Lack of exit strategies for current smokers fueling tobacco epidemic

Islamabad:Nearly 8 million people die from smoking-related diseases every year and a projected 1 billion people will die from smoking-related diseases by 2100. The primary aim of tobacco control should be to offer suitable exit strategies to current smokers. Tobacco Harm Reduction (THR) should be properly defined by parties to the Framework Convention for Tobacco Control (FCTC) to sit alongside demand and supply reduction, recommends the Global State of Tobacco Harm Reduction 2020.

Titled ‘Burning Issues,’ the report focuses on the benefits of having access to affordable, appropriate and acceptable safer alternatives to combustible tobacco products. It also focuses on the rights of smokers, who need the opportunity to switch from smoking and those who have chosen safer alternatives.

The report calls upon the World Health Organization (WHO) to play a lead role in encouraging FCTC signatories to take a more balanced view of the potential for Safer Nicotine Products (SNPs) to help encourage a switch away from combustible products. The current interpretation of Article 5.3 of the FCTC is stifling open debate on the merits of SNP. “A new and inclusive approach is required, engaging with all stakeholders with no exceptions, to evaluate the merits of new technologies and products, based on scientific principles rather than ideology,” the report states.

The publication believes that the WHO’s MPOWER initiative alone will be insufficient in hastening an end to smoking. It sees ‘O’—offering help—as the weakest area of achievement. “Harm reduction is embedded in nearly every field of the WHO’s work except tobacco. Those most affected by tobacco control policies have been stigmatized and excluded from the policy conversation. Good public health engages affected populations. The slogan “Nothing about us without us” is central to THR, as it is to any field in public health,” the report reminds.

According to the report, the current predicted toll from smoking can only be averted by hastening a switch from smoking by established smokers. In this context, it recommends that access to SNP should be a right for all potential beneficiaries irrespective of gender, race, social or economic circumstances, and consumer wellbeing should be at the centre of international planning and policy.

“Companies making SNP should strive to reach the largest number of smokers globally with appropriate and affordable products. The role of governments should be to hasten the switch from smoking, rather than to place obstacles in the way of those who wish to use SNP,” the report recommends.

No action should be taken which has the consequence of favouring smoking over SNP, such as making SNP harder to obtain and use than cigarettes, or through unfavourable pricing (e.g. through taxes). “Smokers have the right to evidence-based information about the potential benefits of switching to SNP,” it states.

The report recommends that SNP be controlled and regulated as consumer products, and consumers be assured of the quality of the products they are using. It also affirms that there is no identified risk of ‘passive vaping’ to bystanders. “Public health communication shou-ld explain that vaping is not smoking, and ultimately the decision to control vaping in particular locations should be left to individual organisations and businesses, rather than through blanket prohibition by government bodies,” it recommends.

Eighty percent of the world’s smokers live in low and middle income countries, but have the least access to affordable SNP. The global number of smokers has remained unchanged at 1.1 billion since the year 2000, and in some poorer countries this is set to rise due to population growth.

According to the report, the evidence for SNP demonstrates that they are substantially safer than combustible tobacco, both for smokers and by-standers, and contribute to helping those wishing to stop smoking. SNP have the potential to substantially reduce the global toll of death and disease from smoking. However, progress in the adoption of SNP has been slow. An estimated 98 million people globally use SNP—including 68 million vapers—amounting to only 9 per 100 smokers. There is an urgent need to scale up tobacco harm reduction and to capitalize it as an opportunity rather than viewing it as a threat, the report states.