Strengthening Tobacco Control during the COVID-19 Pandemic in India: A Secondary Policy Review and Analysis.

India's response to the COVID-19 crisis involved invoking a combination of emergency and penal laws and regulations to prevent tobacco use, especially in public places to prevent transmission of COVID-19 in the country. This paper presents a review of the laws, policies, and administrative actions undertaken for strengthening and advancing tobacco control during the COVID-19 pandemic in India. All possible pre- and post-independence legislation were used to strengthen, advance, and implement effective tobacco control measures during the COVID-19 pandemic to prevent its transmission. Most restrictions were imposed under the Epidemic Diseases and Disaster Management Acts, in conjunction with laws under the penal code, food safety regulations, and tobacco control statutes. The restrictions were issued in the form of official orders and notifications, primarily aimed at prohibiting the use of tobacco products and spitting in public spaces. Advisories and orders were issued from the national level, the state governments, and district administration in taking these initiatives. Judicial decisions also supported this approach. More than 90% of the reviewed directives specified the type of tobacco products subject to restrictions, 85% cited COVID-19 as the rationale for these measures, and 90% designated enforcement authorities to ensure compliance with the directives. India's longstanding history of tobacco control legislation played a pivotal role in addressing tobacco use as a preventive strategy during the COVID-19 pandemic. The experience of India's pandemic response suggests that a judicious use of existing legislation may offer a pragmatic solution for effectively addressing public health emergencies.