After being for several years the main benchmark in the region and one of the most recognized in the world in the fight against tobacco, a year ago Uruguay became the example used by the tobacco industry to promote innovative heated tobacco devices, without independent scientific validation that ensures a less harmful use than the traditional cigarette.

Sudestada was able to confirm how during 2021 the company Philip Morris International (PMI), which in 2016 lost a lawsuit against Uruguay before the International Center for Settlement of Investment Disputes of the World Bank, known as ICSID, now has the country as a silent ally when showing its advances in the region in regulatory aspects. 

The company  did so, for example, on April 21, 2021 when it  presented the financial results for the first quarter of the year before the  Securities and Exchange Commission (SEC) of the United States. That day in the  presentation they  included a list of four countries that had approved regulations that favored them in their  business strategy. The first on the list was Uruguay. 

«The presidential decree revoked the ban on importing heated tobacco products, recognizing that there are now alternatives to cigarettes with a different risk profile that may play a role in reducing the impact of smoking in the country,» said the document of the world’s largest tobacco company on page 9. 

After Uruguay on the list of countries that had «positive developments from regulators that recognize the harm reduction potential of reduced-risk products” came Lithuania, the United Kingdom and New Zealand, which agreed to apply a totally different strategy to the one Uruguay had until now to combat smoking. 

But this was not the only time that the industry used the Uruguayan example to promote its business at the regional level, doctor Wilson Benia, a consultant and specialist at the Pan American Health Organization (PAHO), explained to Sudestada. 

“The operators in the deterioration of the health of the populations, go to governments like Panama, Brazil, which have implemented very restrictive regulations prohibiting heated tobacco products, to tell them ‘if Uruguay made it more flexible, boys, it turns out that this is not it’s so bad, make yourself more flexible too,’” Benia described.

Cardiologist Eduardo Bianco, a benchmark for Uruguayan civil society in the fight against tobacco and founder of the Smoking Epidemic Research Center (SERC), confirmed to Sudestada that Philip Morris spokesmen contacted Brazilian health authorities to show the new Uruguayan example. In the days after the signing of the decree «I was consulted by people from the Brazilian Ministry of Health, to find out what happened in Uruguay that allowed this, because they are now appearing in Brazil to also endorse these products.» 

“And the same thing happened in Panama, where they were also prohibited and they went to pressure saying that Uruguay had allowed this. The move was made by the Philip Morris company, which was the one behind this,» said Bianco.

This modification in the regulations that the Executive Branch directly implemented came to the surprise of civil society and academia, but also of the health authorities, who later had to accommodate the new guidelines that came from the Presidency. 

This confirms the suspicion that civil society has had for months. «Uruguay was used in a regional strategy, because the Uruguayan market is not attractive for the tobacco industry, surely because of the population we have and the consumers,» Diego Rodríguez, current member of the SERC, told Sudestada.

“We believe that this is the same strategy again; The market of potential consumers, of heated tobacco products  in Uruguay, is not so important, but rather bending, undermining in some way the regulation of Uruguay to use it as a strategy for a more regional and global market”, explained Laura Llambí, associate professor of the Faculty of Medicine of the University of the Republic and member of the advisory commission of the Ministry of Public Health.

“When this decree emerged, not all the relevant actors in the government were aware of its provision and implementation,” said Benia. Llambí and Rodríguez expressed it in the same way. «It was a great surprise because it is a decree whose analysis did not go through the usual advisory places of the Ministry of Public Health  to make these decisions on health policy,» Llambí said. 

Regulations like these «always come from the Ministry of Public Health» and «do not arise from the presidency or from the presidency’s advisors» as happened with this decree, Rodríguez explained. 

The worrying interference at a global level

The head of the Secretariat of the Framework Agreement, the Uruguayan doctor Adriana Blanco, told Sudestada that the tobacco companies «try to confuse and use different arguments in different situations.» 

