By Ties Keyzer, Tim Luimes, Eva Schram (The Investigative Desk) and Stéphane Horal (Le Monde)
On a flight from New York to Geneva in 2015, Derek Yach looks around: is there anyone he knows on the plane, who will ask him what he is going to do in Geneva? Yach is relieved when he does not see any familiar faces. They would probably think he had been bribed. 'I know that I run the risk of being excluded by my scientific colleagues.'
South African Derek Yach, a rock star in the fight against tobacco, describes the trip in his memoirs (1, zie bronnen onderaan). For years, Yach worked at the World Health Organisation (WHO) in Geneva as one of the architects of the anti-tobacco treaty: the 2005 Framework Convention on Tobacco Control (FCTC). The FCTC has now been signed by 182 countries, committing them to reduce smoking and fight the tobacco lobby - an answer to the estimated 100 million tobacco deaths in the 20th century.
'We are fighting to save lives,' Yach said during a speech (2) in Johannesburg in 2001, in which he discussed the global treaty in the making. They are engaged in a battle for profit, where lives matter little. Tobacco companies, he said, are 'wolves in sheep's clothing' who seek to sabotage the work of the WHO with the help of 'umbrella organisations' and a 'web of lies'.
'Don't panic. Keep breathing. It's just a meeting,' Yach tells himself years later on that plane to Geneva. This time he is not on his way to the WHO, but to Marlboro manufacturer Philip Morris International (PMI). He will meet its CEO Andre Calantzopoulos. As governments and investors lose appetite for cigarettes and sales in Western markets decline, the chief executive is charting a new course. The world must get rid of cigarettes, and Philip Morris promises to do its absolute best to achieve this. Calantzopoulos wanted to convince Yach to join this mission.
Calantzopolous succeeded. After the meeting, Yach became chairman of the Foundation for a Smoke-Free World (FSFW). The Foundation claims to be completely independent from founder Philip Morris and its mission is 'to end smoking in this generation'.
After leaving the WHO, Yach took several detours and ended up at multinational PepsiCo in 2007, where he wanted to change the industry from the inside. His move to 'Big Soda' surprised many. How could Yach, the ultimate health advocate and scourge of both the food and tobacco industries, join PepsiCo? In 2017, he explained in the Financial Times: 'I spent many years with WHO as a powerful advocate for the role of government. I could see where the limitations were. Law and books don't translate into action in the streets.'
It seemed that the tobacco industry could not change, though. Yach told US radio station NPR in 2013 that to fight obesity, you cannot just introduce taxes, because that will not solve the problem. When it came to tobacco, however, the formula was simple, Yach said: 'Demonise the industry. Tax it through the roof. Ban all forms of marketing.
However, during that meeting in Switzerland, Yach became convinced of Philip Morris' new course. 'Perhaps I am naive,' he writes in his memoir Project Unthinkable: A Doctor's Gamble to Save Millions of Lives (2018). 'I believe that people, and even entire industries, can change their minds. Maybe I just want to keep an open mind. Growing up in South Africa during Apartheid, I was taught to believe that the racist, repressive system of government would change. It had to. Why couldn't Philip Morris do the same?'
Harm Reduction Incorporated
In the summer of 2017, Yach spent two weeks in Alpine-surrounded Lausanne, on the shores of Lake Geneva, with directors and researchers from Philip Morris. 'We were putting the finishing touches on who was going to be on the board, he writes in his memoirs. 'And what the priorities for the new Foundation for a Smoke Free World were to be.'
By the autumn of 2017, Philip Morris is already selling its new IQOS in 38 countries. This electronic device heats tobacco to half the temperature of a lit cigarette. According to the company, no combustion occurs and the product is 'smokeless'. Based on its own studies, PMI claims that the new so-called heat-not-burn cigarette emits 90 to 95 per cent less harmful substances than traditional cigarettes, which would make the IQOS a 'considerably less harmful novel smokeless tobacco product'.
