Photographs, among dozens taken by the author, in 2013, of British American Tobacco Rothmans cigarette posters, in Addis Ababa, Ethiopia. The posters were illegal according to Ethiopian law, but were nevertheless sanctioned by the Ethiopian government and advertised in poor areas of Addis Ababa by BAT in collusion with the Ethiopian government, to the detriment of Ethiopia’s youth and public health.
In 2013, just months after I had arrived in Ethiopia to work as a volunteer professor in Addis Ababa University Medical School, Ethiopia, I noticed posters advertising British American Tobacco’s Rothmans cigarettes appearing on shop fronts in my neighbourhood in Addis Ababa. I couldn’t miss them- they shocked me because not only am I British, but also I knew that advertising cigarettes was illegal in Ethiopia.
Before I came to Ethiopia I had researched the tobacco situation there and was very pleased to find out that Ethiopia ranked among the countries with the lowest smoking rates.
For years, as a child, I was exposed constantly to passive smoking and to relatives, friends and family members who suffered or died from tobacco-related diseases. Later on, when I practiced medicine as a doctor in the USA and saw daily the devastating health consequences of smoking, I felt even more strongly about tobacco and its associated health problems, and my smoking patients will tell you that I was passionate in advising and encouraging them to quit smoking!
Soon, hundreds of those Rothmans cigarette posters appeared all over Addis Ababa, Ethiopia, decorating store fronts and standing out, with their royal blue colour, above other advertisements . Most of these posters were made of sturdy plastic and were resistant to the heavy downpours of the rainy season. Some shops displayed two or three posters. I have, in my possession, one of these posters, which I bought from a poor storeowner while I lived and worked in Ethiopia.
Many of the posters appeared on busy streets, easily visible to pedestrians as well as to passing traffic, and were predominant particularly in poor areas of Addis, where many impoverished kids would see them clearly. Many were in areas where young children could be seen selling cigarettes on the streetside, or where homeless street children (there are well over 100,000 of them in Ethiopia) beg for money and use some of it to buy cigarettes.
Some shop owners told me that the posters were just “put there” overnight. Some were made of paper and were pasted onto their shop fronts without them knowing, they said. But most were made of strong plastic, designed to survive for years and advertise British American Tobacco’s addictive and health-destroying products to Ethiopians.
Following the appearance of the posters, shopkeepers were given “special” plastic dispensers that were elegantly inscribed with the Rothmans logo, complete with packs of Rothmans cigarettes ready to sell.
One storekeeper thought the Rothmans posters and cigarettes were illicit forgeries, whereas another believed they were “smuggled” in from Kenya. I later learned that neither of these suppositions was correct, but that the Ethiopian government had authorized British American Tobacco (BAT) executives to put those illegal posters up on poor storefronts in Addis Ababa, even though both of them knew that advertising cigarettes was against Ethiopian law.
Indeed, British American Tobacco ignored all of my attempts to contact them through their web site about these posters.
The posters would be illegal if they were posted on storefronts in the UK. They would break UK laws on tobacco advertising. As I said, they also were illegal in Ethiopia. As stated in Ethiopia’s legal code, the Negarit Gazeta, advertising of cigarettes or any form of tobacco, by any means, including cigarette poster advertisements, was, and still is, against Ethiopian law (Ethiopia Proclamation 759/2012 laws of advertising):
“Advertisement Proclamation No. 759/2012
PROHIBITED AND RESTRICTED
25. Prohibited Advertisement
1/ The direct or indirect dissemination of the following advertisements through the use of any means of dissemination shall be prohibited:
i) advertisement of cigarette or other
The posters also appeared to contravene Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control regulations (WHO FCTC), which prohibits governments from making deals with the tobacco industry. I contacted WHO regarding this issue, but Ethiopia had not at that time ratified the WHO FCTC tobacco treaty, so neither BAT nor the Ethiopian government, they said, had broken WHO FCTC rules. The rules, I was told, cannot be broken if a company from a country that has ratified the treaty (UK in this case) “breaks” the rules in a country that has not ratified the treaty.
