Governments' accountability for responding to COVID-19, NCDs and tobacco epidemics

Shobha Shukla *

Politics, in many ways, is the ultimate determinant of health, had said Dr Richard Horton, Editor-in-Chief of The Lancet, a couple of years back.

In lead up to the 2020 World No Tobacco Day, and before the first virtual World Health Assembly began, a high level virtual meet with several government leaders from Asia and the Pacific region, convened to discuss governments' accountability in the context of the global public health emergency caused by coronavirus disease (COVID-19), and non-communicable diseases (NCDs) that not only cause over 70% of deaths globally but also increase the risk of developing serious outcomes of COVID-19, including death. Tobacco use which kills over 8 million people every year, and, is an entirely preventable and common risk factor of major NCDs, was also on the agenda.

This Webinar brought together Members of Parliament (MPs), Mayors, Governors and other local government leaders, public health experts, medical experts, media, those who live with NCDs or have survived killer NCDs, among others.

It was hosted by APCAT (Asia Pacific Cities Alliance for Tobacco Control and NCDs Prevention) - a forum for subnational leaders working to advance tobacco control and prevent NCDs in 65 cities of 12 countries in Asia and the Pacific region. 514 participants from 49 countries (913 registration from 66 countries) globally attended this session with significant representation from Indonesia, Cambodia, Myanmar, Lao PDR, Nepal, Philippines, Singapore, India, Bangladesh, Vietnam, Malaysia and Timor-Leste.

Deadly connect: COVID-19, NCDs and tobacco

"Tobacco kills over 8 million people every year globally, out of which 2.3 million deaths occur in the Asia Pacific region", said Dr Tara Singh Bam, Deputy Regional Director (Asia Pacific) of the International Union Against Tuberculosis and Lung Disease (The Union). Tobacco use is the leading common risk factor for major NCDs, such as cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases.

"Scientific studies show that tobacco use is associated with poor prognosis and serious outcomes of COVID-19, including death", added Dr Bam. Dr Vinayak Prasad who heads the Tobacco Free Initiative (TFI) of the World Health Organization (WHO) also reaffirmed this by sharing that "Review studies done by public health experts convened by WHO on April 29 found that smokers are more likely to develop severe coronavirus disease, compared to non-smokers."

The WHO recommends that governments should provide smoking cessation services in the form of Quit lines, counselling, etc. The WHO also recommends ban on waterpipe smoking, increase in taxes on tobacco and alcohol, and collection of scientific data on status of tobacco smoking among COVID-19 positive people.

Parliamentarians have more critical role to play during a crisis

Policy makers at different levels have a critical role to play, especially during crises like COVID-19 pandemics. Khagraj Adhikari, Member of Parliament from Nepal, former health minister and Chair of APCAT Parliamentarians (Asia Pacific Parliamentarians Caucus for tobacco control and NCDs prevention) said that given the rising evidence on COVID-19 comorbidities, parliamentarians should, "review and amend existing tobacco control policies, including raising taxes and prices of tobacco products. We must also enact policies to restrict the sale of and/or ban the harmful products such as alcohol and tobacco.

Industry’s donation to market these harmful products should be banned. We must make governments accountable for health of their people by pushing for best practice health policies." He further added NCDs and TB services should be continued even during the COVID-19 pandemic.

Health security is vital for sustainable development

Barrister Shameem Haider Patwary, Member of Parliament from Bangladesh said that COVID-19 has underlined the importance of health security for sustainable development. Mobilizing political will for greater health investment is vital. Barrister Shameem Haider Patwary, Member of Parliament from Bangladesh shared that parliamentarians can "make health policies a priority and enact them as quickly as possible.

We can ensure that there is enough budget for NCDs, tobacco control, TB and HIV, and other essential services, including immunizations. I have also suggested to the Parliament that every constituency should have one park and stadium for people to exercise, to promote a healthy lifestyle." He also shared that the majority of COVID-19 positive cases in Bangladesh are among younger people, thereby dispelling the myth that COVID-19 is affecting the elderly more.

Humanitarian crisis warrants stronger health responses

Humanitarian crises, like COVID-19, should warrant stronger health responses on the ground. At the subnational level mayors can ensure better implementation and enforcement of best practices for tobacco control and NCDs prevention. Dr Bima Arya Sugiarto, Mayor, Bogor City, Indonesia and Co-chairs of APCAT; said that they are trying "to ensure adequate social distancing and other measures to break the chain of transmission of COVID-19.

The measures are implemented with sanctions. Bogor City government’s mission is to save as many people as possible from COVID-19. Individually, abstaining from tobacco use and preventing NCDs is an effective method to ensure that one does not suffer from severe outcomes of COVID-19."

The city is also ensuring that tobacco control policies do not take a backseat in crisis-situation, rather they are continually enforced by maintaining smoke-free public places, workplaces, and public transport. Bogor City government is also refusing to accept donations of aid (such as sanitizers, masks, gloves) from the tobacco industry.

Mayor Bima Arya also shared his personal experience of being tested positive for COVID-19. "I strongly believe that because I maintain good physical health, do not smoke and eat healthily, I was able to recover from COVID-19 quickly with minimal symptoms."

Health services must not get disrupted during pandemics

Health promotion and education should not get disrupted during such pandemics. In fact, they should be prioritised for stronger health seeking behaviour and preparedness to effectively respond to the challenge. Han Kosal, Deputy Governor of Kampong Cham in Cambodia said that "It is important to increase awareness of the public on their active role in responding to COVID-19 and health promotion during the pandemic.

In Kampong Cham we are identifying suspected cases daily, conducting specimen collections and admitting those in need to the quarantine wards. All schools and entertainment venues have been closed. Gatherings are limited and we even cancelled celebrations for the Cambodian New Year. We continue to promote smoking cessation during this pandemic."

He added "Although COVID-19 has contributed to many deaths around the world it has also reminded the government of what should be done to improve the healthcare system. It has encouraged us to think and revise all development plans to do so. We now have to be more proactive to develop readiness tools to respond to the second wave of infections (if any) or any other pandemic in the future."

Jose Martinho Dos Santos Soares, Mayor, Ermera City, Timor-Leste shared that "In Timor-Leste we have 24 cases of COVID-19 and no deaths (as of 12 May, 2020). But this does not mean that we can be complacent. We are communicating about prevention and control measures by engaging with media, public health and community-based networks, local governments, NGOs and other sectors. We continue to promote smoking cessation and healthy lifestyle as we know that people with NCDs are at greater risk of facing aggravated COVID-19 outcomes."

Role of local leaders become more vital during emergencies

APCAT webinar raised the spotlight on the critical role of local leaders, which becomes even more important during the pandemics. NCDs and COVID-19 pandemics have one common risk factor – tobacco use - which is entirely preventable. Enacting stronger lifesaving health policies, approving the budgets and mobilizing more resources, providing oversight to ensure government accountability in implementation of global and national commitments, ensuring implementation of tobacco control, NCDs prevention and other essential primary healthcare programmes, such as TB control, were among the key recommendations that emerged.

Forward looking next steps for Members of Parliament and Ministries of Health was to ensure inclusion of tobacco control, NCDs and TB services in the national COVID-19 response plan. Mayors, Regents and Governors to ensure effective implementation of smokefree policies, ban on tobacco advertising, ban on donation from tobacco industry, ban on the sale of tobacco and alcohol products during COVID-19 pandemic, and to ensure uninterrupted health services for NCDs and TB.