Independent scientists refute these claims. Researchers from the universities of Lausanne and Bern published a study in the JAMA Internal Medicine journal in 2017. They conclude (3) that the IQOS is 'about as harmful' as a cigarette and that heat-not-burn is just 'smoke by another name'. In 2020, the US Food and Drug Administration (FDA) acknowledged that the IQOS emits certain harmful substances in lesser amounts, but considered it unproven that the product would therefore be less harmful. (4)
Nevertheless, Philip Morris celebrates the FDA ruling as a victory. According to them it proves that the IQOS can be used for so-called harm reduction. Just as heroin addicts are given methadone in clinics to reduce their addiction, 'alternative nicotine products' such as e-cigarettes and heat-not-burns could help smokers to quit tobacco. (5)
But whereas harm reduction in drug treatment is a proven method, there is no scientific consensus that the principle works for tobacco addiction. Heat-not-burn is not designed to gradually reduce nicotine intake - and therefore addiction - and it is not clear what the long-term harm is. Health experts fear that the new flavours of e-cigarettes and heat-not-burn products may appeal to young people. Researchers from Stanford University in the US also expect the IQOS to attract young people because of its sleek design and sales through Apple Store-like shops.
With Philip Morris, these concerns fall on deaf ears. 'A potential paradigm shift for the industry, public health and smokers,' calls top executive Calantzopoulous the IQOS at its launch in 2016. The device would reduce the harm of smoking and increase profits for Philip Morris. By the time cigarettes have been replaced, the Greek top executive said, Philip Morris' 'undisputed leadership' of the new tobacco market will be established.
This does not mean that Philip Morris is abandoning the cigarette: in 2019 and 2020, the company spoke out against the limitation of tobacco advertising, incorporated the Marlboro colours and advertising slogan into Swiss IQOS ads and openly advertised its best-known cigarette brand in Israel and Indonesia.
Philip Morris pledged to put nearly a billion dollars into the Foundation for a Smoke-Free World in 2017, the funding agreement shows. (6) According to its bylaws, the foundation aims to 'promote and support significant scientific research that advances the field of tobacco harm reduction' and to work on alternative sources of income for tobacco farmers. In addition, the foundation wants to 'create consensus' on how to reduce the harm of smoking.
The FSFW is housed in a luxurious skyscraper on 5th Avenue in Manhattan, New York: one of the most exclusive streets in the world. The Yach-led Board does not include people with a history of working in the tobacco industry; it consists mainly of people who have worked in philanthropic organisations. This gives the Foundation a friendly, progressive face.
The main research centre funded by the Foundation is located on the Italian island of Sicily, in the Torre Biologica of the University of Catania: the Centre of Excellence for the Acceleration of Harm Reduction (CoEHAR). Until recently, this centre was headed by Riccardo Polosa, professor of Internal Medicine specialising in tobacco. He is one of the most prominent scientists (7) in the field of tobacco harm reduction and has more than 400 scientific articles to his name. He was also chairman of the Italian anti-smoking organisation Lega Italiana Anti Fumo (LIAF) for many years, where he still has an advisory role.
In 2019, Polosa's company ECLAT, an academic spin-off from the University of Catania, received over $8 million (8) from the FSFW to set up the CoEHAR and conduct research on harm reduction. Polosa is, for example, researching the effects of cigarette smoke and nicotine vapours on the human body.
Polosa had been working with the industry since at least 2003, when, as the then president of the Italian anti-smoking league, he received almost $300,000 from Philip Morris for a study on smoking cessation. In 2017, Polosa became principal investigator in a study of the health effects of smokers 'not motivated to quit' and switched to heated tobacco products. For this study, the University of Catania received almost €1 million from Philip Morris. His harm reduction studies do not consistently mention the relationship with the Foundation or the tobacco company, even though international guidelines require this.
The funding programme
The eight million dollars that Polosa's company received in 2019 is part of a large funding programme from the FSFW, of which the centre in Catania received the largest donation.
Although the FSFW states transparency is 'a core principle', an analysis of its US tax returns is needed to understand its finances. On the Foundation's website, the supported projects are described only summarily, without mentioning amounts. On request, the Foundation refuses to make public any reports or documents about the research projects it funds.
