’A contradiction between our state and the tobacco company’: conflicts of interest and institutional constraints as barriers to implementing Article 5.3 in Bangladesh

Abstract

IntroductionBangladesh has not yet adopted measures to implement Article 5.3 of the WHO Framework Convention on Tobacco Control. The National Tobacco Control Cell (NTCC) has drafted a guideline for implementation, but progress has stalled amid high levels of tobacco industry interference in public policy. This paper examines the barriers to minimising industry interference in a context of close relationships between government officials and tobacco companies.MethodsIn-depth interviews were conducted with government officials, representatives from civil society, think tank and media organisations, and academic researchers. The data were analysed using a ‘3 Is’ framework developed within the political sciences, emphasising the interactive role of ideas, interests and institutions in policy change.ResultsThe findings indicate that policy ideas about protecting public health policy making from tobacco industry interests are largely restricted to the Ministry of Health and Family Welfare, and the NTCC specifically. Both individual and institutional conflicts of interest emerge as key barriers to progress to minimising industry interference and for tobacco control governance more broadly. The data also suggest that development of an Article 5.3 guideline has been shaped by the perceived interests of political actors and institutions, and the institutional position of the NTCC, constrained by limits on its resources, authority and isolation from other ministries.ConclusionNTCC’s initiatives towards implementing Article 5.3 constitute an important opportunity to address conflicts of interest that restrict tobacco control in Bangladesh. Progress in minimising industry interference is essential to realising the commitment to being smoke free by 2040.

Advancing whole-of-government approaches to tobacco control: Article 5.3 and the challenge of policy coordination in Bangladesh, Ethiopia, India and Uganda

“…Conversely, in Bangladesh, measures seeking to implement Article 5.3 measures have not been adopted. While the National Tobacco Control Cell has developed a draft code of conduct and guidelines, the process of approving such measures has stalled 23. Civil society monitoring reports indicate varying levels of tobacco industry interference across the four countries; of 57 countries in a 2020 ranking report, for example, Uganda and Ethiopia were identified as high performing states (ranked 3rd and 10th overall), while rankings for India and Bangladesh were less encouraging (31st and 41st) 31…”

“…This paper builds upon linked case studies examining contextspecific challenges of tobacco control governance in Bangladesh, 23 Ethiopia, 24 Uganda, 25 the Indian state of Karnataka, 26 and the dynamics of implementation across India's states and union territories. 27 Our case selection covers diverse tobacco control experiences and trajectories via which to understand coordination challenges and opportunities associated with Article 5.3 implementation.…”

Tobacco industry interference to undermine the development and implementation of graphic health warnings in Bangladesh

“…seeking to strengthen tobacco control. 20 The government's share in BATB and the presence of high-level officials on the company's Board of Directors are particularly concerning. [26][27][28] The findings also illustrate how bureaucratic processes can favour the tobacco industry: the complex procedures delay in involving various government organisations helped the cigarette companies create conflict and confusion between these agencies, significantly delaying GHW development and implementation.…”

Firm foundation or neglected cornerstone? The paradox of Article 5.3 implementation and the challenge of strengthening tobacco control governance

“…This achievement explains the esteem in which Article 5.3 is held by those seeking to demonstrate a need to minimise policy interference by other unhealthy commodity industries, but presenting it as a model can convey an impression within commercial determinants of health debates that this problem has been solved in tobacco control 11 13. The scope of the remaining task is demonstrated by the limited development of rules and tools to define and manage interactions36; by mapping consistent gaps in coverage of guideline recommendations31; by highlighting the ‘lacuna’ under which engagement with industry CSR activities may not be seen as violating Article 5.3 guidelines32; and by demonstrating the challenge of managing close relationships arising from state interests in the tobacco industry 30 33…”

“…While those studies explore contexts that have seen substantive policy innovations, in Bangladesh Abdullah et al focus on the stalled development of proposed Article 5.3 measures. 33 They demonstrate how institutional and individual conflicts of interest between government officials and tobacco companies have obstructed progress, with the National Tobacco Control Cell lacking the resources and political authority to break this impasse. The final case study is drawn from a linked research project on tobacco control in the UK Overseas Territories, exploring the complexities of managing conflict of interest in small island contexts.…”