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COVID-19 has had many negative impacts on all our lives as well as on tobacco control efforts.

Most research shows that among people infected with COVID-19, smoking is associated with a higher risk of severe illness. Studies from China found smoking is associated with three times the risk of mortality from COVID-19 when compared with those who never smoked. Studies of adults admitted to critical care facilities with COVID-19 also found that smoking is associated with a higher mortality when compared to non-smokers. Moreover, globally, the pandemic has contributed to less government attention to regulation, monitoring, and advancing prevention for chronic disease drivers as governments concentrate their efforts on the urgency of infectious disease control. Tobacco companies have taken full advantage of this situation in their efforts to increase market shares, attract new customers, retain smokers, and polish their corporate reputations.

Altria, one of the world’s largest tobacco companies, reported to their stockholders a 4.9% increase in sales in the quarter that ended December 31, 2020, compared to 2019. During lockdowns, Philip Morris International (PMI) fought to push e-cigarettes as an essential service and even offered home deliveries in Russia. The industry also worked to garner goodwill by providing ventilators in Greece (PMI) as well as hand sanitizer and personal protective equipment in Bangladesh (British American Tobacco). In Pakistan, PMI lobbied successfully to keep its factories open even while most other non-essential businesses were temporarily shut.

Some countries fought back. India, Botswana, and South Africa implemented limitations on tobacco sales during the pandemic, with South Africa declaring that—as tobacco is not an essential service—it would not be allowed to be sold throughout lengthy lockdown periods.

Following the spread of the COVID-19 pandemic around the world, 17 countries in the Eastern Mediterranean region banned waterpipe use temporarily in public places. Waterpipe use creates opportunities for the spread of COVID-19 due to the communal nature of its use that makes physical distancing difficult as well as the sharing of a single mouthpiece. Because of this, the WHO’s Regional Office for the Eastern Mediterranean urged countries where bans were not already in place before COVID-19 to consider bans on tobacco and waterpipe use in all public places, for public health reasons associated with harms from tobacco use and to limit the spread of COVID-19.

E-cigarette companies using COVID-19 as a business opportunity
Some e-cigarettes companies openly used COVID-19 as part of their promotional strategy including urging people to stay home and vape, and some even sold protective .
The tobacco control community fought back with its own important messaging
COVID-19 F.A.C.T. Campaign
The WHO warning strongly that sharing waterpipe mouthpieces and excessive open exhalation among small groups would likely heighten the probability of COVID-19 transmission.


Smoking and COVID-19 outcomes:

Clift AK, von Ende A, Tan PS, et al. Smoking and COVID-19 outcomes: an observational and Mendelian randomisation study using the UK Biobank cohort. Thorax 2022;77:65-73.

Gao M, Aveyard P, Lindson N, Hartmann-Boyce J, Watkinson P, Young D, Coupland C, Clift AK, Harrison D, Gould D, Pavord ID. Association between smoking, e-cigarette use and severe COVID-19: a cohort study. International journal of epidemiology. 2022 Feb 18.

Shi, C., Wang, L., Ye, J. et al. Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis 21, 663 (2021).

Taylor EH, Marson EJ, Elhadi M, Macleod KD, Yu YC, Davids R, Boden R, Overmeyer RC, Ramakrishnan R, Thomson DA, Coetzee J. Factors associated with mortality in patients with COVID‐19 admitted to intensive care: a systematic review and meta‐analysis. Anaesthesia. 2021 Sep;76(9):1224-32.

Waterpipes and COVID-19:

World Health Organization, Eastern Mediterranean Regional Office. 2020. Tobacco and waterpipe use increases the risk of COVID-19. Website: Last accessed 5/3/2022.

Changing product landscape during COVID-19:

Asare S, Majmundar A, Islami F, Bandi P, Fedewa S, Westmaas LJ, Nargis N. Changes in Cigarette Sales in the United States During the COVID-19 Pandemic. Annals of Internal Medicine. 2022 Jan;175(1):141-3.

Besaratinia A, Tommasi S. The consequential impact of JUUL on youth vaping and the landscape of tobacco products: The state of play in the COVID-19 era. Prev Med Rep. 2021 Apr 20;22:101374. doi: 10.1016/j.pmedr.2021.101374. PMID: 34168950; PMCID: PMC8207461.

Tobacco company profits during COVID-19:

Chaloupka F, Drope J, Siu E, Lee, HM. Big Tobacco Continues ‘Business As Usual’ Despite Covid-19 Pandemic [Policy Brief]. 2021. Chicago IL: UIC-IHRP-Tobacconomics.

Tobacco company interference during COVID-19:

STOP. Monitoring Brief: Tobacco Industry responses to the COVID-19 pandemic. Edition 1: Covering the period March 20 – April 16, 2020. Available at:

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