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Understanding Covid-19 and Tobacco in six Low and Middle Income Countries: findings and reflections from a desk-based mapping study

Authors: Hayley Dunlop, Prerna Krishan, Loren Kock, Fiona Dobbie

In May 2020 a team of researchers from the University of Edinburgh, in collaboration with colleagues from six low and middle income countries (Bangladesh, India, Ghana, Uganda, Ethiopia, and Pakistan) were commissioned to conduct a rapid response study to examine tobacco use and tobacco control during Covid-19. The study aimed to produce country-specific Covid-19 and tobacco policy briefings to support policy and practice to address tobacco use during and beyond the Covid-19 pandemic.

Further information about the study method and findings on the study webpage

One element of the study was to conduct a desk-based mapping to identify data sources that had not been published in peer-reviewed journals.  These data sources included materials such as government reports, online print press and social media. Here we present key findings from the mapping as well as reflections from the postgraduate students who conducted the data search and data extraction.

What did we do?

The mapping was led by Fiona Dobbie and three postgraduate students (Hayley Dunlop, Prerna Krishan, Loren Kock), with support from the wider project team. A mapping protocol was created to set out the aims and parameters of the study. This was used to guide the mapping exercise and data extraction.

Three rounds of data searching were conducted between 14th May and 01 July 2020. Search terms related to Covid-19 and tobacco, smoking, smokeless tobacco, and the tobacco industry were entered into Google “All” and Google “News”. Google Alerts were used to identify additional online print press resources. The websites and twitter accounts for each country’s WHO Country Office, Ministry of Health and Ministry of Information (if applicable) were searched for content related to Covid-19 and tobacco. Relevant Non Governmental Organisations (NGOs) were identified for each country and the websites and twitter accounts of these NGOs, along with twitter accounts of active researchers, clinicians in the field, and government officials. Consultations with our in-country collaborators helped the robustness of our data search, with additional data sources and document translation offered as required.

What did we find out?

Print press and social medial (Twitter) were important mediums to convey Covid-19 information and advice to tobacco users. Across all countries, the key and consistent message was to stop using tobacco products. This is due to the risk of contracting and spreading Covid-19 due to hand to mouth contact and the sharing of mouthpieces when using water pipes. Despite this advice, our search found no evidence of a population-level policy responses to promote tobacco cessation or to strengthen/enforce existing tobacco control measures in any of the six countries in our study.

However, tobacco advertising was banned in Pakistan in all forms of media and India implemented measures to curb tobacco manufacturing, distribution and usage, during Covid-19 lockdown. NGOs and tobacco control organizations in Bangladesh also campaigned for a temporary ban of tobacco usage and tax on tobacco products to protect public health and repair the economic damage caused by Covid-19. Similar calls came from the Ghana NCD Alliance and the Vision for Alternative Development for the Ghanaian government to strengthen or enforce existing tobacco control measures.

The mapping found little information about the tobacco industry’s response to Covid-19. However, tweets from the Uganda Health Communication Alliance and Tobacco Control Uganda were found that responded to industry claims that nicotine had protective factors against Covid-19.

Reflections from the postgraduate students who conducted the data search and data extraction

The data mapping project taught us a great deal about conducting a goal-oriented, strategic and systematic search process. This included the need for maintaining transparent, understandable and easily accessible data records to enable our country collaborators to continue the mapping exercise. There were a substantial number of data sources for each country identified with new data sources appearing daily, so it became clear that having records of each search would be essential to maximize the efficiency of our work and to ensure it could be replicated in the future as more information regarding Covid-19 and tobacco became available for each country.

The research process also helped us to better understand the factors impeding health policy agendas for tobacco cessation and relationships between Covid-19 and tobacco use. Public information regarding the risk of tobacco use and Covid-19 was not readily available in many countries via official government channels of public communication, nor has policy change taken place. Instead, we noted multiple innovative methods that have been devised by NGOs to disseminate information regarding Covid-19 risk and smoking cessation. This emphasises the importance of clear and comprehensive health risk communication during pandemics.

After reviewing the policy briefing for each country we read about tobacco lobbies, industry donations, and unconventional methods of tobacco sale used to subvert tobacco control efforts during the Covid-19 pandemic. We realised that continued promotion of tobacco cessation, public information about tobacco use and Covid-19 and how tobacco sales should be addressed during this and future respiratory disease epidemics are important for  pandemic NCD prevention.