Last week, Brazil released the results of the 2019 National Health Survey. One very encouraging piece of news that the survey brought is that the prevalence of tobacco product use dropped below 13%. These levels of tobacco use have not been seen in Brazil since nearly half a century and the pace of prevalence decline sets Brazil on the path to reach the World Health Organization’s target of reducing smoking prevalence by 30% by 2025. The declines are a direct result of strong tobacco control measures that have been implemented in Brazil over the last four decades. The progress that this national survey documents stands in a stark contrast to the tobacco industry’s claims that tobacco consumption in Brazil is growing due to increasing illicit cigarette consumption.

In fact, the illicit cigarette trade registered by the 2019 National Health Survey (34.7% of the market) indicates that the illicit cigarette market share declined by over 8 percentage points compared to the 2016 estimates. This drop also comes as no surprise. In the last years, Brazil became a party to the Protocol to Eliminate Illicit Trade in Tobacco Products and implemented a series of measures to address the problem of illicit cigarette consumption.

Part of Brazil’s progress can be attributed to its efforts to monitor behaviors related to tobacco use. Knowing the scope and the nature of the problem allows the country to take targeted actions. While monitoring of the prevalence of tobacco product use is part of activities that a typical country takes when addressing the tobacco use epidemic, Brazil’s strong grasp of the scope of the illicit cigarette trade problem is unique. For the last several years, there have been extensive efforts undertaken by the Brazilian National Cancer Institute (INCA) to estimate the scope of illicit cigarette use in the country using data from surveys of Brazilian smokers. However, because the survey results can be biased due to the smokers misreporting their behaviors, the estimates based on the survey results need to be verified by the use of other methods to estimate illicit trade in tobacco products, which involve direct pack observation.

This is exactly what has been done in Brazil. In a new study, co-authored by researchers from INCA, the WHO, the University of Illinois-Chicago, FIOCRUZ and Johns Hopkins University, compares the illicit cigarette trade estimates from four different approaches: a telephone survey of smokers, a household survey of smokers with examination of the smokers’ packs, a collection of littered packs from the streets, and an examination of packs that were properly disposed in the household garbage. This study not only to contrasts the results across the methods, but also to points to differences in illicit trade levels and in brands of illicit cigarettes across Brazil’s regions as well as across age and socio-economic groups.

The diligence in measuring the illicit cigarette trade sets Brazil as a role model for other countries to follow. Illicit trade is an obstacle to almost every country’s efforts to reduce the health and economic burden related to tobacco product use. While illicit trade can be effectively tackled by a series of supply chain control measures and close international cooperation, understanding the levels and the nature of the problem are the natural first steps in these efforts. Brazil’s approach to monitoring the trends in the illicit cigarette trade using the survey data, with occasional triangulation of the results through a direct pack observation, is a gold standard of illicit trade surveillance.

By Michal Stoklosa

Cover Image Credit: Tobacco Pack Surveillance System (TPackSS). While the pack was purchased in a store in Salvador, Brazil, a marking on the pack says: “For exclusive sale in Paraguay”.