Table 1.

Policies implemented, tobacco industry responses and lessons learnt

Tobacco control policies	Provisions content	Tobacco industry response	Lessons learnt and suggested actions
Tobacco advertising, promotion and sponsorship	Restrictions on advertising, promotion and sponsorship, except: Newspapers (print media). However, for each advertisement in the print media, an adjacent counter-advertisement by the MOH will be published in the same newspaper. In addition, only one advertisement per each printed edition is allowed and needs to include a textual health warning covering 30% of the print media advertisement area; Art objects; Specialised tobacco and/or alcohol shops; Direct written mailing to over 21 years old, with pre-authorisation.	Industry offset the MOH counter advertisements by using advertisements that neutralise/correspond to the MOH counter advertisements. This was possible due to the fact that the MOH was required by law to pre-publish each counter-advertisement on their website. For example, in months when electronic cigarettes were negatively featured in the MOH counter advertisement, the industry placed less priority on electronic cigarette advertisements. In months when cigarettes were featured in the MOH counter advertisement, industry placed more priority on advertisements with electronic cigarettes or heated tobacco products and included messaging promoting switching and implying harm reduction. QR codes were included in print media advertisements exposing consumers to direct advertisements not covered by legislation (figure 1A, red circle). Print media advertisements included small background elements that resemble the previous non-plain packaging (eg, the Marlboro red colour and format without the brand name) (figure 1A, red circle). When this was not met with a response, they including the full-size previous packaging in the advertisement (figure 1B.) Direct advertisement included messaging to continue to promote specific brands of cigarettes despite plain packaging (eg, highlighting same low price, highlighting same taste). License request wording for their mobile stands was changed to a ‘mobile shop’ to be able to locate these at events such as university student fairs.	Advertisement ban must be complete and include all forms of media, with no exemptions. If this is not possible: Regulatory agencies should not release in advance mandatory governmental counter-advertisements Consider requiring the industry to submit their advertisements prior to publishing them allowing regulatory agencies to inform their counter-advertisements based on industry messages. Specify no allowance of QR codes or any other means of directing people to advertisements Specify which, if at all, branding elements are allowed as part of the advertisements Specify exact wording and elements allowed as part of direct advertisements, and that direct advertising is only allowed on the official website. Ban mobile stores selling tobacco or vaping products altogether.
	Point-of-sales display ban, except: Specialised tobacco and/or alcohol shops (as long as not visible from outside the store); Duty-free shops (as long as not visible from outside or from other parts of the shop); Dedicated online shops (allowed to only include specific details of the product without pictures).^*	Attractive display cases, not hermetically closed (thus allowing products to be somewhat visible) were supplied by the industry (figure 2C) Signs that feature text saying “We sell cigarettes” (figure 2C), as well as display boxes for heated tobacco product with text on the exterior saying “An alternative to cigarettes” or “We sell HEETS”, and display boxes for electronic cigarettes that say “Vaping products”.^†	Specify the display case features that are allowed, including how the display will open, hermetic closing and wording allowed (or not) on the display or signs.
Tobacco packaging and labelling	Plain packaging using the colour Pantone 448 C, for all tobacco products, including heated tobacco and electronic cigarettes. Only specific wording is allowed on the packaging (including the name of the product and the manufacturer). Textual health warnings will be included on both the cover and back of the package, covering 65% of the package for tobacco products and 30% for electronic cigarette products. All packaged products will also include an insert with health warnings and smoking cessation support options.^‡	Prior to legislation taking effect, PMI distributed branded tin cigarette cases (to encase plain-packaged cigarettes). Packaging was altered to include branding and advertisements inside packages and on single cigarettes. Print media advertisements were used to offset the impact of plain packaging. For example, highlighting that plain packaging did not change the product (‘different packaging, same product’) or using original colours and names adjacent to plain packaging in advertisements to highlight the differences between the different brands. (figure 1C)	Ban the use of branded tobacco accessories Ban any branding and advertisement inside packaging and on single cigarettes. Specify exactly the additional wording and colours allowed to be used in any advertisement, with reference to plain packaging.

Tobacco control policies

Provisions content

Tobacco industry response

Lessons learnt and suggested actions

Tobacco advertising, promotion and sponsorship

Restrictions on advertising, promotion and sponsorship, except:

Newspapers (print media). However, for each advertisement in the print media, an adjacent counter-advertisement by the MOH will be published in the same newspaper. In addition, only one advertisement per each printed edition is allowed and needs to include a textual health warning covering 30% of the print media advertisement area;
Art objects;
Specialised tobacco and/or alcohol shops;
Direct written mailing to over 21 years old, with pre-authorisation.

