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The global tobacco industry has aggressively lobbied governments during the COVID-19 pandemic to expand markets and blunt measures designed to curb their business, a report from watchdog groups aligned with the World Health Organization claimed on Tuesday.

A ranking of 57 countries based on their willingness to keep Big Tobacco at bay puts Japan and Indonesia at the bottom of the list, with Romania, China and Lebanon among the 10 worst offenders.

The United States ranked lowly, with Malaysia, Spain, Germany and India also seen as too accommodating, said the report by non-profit groups based in France, England and Thailand.

“The tobacco industry has a well-documented history of deception and of capitalizing on humanitarian crises, and it is using the pandemic to attempt to improve its deteriorating public image,” commented Adriana Blanco Marquizo, head of the secretariat for the World Health Organization Framework Convention on Tobacco Control.

Tobacco claims some eight million lives each year from cancer and other lung diseases, with a million in China alone.

In several countries, stringent tobacco control measures were defeated or diluted.

Philip Morris International (PMI), for example, “lobbied for the promotion and sale of its heated tobacco product in a dozen countries,” resulting in the lifting of bans, lower taxes, and a voice in government-led deliberations on regulating tobacco products, the report found.

Taxes on these new nicotine delivery devices are now lower than cigarettes in France, Germany and Japan.

Costa Rica, Zambia and Bangladesh also eased the tax burden for tobacco firms.

During the pandemic, tobacco firms have been handing out personal protective equipment, ventilators and hand sanitizers in countries around the world.

“While publicizing its charitable acts to resuscitate its image as being part of the solution, the industry was simultaneously lobbying governments not to impose restrictions on its business,” the report said.

In Kenya, the government listed tobacco products as “essential products” during the pandemic, and in Jordan cigarettes were delivered with bread and other foods directly to neighborhoods.

In contrast, India and South Africa banned the sale of tobacco products during the pandemic.

Meanwhile, Big Tobacco has sued to block plain packaging for cigarettes, sponsored cultural events or sports teams, and challenged the legality of smoke-free zones.

The report was put together after former New York mayor Michael Bloomberg gave the researchers a three-year grant of $20 million to track how the industry markets its wares worldwide, especially in developing countries.

“This is the only product I know of where if you use it as advertised, it will kill you,” Bloomberg said in 2018, when he awarded the grant.

More than 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries.

Smoking has plateaued in most rich nations, but in the developing world the total number of tobacco users — overwhelmingly men, especially the young — continues to climb.

The global tobacco market size was valued at nearly $850 billion in 2019.

The groups collaborating on the report included the Tobacco Research Group at the University of Bath, the Global Center for Good Governance in Tobacco Control and the International Union Against Tuberculosis and Lung Disease.

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