The tobacco industry (TI) is known to conceal the harmful effects of tobacco use from the public and use tactics to influence public policies related to tobacco for commercial gains. An extensive tool namely Global Tobacco Industry Interference Index exists which assesses the level of tobacco industry influence by measuring the Implementation of Article 5.3.

How exactly (using specific tactics) TI interferes in tobacco control over time in India and what has been government response over time. Understanding and analysing TI strategies along with government response is essential for policy makers to take appropriate preventive and corrective measures in order to limit TII in policy making.

The findings will help policymakers improve their approaches and bolster their efforts to prevent/minimise TII to safeguard public health.

The secondary data originated from the four rounds of the Global Tobacco Industry Interference Index; the first index in 2019 encompassed 33 countries, followed by the second index in 2020 covering 57 countries, and subsequently the third index in 2021 covering 80 countries and fourth index in 2023 evaluating 90 countries. The country’s ranking was executed using the identical questionnaire and scoring approach as the ASEAN Index, devised by the Southeast Asia Tobacco Control Alliance (33). The Global Center for Good Governance in Tobacco Control (GGTC), situated at the School of Global Studies, at Thammasat University, acts as the leading center with support from Stopping Tobacco Organizations and Products (STOP), Thai Health Promotion Foundation, and the Bill and Melinda Gates Foundation (facilitates the assessment of countries and the formulation of the index) (34), which assists in assessing countries and formulating the index. The index is based upon a publicly accessible dataset concerning TII within countries, as well as the responses of their respective governments and civil society organizations about the domains of the index to such interference (34).

The Global Tobacco Index (or Global Tobacco Industry Interference Index) rates a nation according to how governments address the industry, incorporating preventative measures (34). The seven major domains of the index are Participation in Policy Development, Tobacco-Related CSR Activities, Benefits to Tobacco Industry, Forms of Unnecessary Interaction, Transparency, Conflict of Interest, and Preventive Measures (34–37).

A composite score was obtained after adding the scores for various domains of the Global Tobacco Industry Interference Index for each year. A lower score indicates a reduced level of overall interference, which is considered beneficial for the country’s public health efforts (34).

The study relies on publicly available secondary data, eliminating the need for informed consent. Data privacy and confidentiality are ensured by utilizing aggregated information. Since no direct interaction with human participants took place, the study does not involve potential harm to individuals.

Despite being a signatory to the convention for 15 years, India has not been able to establish a national policy for all government officials that effectively prevents interference from the TI (38). Many countries such as Iran, Korea, Nepal, Kenya, the UK, Uganda, and Uruguay have set commendable examples by excluding the TI from policy-making discussions and rejecting any form of support, collaboration, or input from the industry when developing and implementing public health policies (36, 38, 39). In India, though the TI is not part of policy development, indirect lobbying efforts and political favors influence the policy (40). In addition, health is a state subject in India, so many state governments have taken proactive initiatives to control the interference of the TI. For example, the High Court of Karnataka demanded the Tobacco Board of India to withdraw its participation and funding from a TI event, in addition to asking governments to consider a “code of conduct” for dealing with the TI (41). To date, 22 states of India have enacted a protocol for public employees, banning the exchange of favors or any cooperation between a public agency and the tobacco business, hence limiting the interactions between public officials and the TI (42).

India’s corporate sector, including cigarette corporations, is mandated to allocate a minimum of 2% of profits to corporate social responsibility (CSR) activities under the Companies Act if the net worth of the company is more than 500 crore or their annual turnover is above 1,000 crores or the net profit is above 500 crores (43). As this rule also applies to some cigarette companies, a challenging situation has emerged because the social welfare initiatives of these companies may indirectly encourage tobacco use. To manage this shortcoming in the Companies Act, both the Cigarettes and Other Tobacco Products Act (2003) and FCTC recommend banning TI CSR activities to de-normalize and regulate their so-called “socially responsible” actions (22). The government has witnessed a gradual rise in the contributions received from the TI, and an increase in collaborations between the government and the industry for CSR initiatives over time (23). In one of the instances Indian tobacco businesses contributed close to US$37 million to government coffers as part of COVID-19 relief initiatives (23), for enhancing their corporate image and generating profits, thereby contravening the provisions under COTPA 2003 and FCTC Article 5.3. These CSR activities conducted by Indian tobacco companies involve the utilization of their corporate trademarks, which are also present on their respective tobacco products. As a case in point, ITC employs the “ITC” trademark across all its tobacco and non-tobacco goods, while “Godfrey Phillips” and “DS Group” employ the same trademark for their entire product range. These instances of CSR activities conducted by Indian tobacco companies, especially the usage of company trademarks, violate not only Section 5(3)(b) of COTPA 2003 but also Article 13 of the WHO Framework Convention on Tobacco Control (WHO FCTC) and the associated implementation guidelines (12, 23). For example, in response to a legal petition, one of the high court of India has categorically outlined that the cigarettes and TI, in the course of their CSR activities, cannot breach the provisions outlined in the COTPA, 2003 (44).

