“Fewer people reported smoking (18.1% to 15.8%),”continued,“with fewer smoking daily (15.1% to 12.8%). Weekly consumption of cigarettes decreased (111 cigarettes to 96 cigarettes), and there was an increase in average age of initiation (15.4 years to 15.9 years) and never smoking (57.8% to 60.1%).” This, it said, is suggestive of “tobacco control in Australia being a resounding success.”

Such a conclusion has been supported by Australian government. “Tobacco plain packaging in combination with graphic health warnings was associated with a statistically significant estimated decline in smoking prevalence,” said the country’s Department of Health in its review of plain packaging this year. Between December 2012 and September 2015, the review said, plain packaging reduced the number of smokers in Australia by 108,228.

Some, however, have objected to this conclusion. An op-ed in Fortune magazine last year argued that, in Australia, “not only did [plain packaging] not work, the status quo got worse.” It pointed towards findings of the National Drug Strategy Household Survey which, it said, did not reflect any significant decline decline in Australia’s daily smoking rate. If one accounts for population increase, the op-ed argued, the number of smokers in the country actually increased.

Speaking to Health Issues India, Philip Morris International (PMI) argued that a switchover from cigarettes to smoke-free tobacco products would be more effective than plain packaging legislation.

“PMI is building our future on smoke-free products that are a better choice than continuing to smoke cigarettes,” the company told HII. “Our vision is that these products replace cigarettes as soon as possible…In this context, sensible, risk-based regulation of smoke-free products, combined with further restrictions on cigarettes, can help address the harm caused by smoking more effectively – and faster – than plain packaging and other traditional regulatory measures.”

It is worth noting that cigarettes do not solely account for tobacco consumption in India. “Tobacco use in India is mostly in the form of smokeless tobacco,” Dr Monika Arora of the Public Health Foundation (PHFI) told HII. “Thus any tobacco control measure has to be implemented with its applicability across smoking and smokeless forms. Even among current smokers (11%), bidi smoking (8%) is more prevalent than cigarette smoking.”

For Dr Arora, this variation is a challenge to the efficacy of pictorial health warnings (PHWs). “There is great variation between packaging size and shapes of packs of bidis, smokeless tobacco and cigarettes,” she says. “Even among cigarettes, the packaging size varies and there is no uniform pack size. The varying sizes of packs reduces effectiveness of strong PHW as they are hardly visible on small packs of bidis and smokeless tobacco.”

A transition to completely standardised packaging could resolve these issues, she suggests. “Plain packaging in India would…remove appealing packaging of tobacco products, misleading descriptors would not be allowed and would help move in the direction of having standardize packs, so as to make PHWs visible enough for the consumers.”

One crucial consideration when it comes to implementing plain packaging legislation is the potential for substantial legal action undertaken against India by the tobacco industry. If this were to occur, the legal costs could be substantial. In defending its plain packaging legislation against a suit brought by PMI, Australia spent close to 40 million USD – costs PMI was ordered to pay Australia after it lost its suit last year.

The prospect of protracted and costly litigation might dissuade India from following in Australia’s footsteps with plain packaging legislation. That tobacco is an 11 billion USD industry in India might add to reluctance by the Centre to implement plain packaging laws.

It has been suggested in the past that pressure from the tobacco lobby has made the government reluctant to push for reform in areas such as taxation. Some have opined that Big Tobacco’s influence may have prompted increased scrutiny of non-government organisations (NGOs) – and even government departments – involved in anti-tobacco activities.

Globally, it is clear that the tide is turning against Big Tobacco.The decision of the World Trade Organisation (WTO) to uphold Australia’s plain packaging laws – despite vociferous challenges from large tobacco-exporting nations such as Indonesia – is indicative of this.

Some even suggested the WTO’s ruling might assuage the reluctance of some governments to implement plain packaging laws. In fact, in Bloomberg’s coverage of the decision, India is mentioned as one of several countries considering plain packaging laws who might now be emboldened to do so.

The idea of plain packaging laws in India has actually been on the table for some time now. In 2012, Member of Parliament Baijayant Panda introduced a bill in the Lok Sabha calling for plain packaging legislation. In 2014, the Allahabad High Court (AHC) directed the Centre after allowing a writ petition calling for plain packaging. Similarly, in 2016, the Supreme Court issued notice to the Ministry of Health and Family Welfare (MoHFW) after hearing a public interest litigation (PIL) calling for plain packaging laws to take effect in India.

The argument in all cases tends to pivot on a central premise: that the health of citizens enjoys primacy over the business rights of the tobacco industry. This much was articulated by the SC in January, when it stayed a controversial decision by the Kerala High Court (KHC) overturning the directive of the MoHFW that pictorial health warnings (PHWs) must cover 85 percent of tobacco product packaging.

This is not to say that rollout of plain packaging will be easy. There is the prospect of legal action by tobacco companies. In addition, practical challenges loom.

Many cigarettes are sold loose in India. In 2015, it was reported that loose cigarettes account for as many as 75 percent of tobacco sales. A ban on the sale of loose cigarettes is supported by 59 percent of Indians and has already been enforced in Karnataka and Bihar. Nonetheless, the practise continues across India – even (illegally) outside schools.

Tobacco companies argue that plain packaging fuels cigarette smuggling. It is even argued by some that illicit practises such as the sale of loose cigarettes outside schools might actually be driven by more restrictive laws concerning the packaging of cigarettes.

Researchers have questioned these claims. However, they gain traction nonetheless, creating the notion that plain packaging laws are futile in cutting smoking rates. Instead, critics allege they drive the sale of tobacco underground.

It must be acknowledged that the situation surrounding tobacco consumption in India is complex and nuanced. Numerous issues surround it, many of which will not be resolved by plain packaging laws. However, as part of the country’s seemingly deepening stand against Big Tobacco, plain packaging might yet find a part to play in the near future.

“Witnessing the success of plain packaging in countries that have enforced this legislation,” says Dr Arora. “The logical next step for India after 85% PHW would be plain packaging. The recent WTO ruling upholding Australia’s right to standardize packaging of tobacco products gives confidence to many countries to move in this direction.”

This article was originally published in Health Issues India. It is reprinted here with permission.