I devised and taught a tobacco course at Addis Ababa University Medical School to educate medical and other students about tobacco issues, and I had repeatedly asked them how it could be that Ethiopia was still one of a handful of countries that had not yet ratified (put into law) the WHO FCTC tobacco treaty, which it had signed 9 years previously. By the way, I had a great deal of difficulty in getting this course approved, such is the control of Ethiopian universities by the federal government.
Why hadn’t Dr Tedros Adhanom, who was Minister of Health from 2005 to 2012, Foreign Minister from 2012 to 2016, and now WHO Director General, pushed to ratify the WHO FCTC treaty, given his stated concerns for escalating prevalence of non-communicable diseases (NCDs) in developing countries?
Those posters bothered me so much that I decided to contact the internationally renowned medical journal, The Lancet, about them. I sent photos of the posters and described my experience with them. The Lancet willingly published them. Here is the link to the article:
At the time, I was afraid of getting into trouble for writing such an article, and friends had told me to be careful because the government in Ethiopia could throw me out of the country for criticising it, so I asked the Lancet editor for my identity to be anonymous.
This is the state of Ethiopia: everyone is afraid to even whisper anything that criticizes the Ethiopian government, for fear of being punished.
Ethiopia finally ratified the WHO FCTC tobacco treaty in 2014. Not long- within a month- after the Lancet article bringing attention to the Rothmans posters appeared, Ethiopian Parliament debated and approved the ratification of the WHO FCTC. I and many people there believe that the Lancet article was influential in bringing about ratification of the WHO FCTC, because the Ethiopian government had ignored ratification of this treaty for 10 years, since 2004, when it signed (but did not ratify) the treaty.
It worried me also that, soon after Ethiopia officially ratified the WHO FCTC treaty, the government, through its own tobacco monopoly, National Tobacco Enterprise (NTE), spent 140 million birr (US$7 million) on a machine that makes up to 12,000 cigarettes a minute:
US$7 million is a huge amount of money in Ethiopia. It could be used for more humanitarian and ethical purposes, rather than for buying a cigarette-making machine!
NTE also increased production of cigarettes for the domestic market from 4 billion to 6 billion cigarettes a year, and states on its web site that it plans to expand its tobacco fields and sell more cigarettes to meet what it claims to be Ethiopian peoples’ “demand” for more cigarettes:
Was Health Minister, Dr Kesetebirhan Admasu, aware of the expensive cigarette-producing machine and the posters, and the increased cigarette production that could devastate the health of his fellow Ethiopian citizens; that could jeopardise, through increased smoking rates, tuberculosis control programmes? NTE sells cigarettes mostly to its own citizens and Nyala, the main brand, is sold exclusively to the domestic market!
Smokers are twice as likely to get tuberculosis than non-smokers, and tuberculosis patients who smoke are twice as likely to die from tuberculosis than those who don’t smoke. Smoking, therefore, is a great hindrance to Ethiopia’s ability to conquer TB. Similarly, smoking increases morbidity and mortality of HIV, and there is the added health concern that those with HIV are more prone to TB, so we can imagine the problems of smokers with both HIV and TB!
Even more concerning, since this post first appeared, Japan Tobacco International acquired, in July 2016, 40% shares in National Tobacco Enterprise, Ethiopia’s government-owned tobacco company, with the presumed aim of increasing smoking prevalence in Ethiopia and adding to the epidemic of tobacco-related diseases there.
Japan Tobacco International paid the preposterous sum of US$510 million (10 billion Ethiopian birr) to the Ethiopian government to increase smoking rates and expand tobacco production in Ethiopia, at a time when 15 million Ethiopians were at risk from famine due to the severe drought caused by El Nino!
