Motivated by public health concerns about the dangers of tobacco use and the worldwide spread of tobacco, tobacco control civil society organisations embraced the idea of an international convention on tobacco control. These organisations mobilised during the FCTC negotiations under a single umbrella organisation, the FCA, using the Internet. The FCA worked to influence the development of the FCTC within a state-centric UN system by publicising the position of countries and staging worldwide campaign against recalcitrant countries. The FCA participated in the policy-making processes by motivating and mobilising (Peterson 1999
) civil society organisations around the world and, so, emerged as an important transnational actor during the negotiation (Keck and Sikkink 1998
The FCA's ability to garner support for the FCTC represents a great achievement. As of November 2007, three of the ‘big four’ had ratified the treaty. By helping to bring the FCTC into being, the FCA helped put tobacco control on many countries' agendas. Another important FCA achievement was a provision that allows civil society participation in the FCTC implementation process. Article 4: Guiding principles, No.7 of the FCTC states: ‘The participation of civil society is essential in achieving the objective of the Convention and its protocols (World Health Organisation 2003
At the same time, the FCA did not get everything it wanted. The language of the FCTC is generally framed as recommendations rather than the obligations the FCA espoused. The FCTC did not impose a worldwide comprehensive ban on tobacco advertising, promotion and sponsorship because the FCTC subjected this ban to domestic constitutional limitations. The FCA's inability to secure a provision that explicitly gives the FCTC precedence over the international trade regime under the World Trade Organisation is its biggest failure. This failure indicates the tobacco industry's successful use of the economic rationale to dissuade governments from enacting effective tobacco control measures not only at the domestic level but also at the international level.
The successful negotiation of the FCTC demonstrates how civil society can help facilitate cooperation among countries within the UN system. For this reason, the survival of the FCTC depends not only on the will of countries but also the ability of the FCA to sustain the campaign at all levels of governance (Wipfli, Stillman et al. 2004
). After approval of the treaty, the FCA shifted its attention to ensuring ratification and monitoring compliance of the FCTC, two key roles of civil society organisations (Peterson 1999
There are several lessons to be learned from the FCTC negotiations for other global public health problems:
Civil society organisations should be involved in international negotiations on public health issues. Civil society organisations involved in international negotiations on any public health issue should focus on providing and sharing scientific information on the issue with national delegates. All the delegates and FCA participants in the FCTC pointed out that there was a wide variation in the level of knowledge of tobacco use and tobacco control among the national delegates at the beginning of the INB sessions. The FCA helped to close this gap by providing and sharing information with the delegates.
The strategy of holding countries accountable by publicising their positions and using awards to recognize positions that support strong treaty or to shame recalcitrant states can be used to address many global public health issues where some countries would like to put political expediencies and individual countries' interests above collective global interests.
The strategy of limiting the influence of the tobacco industry demonstrates the importance of identifying key opponents of public health within the non-state sector and focus on limiting their influence in international negotiations. Public health groups should expect the tobacco industry to use economic arguments to dissuade governments from promulgating effective tobacco control measures and should aggressively engage the industry on the economic issue. While the FCA failed to win a provision in the FCTC that explicitly gave public health precedence over trade issues, it did win language that put public health on a par with trade, representing a “draw” in the battle with the tobacco industry.
Civil society organisations should pressure countries, particularly members of the FCTC's implementing Conference of the Parties, to honour their commitments by aggressively implementing the FCTC. In this respect, the FCA has become important non-state transnational actor in global tobacco control (Keck and Sikkink 1998
) by participating in the FCTC Conference of Parties as a formal participant and by conducting workshops around the world to build capacity for implementing the FCTC. In the end, civil society organisations will need to sustain policy makers' interests or political will in the FCTC, just as they did during the FCTC negotiations, to ensure successful FCTC implementation around the world.