Standardised Packaging of Tobacco Products -SCOT response

RCPE is a member of SCOT and endorses this SCOT response.

SCOT - the Scottish Coalition on Tobacco - is a campaigning coalition of 13 health and medical organisations that have a shared interest in matters relating to tobacco and health.

Members of the coalition are: ASH Scotland, British Heart Foundation Scotland, British Lung Foundation Scotland, British Medical Association, Cancer Research UK, Chest Heart & Stroke Scotland, Macmillan Cancer Support, Royal College of Nursing, The Roy Castle Lung Cancer Foundation, Royal College of Physicians of Edinburgh, Royal College of Psychiatrists, The Stroke Association (Scotland office), and the Royal Environmental Health Institute of Scotland.

This is the agreed SCOT coalition response representing the majority view of members and does not necessarily represent the view of each member organisation. If individual members have taken a different position on particular points, or are providing a more detailed response to the consultation, this will be reflected in their own submissions.

1 Do you have any observations about the report of the Chantler Review that you wish to bring to our attention?

In our view the Chantler Review was carried out in a careful and robust manner. The conclusion that ‘ … standardised packaging [of tobacco] would be very likely over time to contribute to a modest but important reduction in smoking prevalence especially in children and young adults’ is rooted in the available evidence and closely aligns with the views of the members of the SCOT coalition.

Members of SCOT expressed concern that tobacco industry representatives met with and presented their views to Sir Cyril Chantler and his team face-to-face. This seems to be in direct contravention of Article 5.3 of the Framework Convention on Tobacco Control[1], which clearly sets out that the tobacco industry should not be allowed to influence public health policy. The industry has no valid place as a stakeholder in a review framed around research and impact evidence and intended to inform Government health policy decisions, and a written submission should be considered sufficient.

Every day around 40 young Scots become smokers.[2] With the clear conclusion that requiring standardised packaging for tobacco products can make a significant impact on these figures, we urge the Department of Health (DoH) to proceed with enacting these regulations in the fastest reasonable timescale.

2 Do you have any information, in particular any new or additional information since the 2012 consultation, relating to the wider aspects of standardised packaging that you wish to bring to our attention?

While standardised packaging is a policy measure that is focused on change in the medium to long term we are conscious that there has been a great deal of activity and debate during the 18 months since standard packs were introduced in Australia. We are aware of some initial evidence from the Australian experience (detailed below) and assert that this provides initial support to the efficacy of standardised packaging; the evidence also provides a stronger rebuff to the oppositional arguments presented by the tobacco companies, and the groups who speak on their behalf.

Organisations with a stake in the sales of tobacco products – such as The Tobacco Retailers Alliance (TRA), a body funded by tobacco companies that reliably echoes industry positions – have consistently presented standardised packaging as damaging to small retailers due to a claimed increase in shop serving times and errors. We note that the surveys indicating TRA member concerns on this issue mirrors the consistent TRA messages to their members telling them that this is a problem. We suggest that these concerns cannot be considered to represent independent or reliable evidence on the likely impact of standardised packaging and are not supported by existing evidence. 

On the contrary, the one peer-reviewed, published study carried out in a real-world situation in Australia after the introduction of standardised packaging found ‘a very small increase in serving time which lasted only for the first week of implementation.  After that, it was business as usual’.[3]

It is significant to note here that much of the new evidence emerging from the Australian implementation of standardised packaging is research that was accepted to be robust by peer-reviewed journals such as the Medical Journal of Australia and Addiction. The peer-review process ensures standards of quality control and validity, particularly in relation to the research’s methodology.  In contrast, evidence supplied by the tobacco industry is well-known as questionable and unreliable; both the British Medical Journal and the European Journal of Public Health refuse to publish any research that is funded, partially or wholly, by the tobacco industry.[4] [5]  Recently, BMJ Open published the results of a critical review of the tobacco industry’s evidence opposing standardised packaging, and concluded that largely the evidence either lacked policy relevance or robust quality assessment markers.[6]

Impact on desire to quit:

The tobacco companies have also paid for the Hands Off Our Packs[7] campaign to present the image of a grassroots movement to oppose the introduction of standardised packs. Hands Off Our Packs presents the message that “I didn’t choose to smoke because of a brightly coloured packet”, claiming that packaging plays little part in the appeal of smoking. This view is categorically contradicted by pre-implementation research in the UK, and now by the early post-implementation evidence from Australia.

The Public Health Research Consortium’s systematic review, in advance of the first consultation on standardised packaging, found that:

‘12 studies examined perceptions of the quality of standardised packs in terms of perceived quality, taste, smoothness and cheapness. The studies which compared perceptions of standardised and branded packs consistently found that standardised packs were perceived to be of poorer quality by both adults and children.’[8]

The Chantler review agreed with this analysis.