I lived and taught in Addis Ababa during this time. I devised and gave my own lecture course on tobacco education to students at Addis Ababa University. Many of my students were devastated and incredulous that their government would make such a huge tobacco deal.
I never heard the Minister of Health, Dr Kesetebirhan Admasu, or the previous Minister of Health, Dr Tedros Adhanom (now the WHO Director General!), say anything against this unhealthy deal! What were they thinking of?
Yet this massive deal with Japan Tobacco International also broke the rules of the WHO FCTC tobacco treaty (Article 5.3), which states that governments should avoid interactions with, and not make partnerships with the tobacco industry. And this time, the rules were broken, because the deal was made after the WHO FCTC tobacco treaty was ratified by the Ethiopian government.
By the way, after I left Ethiopia in January, 2017, I was criticized and personally attacked by Dr Kesetebirhan Admasu, health minister at the time of the Japan Tobacco deal, and by the President of Addis Ababa University, Dr Admasu Tsegaye, among others, after I questioned Dr Tedros Adhanom’s candidacy for WHO Director General, for ignoring these tobacco deals, which stand to harm the health of millions of Ethiopians. My criticisms were published in the world-renowned medical journal, The Lancet:
Back to the BAT Rothmans posters. I had no idea how British American Tobacco managed to get those Rothmans cigarette advertisements posted. I tried to contact Nicandro Durante, the CEO of British American Tobacco, asking for an explanation as to why his company could manage to get those posters illegally on storefronts in Ethiopia and target poor Ethiopian youth to smoke, but there was no response– he was a very difficult person to contact.
Therefore I contacted the British Member of Parliament, Andrew Jones, who represents my constituency (district) in the UK. He was, like me, concerned that a British tobacco company, BAT, was advertising its cigarettes illegally in a developing country.
Of course, there were two sides to this deal: British American Tobacco and the Ethiopian government. It was easier for me to exercise my democratic rights in the UK and contact my MP and deal with the BAT/UK side of things, than it was to deal with the oppressive Ethiopian government, which doesn’t take too kindly to criticism and is known to torture and jail people who criticize its policies. And I didn’t want to get deported, or- worse still- end up in an Ethiopian prison!
My MP, The Right Honourable Andrew Jones, contacted BAT directly about those Rothmans posters.
Some weeks later, Mr Jones received a response from an executive at British American Tobacco, addressing my concerns and even offering to meet me to discuss the Rothmans posters! I’m not sure why they would wish to do that (are you?), but in any case I refused the offer.
The response from the BAT executive was that BAT managed to get those illegal posters up on Addis store fronts with an agreement from “the appropriate authorities” in Ethiopia. I presume the “appropriate authorities” refers to Ethiopia’s government-owned tobacco company, National Tobacco Enterprise.
Here is a copy of the BAT letter to my Member of Parliament, referring to my query about the BAT posters in Ethiopia, but indirectly addressed to my MP:
In effect, the Ethiopian government broke its own laws of cigarette advertising! And it permitted BAT to break those laws.
Some kind of “deal” was obviously made between the Ethiopian government and BAT to achieve a better cigarette business in Ethiopia, which would lead to increased addiction of Ethiopia’s poor youth, with the consequent devastating health problems due to tobacco-related disease.
The letter from BAT went on to say that BAT does its “very best” to ensure that it does not target the under-18 population. How can BAT put hundreds of posters all over Addis Ababa, most of them in desperately poor neighbourhoods, where kids abound, and say they don’t target under-18-year-olds? It’s laughable!
I believe that BAT knew full well that Ethiopia had a low smoking rate and that Ethiopian kids are an ideal target for their advertising and addictive products. The Ethiopian government was authorizing BAT to advertise the cigarettes, neglectful of the devastating public health consequences it could cause, and careless of the fact that the Ethiopian government was breaking its own tobacco advertising laws!
