Every year, tobacco use leads to more than eight million deaths globally and one million deaths in the Region of the Americas (¹1. World Health Organization. WHO report on the global tobacco epidemic, 2021: addressing new and emerging products [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/343287
https://apps.who.int/iris/handle/10665/3... ,²2. Institute of Health Metrics. Database of Global Burden of Disease [Internet]. Washington, D.C: IHME; 2019 [cited 2022 Feb 1]. Available from: https://www.healthdata.org/data-visualization/gbd-compare
https://www.healthdata.org/data-visualiz... ). The global economic cost of smoking is estimated to be US$ 1.4 trillion yearly and it disproportionately affects people in low-and middle-income countries (¹1. World Health Organization. WHO report on the global tobacco epidemic, 2021: addressing new and emerging products [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/343287
https://apps.who.int/iris/handle/10665/3... ). The devastating health, social, environmental, and economic consequences of tobacco use and exposure to tobacco smoke ultimately constrain development (³3. World Health Organization. WHO Framework Convention on Tobacco Control [Internet]. Geneva: World Health Organization; 2003 updated reprint 2004, 2005 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/42811
https://apps.who.int/iris/handle/10665/4... ).

Noncommunicable diseases (NCDs) are the leading cause of death and disability in the Americas and they account for 81% (or 5.8 million) of deaths per year (⁴4. Pan American Health Organization. The disease burden of noncommunicable diseases in the Region of the Americas, 2000-2019 [Internet]. 2021 [cited 2022 Jan 25]. Available from: https://www.paho.org/en/noncommunicable-diseases-and-mental-health/noncommunicable-diseases-and-mental-health-data-43
https://www.paho.org/en/noncommunicable-... ). Tobacco use is a major risk factor underpinning each of the four principal NCDs (⁵5. Pan American Health Organization. Report on Tobacco Control in the Region of the Americas [Internet]. Washington, D.C.: PAHO; 2018 [cited 2022 Jan 25]. Available from: https://iris.paho.org/handle/10665.2/49237
https://iris.paho.org/handle/10665.2/492... ) and leads to 15% of cardiovascular deaths, 24% of cancer deaths, and 45% of deaths from chronic respiratory diseases (²2. Institute of Health Metrics. Database of Global Burden of Disease [Internet]. Washington, D.C: IHME; 2019 [cited 2022 Feb 1]. Available from: https://www.healthdata.org/data-visualization/gbd-compare
https://www.healthdata.org/data-visualiz... ). These severe consequences of tobacco use have been exacerbated by the COVID-19 pandemic, with users having a higher risk of severe disease and death, highlighting the deadly interplay between the SARS-CoV-2 virus and NCDs and their underlying risk factors.

There is now a large body of evidence about how we should tackle the tobacco epidemic in highly cost-effective ways by applying the mandates of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) (³3. World Health Organization. WHO Framework Convention on Tobacco Control [Internet]. Geneva: World Health Organization; 2003 updated reprint 2004, 2005 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/42811
https://apps.who.int/iris/handle/10665/4... ), and the Protocol to eliminate illicit trade of tobacco products (⁶6. World Health Organization. Protocol to eliminate illicit trade in tobacco products [Internet]. Geneva: World Health Organization; 2013 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/bitstream/handle/10665/80873/9789241505246_eng.pdf?sequence=1&isAllowed=y
https://apps.who.int/iris/bitstream/hand... ), as well as the WHO MPOWER package guidance (⁷7. World Health Organization. MPOWER: a policy package to reverse the tobacco epidemic [Internet]. Geneva: World Health Organization; 2008 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/43888
https://apps.who.int/iris/handle/10665/4... ).

