The Tobacco Industry's Successful Efforts to Control Tobacco Policy Making in Switzerland

Cigarette consumption among people 15 years or older peaked in Switzerland in the early 1970’s with 3,700 cigarettes per capita and per year, followed by a decline to 2,800 cigarettes per capita and per year in 1994. After a decline of the proportion of smokers from 37% in 1980 to 31% in 1992, this proportion has increased again to 33% in 1997. Women, particularly the young, and children and adolescents, have shown a continued increase in smoking prevalence, despite the focus of tobacco prevention efforts on children and adolescents. Every year, over 10,000 people die from tobacco use in Switzerland, about a sixth of all annual deaths in Switzerland, making smoking the leading preventable cause of death in Switzerland. This number is more than 20 times higher than the number of deaths caused by illegal drugs. The tobacco excise tax in Switzerland is the lowest in Western Europe. The laws governing tobacco products, their marketing and sales, are weak and have little practical effect on the tobacco industry. There is no meaningful protection of nonsmokers from the toxic chemicals in secondhand tobacco smoke, in public places or work places. A ten-country survey on people’s experiences and attitudes concerning tobacco and smoking in 1989, commissioned by Philip Morris International, showed that Swiss people were aware of secondhand smoke’s adverse effects on health, but only a minority favored government regulations for smoking in restaurants and workplaces. A first comprehensive 5-year tobacco prevention program, 1996 to 1999, issued by the Swiss Federal Office of Public Health lacked adequate financial resources, focus on specific interventions, cooperation between partners for tobacco prevention, and program coordination and management. It ignored the role of the tobacco industry. As a result of recent events in the US and WHO’s active engagement of the tobacco industry, the draft five-year plan for tobacco prevention in Switzerland for 2001 to 2005 identifies the tobacco industry as a major obstacle to tobacco prevention. Until the recent merger of British American Tobacco (BAT) with Burrus-Rothmans in 1999, the single most important tobacco company in Switzerland was Philip Morris (PM), with a market share of close to 50% (and close to 25% for Marlboro alone). Since the merger, the tobacco market is dominated by PM and BAT, each with a market share of cigarette sales between 45% and 50%. As was the case in the US, in the early 1960’s, the scientists in Swiss tobacco industry research laboratories (in this case, FTR (Fabriques de Tabac Réunies) / Philip Morris) accepted and discussed the dangerous effects of smoking on health in internal company communications. At that time, these scientists earnestly tried to find ways to reduce the carcinogenic effects of cigarettes through elimination of carcinogenic components. Contrary to privately expressed views, tobacco industry’s public position in Switzerland was that there was ongoing controversy in the issue whether smoking caused diseases or not. The “controversy” was nurtured through regular media briefings and scientific meetings with carefully chosen scientists who would publicly support the industry’s position, but without declaring their liaisons with the tobacco industry. Relationships with these industry “consultants” or “witnesses” were maintained through direct payments and indirectly through funding of their research. By late 1980’s the tobacco industry had identified the decline of social acceptability of smoking in Europe as a major threat to its viability. This recognition led to the development of a comprehensive strategy to fight the secondhand smoke issue. “Courtesy and tolerance” and economic arguments were used to divert the public’s and policy makers’ attention from the health issue. The resulting strategies were often devised in consultation with executives of other Philip Morris subsidiaries and Philip Morris International headquarters in New York. Well aware of its low credibility with the public, journalists were given interviews and told not to mention the tobacco company’s name in the newspaper article. Official publications, such as “Smoking and Mortality in Switzerland” by the Federal Office of Public Health, the report on the respiratory effects of secondhand smoke by the US Environmental Protection Agency, as well as original scientific publications, such as an article in the American Journal of Respiratory and Critical Care Medicine, dealing with secondhand smoke and respiratory symptoms in Switzerland (SAPALDIA study) written by a group of Swiss scientists, were massively attacked by the tobacco industry. The tobacco industry employed “consultants” and politicians with industry ties, who used standard industry arguments. One of the most active industry consultants in Switzerland was Peter Atteslander, a Swiss citizen and professor at the University of Augsburg in Germany. He wrote white papers for the tobacco industry and reported from meetings worldwide. Atteslander appeared to be the essence only member of the Switzerland-based “Arbeitsgruppe für Gesundheitsforschung (AGEF) (“Working Group on Health Research”), which published his work without disclosing the ties to the tobacco industry. To fight smoking restrictions in restaurants and hotels, the tobacco industry developed a strong ally in the hospitality association, the International HoReCa. The secretary general of International HoReCa at the time was Dr. Xavier Frei, also president of the SCRA (most likely the Swiss Café and Restaurant Association). The hospitality association made extensive use of tobacco industry resources and repeatedly printed tobacco industry positions in hospitality industry newsletters, without the members of International HoReCa or SCRA being informed about the close ties between their organization and the tobacco industry. The “accommodation program,” a well-known tobacco industry strategy to preempt regulatory measures against smoking in restaurants and workplaces first developed in the United States, was used in Switzerland. The fact that even the logo was the same as the one used in the US is another illustration of tobacco industry’s recycling of strategies and tactics worldwide. The shift of focus from the problem of secondhand smoke to one of indoor air quality in general was (and remains) a major strategy used by the tobacco industry worldwide to dilute the problem of secondhand smoke with other indoor air pollutants and ventilation of buildings. To this end, an indoor air quality control company with close ties to the tobacco industry, ACVA Atlantic Inc., USA, later renamed Healthy Buildings International, HBI, collected data which was used extensively by the tobacco industry to further their goal of downplaying the role of secondhand smoke as a major component of indoor air pollutant. Employees of HBI were sent to Switzerland to collect data on Swiss office buildings, and the data were used in the newsletters of HoReCa to support the accommodation program and against non-smoking regulations. HBI has been discredited in the US. The tobacco industry tried to influence smoking policy in airplanes through partial funding of IFAA’s (International Flight Attendants Association) world congresses. This influence was established through close relationship with the president of the association, a common industry strategy in influencing organizations. When, in the wake of smoke-free flights in the US and other countries, Swissair finally introduced smoke-free flights, it was heavily criticized in newspaper articles by the Swiss “Smokers Club,” and later the Swiss “Club of Tobacco Friends,” whose president and founder is a former public relations official for the tobacco industry. The Swiss Cigarette Manufacturers Association successfully influenced smoking policy in railway trains through letters to the publishers of newspapers and direct lobbying toward cantonal authorities and the head of the national railways. Two referendums on tobacco and alcohol advertising bans in 1979 and 1993 were rejected by Swiss voters despite pre-referendum polls favoring advertising bans through a strong and lasting alliance of the tobacco industry with the advertising agencies and the print media. The tobacco industry successfully kept itself behind the scenes in order to avoid negative publicity while financing the anti-advertising ban campaigns and supplying the alliance against advertising bans with well-crafted arguments by tobacco industry public relations and law firms through the International Tobacco Information Center, INFOTAB. The tobacco industry and its allies used economic and political arguments, such as purported effects on employment, state tax revenues, and individual and corporate freedom to fight the advertising bans. Close relationships with officials and politicians were emphasized and maintained through regular meetings with the head of the political parties and briefings of the “tobacco caucus” in the parliament. This caucus gave the tobacco industry the means to stay well informed about the political agenda and to easily influence the political process in their favor. While Switzerland has some of the most progressive and innovative public health promotion programs, most public health advocates underestimate the power of, and driving forces behind, a tobacco industry, and only few of them have confronted the industry directly.