Activists have accused the United States, Germany and Japan of thwarting efforts to reach a tough global pact against smoking and say other countries may need to seek a deal without them.
They said the three powers, home to big cigarette firms, were almost alone in opposing a sweeping ban on tobacco advertising in treaty talks in Geneva.
"There are three countries blocking it [the treaty]," said Clive Bates, of the British-based Action on Smoking and Health (Ash).
"If it were not for them, we could quickly finish this."
Member countries of the World Health Organisation (WHO) have been at the penultimate round of talks on the first global bid to kick a habit that causes millions of deaths a year.
A further session is set for February before the first international public health treaty is due to be approved at the May annual meeting of the 192-country United Nations body.
The death toll from smoking-related diseases has risen to 4.9 million a year from the previously estimated four million and will double over the next 25 years, with 70 per cent of deaths occurring in developing countries, the WHO has warned.
Apart from advertising, which some developed countries already ban, the treaty would tackle issues such as youth smoking, smuggling, raising tobacco taxes, passive smoking, and rules on labelling and packaging.
Last week, three leading medical pressure groups, including the World Heart Federation, demanded that Philip Morris, British American Tobacco and Japan Tobacco International halt global advertising campaigns that the companies say aim to deter young people from smoking.
"Despite its rhetoric and public relations, the tobacco industry is not part of the solution," they said.
"It supports only those measures known not to work, while opposing measures - such as raising taxation, and complete advertising bans - that do."
Some developing countries are pressing for the pact to make clear that anti-smoking measures take precedence over World Trade Organisation rules on free trade in order to ward off any legal challenge by tobacco companies.
Some multinationals have threatened, for example, to take action against efforts to prevent the use of labels such as "mild" or "low tar" on cigarette packaging because, they argue, that would break trademark protection rules.
The WHO says the labels are misleading because there is no evidence these types of cigarette are any less harmful.
But for activists, the key battle is over advertising and sponsorship, particularly in sport where tobacco companies spend tens of millions of dollars a year.
The US and Germany say they cannot stop advertising entirely because that could violate constitutional guarantees on freedom of speech.
But they have angered other delegations by refusing to consider the inclusion of an advertising ban even with a let-out clause for states facing constitutional problems.
- REUTERS
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Major powers 'blocking' tobacco advertising ban
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