India and the framework convention on tobacco control: the politics of rising power attitudes toward international rules

ABSTRACT

This paper investigates why India actively negotiated and ratified the Framework Convention on Tobacco Control (FCTC), the first global health treaty to curb tobacco use worldwide. The World Health Organization’s (WHO) decision to conduct FCTC negotiations aligned with India’s shifting disease burden that was pivoting from infectious to non-communicable diseases, particularly cancer, which shot up due to surging tobacco use. The WHO’s decision to frame the agreement around constraining global tobacco commerce, particularly the might of multinational tobacco companies, meshed with the interests of New Delhi, which was concurrently seeking to curb surging tobacco consumption. This triggered a positive approach and attitude to FCTC negotiations, leading to India’s ratification. India’s negotiation and ratification of the FCTC shows that the literature(s) on rising powers and international organizations must consider how factors like the WHO’s institutional politics, specifically the intent to negotiate a focused global agreement to curb tobacco production and distribution worldwide, affects how countries perceive and seek to use that agreement to bolster domestic policy concerns like tobacco control.

KEYWORDS:

• India
• global governance
• global health governance
• tobacco control
• rising powers
• international rules

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 International organizations and international rules can allow states to handle, address and resolve domestic political conflicts and concerns and demonstrate their commitment on issues that then influences their behaviour within international organizations. For instance, Jon Pevehouse (2002, 2003) argues that states join IOs not to resolve coordination problems or curb information asymmetries but instead driven by domestic political concerns. Pevehouse argues that leaders in nascent democracies push for IO accession to exhibit credible commitments to democratic reform, including political and economic; and membership affords them greater credibility in that respect as well as political leverage vis-a-vis domestic opponents (Pevehouse 2003). Similarly, Sinha (2016) demonstrates how WTO increased transaction costs and left behind various institutional effects as India engaged the regime through the dispute-settlement mechanism. IOs can interact with and affect political institutions and agencies that, in turn, influences their international responses (Sinha 2016). Domestic political institutions affect the salience of an international norm domestically. Through legislation, certain international norms are activated by domestic actors that intend to enhance its legitimacy and extol its importance. Audie Klotz’s account of the move to globally sanction the Apartheid regime for its transgressions, despite strategic and economic interests, illustrate the process of how a global norm (racial equality) when institutionalised domestically (in the US through the Comprehensive Anti-apartheid Act) precipitated a shift in the interests of various domestic groups and eventually, state behaviour (Klotz 1995). Similarly, Amy Gurowitz outlines how Japanese ratification of various international human right covenants and treaties (e.g. ICCPR, ICESCR, CEDAW, CERD) in the 1980s and 90s precipitated policy changes improving the economic and social plight of Korean migrants, hitherto excluded from citizenship privileges, including benefits, etc. (Gurowitz 1999).

2 I define rising powers as states whose material capabilities are relatively underdeveloped but whose upward economic trajectories, pivoted on material and demographic advantages, give them international prominence. Since this paper focuses on the diplomatic engagement of rising powers within international organizations, emphasis will be given to understand how these states perceive and negotiate international rules. Power transition theorists have generally not investigated this issue, instead focusing largely on how a states’ rise, given economic and military capabilities, precipitates systemic destabilisation and eventually war (Organski 1958; Gilpin 1981).

3 I define international organizations, also referred to as international institutions as ‘sets of rules, norms, practices and decision-making procedures’ that allow states to iteratively interact and cooperate (Simmons and Martin 2002). International rules, seen this way, are a function of international institutions.

4 By international rules, I refer to international treaties and agreements, both legally binding and voluntary, that states negotiate to address a mutually shared problem. Treaties and different types of international agreements are also referred to as commitment rules that result in policy commitments that states reciprocally adopt to address a problem (Onuf 2012).

5 Miller’s recent work focuses on several rising powers including China and India and how domestic narratives influence their multilateral positions, a critical part of their journey as a rising power. Miller 2021. Why Nations Rise: Narratives and the Path to Great Power. Oxford University Press.