WHO Article 5.3 demanded that the countries should refrain from providing advantages or incentives to the TI (36). In the countries, where CSR activities were reportedly intensive such as Malaysia, Pakistan, Tanzania, and Zambia, it was observed that these countries did not impose any tax increases on tobacco (36). In a similar fashion, India was unable to make progress in ceasing the provision of benefits to the TI, as evidenced by a consistent score of five points maintained between 2019 and 2021. The evidence suggests that the Indian government continues to grant privileges, incentives, exemptions, or benefits to the TI (34–36). However, there has been improvement in the period from 2022 to 2023, with the score decreasing to four. The introduction of India’s Goods and Services Tax (GST) in 2017 brought about substantial changes to the system of indirect taxation. All tobacco products became subject to the highest slab (28% GST) with an additional compensation cess for cigarettes and smokeless tobacco products (45). However, for some states, the newly introduced taxes were less as compared to the old VAT regime (45). Moreover, the beedi (hand-rolled tobacco wrapped in specific tendu leaves) industry enjoys the status of a cottage industry and remains out of this tax slab. Furthermore, companies with <20 employees or small tobacco farmers and exporters are also exempted from tax (40). Such exemption should be withdrawn and uniform taxation should be introduced to all tobacco products in line with WHO recommended taxation of 75% on the retail price of tobacco products (46).

Unwarranted engagements take place when high-ranking government officials attend social events organized by tobacco companies or when the government embraces offers of assistance or forms partnerships with the TI (34). The TI has gained notoriety for its resourcefulness in maintaining relationships with governments worldwide (47). In 2015, India’s largest cigarette manufacturer provided funding for the 10th Sustainability Summit held in the capital city of New Delhi (47). This tobacco company has a long-standing association with the CII-ITC Center of Excellence for Sustainable Development, which regulates these events with partnerships with various government ministries, including Housing and Urban Poverty Alleviation and Environment, Forests and Climate Change, and GIZ (German Society for International Cooperation, Ltd.) (47). Few prominent figures from the TI often held key positions in these summits, frequently alongside policymakers. A representative from the United Nations Development Program (UNDP) was also listed as a speaker (47). This summit evoked memories of the World Business and Development Awards, an initiative supported by UNDP to recognize private sector entities striving to achieve the Millennium Development Goals (47).

The significance of transparency is emphasized in WHO Article 5.3, which urges governments to establish mechanisms that mandate the TI to provide regular disclosures regarding their activities and practices. However, the government falls short of ensuring such obligations from the TI, as evident from the rise in the overall score from nine in 2019 to 10 in both 2020 and 2021. Additionally, there has been a rise in the score from four in 2019 to five in both 2020 and 2021, followed by a decline to four in 2023 regarding the need for the government to implement rules regarding the disclosure or registration of TI entities, affiliate organizations, and individuals acting on their behalf, including lobbyists (34–37).

The guidelines outlined in Article 5.3 recommend the avoidance of conflicts of interest among government officials and employees, along with the establishment of rules to safeguard public health policies from interference by the TI (34). To prevent industry influence on tobacco control policies and programs, India’s Ministry of Health and Family Welfare adopted a code of conduct in 2020 after 13 states implemented Article 5.3; however, the scope of application is restricted to health ministry officials (48). A former member of the Indian Administrative Service (IAS) who held several high-level positions in the Ministries of Communications, Information Technology, and Home Affairs in India has joined the Godfrey Philips board as an independent director (49). A former Honorable President of India was the chief guest at the Confederation of Indian Industry (CII)-ITC Sustainability Awards event in 2012, which presents a conflict of interest (13). Furthermore, in 2011, the Chairman of one large tobacco company was bestowed with the Padma Bhushan, which is India’s third highest civilian award, thereby highlighting a possible contradiction between their official positions and their associations with the TI (13). Over the course of 5 years, the Indian government has demonstrated progress in addressing conflicts of interest, as reflected in the decrease in scores from 12 in 2019 to 10 in 2020 and further to 9 in 2021 and 2023.