Industry offset the MOH counter advertisements by using advertisements that neutralise/correspond to the MOH counter advertisements.

This was possible due to the fact that the MOH was required by law to pre-publish each counter-advertisement on their website. For example, in months when electronic cigarettes were negatively featured in the MOH counter advertisement, the industry placed less priority on electronic cigarette advertisements. In months when cigarettes were featured in the MOH counter advertisement, industry placed more priority on advertisements with electronic cigarettes or heated tobacco products and included messaging promoting switching and implying harm reduction.

QR codes were included in print media advertisements exposing consumers to direct advertisements not covered by legislation (figure 1A, red circle).
Print media advertisements included small background elements that resemble the previous non-plain packaging (eg, the Marlboro red colour and format without the brand name) (figure 1A, red circle).
When this was not met with a response, they including the full-size previous packaging in the advertisement (figure 1B.)
Direct advertisement included messaging to continue to promote specific brands of cigarettes despite plain packaging (eg, highlighting same low price, highlighting same taste).
License request wording for their mobile stands was changed to a ‘mobile shop’ to be able to locate these at events such as university student fairs.

Advertisement ban must be complete and include all forms of media, with no exemptions.

If this is not possible:

Regulatory agencies should not release in advance mandatory governmental counter-advertisements
Consider requiring the industry to submit their advertisements prior to publishing them allowing regulatory agencies to inform their counter-advertisements based on industry messages.
Specify no allowance of QR codes or any other means of directing people to advertisements
Specify which, if at all, branding elements are allowed as part of the advertisements
Specify exact wording and elements allowed as part of direct advertisements, and that direct advertising is only allowed on the official website.
Ban mobile stores selling tobacco or vaping products altogether.

Point-of-sales display ban, except:

Specialised tobacco and/or alcohol shops (as long as not visible from outside the store);
Duty-free shops (as long as not visible from outside or from other parts of the shop);
Dedicated online shops (allowed to only include specific details of the product without pictures).^*

Attractive display cases, not hermetically closed (thus allowing products to be somewhat visible) were supplied by the industry (figure 2C)
Signs that feature text saying “We sell cigarettes” (figure 2C), as well as display boxes for heated tobacco product with text on the exterior saying “An alternative to cigarettes” or “We sell HEETS”, and display boxes for electronic cigarettes that say “Vaping products”.^†

Specify the display case features that are allowed, including how the display will open, hermetic closing and wording allowed (or not) on the display or signs.

Tobacco packaging and labelling

Plain packaging using the colour Pantone 448 C, for all tobacco products, including heated tobacco and electronic cigarettes. Only specific wording is allowed on the packaging (including the name of the product and the manufacturer). Textual health warnings will be included on both the cover and back of the package, covering 65% of the package for tobacco products and 30% for electronic cigarette products. All packaged products will also include an insert with health warnings and smoking cessation support options.^‡

Prior to legislation taking effect, PMI distributed branded tin cigarette cases (to encase plain-packaged cigarettes).
Packaging was altered to include branding and advertisements inside packages and on single cigarettes.
Print media advertisements were used to offset the impact of plain packaging.

For example, highlighting that plain packaging did not change the product (‘different packaging, same product’) or using original colours and names adjacent to plain packaging in advertisements to highlight the differences between the different brands. (figure 1C)

Ban the use of branded tobacco accessories
Ban any branding and advertisement inside packaging and on single cigarettes.
Specify exactly the additional wording and colours allowed to be used in any advertisement, with reference to plain packaging.

Internet sales of products are only allowed to include the name of the product, country of manufacturer, price, parts and components of the product and their amount, and regarding electronic cigarettes—also the nicotine concentration in the product.

^†

It is not completely clear whether these new signs are considered a violation of the new law. The wording in the legislation does not permit any advertisement at the point-of-sales. However, it is not clear whether that refers to advertisements that include a specific brand or whether that includes also general advertisements that are not specific to a certain brand. Differing legal advice has been issued on this topic, but due to lack of enforcement, this was never challenged publicly.

^‡

The inserts require the Ministry of Health, after authorisation from the Economic Committee, to publish specific regulations regarding the inserts size, design, form, language used, messaging turnover and the inclusion of graphic health warnings. This has not been done yet by the Ministry of Health and therefore the use of inserts is not currently implemented.

MOH, Ministry of Health; PMI, Philip Morris International.