Lessons for the Tobacco Endgame: a comparative case study analysis of Bhutan, Brunei Darussalam and South Africa

The tobacco ‘endgame’ conceptualises policy approaches which aim to end, rather than simply control the tobacco epidemic. Several countries have set tobacco endgame targets, and some jurisdictions have implemented or are planning to introduce tobacco endgame strategies. This research will explore three diverse cases where endgame strategies have been implemented either through government policy or commercial decisions by the tobacco industry. Bhutan banned all tobacco sales from 2004 to 2020; the ban was rescinded during the Covid19 pandemic and has not been reinstated. Brunei Darussalam has no tobacco companies operating in the country and no tobacco distribution licences issued since 2014. South Africa introduced a temporary sales ban on tobacco products to support public health measures during the COVID-19 pandemic. Comparing these cases offers a unique opportunity to identify lessons for the tobacco endgame. A mixed methods case study approach will be used to examine the impact on smoking prevalence, unpack the policy processes involved and compare and contrast the experiences of the three countries to draw lessons which add to the growing evidence base for the tobacco endgame internationally.