Background:
Tobacco kills over seven million people annually. Despite the availability of effective evidence-based tobacco control strategies, their implementation remains a challenge in most low- and middle-income countries like Pakistan. Use of traditional technical tools from public health and economics have failed to address the issue. The literature highlights one reason tobacco is so difficult to control is that its political economy has yet to be adequately understood and addressed.

Objective:
The aim was to identify tobacco taxation policy actors in Pakistan and to collect their views on the current taxation regimen and on challenges in the modification of the policy to achieve both fiscal and health objectives in Pakistan.

Methods:
A qualitative study based on 25 face-to-face interviews with tobacco taxation policy actors was carried out in Pakistan. Framework analysis approach was used to answer the research question.

Results:
Tobacco taxation policy is highly influenced by politics in Pakistan with complex competing and vested interests. A modification of the system, to achieve health objectives, would mainly involve decreasing the economic dependence on tobacco-related revenues, strong tax enforcement, correcting the knowledge asymmetries and dealing with tobacco industry interference.

Conclusion:
Tobacco taxation is a political matter in Pakistan, which has a tobacco-dependent economy. Considering the current political economy scenario a step-wise approach to the implementation of Article 6 of the FCTC is warranted along with a strong political will. There is a need to understand and address the national policy environment while implementing Article 6 of the WHO FCTC.