6 A rich literature has emerged covering the domestic factors shaping the rise of China and India, See Pocha, Jehangir and Ha Jin, 2003 “The Rising ‘Soft Power’ of India and China,” New Perspectives Quarterly 20, no. 1: 6–13; Chatterjee Miller, M., 2014. The un-argumentative Indian: Ideas about the rise of India and their interaction with domestic structures. India Review, 13(1), pp.1-14; Huang, Yanzhong and Sheng Ding, (2006) “Dragon’s Underbelly: An Analysis of China’s Soft Power,” East Asia 23, no. 4: 22–44; Buzan, Barry (2010) “China in International Society: Is ‘Peaceful Rise’ Possible?” Chinese Journal of International Politics 3, no. 1: 5– 36; Mingjiang, Li. (2008) “China Debates Soft Power,” The Chinese Journal of International Politics 2, no. 2,: 287–308; Hymans, Jacques (2009) “India’s Soft Power and Vulnerability,” India Review 8, no. 3: 234–265; Chestnut and Alastair Iain Johnston, “Is China Rising?,” in Global Giant: Is China Changing the Rules of the Game, eds. Eva Paus et al. (New York: Palgrave MacMillan, 2009), 239–240; Ikenberry, John (2008) “The Rise of China and the Future of the West: Can the Liberal System Survive?,” Foreign Affairs 87, no. 1,: 23–37. Paul, T., Welch Larson, D., & Wohlforth, W. (Eds.). (2014). Status in World Politics. Cambridge: Cambridge University Press.

7 That said, a burgeoning literature has emerged covering the international sources of India’s foreign and economic policy in India. Kapur (2010) and Ye (2014) focus on how the India diaspora affect investment trends and consumption patterns through ideas and capital. International organizations can spur domestic policy change. Sengupta (2009) analyzes how the IMF soft-pedaled New Delhi to institute reforms and reverse the downward economic slide. Sinha (2016) clarifies the WTO’s unintended impact and effects on the institutional preferences of India’s trade policy.

8 From 1949, WHO teams supplied insecticides, drugs, transport, and equipment alongside malariologists to tackle Malaria (WHO 1958) across South and Southeast Asia. Mass TB vaccination campaigns occurred under the aegis of the Scandinavian-led International Tuberculosis Campaign (ITC), UNICEF, and the WHO (WHO 1958). In India, WHO officials also handled TB, Malaria, venereal diseases like syphilis, cholera, new strains of influenza, and built capacity to develop drugs and vaccines (WHO 1958). The WHO's targeted technical focus fit India’s nascent disease burden, namely infectious diseases, that required immediate attention.

9 The ruling which was released in an extensive report from the dispute resolution body was the first time that GATT dispute resolution procedures were invoked for tobacco products. See GATT (1990), Thailand—Restrictions on Importation of and Internal Taxes on Cigarettes.

10 By 1988, an active anti-smoking movement led by NGOs like the Thai Anti-Smoking Campaign Project (ASH) sought to improve Thailand's tobacco control laws. Through a combination of methods including media, marketing and other forms of social mobilisation, the ASH managed to change social and political attitudes on tobacco control. New tobacco control laws were introduced in 1989 (Chantornvong and McCargo 2001).

11 Since the 1990s, public health and trade have entangled frequently with the latter generally trumping the former. Since the Doha trade round, developed countries have attempted to use WTO provisions to assist global pharmaceutical firms export their drugs and medicines abroad, particularly to developing countries tackling infectious diseases like HIV/AIDS, TB and Malaria. Developing countries like India and Brazil have, in response, leveraged specific trade measures like compulsory licenses, despite pressures to enforce and emphasize intellectual property and innovation, to secure affordable medicines. Though the 2001 Doha declaration conferred primacy to public health considerations over intellectual property rights, including the indefinite use of compulsory licenses to override patent restrictions to address challenges like HIV/AIDS, it has not been implemented given palpable trade differences between developed and developing countries. The FCTC represents an exception where multilateral health concerns trumped international trade obligations, though not without struggle (t’Hoen 2002; 2009; Olsen and Sinha 2013)

12 Interview with PC Gupta, Mumbai, February 4, 2015.

13 Interview with K Srinath Reddy, New Delhi, January 11, 2015.

14 Before tabling the bill, Mahajan shared the government’s reasoning, ‘an estimated 13,517 Crore Rupees would be required to provide treatment to persons suffering from tobacco control diseases which was much more than what was earned by the production and sale of tobacco products’ (The Times of India 2000).