Researchers analysing calls to the Quitline service in New South Wales and the Australian Capital Territory found a sustained 78% increase in calls to the Quitline after the introduction of standardised packaging.[9] Another peer-reviewed academic study found that after the introduction of standardised packaging, smokers were less likely to have their cigarette packs openly on display and more likely to hide or obscure them, particularly in venues where children were present.[10] A further study found that long-term smokers reported that plain-packaged cigarettes taste worse and that they were less able to differentiate between brands.[11]

Taken together these initial studies suggest that removing the branding and designs from tobacco packaging is indeed having a measurable effect on the attraction and appeal of tobacco.

While it will be some time before we can review comprehensive rigorous information on the impact of standardised packaging, recent figures on smoking rates and tobacco consumption in Australia allow us to critically examine tobacco industry claims that standardised packaging will boost the illicit market and possibly increase – rather than reduce –  the smoking rates.

The Australian Treasury has published figures showing that tobacco clearances in 2013, the year after standardised packaging was introduced, fell by 3.4%.[12] Allowing for the population increase of 1.7% over the year[13], that equates to a very substantial 5% decline in per capita spend on tobacco following the introduction of standardised packaging.

Actual smoking rates are measured every three years by the Australian Institute of Health and Welfare.[14] The latest figures suggest that daily smokers aged 14 years or older fell from 15.1% in 2010 to 12.8% in 2013. While covering three years, only the last of which with standardised packaging, the fact that this was a significantly larger decline than in previous reports seriously undermines any suggestion that standardised packaging will slow or reverse the decline in smoking rates.

With regard to the illicit trade, the dire warnings of a huge boon for smugglers and counterfeiters seem to have come to nothing. Customs authorities in Australia indicate that only 4% of cigarettes seized in the period following the introduction of standardised packaging were in the new, unbranded format. A spokesperson was quoted as saying that ‘plain packaging simply did not appear to have an effect on smugglers’.[15]

While the tobacco companies in the UK, and those who speak on their behalf, continue to raise the spectre of the illicit trade, the argument is proving increasingly difficult to support. A British American Tobacco representative told Sir Cyril Chantler that in their experience counterfeiting had reduced since the introduction of standardised packaging.[16] Sonia Stewart, who as Head of Corporate Affairs and Legal for Imperial Tobacco Australia was a leading voice raising concerns over the illicit trade, has admitted that ‘there doesn't appear to be any evidence that plain packaging itself has caused an increase in tobacco smuggling’. [17]

Reporting on its investigation into the illicit tobacco trade the House of Commons Home Affairs Select Committee concluded that, ‘we believe that the decision on standardised packaging should be driven by health reasons and the imperative need to reduce the numbers of young people who start smoking. We note the statement of Sir Cyril Chantler to the effect that he was not convinced that standardised packaging would bring about an increase in the illicit market; even if this were the case, we believe that the proper response would be a more vigorous effort on enforcement rather than any lessening in the Government's drive towards introducing standardised packaging’.[18]

3 Do you have any comments on the draft regulations, including anything you want to draw to our attention on the practicalities of implementing the regulations as drafted?

We are broadly supportive of the draft regulations, which on the whole represent an effective and robust proposal for the public health goal of reducing the appeal and attraction of tobacco products. We suggest incorporating and using the European Union’s Tobacco Products Directive list into the UK legislation, which would allow modifications to the prohibited variants and put a positive obligation on tobacco companies regarding responsibilities of adherence. Specifically, we have two particular concerns over what we see as omissions in the proposed regulations:

1. The proposed regulations focus on cigarettes and hand-rolling tobacco and do not cover other tobacco products, such as cigars, pipe tobacco and minority ethnic forms of tobacco. Given the harm caused by all forms of tobacco, and the need to present a clear public health message on the nature of tobacco use, we urge the DoH to include all forms of tobacco in the final regulations and to avoid the loophole that would allow the tobacco industry to glamourise this addictive and lethal substance in any form.
2. We are concerned that the lack of regulation of pack dimensions or of the specific number of cigarettes in a pack leaves a loophole for industry promotions; for example, through using slim cigarette shapes or offering extra cigarettes. We recommend that the regulations be amended to require that individual packs should only contain 20 cigarettes and to specify the actual pack size.

4 Are you aware of any further evidence or information which would improve the assumptions or estimates we have made in the consultation-stage impact assessment?

We have not seen any credible mechanism proposed to support the suggestion of ‘possible losses from a potential increase in consumption of illicit product and/or product legitimately bought outside the UK’ and believe that the initial evidence from Australia further undermines this scenario.