In February, billionaire Michael Bloomberg's philanthropic organization, the Bloomberg Philanthropies, announced an additional $420 million commitment to tobacco control, with a significant portion earmarked for low- and middle-income countries (LMICs) where 80% of smokers live.
The funds are intended to reduce tobacco use and protect non-users from harm. However, advocates for harm reduction, consumers, and some lawmakers worry they will be used to push policies that run counter to the public health interests of these countries.
According to data from the World Health Organization (WHO), the four-year investment is negligible in the long run, compared to the over $2 billion governments invest annually in tobacco control, and is minuscule compared to the $94.1 billion global tobacco and nicotine product market, expected to reach $10 billion by 2023.
Despite tobacco control funding comprising only about 10% of Bloomberg's total donations, it is seen as his most influential public contribution, directly impacting the lives of 1.3 billion tobacco users.
Over the past 20 years, Bloomberg Philanthropies has spent $1.58 billion in 150 countries, making it the largest private donor to tobacco control in LMICs. By funding hundreds of government and influential non-profit organizations, it has tremendous power to influence national tobacco control policies.
At the global level, the organization has also donated nearly $1 billion to the WHO for anti-tobacco work. Since 2016, Bloomberg has held the prestigious title of WHO Ambassador for Noncommunicable Diseases.
Although Bloomberg Philanthropies' tobacco control work is often a positive force, helping to gradually reduce direct and indirect tobacco harm, its negative impact is increasingly being seen in many low- and middle-income countries. This is because it tends to promote a one-size-fits-all approach, which either cannot be implemented or can cause harm - especially in countries without public healthcare and health insurance, where it opposes measures to reduce tobacco harm.
Many activists say that these tough policy positions fail to take into account local context, culture, and needs.
"Bloomberg Philanthropies provides tobacco control grants in exchange for policy amendments," Joseph Magero, President of the African Coalition for Tobacco Control, told Filter. "Unfortunately, their ban agenda has pushed nicotine products, including cigarettes, into the thriving black markets in low- and middle-income countries. Despite 44 African countries ratifying the WHO Framework Convention on Tobacco Control, smoking rates are still on the rise."
In at least one example, national lawmakers intervened to prevent Bloomberg Philanthropies from interfering in their domestic policies.
"I welcome well-meaning organizations that aim to promote public health in the Philippines," Congresswoman Estrellita Suansing told Filter. "However, in the case of the Philippines, what we see in Bloomberg Philanthropies and its sponsored organizations is that government agencies that receive grants are actually incentivized to mimic their stance on regulatory policies, even if it runs counter to the direction of Congress."
Suansing refers to the grant received by the Philippines' Food and Drug Administration (FDA) from an organization funded by Bloomberg. These grants have led the agency to adopt a prohibitionist stance on e-cigarette products and oppose efforts by Congress to provide reduced harm smoking alternatives. In a country that has been waging a long and bloody war on drugs, adding e-cigarettes to the list of prohibited substances could bring special dangers.
"We follow the footsteps of the UK and New Zealand, acknowledging that these e-cigarettes are less harmful than cigarettes," Suansing said.
"When foreign organizations' funds push government agencies' regulatory policies in ways that violate our national laws, there will be a disconnect," Suansing continued. "According to our tax laws, Congress authorized the Philippine FDA to regulate vapor products and heated tobacco products in 2020. However, we see that the FDA is not a balanced regulatory agency when it releases a proposed regulation that includes very expensive and time-consuming requirements, resulting in the ban of these products in practice."
Suansing then submitted a bill that would free the executive branch from pressure from foreign interest groups, and Congress passed the Vaporized Nicotine and Non-Nicotine Products (VNNP) Act in 2022.
"We follow the footsteps of the UK and New Zealand, acknowledging that these VNNPs are less harmful than cigarettes and should be provided to adult smokers to help them break this deadly habit," she said.
Philippine lawmakers successfully blocked Bloomberg's intervention, but most low- and middle-income countries are not ready or willing to do so.
Bloomberg-funded groups often celebrate the success of prohibitionist legislation, such as in India, where a ban on nicotine e-cigarettes was imposed in 2019. The Union released a press release outlining how it influenced the outcome. In Mexico, in 2021, the legal advisor of a smoke-free children's movement drafted legislation to ban e-cigarettes in parliament.
"It replaces the local groups' expertise on the needs of the communities they serve, and this is the direction of a distant American billionaire," she said.
This situation has raised concerns that a new round of Bloomberg funding will again push for the prohibition of safer nicotine alternatives in LMICs.
Michelle Minton, senior policy analyst at the Reason Foundation, emphasized many such interference incidents in a 2021 report titled "Exposure: Bloomberg's Antismoking Interventions in Developing Countries." She describes Bloomberg's fundraising as philanthropic capitalism.
"So much funding, particularly in countries where charitable funding is limited, is almost certain to cause some part of civil society to change their priorities to be eligible for the grants," she told Filter, "replacing local groups' expertise on the needs of the communities they serve and the direction of a distant American billionaire, whose primary interest is passing legislation rather than improving outcomes."
It is noteworthy that the Bloomberg Philanthropies stated that it does not advocate for a ban on all e-cigarette products, although it actively supports a ban on flavors that smokers seeking to quit find helpful.
A Bloomberg Philanthropies spokesperson declined to directly comment on the inconsistency between this position and the Bloomberg-funded organization seeking a comprehensive ban.
Dr. Kelly Henning, director of public health programs at Bloomberg Philanthropies, wrote in a letter to prominent scientists seeking to reduce tobacco harm in 2021:
"I want to reiterate; we are not advocating for a policy to ban the sale of all e-cigarettes. We are not opposed to the sale of tobacco-flavored e-cigarettes and support the federal government taking more steps to protect young people and ensuring that the products offered to adults who want to quit smoking are effective, increase the chances of smokers quitting completely, and, where quitting is not possible, switch to less harmful products, which is the ideal way to quit smoking."