Tobacco took the world by storm for almost 100 years. Multi-national tobacco industries have grown into powerful giants capable of dictating policies to the governments, especially in the low-and-middle-income countries (LMICs).

Pakistan has been a signatory to the World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC) since 2005. The treaty calls for policies that can limit and ultimately end the use of tobacco products.

WHO’s cost-effective, tested and high-impact MPOWER measures are guideline for the signatories. M is for monitoring tobacco use, P is for protecting people from tobacco use, O is for offering help to quit tobacco use, W is for warning about the dangers of the tobacco, E for enforcing a ban on advertising, promotion and sponsorships, and R is for raising taxes on tobacco products.

Pakistan has been working on most of these measures barring O – offering help. In line with Article 14 of the WHO FCTC, in May 2021, the Tobacco Control Cell (TCC) at the Ministry of National Health Services Regulation and Coordination inaugurated the Tobacco Cessation Clinic, to fulfill this obligation. This was a long-awaited step in the right direction.

Cessation help has been visibly absent from the implementation of the FCTC guidelines in Pakistan. In 2007, only 10 countries provided these services to their citizens. By 2019, almost 2.4 billion people were covered by the facility in 23 countries.

By becoming a participant in the effort, Pakistan has added a whopping 24 million tobacco users to the list, many of whom have been willing to quit and have already tried. The WHO claims that due to severe impact of Covid-19 on the health of the tobacco users, almost 780 million people around the globe are willing and eager to quit. Pakistan’s health system is struggling to cope with the coronavirus pandemic. Tobacco users continue to add fuel to the fire.

As per the FCTC recommendations, Pakistan, through this TCC aims to integrate tobacco interventions into primary care, offer counselling services, bring forth a quit helpline to the rescue and facilitate access to and affordability of smoking cessation medications and therapies that can cut the craving and ease the physical discomfort of nicotine withdrawal.

Tobacco industry is fully aware of these and many more impending policies and continues to plan and implement addictive methodologies in anticipation, mostly with impunity.

Introduction of Velo, and vaping as cessation or replacement therapies can be taken as a pointer. British American Tobacco (BAT) has identified Pakistan and Kenya as the two target countries to spread these products and then market them with the help of social media and electronic media influencers. The BAT has spent up to $1 billion in marketing these products despite the Tobacco Advertisement and Point-of-Sale Ads ban promulgated in February 2020. Since this ban does not prohibit online advertisements, the BAT and Philip Morris are targeting the youth through social media and getting away with it.

Tobacco industry proposes vaping heated tobacco products, E-cigarettes, and chewable products, such as Velo, Lyft and Zyn, as quit or replacement therapies. A majority of studies or advertisements showing these products as safe or as replacement products are sponsored by the tobacco industry.

There is no credible scientific evidence that vaping products are safer than smoking products. It is only commonsense to understand that vaping or chewing tobacco products can never be a replacement for smoking. These are tobacco industry’s ploys to attract young tobacco users.

A clear and unequivocal case has been made in a research titled, Deconstructing Disruptive Industrial Technological Models: Concord between Smoking and Vaping. The research has been published in the Journal of Development Policy, Research and Practice by the Sustainable Development Policy Institute. The study argues that tobacco industry manufactures products that kill 50 percent of its users. It wants attract new users, who are much younger and will continue to use these products for many decades, ensuring profitability.

WHO Director General Tedros Adhanom Ghebreyesus said, “to truly help tobacco users and to strengthen global tobacco control, governments need to scale up policies and interventions that we know work”. He suggests that the governments need to intervene with the “tried and tested” pharmaco-therapies to promote cessation.

Pakistan’s tobacco control advocates have appealed many times for policy interventions to double down on preventing the tobacco industry from promoting such products and narratives. E-cigarettes were once starting to make their way in Pakistani market. Within a very short span of time, the markets have been infested with the chewing tobacco products, such as Velo by the BAT and E-Cigarette in uptown markets across Pakistan. Absence of an online advertising ban, weak vendor licensing regulations (especially for E-Cigarette vendors), and unchecked imports are all facilitating the tobacco industry keep its hold the youth.

It is important to reiterate the need to strengthen the Tobacco Cessation Clinic at the Ministry of Health. There is a need to support the WHO’s year-long Commit to Quit campaign. This campaign aims to help more than 100 million users stop using tobacco products and banks on its powerful publication “More than 100 reasons to quit tobacco”.

“Covid-19 has devastated communities and is presently decimating much of South Asia, but there may be a silver lining to this pandemic as more people embrace the importance of lung health and the urgency to stop using tobacco,” said Gan Quan, director of The Union’s Tobacco Control Department. “The WHO’s Commit to Quit campaign provides evidence-based, digital tools to help users stop using a lethal product. In the past year, LMICs have taken important steps to limit novel product availability. Combined, the campaign and policy changes can be the one-two punch to turn the tobacco epidemic around.”

Syed Ali Wasif Naqvi heads the Centre for Health Policy and Innovation, Islamabad.

Syeda Aneeqa Hassan is a Food Safety Officer with Punjab Food Authority, Rawalpindi