Tobacco industry access to policy elites and the implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control.

Introduction: Article 5.3 WHO Framework Convention on Tobacco Control (FCTC) aims to prevent tobacco industry interference with public health policy. The degree of protection depends on several factors: the interpretation of Article 5.3 by governments; the presence of codes of practice; and the effectiveness of industry lobbying versus public health advocacy. We examine these factors with reference to the Dutch government's interpretation of Article 5.3.

Methods: We searched the Dutch Tobacco Industry Special Collection, part of the Truth Tobacco Industry Documents archive, containing more than 1100 Dutch government documents.

Results: Between 2007 and 2012, under consistent pressure from the industry, an initial strict view of Article 5.3 gave way to increased contact with the industry. The industry tried to shift the governance of tobacco policy back to the Ministry of Economic Affairs. Around 2010, Dutch public health advocates began to use Article 5.3. Efforts included naming and shaming government contact with the industry, parliamentary questions about industry-government contact, a report outlining how Article 5.3 should be observed and, most importantly, a court case. In response to this, the government produced a formal code of practice, which was used to prevent industry involvement in the development of a new National Prevention Accord.

Discussion: The Dutch government's initial decision not to codify Article 5.3 created an administrative environment in which health ministers' interpretation of Article 5.3 was able to shift according to their political beliefs. The findings support the recommendation that Parties to the FCTC take a strict approach and formally codify Article 5.3 to ensure effective implementation.