working with the media was perceived as challenging as the tobacco industry sought to do the same. The industry built its relationships with the media, using incentives, including training for journalists. In all countries, interviewees saw their CSOs as unable to compete with the financial benefits the industry offered to media professionals. While participants from most countries reported that the tobacco industry concentrated on topic-specific media outlets popular among certain stakeholders, in other countries, it targeted widely read generic media outlets. A second challenge related to the above-mentioned lack of evidence: it was difficult to interest media professionals in exposing TII based on suspicions rather than clear evidence since this would require an investment of the journalist’s time with an unknown return.

Engaging in a national tobacco control coalition

Tobacco control CSOs often attempted to form national coalitions to join forces and use each other’s strengths to maximise advocates’ impact. Yet, only in one country, where an alliance had existed for several years, was the national coalition perceived as robust. Elsewhere, coalitions were experienced as fragile, negatively impacting on the strength and scale of activities to counter TII and advance tobacco control.

The capacity of coalition members, in terms of numbers, time and skills, was seen as a key obstacle to a strong coalition—all perceived as determined mainly by financial resources. Almost all CSOs depended on short-term project-based grants which had limitations:

We cannot afford to have staff permanently. It is just a project that gets approved, then we pool all the resources that we have, to make sure that the project is executed. But it is expensive to operate as an organisation in a country like ours. We need to pay taxes […] we have bureaucratic expenditures, that never stops. (P21)

Interviewees indicated that funding hindered coalition formation and functionality in two ways. First, scarce opportunities to secure funds led to competition rather than collaboration between CSOs, inhibiting coalition development and longevity. This was also identified as leading to a lack of coordination among CSOs, resulting in duplication of efforts. Second, CSOs were often constrained by their funders’ agenda, which often emphasised policy advocacy and implementation rather than addressing TII:

[funders' name] now concentrates… less on tobacco industry accountability, probably because of their area of focus or their internal issues. For that reason, we had to compromise our staff assigned on industry accountability work. (P17)

In some countries, CSOs reported a lack of flexibility from funders, which could mean that locally identified needs—such as countering TII—could not be addressed as part of the contract:

I have seen organisations which come with ready agreements, and they are not happy to change it, you just sign it or not sign it, right? That’s not a true partnership. (P16)

Generating and compiling data and evidence

Advocates identified two main ways through which the data and evidence gaps could be addressed. First, by supporting the development of advocates’ skills to generate new data and evidence, contextualise generic data and evidence, and undertake tobacco industry monitoring and investigative research. Webinars or e-learning modules were seen as having a wider reach than on-site training. Yet, the latter could be more impactful since they could be tailored specifically to the context. For virtual or on-site initiatives, advocates highlighted the need for continuous support; “you cannot say I am giving a training once and people will be able to implement all those articles, forget about it.” (P12). Reflecting on their experience with courses to date, these were perceived “like a foundation, [but] you need continuous input to strengthen” (P6). Second, most advocates appreciated and used the information on TII available on websites such as Tobacco Tactics but wanted them to include more LMIC-specific data and success stories. Furthermore, an e-learning module could accompany existing resources such as this, guiding advocates on how to use the material.

Accessing policymakers and restricting tobacco industry access

To gain better access to policymakers, advocates reported they needed to become better at speaking the ‘language’ of non-health politicians and public officials. This could entail framing tobacco control as a development issue rather than just as a matter of public health. To restrict tobacco industry access to policymakers, participants proposed webinars and other forms of training to increase advocates’ understanding of FCTC Article 5.3, as well as that of others such as non-health stakeholders and policymakers. These could be developed in close collaboration with local advocates to ensure they are context-specific and target the appropriate audiences. Lastly, interviewees suggested that the informal ties between policymakers and the tobacco industry, and the conflicts of interest those pose, could be addressed by better exposing these links which, again, could be achieved through investigative skills training for advocates and also journalists.

Working with media

Advocates stressed the need to raise awareness of and interest in TII among media professionals including editors and journalists and—as noted above—to strengthen their investigative skills through training so they could better expose industry behaviour. The latter could either take the form of webinars targeting journalists directly or written material which LMIC-based advocates can adapt. Advocates also suggested that sharing success stories of advocates working with journalists could inform their approach.

Engaging in a national coalition

Difficulties around developing robust and sustained tobacco control coalitions were arguably more difficult to address in the short-term, as they reflected broader challenges relating to funding and state capacity and government priorities. Nonetheless, one suggestion was to support advocates in developing coalitions that extend beyond tobacco control, engaging development-oriented CSOs to help frame tobacco control as a development priority. While participants were confident that they could identify, approach and work with crucial coalition supporters, including policy brokers, they suggested management training on coordinating and working more effectively in a coalition.

Overarching needs

In addition to these focused and pragmatic measures, interviewees consistently pointed to two overarching needs and linked solutions which could facilitate their work in all four areas of activity and improve its impact.

The first was an expressed need for structural change in the way support for LMIC-based tobacco control was funded and coordinated. A move from short-term to longer-term funding to allow more sustainable capacity building, meaning that, for example, capacity built through training would not be lost when funding came to an end. Furthermore, a collaborative rather than competitive approach to funding would encourage coordination among those CSOs working in tobacco control and beyond. Through this, competition and duplication of efforts which lead to inefficiencies could be prevented. Some participants also suggested the possibility of having some additional flexibility in their contracts to more readily counter TII. Lastly, some advocates wanted to be identified more as partners rather than recipients and showed great interest in contributing their knowledge and experience to future capacity-building efforts. This could add to South–South knowledge exchange: “The beauty is that if we stop thinking that I’m here to only benefit the other person. Then you start seeing that there is a lot of scope for mutual learning, right?” (P16).

The second overarching need related to sharing knowledge and learning from each other’s experiences; “We don’t need to reinvent the wheel because we need to learn from how others handled this situation.” (P11). One possible way of meeting this need was establishing or strengthening a network linking LMIC-based advocates, where they could exchange information on instances of TII and how to address it and share success stories. Meeting this need would not require as large-scale changes as the other overarching need.

Table 3 summarises the key findings from the result section.