«The tobacco industry has never stopped trying to interfere with tobacco control policies,» said Blanco, and considered that «it is recycling new strategies.»

Putting this strategic recycling into practice, Blanco said that when the industry notices that people are worried about the health effects of tobacco, “they look for a change  to present a lower-risk product. This did not start now, this started a long time ago with the filters”, she recalled. 

«Then the story was, ‘oh,  now we have these products, the light, the ultra light, the mill’, which are less harmful when we all know that in reality these products only have more ventilation in the filter,» she claimed. . 

For Benia, meanwhile, this is «part of a systematic action to undermine regulations related to tobacco control and one more expression of a continuous dynamic of the tobacco industry.» What happened with the approval of decree 87/021 was «a fissure in a regulatory shield that had been progressive and coherent.» 

The PAHO representative explained that just as Uruguay was a benchmark in the region for the implementation of actions to protect the population with measurable results, it is now viewed with concern by the countries of the region.

Always latent threats 

Due to  the approval of the decree, the members of the inter-institutional advisory commission met with Minister Daniel Salinas and the General Director of Health, Miguel Asqueta, to receive an explanation of why the authorities endorsed this regulatory setback. “We did not get further explanations. The minister promised to organize a meeting with the advisors of the Presidency, to discuss the issue. That meeting never happened,” Rodríguez explained.

While Salinas gave these modest explanations to the advisory commission, at the same time he signed an official document from the MPH for World No Tobacco Day in 2021. There, the head of the Ministry  maintained that “The introduction to the market of new and emerging products for tobacco consumption is an immediate challenge, because its use is not without risk and experience has shown that one of the consequences is a rapid increase in tobacco consumption, both in its novel and traditional forms”. 

“Knowing that the always latent threats of the stimuli for more and more people to fall into tobacco addiction -which is ultimately what those who market these products are pursuing- are always upon us, we have to be smart enough, united and consistent enough to achieve what we want to achieve, protect present and future generations from the devastating health, economic and environmental consequences of tobacco consumption and exposure to tobacco smoke,” Salinas wrote, but everything remained in words because the decree remained in force. .

In fact, as Sudestada learned, the comment in the MPH  offices was that the person responsible for drafting the decree was the pro-secretary of the Presidency, Rodrigo Ferrés, and that he should be the one who gave the explanations to civil society, but that never happened. 

Another of the ministerial authorities who stood firm in defense of the decree in question was the general director of Health of the MPH, Miguel Asqueta, who before taking office had been president of the SERC. As a member of civil society, Asqueta actively participated in the implementation processes of tobacco control measures in Uruguay. «My team beat Philip Morris» he says on his Twitter profile, however on the other side of the desk the match does not look so victorious.

In February 2019, in his capacity as president of the SERC, he sent a letter to the then Minister of Health, Jorge Basso, to urge the administration to be «alert to prevent interference from the tobacco industry» and not associate with the Foundation for to Smoke-Free World (FSFW), financed by Philip Morris. 

«An organization funded by the tobacco industry is not a public health partner,» he said in the letter.

The letter signed by Asqueta ensures that Philip Morris International offers funds through the FSFW for studies on, among other topics, «alternatives to smoking, such as electronic nicotine delivery systems (including IQOS, a device that PMI aggressively promotes)» . 

However, two years later, it endorsed the marketing of heated tobacco products, by upholding a decree based on evidence questioned by the academic community.

«The tobacco industry is a danger to Uruguay and the region, trying to interfere in the progress of tobacco control in our country,» the current Director General of Health stated in that letter. «The government of Uruguay is obliged to protect its public health and tobacco control policies against interference by the tobacco industry by virtue of Article 5.3 of the WHO Framework Convention on Tobacco Control,» said the current Director.

Sudestada contacted the ministerial authorities to find out their position on this regulatory change, but until the closing of this article it was not possible to arrange the interview with Minister Daniel Salinas or with the General Director of Health Miguel Asqueta.