BioEd Online

A historic agreement to curb the millions of deaths caused each year by tobacco comes into force this weekend. The pact is the first international and legally binding treaty targeted at the use of tobacco.

Tobacco kills nearly 5 million people every year, around one in ten adults. It is the leading preventable cause of death. Whereas some countries have already successfully introduced measures to check smoking, the habit is rampant in others, such as China and India.

The World Health Organization (WHO) Framework Convention on Tobacco Control aims to rein in tobacco's use and the harm it causes. Countries that ratify the treaty have to introduce regulations and restrictions such as health warnings on cigarette packets, limits on tobacco advertising and protections against secondhand smoke.

The convention is the first legally binding treaty to be negotiated by the WHO, the branch of the United Nations that specializes in health; it normally relies on non-binding resolutions. "It's historic from the WHO point of view and the public health point of view," says Vera Luiza da Costa e Silva, director of the organization's Tobacco Free Initiative based in Geneva, Switzerland.

Joining fast

The WHO began work on the tobacco convention in 1999. It was adopted by member states in 2003, but required more than 40 countries to ratify the agreement before it became law. When Armenia and Ghana did so in late November 2004, this triggered a 90-day countdown to the convention coming into force, on Sunday 27 February.

The treaty has now been ratified by 57 out of 192 member countries in the WHO, together representing about one-third of the world's population. Costa e Silva expects many more to join within the next few months, and says that the treaty is one of the fastest to be embraced in the United Nations. "We are very proud," she says.

Even before it came into force, the treaty prompted many countries to implement measures to discourage smoking. Within the last year, for example, Ireland, Norway and Italy have introduced smoking bans in workplaces or public spaces.

But public-health experts believe the agreement will strengthen and coordinate efforts made by individual countries, so they are better able to combat multinational tobacco companies and deal with problems that span country borders.

For example, the treaty requires countries to stem the widespread practice of cigarette smuggling by clamping down on counterfeiting and improving tracking and accounting for products. "It's a tremendous step forward," says Jonathan Samet, a specialist in smoking and health at Johns Hopkins University in Baltimore, Maryland.

Not giving up

Those involved in the treaty say that it is just a start. Many countries now need money and support to help them enforce the new rules. For example, some nations lack a central office for tobacco control. "The current rate of change is pitifully slow," says Derek Yach of Yale University in New Haven, Connecticut, who previously headed the WHO's Tobacco Free Initiative.

Indeed, the impact of the treaty on deaths from smoking may not be seen for 30 to 40 years, Costa e Silva says. The new restrictions are expected to cut smoking-related deaths by around 1% per year, but it will take far longer for this decline to outweigh the growth in the world's population and the accompanying growth in the number of smokers.