The University of Bath has set up a database for its Tobacco Tactics project in which the grants are searchable. Analysis of the tax return and the project information shows that these are the Foundation's five largest donations until 2020:
|ECLAT (Italy), privateresearch facility||$23 million (currently $8 million paid out)||Establishment of a Centre of Excellence, which will, among other things, expand knowledge on tobacco harm reduction|
|Rose Research Center (US), private research facility||$20.6 million (currently $4.7 million paid out)||Establishing a research centre for harm reduction and innovative ways to quit smoking|
|Etheim Biotics (US), private researchfacility||$4.3 million (currently $3.4 million paid out)||A study of the impact of tobacco smoke and nicotine vapours on the human microbiome|
|SustainAbility Inc. (US), consultancy||$1.8 million (currently $3.1 million awarded)||Development of an advisory panel for the Tobacco Transformation Index, where the Foundation tracks tobacco companies' commitment to harm reduction|
|Michigan State University (US)||$5.2 million (currently $3 million paid out)||Development of a policy proposal for Malawi on 'economic and agricultural transformation'. FSFW aims to provide alternative sources of income for tobacco farmers|
The funder decides
The FSFW emphasises its independence in all communications. For example, in 2017, Yach wrote in medical journal The Lancet that the foundation statutes 'prevent him and other board and staff members from accepting any form of remuneration from PMI'. 'We are therefore independent of our funder,' Yach reiterates in 2019. 'This is not a claim; it is a legal, ethical and non-negotiable fact.'
However, financial records show that Philip Morris is the Foundation's sole funder. When it was set up, the foundation promised to attract other donors, but those attempts led to nothing (9). As a funder, Philip Morris has a decisive influence on the objectives and policy of the Foundation. If the latter were to shift its focus, for instance from harm reduction to smoking cessation, PMI could, according to its founding documents, cut off its funding entirely. Meanwhile, the budget that Philip Morris gives to the foundation has been halved to $525 million; it is not clear why.
Meanwhile, millions of dollars go from the FSFW to various public relations firms, many of which have long-standing links to the tobacco industry. This is evident from the foundation's tax documents. For example, public relations and advertising firm Ogilvy, which was previously involved in many of Big Tobacco's campaigns, received nearly$7 million. The company, according to PRWeek, cancelled its partnership with the FSFW in 2019 to avoid conflicts with healthcare clients.
PR firms Mercury and Ruder Finn, which worked with Philip Morris and Altria (10), received (11) more than $650K and $2 million respectively. Lawyers from BakerHostetler regularly sit in on FSFW Board meetings. BakerHostetler has also represented a group of tobacco companies in litigation in the United States since 2015. APCO Worldwide, a company that according to the University of Bath has long worked with the tobacco industry, was given over $1 million to introduce the FSFW in China. The FSFW thus spends millions of dollars on advertising and lobbying.
The Foundation is not independent and acts as a front for the tobacco industry', says Lourdes Liz. She was director of social media at the FSFW, and after her dismissal she filed a lawsuit against her former employer. In her writ of summons she accuses the FSFW of dancing to the tune of Philip Morris. According to Liz, Yach met with representatives of Altria, the parent company of Philip Morris USA, in order to align the foundation's and the company's communications.
Liz protested at the time; such arrangements were not permitted under the funding agreement. After her resignation, the passages in question were amended: since then, nothing stops the FSFW from 'exchanging information or interacting with any third party'.
The tax-exempt status of charities in the United States is conditional on them not engaging in lobbying. However, the Foundation does lobby, says Liz, and 'vehemently' disagrees with the 'egregious exploitation ' of its status to promote new tobacco products.
The lobbying strategy
'Establish PMI as a reliable and indispensable partner.' It is one of the first points from a leaked 2014 Philip Morris document, published by Reuters. 'Be for something.' The company, which normally fights any regulation tooth and nail, decided that a positive image was necessary to enter the scientific and political debate. The transition from cigarettes to IQOS, and a donation of $1 billion to tobacco harm reduction through the FSFW, should create that image.
Philip Morris has indeed conducted a positive lobbying effort in the US and North West Europe in recent years. Its fierce opposition to stricter cigarette regulations has partly ceased, with the manufacturer telling policymakers that IQOS and e-cigarettes are an essential part of successful anti-tobacco policies. To achieve that success - and get smokers to switch - these new products need to have the fewest possible regulations (12) regarding pricing, packaging and health warnings.
The Foundation fits perfectly into that lobbying strategy. In the autumn of 2020, for example, Yach co-authors an article (13) for a special on e-cigarettes in scientific journal the American Journal of Public Health (AJPH). In it, he argues against a ban on flavours in e-cigarettes, arguing that such a ban would make the transition from the traditional cigarette to new products more difficult. This led to angry letters to the editor from health organisations and experts. 'We strongly suspect that - even as we speak - representatives of the Foundation for a Smoke-Free World are gleefully presenting copies of Dr. Yach's AJPH article to Ministries of Health in low-income and middle-income countries around the world and using his printed words in a prestigious journal to argue the safety of e-cigarettes,' scientists wrote (14) in one of these letters. The magazine states that the tobacco industry is indeed notorious for its attempts to control the scientific debate, but that the AJPH wants to provide a platform for a 'wide range of views'.