15 Interview with PC Gupta, Mumbai, February 4, 2015.

16 Interview with Salim Habayeb, email, January 25, 2015.

17 Interview with Salim Habayeb, email, January 25, 2015.

18 Interview with K Srinath Reddy, New Delhi, January 11, 2015.

19 Interview with Vineet Gill, New Delhi, January 20, 2015.

20 After 1948, South Asia and India became priorities for the WHO as its institutional orbit expanded. The importance of South Asia precipitated the creation of the WHO’s first regional office in Southeast Asia (SEARO) located in New Delhi from 1949 (WHO 1958). Most SEARO members had similar public health features - largely rural economies with limited health services whose problems included malnutrition, maternal and infant mortality and the prevalence of infectious diseases associated with poor sanitation and housing. These conditions focussed the nature of WHO programs and projects across the region.

21 Vajpayee’s pleas for sustained WHO support had precedent. In 1948, India’s first Prime Minister Jawaharlal Nehru declared that “India attaches the greatest importance to the work of the WHO, more especially from the point of view of Southeast Asia, which was very backward in health conditions” (Amrith 2007). Nehru underscored the interconnected nature of health challenges that warranted high levels of concrete WHO support for countries like India that lacked both capacity and resources to manage stark public health burdens. New Delhi’s motivation was to leverage international financing and administrative support to tackle infectious diseases like TB, Malaria, Smallpox, and Cholera while building a workable public health service (Duggal 2005).

22 Interview with PC Gupta, Mumbai, February 4, 2015.

23 Interview with K Srinath Reddy, New Delhi, January 11, 2015.

24 Interview with K Srinath Reddy, New Delhi, January 11, 2015.

25 Interview with Srinivas Tata, telephone, February 17, 2015.

26 Interview with Srinivas Tata, telephone, February 17, 2015.

27 Questions around warnings on tobacco products remain a contentious and unsettled domestic affair in India. The quest to implement plain packaging on tobacco products in India continues despite efforts in 2012 when the Australia-India Institute published a study on plain packaging on tobacco products, recommending that policy change (Grills and Moodie 2012). Despite internal and external efforts to implement this policy, the Indian government has not yet committed just as tobacco use and the health effects of sustained use rise. The call to amend this policy remains even after the Indian Supreme Court decided in 2018 that tobacco products must carry pictorial and health warnings on 85% of its packaging. Little, however, has changed (Lince 2021)

28 Interview with Srinivas Tata, telephone, February 17, 2015.

29 Interview with Shoba John, telephone, February 24, 2015.

30 Interview with K. Srinath Reddy, New Delhi, January 11, 2015.

31 Resistance surfaced from legislators representing tobacco interests. Several MPs expressed objections to the impact COTPA would have on tobacco workers in their constituency. Former Prime Minister Deve Gowda, MP from Karnataka, feared the bill would ‘destroy the very industry itself and cast doubts on whether the bill would be implementable, specifically provisions regulating point of sale. See “Lok Sabha Debates: 11thSession,” Accessed April 30, 2015. http://164.100.47.192/Loksabha/Debates/Result13.aspx?dbsl=5845.

32 Interview with Shoba John, telephone, February 24, 2015.

33 Interview with Srinivas Tata, telephone, February 17, 2015.

Additional information

Notes on contributors

Karthik Nachiappan

Karthik Nachiappan is a Research Fellow at the Institute of South Asian Studies, National University of Singapore. His research interests focus on India’s approach toward global governance, specifically issues like climate change, global health, technology and trade. He is the author of Does India Negotiate? (Oxford University Press, 2020).