In February, billionaire Michael Bloomberg’s charitable organization Bloomberg Philanthropies announced an additional tobacco control commitment of $420 million. A significant proportion of this is to be spent in low- and middle-income countries (LMIC), where 80 percent of people who smoke live. The stated purpose of these funds is to reduce tobacco use and shield non-users from harms. But there is concern among harm reduction advocates, consumers and some lawmakers that they will be used to push policies antithetical to the public health interests of these nations.
Put in perspective, the four-year infusion is meager compared to well over $2 billion invested in tobacco control by governments each year, according to the World Health Organization (WHO)—and insignificant when weighed against the global tobacco and nicotine products market of $941 billion in 2023. Yet, even though tobacco control funding accounts for only about 10 percent of Bloomberg’s overall giving, it is seen as his most impactful public contribution—directly affecting the lives of 1.3 billion people who use tobacco.
Bloomberg Philanthropies’ $1.58 billion expenditure over two decades in 150 nations makes it the largest private tobacco control donor in LMIC. Through funding to hundreds of governmental organisations and influential nonprofits, it has immense ability to influence national tobacco control policies. This is also true at the global level, where the organization has donated close to $1 billion to WHO for anti-tobacco efforts. Bloomberg has retained the prestigious WHO ambassador title since 2016.
“Bloomberg Philanthropies’ tobacco control grants are offered in return for policy amendments.”
While Bloomberg Philanthropies’ tobacco control work has often been a force for good, helping to gradually reduce direct and indirect tobacco harms, it is increasingly seen in a negative light in many LMIC. This is because of its tendency to push one-size-fits-all policies that either cannot be implemented or cause harm—especially its opposition to tobacco harm reduction measures in nations where they are vital, in the absence of public health care and medical coverage.
These hardened policy positions, many activists say, fail to account for local contexts, cultures and needs.
“Bloomberg Philanthropies’ tobacco control grants are offered in return for policy amendments,” Joseph Magero, chair of the pan-African consumer advocacy group Campaign for Safer Alternatives, told Filter. “Unfortunately, their prohibitionist agenda has driven nicotine products, including cigarettes, to the black market, which is thriving in LMIC. Despite 44 countries in Africa having ratified the WHO Framework Convention on Tobacco Control, smoking rates continue to rise.”
In at least one instance, national legislators intervened to prevent Bloomberg Philanthropies from interfering in their domestic policies.
“I welcome bona fide organizations that aim to promote public health in the Philippines,” Congressmember Estrellita Suansing told Filter. “However, what we have seen with Bloomberg Philanthropies and the organizations they fund, as far as the Philippines is concerned, is that the government agencies they give grants to are in effect incentivized to mimic their position on regulatory policies, even if this goes against the policy direction from Congress.”
Suansing was referring to the grants received from Bloomberg-funded organizations by the Philippines’ Food and Drug Administration (FDA). These pushed the agency to take a prohibitionist approach to vaping products and oppose Congress’s efforts to provide with harm reduction alternatives to smoking. Adding vapes to the list of prohibited substances carries particular dangers in a country that has conducted a long and bloody drug war.
“We are following the lead of the United Kingdom and New Zealand in acknowledging that these [vapes] are less harmful than cigarettes.”
“There will be a disconnect when a foreign organization’s funding drives the regulatory policies of a government agency in a way that contradicts our national laws,” Suansing continued. “Congress gave the Philippine FDA the authority to regulate vapor products and heated tobacco products in 2020 under our tax law. However, we saw that the FDA had not been a balanced regulator when it issued draft regulations that included very expensive and time-consuming requirements, resulting in a de facto ban on these products.”
Suansing then filed a bill to insulate executive agencies from pressure from foreign interest groups, and Congress consequently passed the Vaporized Nicotine and Non-Nicotine Products (VNNP) Act in 2022.
“We are following the lead of the United Kingdom and New Zealand in acknowledging that these VNNPs are less harmful than cigarettes and should be made available to adult smokers to help them get rid of this deadly habit,” she said.
Philippines legislators succeeded in thwarting the Bloomberg meddling, but most LMIC are ill-equipped or unwilling to do so.
Bloomberg-funded groups often celebrate the success of prohibitionist legislative efforts. That was the case in India, after it imposed a ban on nicotine vapes in 2019. The Union issued a release outlining how it had influenced the outcome. In Mexico, a legal advisor for Campaign for Tobacco-Free Kids was found in 2021 to have drafted the legislation for banning vapes which was presented in Parliament.
