Background:
The presence of an illicit cigarette trade is used as an argument by the tobacco industry in Ethiopia to halt pro-health tobacco tax policies. The National Tobacco Enterprise (NTE) recently reported that the illicit cigarette market accounts for over 44% of the total market, and over 90% in the Eastern part of Ethiopia. However, it is not clear how those estimates were obtained.

Methods:
We employed a cross-sectional observational study of empty packs collected in Ethiopia from retailers and from the streets in 10 towns, representing 10 regional states, and two autonomous cities. We supplemented these data by a retailers' survey to obtain information about the cigarette supply chain and cigarette prices.

Results:
The majority (80.1%) of the 6438 empty cigarette packs collected (5368 from the streets and 1070 from retailers) belonged to locally produced brands, while the remaining 19.9% were foreign packs, including those allowed to trade in Ethiopia. Based on the pre-determined criteria used for classifying a pack as illegal, we determined that the market share of illicit cigarette packs varied considerably across the country. While as many as 97.7% and 86.6% of the packs collected in Jigjiga and Dire Dawa (both in the East), respectively, were found to be illicit, the packs obtained in the South, the Southwest, and the North were mostly legal (98.2 to 99.0% of them). Some illicit brands are more expensive than the legal domestic brands even though the legally imported foreign brands are more expensive compared to the illegal foreign brands.

Conclusions:
The estimates of the size of the illicit cigarette market vary by region. In the majority of the cities surveyed the share of the illicit cigarette market was considerably lower than the estimates promoted by the tobacco industry. However, illicit cigarettes are disproportionately sold in cities near the border with Somalia. To address this alarming situation, the country needs to strengthen border control and law enforcement, especially in the East. In addition, Ethiopia needs to control the supply of cigarettes better by marking all packs for sale in Ethiopia. Currently, cigarette packs bear no indication that the proper tax was paid. Such markings can be tax stamps linked to a tracking and tracing system (T&T). A secure T&T system would reinforce the efficiency of excise taxation and reduce tax evasion.
Ethiopia should consider ratifying the WHO Protocol on Illicit Tobacco Trade, which would be an important step in joining the international community in the fight against illicit the tobacco trade.