Since the global entry into force of the WHO FCTC on February 27, 2005, there has been significant progress in tobacco control in the Region of the Americas, primarily concentrated on creating smoke-free environments and requiring health warnings on the packaging of tobacco products (⁸8. Pan American Health Organization. Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 [Internet]. Washington, DC: PAHO; 2019 [cited 2022 Jan 25]. Available from: https://iris.paho.org/bitstream/handle/10665.2/51574/PAHONMH19022_eng.pdf?sequence=1&isAllowed=y
https://iris.paho.org/bitstream/handle/1... ). Due to the success of regional tobacco control efforts, the South American subregion is now free of tobacco smoke in indoor public places and workplaces, and with Mexico recently enacting similar legislation, population coverage with this public health measure increased to 63% within the Region (¹1. World Health Organization. WHO report on the global tobacco epidemic, 2021: addressing new and emerging products [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/343287
https://apps.who.int/iris/handle/10665/3... ). However, despite the guidance of the WHO FCTC, key measures such as tobacco taxation and the banning of tobacco advertising, promotion, and sponsorship, continue to be unevenly implemented.

In 2017, the 35 Pan American Health Organization (PAHO) Member States unanimously approved the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas for 2018-2022 (⁸8. Pan American Health Organization. Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 [Internet]. Washington, DC: PAHO; 2019 [cited 2022 Jan 25]. Available from: https://iris.paho.org/bitstream/handle/10665.2/51574/PAHONMH19022_eng.pdf?sequence=1&isAllowed=y
https://iris.paho.org/bitstream/handle/1... ). Its four strategic lines of action were: smoke-free environments and adoption of measures on the packaging and labeling of tobacco products; bans on advertising, promotion, and sponsorship and measures to reduce affordability; ratification of the WHO FCTC and the Protocol to Eliminate Illicit Trade in Tobacco Products by all Member States; and strengthening Member States’ capacity to counter interference by the tobacco industry and allied groups. Without significant acceleration of the implementation of this strategy, it is unlikely that the targets will be met by year-end (⁹9. Sandoval RC, Bacelar Gomes A, Roche M, Parra N, Armada F. Avances en el control del tabaco en la Región de las Américas 2020. Rev Panam Salud Pública. 2021;45:e94. https://doi.org/10.26633/RPSP.2021.94.
https://doi.org/10.26633/RPSP.2021.94... ,¹⁰10. Pan American Health Organization. Indicator monitoring and evaluation tool - Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 [Internet]. [cited 2022 Jan 25]. Available from: https://ais.paho.org/phip/tobaccotool/
https://ais.paho.org/phip/tobaccotool/... ). Of note, the Region of the Americas is likely to achieve the global target of a 30% reduction in tobacco consumption by 2025, together with two other WHO Regions (¹¹11. World Health Organization. WHO global report on trends in prevalence of tobacco use 2000–2025 [Internet]. 4th ed. Geneva: World Health Organization; 2021 [cited 2022 Feb 23]. Available from: https://apps.who.int/iris/handle/10665/348537
https://apps.who.int/iris/handle/10665/3... ).

There are new challenges on the horizon, with the widespread marketing of novel and emerging nicotine and tobacco products such as electronic cigarettes and heated tobacco products. The tobacco industry has been promoting misinformation campaigns that market these products as being safer or effective tobacco smoking cessation aids, specifically targeting children and young people. We must not let our gains in tobacco control be reversed, and I call on governments to use available scientific evidence and the expertise of public health agencies to guide your approaches to these novel products in the best interests of your citizens (¹1. World Health Organization. WHO report on the global tobacco epidemic, 2021: addressing new and emerging products [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/343287
https://apps.who.int/iris/handle/10665/3... ,¹²12. World Health Organization. WHO study group on tobacco product regulation: report on the scientific basis of tobacco product regulation: seventh report of a WHO study group [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 25]. Available from: https://apps.who.int/iris/handle/10665/329445
https://apps.who.int/iris/handle/10665/3... ).

As we celebrate the 120^th anniversary of the PAHO and the 100^th anniversary of the Pan American Journal of Public Health this year, we must reflect on our accomplishments in tobacco control and encourage all of our Member States to move decisively towards full implementation of best practices in tobacco control throughout the Region. This year is the final year of the current Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas, and we must urge Member States to accelerate their public health plans and policies to achieve the desired outcomes in the interests of solidarity and Pan Americanism. The COVID-19 pandemic has highlighted the fragility of our health systems and services but at the same time creates the opportunity for us to all do better, underpinned by a transformative vision for health equity.

This special supplement on tobacco control highlights the joint accomplishments of the Pan American Sanitary Bureau and the Member States and reminds us that there is still a long way to go to ensure full implementation of the WHO FCTC in the Americas.

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