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.
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 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, including cigarette poster advertisements, was, and still is, against Ethiopian law.
The posters also contravened the World Health Organisation Framework Convention on Tobacco Control regulations (WHO FCTC). I contacted WHO regarding this issue, but Ethiopia had not at that time ratified the WHO FCTC tobacco treaty, so BAT had not, they said, 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 7 years previously.
Why hadn’t Dr Tedros Adhanom, who was Minister of Health from 2005 to 2012, pushed to ratify the WHO FCTC treaty?
Ethiopia finally ratified the WHO FCTC tobacco treaty in 2014. Not long after the Rothmans posters appeared, Parliament debated and approved the ratification soon after a letter appeared in the medical journal, Lancet, in which my observations and concerns over these government-authorized posters were reported:
At the time, I was afraid of getting into trouble for writing such an article, so I asked 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.
Why hadn’t the Ethiopian Minister of Health spoken out and stopped these hundreds of cigarette posters from appearing all over Addis Ababa? The Minister of Health at the time was Dr Kesetebirhan Admasu. Surely he was aware of these posters- they stood out like a sore thumb? If he was aware of them, why were they allowed up in the first place, or at least not pulled down quickly?
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 causes 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:
What was the Minister of Health, Dr Kesetebirhan Admasu, time thinking of? Was he communicating with the other ministers who were associated with the government’s tobacco monopoly, NTE?
Was 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 and HIV.
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 millions of Ethiopians are 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?
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 who represents my constituency (district) in the UK. He was, like me, concerned that a British tobacco company, BAT, was advertising its cigarettes in a developing country. He contacted BAT directly about those Rothmans posters.
Some weeks later, my representative Member of Parliament in the UK 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.
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!
BAT knew full well that Ethiopia had a low smoking rate and that Ethiopian kids are an ideal target for their advertising. The Ethiopian government was authorizing BAT to advertise the cigarettes.
Where was the Dr Kesetebirhan Admasu’s Ministry of Health during this time?
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, 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 never 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 walk through every day on my way home from work, I called the MoH again and spoke with the same official there. He assured me that he would get the posters pulled down.
Sure enough, the 31 new posters were gone after just a week, 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!
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 these posters.
Sadly, in 2016, Japan Tobacco International and Ethiopia’s own tobacco company (NTE) joined the trend towards expanding tobacco farms and increase smoking prevalence in Ethiopia with that huge $510 million tobacco deal.
I am puzzled and dismayed by the Ethiopian government’s complicity in displaying those 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. I was particularly appalled by the apparent cluelessness of the Ministry of Health, and its seeming silence about these issues.
I searched widely for statements made against these tobacco deals by Dr Kesetebirhan Admasu, the MoH during these deals, and by the prior MoH, Dr Tedros Adhanom (now the WHO Director General), but I never found a written or spoken word against these deals. They both were as quiet as mice.
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!
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 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.
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