BACKGROUND: Following the unanimous adoption of a series of guidelines and recommendations for the implementation of Article 5.3 (2008), success stories from India seem to follow a ‘domino’ effect, wherein the precedents at one subnational jurisdiction are followed by others. This research scrutinizes Indian tobacco control policy audacity in terms of Article 5.3 of WHO-FCTC and explores the enablers that facilitated it.
METHODS: A census approach-all sub‑national Article 5.3 documents (circulars/letters/notifications/orders) were mapped, followed by objective discussions with key sources from each jurisdiction. Key themes were identified and compared across eligible Indian states/Union territories (UTs), to identify similarities and differences.
RESULTS: Till January, 2025, > 60% of Article 5.3 policy coverage is evident on India’s map. Analyzed documents reveal notable omissions across states/UTs in the adoption of guidelines: only some districts/state governments refer to regulating ‘socially responsible’ industry activities, while none include pre-emptive measures preventing the industry from receiving preferential treatment. Government(s) of Arunachal Pradesh, Assam, Karnataka, Kerala, Manipur, Meghalaya, Nagaland, Puducherry, Sikkim, Tamil Nadu, Uttar Pradesh and Uttarakhand have issued detailed notifications including a protocol, procedure for a meeting (if at all necessary), code of conduct, and empowered committee constitution. Following clustering across the states/UTs, the Ministry of Health was found to be the major enabler; with the Ministry of Higher Education as an outlier (Madhya Pradesh) and Uttar Pradesh en route for a “top-down” model.
CONCLUSIONS: Lessons from India reveal that civil societies, along with policy actors and local governments have been integral in following the “bottom-up” Article 5.3 policy adoption process. ‘Whole of government approach’, intersectoral and multi-jurisdiction collaboration, and lessons learned from previous policies with proactive advocacy strategies are additional drivers that the states/UTs in India and other Parties to the FCTC can employ in adopting and implementing Article 5.3 policy, as they embark upon similar efforts