The posters were increasing in numbers, so, nervously, and after some sleepless nights, I contacted the Ethiopian Ministry of Health, which was under the leadership of Dr Kesetebirhan Admasu, about the Rothmans posters. First, I emailed the MoH through its web site, sending a photograph of a few of the Rothmans posters. I then received an email response, with a telephone number of a top official, and was asked to call him.
The official at the Ethiopian MoH had only recently heard about the posters, possibly through others who had read about them in the Lancet article (A plague rises in Ethiopia) but he didn’t know where they were located.
I was a little surprised at this, because there were hundreds of the posters, highly visible, in almost every district in Addis, and I expected that the MoH would surely know where the posters were to be found (everywhere, actually). Nevertheless, I advised him to drive through several areas of Addis where they were particularly abundant on store fronts. He said he would look into the matter. I didn’t heard back from him.
When, a few weeks later, I noticed that an additional 31 posters appeared overnight in an area of Addis called Filwuha, which I walked through every day on my way home from work, I contacted the MoH again and spoke with the same official there. He assured me this time that he would get the posters pulled down.
Sure enough, the 31 new posters were gone after just a few weeks, and within the next month all of the hundreds of posters in Addis Ababa were taken down.
In fact, I travelled all over Addis Ababa subsequently in search of a Rothmans poster and the only one I saw was protruding from a trash bin of the store that originally displayed it! I believe I am now the only person with one of the posters, because I had managed to buy one from a storeowner a few months before they were pulled down.
It was a sweet victory!
As a doctor who took the Hippocratic Oath, a tenet of which is to “Do No Harm,” and who cares about the health of people; as a lover of the wonderful country and people of Ethiopia; and as someone who is deeply concerned about the targeting of precious children and youth in developing countries by tobacco companies, I was seriously disturbed by those posters
I was (and still am) dismayed by the Ethiopian government’s complicity in permitting those cigarette posters, and in its recent deal with Japan Tobacco International, with its planned expansion of tobacco farms, increased cigarette production, and consequent rise in smoking prevalence among Ethiopians.
As I said, since the $510 million deal with Japan Tobacco International was made after Ethiopia ratified the WHO FCTC tobacco treaty, it contravenes Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC) treaty, which states that governments should limit interactions with the tobacco industry and avoid partnership with the tobacco industry.
Over 80% of smokers are now in the developing world and the number is increasing. Tobacco companies, often liaising with government officials, must be stopped from targeting the world’s poor.
I say to British American Tobacco’s CEO, Nicandro Durante, who after all is at the top of BAT’s ladder: “Shame on you and your company!” And I say the same to Japan Tobacco International’s CEO, Thomas A. McCoy, whose company has targeted African kids and recently (2016) injected a ridiculous sum of money ($500 million) into Ethiopia’s cigarette industry.
I say, also, to the Ethiopian government ministers who supported, or simply turned a blind eye to, the JTI/NTE deal and allowed BAT to advertise its Rothmans posters: Shame on you for your complicity with tobacco farm expansion and increased cigarette production in Ethiopia!
I say to Dr Tedros Adhanom, a key member of Ethiopia’s government, and now WHO Director General, and to Dr Kesetebirhan Admasu, Ethiopia’s Health Minister during these appalling tobacco deals: Shame on you both, for not speaking out against these unhealthy deals and for not supporting the health of Ethiopian people!
The last thing Ethiopia needs is investment in its smokers, an explosion of its tobacco production, and expansion of its agricultural land for growing tobacco instead of food and other, more beneficial, crops.
Tragically, Ethiopia is set to lose its standing as a country with one of the lowest smoking rates, thanks to government and tobacco company liaisons that put profits above the health of Ethiopians. Nonsensically, Ethiopia ratified the WHO tobacco treaty, created a legal document for tobacco control, and at the very same time made disgraceful tobacco deals all during the same period of time! As I said (daringly) during a lecture I was invited, by medical students, to give at Addis Ababa University, “Does the left hand of the government have a clue what the right hand is doing, and vice versa?”
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