A new report issued today shows that the United States has fallen far behind much of the world in requiring large, graphic health warnings on cigarette packs. The report should spur the Food and Drug Administration to quickly develop and implement such warnings, as required by U.S. law, according to Matthew L. Myers, president for the Campaign for Tobacco-Free Kids.

Myers says the US is tied for last among 198 countries/jurisdictions based on the size of its warnings, woefully behind the 77 countries/jurisdictions that have finalized picture warning requirements, according to the report, Cigarette Package Health Warnings: International Status Report, issued by the Canadian Cancer Society.

The pictorial warnings are spreading rapidly: Canada was the first country to implement such warnings in 2001, and two years ago, when the last edition of the report was issued, 55 countries required picture warnings.

The current US warnings, which are text-only and printed on the side of cigarette packs, are stale and unnoticed, Myers believes. They haven’t been updated in 30 years and are among the least effective in the world. In 2009, a large, bipartisan majority of Congress passed a law mandating graphic warnings that cover the top half of the front and back of cigarette packs and 20 percent of cigarette ads. In June 2011, the FDA issued a comprehensive set of graphic warnings.

Tobacco companies filed two lawsuits challenging the graphic warnings, leading to two federal appellate court rulings. The US Court of Appeals for the D.C. Circuit struck down the specific warnings proposed by the FDA.

However, the U.S. Court of Appeals for the Sixth Circuit upheld the law’s underlying requirement for graphic warnings, finding that the warnings “are reasonably related to the government’s interest in preventing consumer deception and are therefore constitutional.”

The U.S. Supreme Court declined to hear a tobacco industry appeal of the Sixth Circuit ruling, preserving the FDA’s authority to develop new graphic warnings.

The FDA stated in March 2013 that it would begin developing new warnings, but 19 months later it has yet to act, Myers says, adding that the FDA has taken far too long to develop new warnings, and should move quickly to require strong warnings that are based on the best available science, can withstand legal scrutiny and fully inform Americans about the deadly consequences of smoking.