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Expert Q&A

Tobacco’s Goliath-Sized Threat to Public Health

Vital Strategies

Q&A with Rebecca Perl, VP, Policy, Advocacy and Communication

There are a lot of important public health topics out there? Why does Vital Strategies work on tobacco control?

About 12 years ago, New York City Mayor Michael Bloomberg reached out to Tom Frieden, his commissioner at the department of health and told him that he wanted to make a difference in international public health. He asked, what issue he should tackle? Tom’s unequivocal response was “tobacco.” Shortly after, the Bloomberg Initiative to Reduce Tobacco Use was born. Vital Strategies (then called World Lung Foundation), was one of the initial five partners tapped to carry out the initiative, which also includes the U.S. Centers for Disease Control, the World Health Organization and Johns Hopkins School of Public Health. Today the initiative is a flagship program both for Bloomberg Philanthropies and for Vital Strategies and still going strong. It’s a 15-year, one-billion-dollar commitment so far, and I hope it will continue beyond 2022. Among the things we can take some credit for are saving 35 million lives thanks to national policy wins banning indoor smoking, restricting tobacco advertising and higher taxes in Russia, India, Bangladesh, and Turkey.

What damage does tobacco do?

Tobacco kills roughly one in two users, and all of these are preventable deaths that come too early. If nothing is done about tobacco use, it’s on target to kill  a billion people this century. Tobacco contributes to all of the most common chronic killers–heart and lung diseases, as well as cancer and diabetes. It’s the leading preventable killer, and in a way, it should be a simple, winnable battle. If people stop using tobacco this will bring about longer, healthier lives and less disease and suffering. But tobacco control remains a fierce battle.

A fierce battle—why do you say that?

For one reason—like a mosquito that causes malaria, tobacco diseases also have a vector—the tobacco industry. Despite all the resources that have given tobacco control an international voice, this is still very much a David vs. Goliath battle. The industry can outspend us and they are not averse to marketing to vulnerable groups, like children, promoting pseudo-science to confuse, or lobbying against effective policies and laws that reduce smoking among young people. They are always looking for new customers because they kill off about half their users. So, when markets in the West become saturated or laws are put in place that reduce use, they simply move on to newer markets in Asia, Eastern Europe and Africa.

What is Vital Strategies role in the initiative?

We primarily focus on policy and advocacy communication. This means we use communication to build public support for proven policies that protect people from tobacco, such as smoke-free laws and cigarette pack warnings. To do this we employ evidence-based, population-level media campaigns, including broadcast campaigns but also social and earned media strategies, all in partnerships with ministries of health. To date, we have created more then 300 campaigns in 41 countries. You can explore our work at


More recently, we have also been tapped to take on the industry more directly. A new partnership called STOP is a watchdog that is focused on keeping track of what the industry is up to and spreading the word. STOP is now being rolled out by Vital Strategies and several partners including the University of Bath, The Union and The Global Center for Good Governance in Tobacco Control.

What other challenges are on the horizon for tobacco control?

This can be boiled down to two words: new products. The tobacco industry is really giving the public health community a run for our money with e-cigarettes and “heat not burn” products such as IQOS. It seems these new products may be less dangerous than conventional cigarettes but when you consider the source, it makes you wonder. Decades ago, the industry also said that filters and low tar cigarettes would be less harmful too and that didn’t turn out to be true. These products are still very new, so we don’t know their long-term effects. They are gaining popularity among youth in the United States with alarming speed. They are also beginning to be sold across the world.


In a best-case scenario, if you use these newer tobacco industry products, you are still throwing away a lot of money on an addictive product that is going to be very hard to stop. And it seems all that really matters to the industry is that they have you hooked on one of their products, be it conventional cigarettes or new-fangled electronic ones.


Rebecca Perl has been working on tobacco issues since 1993 when, as a reporter, she got a grant to cover the tobacco industry for National Public Radio in Washington, DC. Her reporting won a DuPont award for a story she broke on the ingredients in cigarettes. Since 2008, she has been working in international tobacco control policy and communication projects for Vital Strategies in India, China, Russia, and across  Africa, as well as in other countries where the population is large and the tobacco prevalence high.