Smoking rates in the Middle East kingdom of Jordan have become the highest in the world amid what public health advocates say is widespread interference in policy-making by multinational tobacco companies. More than eight out of 10 Jordanian men smoke or regularly use nicotine products including e-cigarettes, according to a government study carried out in 2019 in collaboration with the World Health Organization. Jordanian men who smoke daily consume an average of 23 cigarettes a day, the survey found. Even excluding e-cigarettes and other “smokeless” products, the research showed 66% of Jordanian men and more than 17% of women were smokers, surpassing the most recent figures for Indonesia, which was long considered to have had the world’s highest tobacco usage. “The rates are dangerously high and a predictor of a future public health catastrophe,” said Firas al-Hawari, a physician and head of the cancer-control office at Amman’s King Hussein Cancer Center. The Jordanian figures contrast with those in Europe, the US and Australia, where smoking has been drastically reduced over the past three decades with the introduction of limits on tobacco companies’ power to lobby and advertise, as well as through awareness campaigns about the dangers of smoking. Industry analysts and public health advocates said Jordan’s rates were exacerbated by the influence of big tobacco, which they said was allowed to operate with comparatively fewer restraints than in the UK – as is the case in many of the lower- and middle-income countries where the majority of the world’s smokers now live. “These companies continue to exercise as much political power as they can in wealthy countries, but they’re more successful in lower-income countries where they face less transparency, can operate more in the dark and overwhelm whatever civic societies exist,” said Rima Nakkash, an associate professor of public health at the American University of Beirut. A Guardian investigation of tobacco industry conduct in Jordan has found: Tobacco lobbyists, including from British American Tobacco (BAT), are regularly involved in debating regulations for their products in Jordan to an extent that anti-smoking campaigners say is inappropriate. Jordan ranked second in the world for tobacco company interference in government, according to analysis by a civil society group. Claims that government officials were lobbied by tobacco industry executives on how they should implement public health legislation alongside offers of access to corporate social responsibility money. Philip Morris International has paid to refurbish schools in Jordan, provide children with school bags and run “career development” sessions for young people. PMI also featured on the social media feeds of the Jordanian prime minister, promoting its economic contribution to the country. ‘The tobacco companies actually sat at the table’ Tobacco company lobbyists have been accused of inappropriate involvement in shaping regulations on their products in Jordan. Meeting minutes seen by the Guardian show that lobbyists from BAT, Japan Tobacco International (JTI) and PMI attended a series of meetings last year to discuss standards for e-cigarettes and heated tobacco products. Among the standards being decided were nicotine content, the size and composition of health warnings, the graphics and colours permitted on the packages, and whether the products could be labelled as less harmful than cigarettes or as an aid to quit smoking. “The tobacco companies actually sat at the table right across from us,” said Princess Dina Mired, a member of Jordan’s royal family, who attended the meetings in her capacity as the president of the Union for International Cancer Control. “They argued against every single standard.” The tobacco companies supported the adoption of regulation comparable to EU directives, according to meeting minutes, while anti-smoking campaigners said they were pushing for more restrictive standards on the products. Mired said: “There was a point when it became very clear that we were wasting our time. We all walked out as a protest. Nothing happened. [The meeting] continued.” Jordan is a signatory to an international tobacco-control treaty that obliges countries to protect their public health laws from tobacco company interference. A civil society group that monitors compliance with the treaty argues that the tobacco companies’ involvement in regulatory meetings in Jordan is an example of lobbying that is contrary to the agreement. PMI and JTI said in statements to the Guardian that it was normal and lawful for their companies to be consulted as stakeholders when relevant regulatory issues were being debated. “Our interactions with government officials in Jordan – like elsewhere – comply with all applicable laws,” PMI said. “In addition, we abide to our own international standards and practices which are stricter than many national laws. In any democratic society, the central objective of regulatory policy – ensuring that regulations are designed and implemented in the public interest – can only be achieved with full participation of those concerned.” JTI said its involvement in the meetings on e-cigarettes and heated tobacco was about providing assistance on technical and industrial standards. “These standards and specifications are very technical, accordingly, and as part of their bylaws, [Jordan’s standards organisation] involves related industries in the process of developing these standards and specifications to ensure applicability and alignment with international best practices, approaches and standards,” it said. “During such meetings, JTI always acts responsibly and to the letter of the law.” Mired said she felt that few of the public health advocates’ concerns were heeded by the committee, which was made up of various ministries and the chambers of commerce and industry. “We failed miserably. They didn’t take a single recommendation from us,” she said. Several former and current government officers said big tobacco had strong relationships with Jordanian MPs and officials, who are not obliged to declare their contact with the industry. Mervat Mheerat, the deputy health manager at the Greater Amman municipality, told the Guardian she was visited by a regional manager for a multinational tobacco company while she sat on a government committee that oversaw how tobacco products were displayed at supermarkets. “I was shocked when the regional manager came to me, and knew what I was saying in the meetings,” she said. Mheerat said she was asked to be “neutral” on some of the issues being discussed in the meeting, and was offered a donation of up to 1m dinars (£1.15m) for anti-smoking campaigns in the city, in what she felt was an exchange. “They approach each person in the style they like,” she said. “So for me, they know I am passionate about promoting health and raising awareness of the dangers of smoking. So they came and said: ‘Let us find some money for your campaign.’” Apparent conflicts of interest go to the heart of Jordan’s anti-smoking lobby. Emails seen by the Guardian show a senior member of a major public health group recused themselves from anti-smoking work after a family member became employed as a lobbyist for a multinational tobacco giant. ‘We are the second-biggest taxpayer in Jordan’ Company filings show big tobacco spends hundreds of thousands of US dollars in Jordan on sponsorship, including of many programmes aimed at young people. In one example, Philip Morris paid to refurbish 10 schools in the Amman neighbourhood where its factory is located, and provided children in 25 schools with bags and stationery. The national/WHO survey found that about 45% of Jordanian students aged 15 or under have used some form of tobacco. Philip Morris has also run careers training programmes, which were widely covered in local media and lauded at events attended by government ministers, local officials and senior police. Public health advocates argue such contributions launder the adverse health and economic impacts of the industry’s products. JTI said in a statement that its corporate social responsibility work strictly adhered to local and international laws and policies and that none of its programmes involved minors. PMI said its factory was located in an underprivileged area “where the local community has often requested much needed in-kind support and aid”. “It is saddening that even actions to improve the living conditions of people around our factory might be seen as a reason to attack us,” the company said. The industry casts itself as a major investor and job creator, an especially potent argument in a country with high unemployment, where tobacco taxes amount to around 18% of the government’s annual revenue. This message has been broadcast directly from government social media channels. “Philip Morris is the largest American investment in Jordan,” the company’s then general manager for the region, Fadi Maayta, said in a video posted by the prime minister’s office last year. “We are the second-biggest taxpayer in Jordan.” PMI said the video was one of several short interviews with local business leaders that featured on government social media. Research funded by the UK government has found that smoking costs Jordan £1.85bn a year in healthcare and loss of productivity, the highest per capita figure in the world, outweighing the approximately £1.03bn the industry pays in taxes, fees and wages to local workers. A Jordanian government source authorised to comment said tobacco companies did not receive special treatment compared with other industries and that anti-smoking awareness campaigns were continuing to try to change people’s behaviour.