The guidelines outlined in Article 5.3 offer a variety of measures that governments can implement to safeguard their tobacco control policies against interference from commercial and vested interests (36). The adoption of a code of conduct for officials dealing with the TI, the implementation of transparency and accountability procedures for interactions, and the prohibition of accepting any kind of contributions—including technical assistance—from the TI are just a few proactive steps that governments can take to protect their officials from exposure to interference (39). Several nations, including the Philippines, the United Kingdom, and Australia, have implemented a code of conduct guiding public official’s interactions with the TI. Following them in July 2020 India has also embraced a similar code of conduct for public officials engaging with the TI (50). This indicator showed the most improvement among all indicators over a 5-year period, reducing from a score of 21 in 2019 to 10 in 2023. However, the national policy, titled “Code of Conduct for Public Officials,” applies only to officials of the Ministry of Health and Family Welfare, limiting its scope (51). This restriction contradicts Article 5.3 guidelines, creating a barrier to effective implementation (13). A broader national policy is needed, aligning with state initiatives, to establish effective multilevel governance for tobacco control (13). Despite the fact that various states have codes of conduct for dealing with public officials across the government; however, they are limited in their implementation and are variable, which are not fully compliant with a recommendation under WHO FCTC Article 5.3 (52).

Despite laudable efforts by India over the last few decades to improve TII scores, there have been increasing rates of cancers. The etiology of cancer is quite complex and is driven by multiple variables including demographic, social, economic, and cultural factors. Effective tobacco control measures usually show their positive impact on cancer incidence only after a decade or more. Therefore, it is not unusual to see enhanced tobacco control measures coexisting with increasing cancer incidence and current prevalence rates. Factors such as age, alcohol consumption, exposure to carcinogens, chronic inflammation, diet, hormonal changes, immunosuppression, infectious agents, obesity, radiation, and sunlight exposure all contribute to the multifaceted nature of cancer risk, highlighting that focusing solely on tobacco control may not be sufficient to reduce overall cancer rates (53). However, accelerated tobacco-control programs, especially in areas where usage is increasing, will be crucial in reducing the rates of tobacco-related cancer mortality (54).

The top tobacco companies operating in India ITC, British American Tobacco’s Indian affiliate, Godfrey Phillips India holds a dominant 90% share of the Indian manufactured cigarette market (55, 56). These figures indicate significant market power and revenue for these companies (55, 56). Historically, Indian tobacco companies spent heavily on marketing and advertising before restrictions, demonstrating substantial financial resources. During the COVID-19 pandemic, tobacco companies made significant donations and CSR contributions, contributing approximately $36.7 million (23). ITC alone committed $13.2 million to the PM CARES Fund and established a $19.8 million contingency fund, reflecting their considerable financial capability (23). Moreover tobacco companies have also continued to influence the government through sponsorship and CSR activities, as highlighted in the India Tobacco Industry Interference Index 2020, indicating their financial capacity to engage in policy-influencing activities.

In the regional context, India’s scores positioned it mid-way, akin to countries such as Pakistan, Vietnam, and the Philippines. Another group of countries, including Thailand, Nepal, Sri Lanka, and Maldives exhibited lower scores (41–50) than India demonstrating a significant improvement in implementation of Article 5.3 of FCTC. Conversely, a cluster of significant economies, including Malaysia, Bangladesh, Lao PDR, China, Indonesia, and Japan, registered higher scores than India (70–88). Notably, India and Sri Lanka made commendable progress, with scores dropping from 69 to 58 and 58 to 42, respectively.

The current study draws patterns from the Global Tobacco Industry Interference Index which only includes data that is readily accessible to the public limiting its scope (36). A major limitation is the reliance on publicly available information. In a country like India, which is vast, multilingual, and has numerous media outlets, as well as many business and government entities operating at various levels and scales, it is challenging to gather and scrutinize all potential evidence of TII present in the public domain. For example, many studies on TII in India have only examined English-language media and have only marginally considered selected regional language media. This limitation is particularly significant in India’s complex landscape. Due to its vast size, linguistic diversity, numerous media outlets, and many business and government entities, comprehensively gathering and analyzing all potential evidence of TII is extremely challenging. Many Indian TII studies have primarily focused on English-language media, with only limited exploration of regional language sources. It is challenging to gather comprehensive data on industry interference, which is a crucial provision of the FCTC rules because of a lack of transparency. Some of the TI’s interference and lobbying activities would have become virtual with the introduction of pandemic-related lockdowns and movement restrictions in many countries, making them less transparent and more difficult to monitor and document (36). Furthermore, the global index provides aggregate scores at the indicator level. In addition, it is limited regarding access to specific TII instances and/or examples of preventive measures scored in order to arrive at indicator-level scores. The lack of such granular-level insights limits us in making more specific recommendations/interpretations.