Introduction:
In 2018, the Conference of the Parties (COP) to the WHO Framework Convention on Tobacco Control (FCTC) adopted decision FCTC/COP8(20), urging countries in complex emergencies to maintain their commitment to tobacco control. This decision emphasized critical obligations under the FCTC, including surveillance, legislation, cessation services, awareness campaigns, and measures to counter tobacco industry interference. Since then, the global health landscape has evolved into a state of "permacrisis," marked by the convergence of the pandemic, climate change, and conflict. Ukraine has been enduring Europe’s most severe military conflict since the Russian Federation’s unprovoked invasion in February 2022. This ongoing crisis has strained public health systems, including tobacco control efforts. In December 2021, after years of debate, the Ukrainian Parliament enacted significant reforms to the country’s tobacco control legislation. Despite the war, the government has pursued a dual-track approach, focusing on resilience, recovery, and reforms. This review assesses Ukraine’s implementation of FCTC/COP8(20), highlighting the challenges and successes in sustaining and advancing tobacco control during the crisis.

Methods:
This review evaluates Ukraine’s progress in tobacco control using the critical pillars of FCTC/COP8(20). It examines the government’s ability to maintain achievements while addressing emerging threats, aiming to inform future discussions on tobacco control in emergency settings.

Results:
Ukraine has remained committed to advancing its tobacco control measures despite the ongoing war. Despite significant challenges, the country has demonstrated resilience and dedication to its FCTC obligations. Surveillance: Ukraine maintained its tobacco control surveillance system, monitoring nicotine and tobacco use among youth and adults. National surveys, including those based on GATS and GYTS, were conducted with support from development partners. Protecting Policies from Industry Interference: Ukraine successfully upheld strong legislation, taxation, and enforcement mechanisms despite the tobacco industry’s attempts to exploit the crisis. Collaboration among government ministries, public agencies, NGOs, and international organizations, including WHO, played a key role. Legislation: Ukraine’s tobacco control laws remain aligned with FCTC and EU TPD obligations. Efforts are ongoing to further harmonize with EU standards, including implementing a trace-and-track system for tobacco products. Enforcement: The tobacco control enforcement infrastructure was maintained across government-controlled territories. Despite a moratorium on business inspections, the Ministry of Health (MOH) prioritized tobacco enforcement through comprehensive checklists and support for disease control centers. Cessation Services: MOH integrated smoking cessation into its emergency response, developed a dedicated website with resources, offered free online training for medical staff, and included QR codes on cigarette packs linked to cessation services. Additional services, such as a hotline and chatbot, are being developed. Awareness Campaigns: Despite challenging conditions, campaigns raised awareness about the risks of tobacco and nicotine use and promoted cessation services. Training: Ukraine continued to invest in capacity-building for both governmental and non-governmental sectors, actively participating in regional and global tobacco control training and networking events. Illicit Tobacco Trade: Ukraine remained actively engaged in international efforts to combat the illicit tobacco trade, regularly reporting to the Convention Secretariat and promoting the ratification of the Illicit Trade Protocol.

Conclusions:
Ukraine has demonstrated remarkable resilience in maintaining its tobacco control efforts during the ongoing war. The country adhered to the FCTC/COP8(20) decision with the support of WHO, the European Commission, CTFK, Vital Strategies, and others. However, emerging challenges, including deteriorating infrastructure, reduced staff capacity, and political instability, continue to threaten progress as the tobacco industry seeks to exploit the crisis. The global response to tobacco control in emergencies remains undocumented. Ukraine’s experience highlights the need for continued international support and raises important questions for future COP meetings on addressing tobacco control in similar contexts.