Speech delivered by Senator Pia S. Cayetano at the 76th World Health Assembly side-event on the topic: ‘Using the power of health taxes to fight non-communicable diseases’ (Geneva, Switzerland)
Good afternoon to everyone. It is my pleasure to share the Philippines’ story on the fight against tobacco. I could stand here all day, I am usually very worried that people would fall asleep. But with this story, I could stand here for three hours and you would not fall asleep. So the challenge will really be on how I can present this to you in a few minutes. I am going to try chronologically so that you have an understanding of the amount of time that has passed from the time I started working on this until today. But bear with me as I insert certain aspects of the journey as I feel it’s relevant despite it being out of the timeline that I am presenting.
So I became a senator in 2004 and my seatmate was the former Secretary of Health [the late Health Secretary and Senator Juan Flavier] who launched his campaign called “Yosi Kadiri.” It means, ‘smoking is disgusting.’ So he was my seatmate and mentor. He was a doctor. And he told me to chair the Committee on Health and that he would guide me. He truly was a good mentor for many years. So sometime in 2008, was my first start with tobacco control. And that was when I filed the bill on Graphic Health Warning. And so the first lesson from this measure was perseverance, because [the bill] passed six years later. And I do have photos, which I hope will be shown in a bit. You will see the pictures of the kids who were part of the advocacy group that were rallying for graphic warnings, and you will see that from kids, they became teenagers over the six years when that passed.
But in 2009, I passed another measure which was strengthening our [Food and Drug Administration]. And the goal here was to cover all products that affect health – that is the definition of the jurisdiction of the FDA. But then the tobacco group filed a case restraining FDA [from controlling] them because they say that they were not covered by FDA. They are not a product that affects health. So let’s digest that for a moment: tobacco products do not affect health. Therefore they are not covered by the FDA. So that was their argument. So that’s how it was for the next decade or so. The case was pending in the Supreme Court and I filed as an intervenor because that was my law. So I had standing to file as an intervenor in that case.
And then in 2012, this was my first sin tax law. And a little bit of history, the Chairman then of the Committee on Ways and Means, the taxation committee, filed a Committee Report with extremely watered down tax provisions, very watered down. And this was just at the beginning of the Twitter age. So there was still not a very strong social media presence. But the advocacy groups, NGOs were very strong and they actually got this Chairman to resign. He resigned and our SenatPresident…ended up… putting forward a new Committee Report that had stronger taxation measures. And he asked me to participate by way of the health measures within that tax measure. So that was my first experience with sin tax in 2012. And this Sin Tax Law, I am happy to report, in the last collection in 2022, two billion dollars is what we are collecting from sin tax. And this goes directly towards our Universal Health Care and also health facilities. And I don’t have time but if anyone is interested, I can tell you all the health work that we have been able to do with this kind of funding. Our Universal Health Care coverage used to be almost nothing, and now, as a public servant, it’s very rewarding that I get messages, I bump into people who say that their mother, father, grandfather, brother, have been able to have some kind of healthcare [because of Universal Health Care]. It’s not perfect, it’s far from perfect, but we’ve come a long way.
So that was 2012. In 2020, we decided to put forward a new tax measure. And this time, I was the Chairman of the Committee on Ways and Means. And so, we had a debate [in the Senate] if we will ban or if we will tax the new products, which are the e-cigarettes, the vapes, and heated tobacco. And it was decided that we will tax. Of course, the Department of Finance would rather tax than ban. And considering that we are a country of 7,000 islands, there is always a lot of contraband coming in and out. So the decision was to tax – so we taxed.
And at that time, my brother [then Taguig Representative Alan Cayetano] was the Speaker of the House of Representatives, I was a senator. And with his support, we were able to come up with very good tax rates and three important health provisions to protect, particularly the youth against the evils of this sin product. So these were: we made the age of access to vapes and e-cigs at 21 years of age; we put tobacco under the jurisdiction of FDA; and we said no flavors except original [tobacco] and menthol. And this passed. It’s the first time that such a strong tobacco measure passed in Congress, especially in the House, and that was because, with all due respect, I am biased of course, he’s my brother, but it would not have happened if there was not a Speaker of the House who would let it happen.
Side story: the members of the House in the bicameral panel would be calling and saying – in the Philippines, the term of endearment for older sister is “ate” – and they were like, “your ate is giving us a hard time.” But [the Speaker] told them that you need to do what is right. We need to look parents in the eyes and tell them, we did what is right for your children. We taxed them and we put these protective measures. So that was 2020.
Barely a year later, my brother was no longer Speaker of the House, and they filed [at the House] a new bill reversing all of these gains. And this is one of the most difficult times of my career because I was the sole oppositor in the Senate. I did have a few colleagues who fought with me on a couple of issues, I have to acknowledge that. But in the end, I was fighting on my own on this measure to ensure that we retain the 21-year age of access, the limitation of flavors, and the jurisdiction. I lost on all. So we now have a law that lowered it to the age of 18; there is a new provision there that basically allows all flavors, although there is a catch-all that says it should not be attractive to children, no cartoon characters, no reference to ice cream flavors, something like that, but otherwise, it’s still open-ended compared to what it was.
Okay, some good news. Around this time, the Supreme Court finally made the decision that the jurisdiction of the FDA includes tobacco. So that was a win after 10 years. And as we speak, a motion for reconsideration is ongoing in the Supreme Court because of course the tobacco lobby will keep on fighting to remove the [FDA’s] jurisdiction.
But that is where we are today and I continue to fight for this because the jurisdiction over vapes is now with the Department of Trade, and I have no idea how the Department of Trade is supposed to ensure the health of people. But I am thankful that at least I am seeing that they are working with our Department of Health and our FDA.
So a few months ago, I filed a resolution, and had a hearing on the proliferation of vape products that were attractive to children. They were literally cartoon packaging, very colorful, ice cream flavors, that are not allowed. And the DTI did work on seizing these products.
So, I want to be hopeful. I hope that we can continue to do the work that we’re doing. I thank you for this opportunity to be at this forum and to share the experiences we’ve had. Because I do believe that with perseverance, if we keep on fighting, the day will come that we will be able to have a more secure place for children and to be able to use the power of taxation for good, which it has done. But when I was asked earlier, is it enough? I said, well not if we don’t put regulatory measures to also ensure limited use, especially for children.
So I will leave it at that for now, and am open to questions later. Thank you. #