In February 2015 Pakistan’s health ministry announced an increase in the area of health warnings on the front and back of cigarette packs to 85 percent. This was in line with the informational commitments to discourage smoking through various means, such as increasing taxes on cigarettes, discouraging tobacco cultivation, and banning advertising by tobacco companies, etc.

The health warning is both textual and graphic and the intention behind placing it on cigarette packs is to make consumers quit smoking. It is also argued that effective health warning may keep non-smokers and beginners away from smoking.

The graphic warning used in the past included image of a person’s mouth and teeth affected by use of tobacco. The image being used today is of a foot damaged by gangrene, which is linked to excessive smoking. Cigarette manufacturers in the country are bound to print these warnings. The cigarette packs which do not carry these warnings are deemed to have been smuggled into Pakistan.

The cigarette companies operating in Pakistan have often raised this issue. They present the sale of such cigarette packs as proof of smuggled cigarettes being sold in the country.

What happens on the ground following a legislation is frequently quite different from what was intended. The decision of increasing pictorial warning to 85 percent has not been implemented though the SRO issued regarding this decision has not been repealed according to the health ministry officials.

Instead, another SRO was issued which said the warning must comprise 60 percent surface area of the cigarette pack and this increase should be made in two increments over two years, from 40 percent to first 50 per cent and then to 60 percent. As per the instructions, the picture and warning must be placed on the front (top) of the pack in Urdu and on the back (top) of the pack in English. The font of the text must be at least 2 mm, on black and white background.

These measures have been contested by anti-smoking campaigners who believe the tobacco industry is using its influence and lobbying with the government to block implementation of this order indefinitely. Malik Imran, who represents Tobacco Free Kids (TFK) in Pakistan, says this is not just an internal matter but linked to international commitments made under the WHO’s Framework Convention for Tobacco Control (FCTC).

“The health warnings are mandated under Article 11 of the FCTC and have to be according to certain directions agreed upon for these purposes. The warnings need be rotated frequently and must comprise a set of messages, not just one message, on the health hazards and social and economic impacts of smoking.”

What happens on the ground following a legislation is quite different from what was intended. The decision of frequently increasing pictorial warning to 85 percent has not been implemented though the SRO issued regarding this decision has not been repealed according to the health ministry officials.

The said Article says, “Each Party shall, within a period of three years after entry into force of this Convention for that Party, adopt and implement, in accordance with its national law, effective measures to ensure that: Tobacco product packaging and labelling do not promote a tobacco product by any means that are false, misleading, deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions, including any term, descriptor, trademark, figurative or any other sign that directly or indirectly creates the false impression that a particular tobacco product is less harmful than other tobacco products.”

These may include terms such as “low tar”, “light”, “ultra-light”, or “mild”, and each unit packet and package of tobacco products and any outside packaging and labelling of such products also carry health warnings describing the harmful effects of tobacco use, and may include other appropriate messages.

These warnings and messages should be approved by the competent national authority, should be large, clear, visible and legible and should be 50 percent or more “of the principal display areas but shall be no less than 30 percent of the principal display areas and may be in the form of or include pictures or pictograms”.

An employee of a multi-national tobacco company who does not want to be named, says they are above the threshold of 50 percent warning image set by FCTC and believes that the warning does not deter smokers from smoking.

Malik Imran of TFK does not buy his argument. “There is a need to increase the warning size as much as possible. The health ministry agreed to increasing the warning size to 85 percent but had to rethink due to the industry’s pressure on the federal government.”

Imran says the civil society, including his organisation, has challenged the issue in the court which is hearing their plea about the decision not being implemented. Imran adds that pictorial warnings are aimed at young prospective smokers to stop them from taking up this dangerous habit.

According to the health ministry figures, 167,000 people die in Pakistan due to smoking, says Imran, adding, “the industry needs their replacement in the form of new smokers.”

Dr Ziauddin Islam, Tobacco Control Cell Director, tells TNS that they want to implement the decision about 85 percent graphic health warning (GHW) but have to wait for the court’s instruction in this regard. He says GHW on a cigarette pack could not be enforced as the tobacco industry opted for litigation. Action is also being taken against violations of pictorial warning size directions and sale of old stocks of cigarettes in the country, he adds. “We are also planning to change the picture shortly as it is the requirement to rotate it to make a bigger impact.”

The writer can be reached at shahzada.irfan@gmail.com