The Foundation and scientists (partly) paid by it also lobby the World Health Organisation. For example, in an open letter in January 2019, Yach called on the WHO to make tobacco harm reduction part of its health policy. According to Yach, awareness of the theory needs to be raised, which is why the FSFW wants to cooperate with the WHO. Yach consulted Philip Morris about the letter, states former employee Lourdes Liz in her writ of summons. And indeed: at the same time PMI pleaded for an 'armistice'. The tobacco company thought that sceptics should put aside their 'prejudices' and support the 'historic mission' of Philip Morris.
The aim is to break up and circumvent the FCTC, the WHO's anti-tobacco treaty - which has banned the industry from all negotiating tables. So says Ruth Malone (15), professor of Social Behavioural Sciences at the University of California and editor-in-chief of the scientific journal Tobacco Control. 'They want to come to the negotiating table and claim they are part of the solution.'
For the upcoming international conference on the FCTC treaty, due to take place in the Netherlands in November 2021, three organisations received (16) funding from the FSFW to gain 'consensus and support' for the idea that harm reduction should be an 'integral' part of tobacco control.
Sicilian scientist Polosa and his colleague Pasquale Caponnetto are not only engaged in scientific research, they also focus on lobbying to include tobacco harm reduction in health policies. According to Polosa, the WHO has 'failed' because it does not do so. Caponnetto signed a letter in 2014 calling on the European Commission to give e-cigarettes an important role in anti-smoking policies. Shortly after, he and other academics wrote to the European Parliament saying it was a mistake that the European Union's new policy offered little room for this.
Caponnetto also intervened in the Dutch political debate in 2019. With thirty-five other scientists, he wrote (17) to the Parliamentary Committee on Health, Welfare and Sport that the National Prevention Agreement did not offer enough room to allow cigarette smokers to switch to less harmful alternatives.
The FSFW should have reopened doors that are now closed to Philip Morris. But the close ties between the foundation and its funder are too conspicuous. The harshest judgment comes from the WHO, which rules out cooperation with the FSFW. Four years ago, the secretariat of the FCTC already called the foundation 'a clear attempt' to break open the treaty. For that reason, the WHO considered any cooperation with the FSFW as cooperation with the tobacco industry, which is prohibited under the Convention. Since then, hundreds of health organisations have spoken out against the FSFW.
'Philip Morris thought the Foundation could appease the WHO because of Derek Yach's former position there,' says Ruth Malone. 'But the tobacco giant may have overestimated Yach's ability to win hearts and minds. And Yach may have underestimated the strength and solidarity within the anti-smoking movement.'
Divide and conquer
Nevertheless, the FSFW has had some success. In the debate on tobacco harm reduction, a trench war is being waged between those who believe that policy should focus on smoking cessation, and those who think that alternative products can have a place in health policies. Philip Morris chooses to fund researchers from the second camp. Because of this strategic meddling by the industry, with Philip Morris in the lead, harm reduction has become an equally charged and complex concept, advocated by lobbyists and scientists with direct links to the tobacco industry, and by researchers and users with a genuine belief in the potential benefits.
This is exactly Philip Morris' strategy. There are divisions within the anti-tobacco movement,',' the company wrote in its leaked 2014 internal lobbying documents. Driving a wedge between those camps creates uncertainty among the general public and politicians as to what the truth is. 'They may not have succeeded in breaking up the WHO,' says Malone. 'But they did break up the anti-smoking movement.'
'Divide and conquer', a tactic Philip Morris has used for decades. The multinational thus hopes that consumers will continue to buy the new products and that politicians will wait to make tough decisions and after more than a decade of political debate, there is still no European excise tax on these products.
FSFW front man Yach has turned one hundred and eighty degrees since he fulminated in 2001 against the tobacco industry, the 'wolves in sheep's clothing', who with 'umbrella organisations' and a 'web of lies' wanted to thwart the WHO tobacco treaty. Twenty years later, he works as the friendly face of the tobacco multinational, attacking the treaty that he himself designed.
Philip Morris International declined an interview and would not answer questions, but sent a general text. It says the company is 'committed' to replacing cigarettes with 'less harmful alternatives'. It also says the FSFW is an initiative that seeks to 'accelerate positive change with scientific evidence', but that it is 'inappropriate' to say anything further about the organisation because of its independence.
