Background and challenges to implementation:
Pictorial health warnings (PHWs) on tobacco products are the most cost-effective means to convey harms of tobacco use to smokers and the public. By 2017, all ten Association of Southeast Asian Nations (ASEAN) countries had legislated PHW requirements in accordance to World Health Organization Framework Convention on Tobacco Control Article 11 Guidelines. Strong opposition came from tobacco companies to undermine PHWs implementation at the country level. These challenges were identified and countered successfully.
Singapore and Thailand were the first ASEAN countries to implement PHWs in 2004 and 2005, followed by Brunei (2008), Malaysia (2009), Vietnam (2013), and Indonesia (2014). In 2016, Philippines (March), Cambodia (July) and Myanmar (September) implemented PHWs. Lao PDR was the latest country to implement (April 2017).
In most countries, the tobacco industry interfered by lobbying policymakers to adopt smaller, ineffective PHWs and delaying the implementation. They also mobilized allies and third parties and misled governments with false claims that PHWs violate international treaties on trademarks and intellectual property rights.

Intervention or response:
Industry claims and tactics were exposed and countered with evidence-based arguments and international best practices. Southeast Asia Tobacco Control Alliance (SEATCA) provided technical support, display kits of sample health warnings from other ASEAN countries, and free use of copyrighted PHWs via a regional image bank.

Results and lessons learnt:
ASEAN is the only region where all member states have successfully implemented PHWs on tobacco packs. The power of teamwork in fighting the industry through a regional platform and sharing experience and resources led to this success.

Conclusions and key recommendations:
The tobacco industry uses a wide range of tactics to oppose implementation of effective tobacco control measures, particularly introduction of prominent PHWs. Industry interference remains a huge threat to public health policy in the region.