1.2m lives can be saved in Pakistan — policy makers need to think and act now

Many countries are grappling with the challenge of reducing smoking prevalence in their populations. Traditional measures for tobacco control have hit a plateau, which is why the right time has arrived to switch to far more effective and globally accepted ‘tobacco harm reduction’ strategies if we wish to save more than 1.2 million precious lives in Pakistan. The spectrum of tobacco harm reduction products reduces toxic exposures by 80% and reduce tobacco-related causes of premature death by 70%.

However, there is one country that has managed to set a new precedent of reducing the prevalence of tobacco smoking – Sweden. In 2022, the Swedish government announced that the smoking rate in the country had dropped to 5.6%. This compares with a rate of up to 25% in some other EU countries.

The Swedes have managed to deliver on this front by harnessing the power of tobacco harm reduction. The Swedish government worked to make alternative products more affordable, accessible, and available. They realised that embracing the alternatives naturally chosen by ex-smokers, like vaping and nicotine pouches, as well as proactive measures for early cancer diagnosis and treatment, are the fastest ways to curtail the impact of combustible cigarettes. Several other countries, such as Japan and the United Kingdom, are also headed in a similar direction. For example, in the UK, the use of e-cigarettes is proactively promoted as a tool for those adults who wish to stop smoking. Smoking rates have almost halved as a result, dropping from 20% to 12% in less than a decade.

A recently published report, “Integrating harm reduction into tobacco control”, co-authored by this writer with a group of doctors and researchers in various countries, makes a compelling case for the integration of harm reduction measures as a cornerstone of comprehensive tobacco control, particularly in Pakistan. The report also notes that the adoption of sensible tobacco harm reduction strategies in Pakistan could save 1.2 million lives. Now that we have access to such data, authorities in Pakistan should begin to focus on tobacco harm-reduction products as a natural next step.

One way of achieving a smoke-free world (and Pakistan) involves advocating for change at a global level. While the World Health Organisation is set to host a COP10 meeting on tobacco policies, Article 1(d) of the Framework Convention on Tobacco Control (FCTC) has not yet been fully deployed. The FCTC has in place all of the elements needed to optimise tobacco control but has so far ignored the need for “harm reduction strategies”, as referred to in Article 1(d).

Furthermore, governments should consider adopting tobacco harm reduction strategies as part of tobacco control in public health regulatory frameworks. Regulations on vapour and nicotine products should be proportionate to the risk they pose to health and in ways that maximise benefits and make healthier choices as easy as possible.

In Pakistan, we can learn from the Swedish model and reduce the cost of tobacco alternatives to reduce harm. On a practical level, human behaviour tells us that cigarette smoking is made up of two components; one is nicotine dependency, and the other is a dependency on the ritual of repeated puffing. Making e-cigarettes available at affordable prices will help limit the harm associated with combustible tobacco, whilst also recognising that stopping this habit altogether might not be possible for some. The high cost of alternatives is a major limiting factor for people willing to let go of cigarettes and desiring to opt for less harmful alternatives.

In addition, not many countries are aware of the impact of the Swedish Smoke-Free model. This is why we need our representatives in the global arena to tell the stories of those who have opted for less harmful alternatives. Let’s invite those who understand the science of reducing the harms of tobacco to utilise the political stage and amplify their voice in calling for the protection of their right to health.

The writer is an Endocrinologist. Currently President - International Society of Endocrinology and has been conferred Tamgha-e-ImitIaz by the President of Pakistan