GENEVA - Concerns about indigenous peoples' rights, free cigarettes for minors and the size of health warnings may stand in the way of the United States adopting an ambitious global anti-tobacco accord.

Germany said it found the plans for tight advertising controls unacceptable, while China and Japan also expressed concern. The concerns — in particular those voiced by the United States — mean there may be pressure on ministers to renegotiate parts of the text at the meeting in May — and thus risk unraveling the entire accord. After nearly four years of negotiations, the language of the U.N. treaty was agreed in the early hours of Saturday by more than 170 countries and will now go to the World Health Organization's annual ministerial meeting in May for adoption. But the United States immediately signaled that it had serious problems with the wording — which was tougher than even anti-smoking activists had expected. "We had hoped this could have been concluded as a consensus text," said U.S. delegate David Hohman. "Unfortunately this is not possible." Hohman told exhausted delegates that Washington would examine all its options. He hinted that the United States might press for parts of the text to be renegotiated at the forthcoming WHO assembly. The accord, called the Framework Convention on Tobacco Control, proposes a ban on cigarette advertising. Countries whose constitution prohibits this — Washington says it would violate free speech — should impose sweeping restrictions on domestic and cross-border advertising and sponsorship. It is also tough on labeling, proposing that health warnings should occupy at least 30 percent of the pack and encouraging the use of pictures of health problems like diseased gums. It urges governments to limit the use of low-tar, light and mild on packs, although does not ban this. For the first time in an international treaty, the concept is introduced that manufacturers may be held liable for the suffering caused by their product. But, to avoid treading on a legal minefield, the wording is fairly vague. It says governments should consider tax hikes and there should be far more international cooperation to stamp out rampant smuggling. It also calls for policies against secondhand smoke that are now routine in the United States. "The convention is a real milestone in the history of global public health," said WHO Director-General Gro Harlem Brundtland, who made the anti-tobacco campaign the focal point of her five-year term. "Tobacco kills in every country of the world, and probably most of us know someone who has died," she added. "Due to the actions that will follow from our shared commitments, millions and millions of lives will be saved" Although the United States has some of the toughest anti-tobacco legislation and long since banned television advertising, it was pilloried by health activists throughout the negotiations. Developing countries were suspicious that the United States — home to the world's biggest exporter Philip Morris — was more interested in protecting Big Tobacco than the health of the poor. The U.S. delegation tried in vain to insert a provision allowing "reservations" a device whereby a government can opt out of an individual clause which is problematic. U.S. officials said such opt-out flexibility would be crucial in determining the acceptability of the treaty. "We are disappointed that reservations are excluded which is a complication for our legislative process," Hohman said. Hohman said the proposals for minimum size of health warnings on packs were unacceptable. The cigarette industry has argued this is in breach of its trademark rights. He also criticized the provisions to ban distribution of free cigarettes to the public. Federal legislation allows for the regulation of commercially sold goods but not free products, he said. And finally, he said the United States could not agree to wording voicing concern about high smoking levels in "indigenous peoples." Washington fears that use of "peoples" rather than "people" could imply sovereignty and would send a wrong signal to native American Indians. Anti-smoking campaigners dismissed the U.S. concerns. "We didn't expect the United States to ratify anyway," said Clive Bates, director of ASH UK. "They haven't ratified treaties like this for years. Their presence here is academic."

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