Introduction
Tobacco use causes more than 8 million deaths each year, including over 1 million from secondhand smoke.1 In 2003, the WHO Framework Convention on Tobacco Control (WHO FCTC), the first global health treaty, was established in response to the globalisation of the tobacco epidemic.2 The WHO identifies the tobacco industry as the most significant barrier to tobacco control since it is aggressively undermining tobacco control measures, opposes regulations and continues to impede the implementation of the WHO FCTC.3 To safeguard tobacco control policies from the tobacco industry’s commercial and other vested interests, the WHO FCTC Article 5.3 was adopted in 2008, with 4 guiding principles, 8 general and 34 specific recommendations.4 The fundamental conflict of interest between the tobacco industry and public health is highlighted in Article 5.3’s guiding principles (principle 1); thus, the guideline recommends that the government must be accountable and transparent (principle 2), demand accountability and transparency from the industry (principle 3) and refrain from providing incentives to the industry (principle 4).3 WHO recommended that the FCTC Article 5.3 be implemented in all branches of government that might be interested in or able to influence public health policy for tobacco control.3 Furthermore, WHO requires FCTC Parties to provide periodic reports to the Convention Secretariat on their efforts to implement its provisions, including Article 5.3, using a standardised questionnaire.5
In 2023, WHO reported that over 70% of the parties had adopted at least one measure recommended in the guidelines for Article 5.3 to protect public health policies from tobacco industry interference.5 Although the data indicates a notable rise since the guidelines were issued, it was unclear how effectively these were implemented, particularly in low-income and middle-income countries.6 For example, WHO has recognised Thailand as a good example of good practice in implementing the Article 5.3 guidelines. After Thailand ratified the WHO FCTC in 2004, it actively implemented several tobacco control policies, remarkably reducing overall smoking rates from 23% in 2004 to 17.4% in 2021.7 However, like other countries, the FCTC Article 5.3 is only recognised by the Ministry of Public Health.8 Between 2022 and 2023, non-health departments in Thailand were lobbied by a non-government organization linked to the Philip Morris-funded Foundation for a Smoke-Free World to revoke the ban on e-cigarettes.9 Therefore, the score for the section on the tobacco industry participation in policy development and implementation increased from 1 in 2021 to 10 in 2023 (the higher the score, the higher the overall level of interference) and Thailand’s ranking in the 2023 Global Tobacco Industry Interference Index dropped from 11 to 26.9
The obstacles to implementing Article 5.3 differ between nations. A common barrier to implementing Article 5.3 effectively was poor attitude and lack of awareness among government agencies, policy-makers, the general public and tobacco control stakeholders. Studies in Uganda, India, Bangladesh and Ethiopia found that levels of awareness and understanding of Article 5.3 were higher among officials in ministries of health and related health agencies but limited among non-health agencies.10 11 In 2018, a study conducted in the European Union (EU) discovered that key policy actors across EU institutions were generally unaware of the FCTC and Article 5.3.12 In 2023, a study in India found that individuals participating in tobacco control at the district level did not fully understand Article 5.3 and its guidelines.13 These studies explored awareness of Article 5.3 qualitatively but did not fully address all guiding principles and recommendations. Also, no studies have examined attitudes towards Article 5.3 among those involved in tobacco control and their relationship with awareness of tobacco industry tactics. This study explored attitudes towards Article 5.3’s guiding principles and recommendations among individuals engaged in tobacco control in Thailand and whether they were associated with awareness of tobacco industry tactics. In addition, we looked into whether different groups in Thai tobacco control held differing views on Article 5.3.