BACKGROUND: HWLs on tobacco packs in Pakistan have undergone significant changes since their inception in 1979. Under the Framework Convention on Tobacco Control (FCTC) guidelines, pictorial health warnings were introduced in 2010, initially covering 40% of the pack. While the size increased to 85% in 2015, subsequent ordinances reduced it to 50% before a marginal increase to 60% in 2019. Since then, there has been no rotation or size increase in HWLs leading to compliance gaps and diminished effectiveness.
METHODS: A market survey and examination of (3000 purchased and used) cigarette packs was conducted across 28 smoke-free cities in Pakistan, including the twin cities of Islamabad and Rawalpindi. The survey assessed the presence, visibility, and quality of HWLs to evaluate compliance with existing laws and their impact on consumer awareness.
RESULTS: Initial findings reveal that almost 50% of cigarette packs from Rawalpindi/Islamabad lacked HWLs, while 8% featured blurred or faded warnings, compromising their clarity and diluting their impact. The average daily smoker in Pakistan (who smokes 13 cigarettes per day), is exposed to HWLs approximately 4700 times a year. However, as per the survey, desensitization and lack of rotation resulted in reduced HWL effectiveness and increased mental saturation.
CONCLUSIONS: The study highlights the diminishing returns of HWLs due to compliance/implementation gaps, lack of enforcement, and desensitization. This research signposts an urgent need for updating the policy including timely rotation, size enhancement, use of locally relevant images, and eventual adoption of plain packaging to restore the effectiveness of HWLs. This study further points to the robust regulatory measures and global best practices, such as standardized/plain packaging, pack color rotation, and warnings on individual cigarettes, guiding the future of tobacco control in Pakistan.