“It supplants the expertise of local groups regarding the needs of the communities they serve with the dictates of a far-off American billionaire.”
Such instances have caused concern that the new round of Bloomberg funds will fuel a renewed push for the prohibition of safer nicotine alternatives in LMIC.
Michelle Minton, senior policy analyst at the Reason Foundation, highlighted many such incidents of interference in a 2021 report titled, “Exposed: Bloomberg’s Anti-Tobacco Meddling in Developing Countries.” She has described Bloomberg Philanthropies’ funding efforts as “philanthro-capitalism.”
“Such large sums of money, particularly in countries with limited funding for charitable work, will almost certainly lead some parts of civil society to alter their priorities in order to qualify for grant money,” she told Filter, “supplanting the expertise of local groups regarding the needs of the communities they serve with the dictates of a far-off American billionaire whose main interest is in passing legislation rather than improving outcomes.”
Notably, Bloomberg Philanthropies states that it is not in favor of the prohibition of all vaping products, though it actively supports banning the flavors that people who switch from smoking find helpful.
A Bloomberg Philanthropies spokesperson declined to comment directly on the dissonance between this position and the Bloomberg-funded organizations seeking blanket bans.
In a 2021 letter to eminent scientists seeking dialogue on tobacco harm reduction, Dr Kelly Henning, who leads public health programs at Bloomberg Philanthropies, wrote:
“I want to reiterate; we are not calling for policies to prohibit the marketing of all e-cigarettes. We have not opposed the sale of tobacco-flavored e-cigarettes and are supportive of efforts to have the federal government do more to both protect youth and to ensure that the products that are made available to adult smokers who want to quit, do in fact, increase the chances of a cigarette smoker quitting altogether and where that is not possible, switching to the use of a product that is demonstrably less harmful, ideally as a pathway to quitting.”
Bloomberg Philanthropies spokesperson Veronica Lewin declined to comment directly on the dissonance between this position and the Bloomberg-funded organizations seeking blanket bans on all vapes—or on whether Bloomberg Philanthropies may hold divergent views on vape policy in Western nations and LMIC.
“Bloomberg Philanthropies and partners utilize a multi-pronged approach, including protecting people against secondhand smoke and raising taxes on tobacco, to strengthen public health and prevent premature deaths related to smoking,” she told Filter. “We have always maintained that if the tobacco industry was serious about health, they would take the formal steps to get e-cigarettes approved as a cessation tool. But they haven’t. Instead, the industry tries to block implementation of tobacco control measures and is increasingly targeting young people with flavored products in the hopes of making them lifelong customers.”
Some tobacco and vape companies have gone to lengths to obtain FDA authorization for their vaping products as “appropriate for the protection of public health” in the United States, where heated tobacco products have also been granted “modified risk” authorization. And in the United Kingdom, efforts to medically licence vaping products are already under way, though tobacco harm reduction experts have argued for them to be regulated as consumer goods to ensure they remain as accessible as tobacco products.
It is impossible to see how banning or heavily restricting vapes serves the purpose of preventing smoking-related deaths in LMIC.
Vaping has long been demonstrated to carry vastly fewer harms than smoking. And the latest Cochrane Review found it to be more effective than nicotine replacement therapies for smoking cessation.
In the UK, where vaping has been broadly welcomed, an estimated 4.3 million people now vape; of these, 2.4 million formerly smoked, another 1.5 million vape and smoke (and may be on a path to switching entirely), and just 350,000 have never smoked. Teen vaping in the US has also fallen significantly after an initial spike, and regular use among those who have never smoked has always been low.
In light of such evidence, it is impossible to see how banning or heavily restricting vapes serves the purpose of preventing smoking-related deaths in LMIC.
“For its work to be meaningful in developing countries, Bloomberg Philanthropies should explicitly state it is against prohibition of risk-reduced alternatives to deadly smoking and local products,” Professor Roberto Sussman, president of the consumer advocacy group Pro-Vapeo Mexico, told Filter. Sussman has previously criticized Bloomberg influence on Mexico’s tobacco control policies.
He continued that Bloomberg Philanthropies should also “provide funds for cessation facilities, help strengthen efforts to prevent sale to minors, reject prescription-only models for e-cigarettes and support tobacco harm reduction measures by halting demands that they be regulated in similar restrictive ways as cigarettes.”
Without such commitments, at least some of the new Bloomberg dollars flowing to LMIC are likely to do more harm than good.
Photograph by Mike Mozart via Flickr/Creative Commons 2.0