The FSFW also declined an interview and did not answer our questions, sending only a general response. It states that the organisation is 'fully transparent' about the financing of Philip Morris and that its tax papers are publicly available. The FSFW says it remains focused on its goal: 'to help billions of smokers and reduce the devastation caused by cigarettes'.
The University of Catania says CoEHAR was established to advance knowledge of tobacco harm reduction, 'with the aim of accelerating smoking cessation through the global dissemination of reliable science'. According to the spokesperson, CoEHAR's research programme is '100 per cent independent of commercial and other vested interests of the tobacco industry'.
This story is the result of a cooperation of The Investigative Desk and Le Monde, and was published in a collaboration of Follow the Money (Netherlands), Knack (Belgium) and Le Monde (France).
The Investigative Desk is a cooperative of specialised investigative journalists. We fund our work with donations, subsidies, grants and publication fees. Our donors have no role or substantive say in our investigations and publications. This specific project was partly funded with a donation/subsidy from the Dutch Cancers Society. More details on www.investigativedesk.com.
Derek Yach: Project Unthinkable: a doctor's gamble to save millions of lives, Barlow Publishing, 2018.
Derek Yach: WHO Consultation on Litigation and Public Inquiries as Public Health Tools for Tobacco Control, 2001: https://www.who.int/tobacco/dy_speeches8/en/
R. Auer, N. Concha-Lozano, I. Jacot-Sadowski, J Cornuz, A. Berthet: 'Heat-Not-Burn Tobacco Cigarettes: Smoke by Any Other Name', in JAMA Internal Medecine 2017 / 177(7):1050-2.
The figures provided by Philip Morris did not say enough about user behaviour, long-term effects and the possible effects of exposure to substances that were actually found in higher concentrations at the IQOS.
PMI Science: Tobacco harm reduction: An excerpt from Scientific Update 10: https://www.pmiscience.com/whats-new/tobacco-harm-reduction-heated-tobacco-FAQ
Pledge agreement: 2017.09.12 FSFW | Executive Summary Pledge Agreement.
Zie Sa'ed, H. Zyoud, Samah W. Al-Jabi, and Waleed M. Sweileh. 'Worldwide research productivity in the field of electronic cigarette: a bibliometric analysis', in BMC Public Health 14.1, 2014. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-667/tables/6
Jean-Francois Etter, 'The Foundation for a Smoke-Free World after two years: can it be trusted?', in: Qeios, 2020. https://doi.org/10.32388/JHYV33
The parent company of Philip Morris USA. Altria has the exclusive licence to sell the IQOS in the US.
Foundation for a Smoke-Free World: Return of Private Foundation OMB No. 1545-0052 Form 990-PF or Section 4947(a)(1) Trust Treated as Private Foundation: https://www.smokefreeworld.org/sites/default/files/uploads/documents/fsfw_2018_form_990-pf_public_inspection.pdf
'Op weg naar een rookvrij Nederland',Philip Morris Holland BV (2018); Innovatie rookloze producten en schadebeperking van tabaksgebruik: brief aan Thematafel Tabak, Nationaal Preventieakkoord.
Brian E. Erkkila, Patricia I. Kovacevic, Derek Yach: 'Restricting Flavors in ENDS Could Have Repercussions Beyond Youths' Use', in: American journal of public health, 110.6 (2020): 777-778: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305674
PJ Landrigan et al.: 'Urgent message to APHA Executive Board and AJPH Editorial Board', 2021. Te vinden op: https://rightoncanada.ca/wp-content/uploads/2021/02/Urgent-message-to-APHA-Executive-Board-and-AJPH-Editorial-Board-2021-01-05.pdf
Interview with Ruth Malone by Stéphane Horel, op 3 maart 2021.
De Argentijnse Asociación Argentina de Servicios y Estudios Médicos de Avanzada, het Pakistaanse 'Alternative Research Initiative en de koepelorganisatie International Network of Nicotine Consumer Organisations kregen alledrie een onbekend bedrag van de FSFW:https://archive.is/BeUVBDe twee laatste organisaties kregen eerder respectievelijk 280 en 260 duizend euro van de FSFW.
D.B. Abrams et al.: 'Tobacco Harm Reduction and the Dutch National Prevention Agreement: Letter from 36 International Experts and Academics', in Tobacco Control, 2019.