Imagine the shock waves reverberating around the world if the WHO announced that every man, woman and child in Brazil, Bangladesh, Nigeria, the Philippines and Indonesia has been wiped out by COVID-19. That’s around a billion people – the same number the WHO continue to estimate will die from a smoking-related disease by the end of the century. The lack of immediacy and topicality of smoking death stats make them less politically explosive, but no less shocking. The big difference is that, at least currently, we can’t stop the spread of coronavirus, but we can do much to lessen the predicted death toll from smoking.
First, here’s what we cannot do – legislate cigarettes out of existence. Some rosy prohibitionist vision of the future won’t wash. There is too much money at stake, not just for multi-national tobacco companies, but for those countries with the most profitable domestic industries, like China and India. Neither are current international regulation and control strategies, enshrined in the WHO Framework Convention on Tobacco Control – especially stop smoking interventions - making enough of an impact. The countries doing best to attain what the WHO call ‘the highest levels of achievement’ in tobacco controls (e.g in northern Europe and Australia) were ahead of the game anyway before the FCTC was enacted in 2005. There is an old saying that if you are digging yourself deeper into a hole without making progress towards your goal, you should stop digging. This lesson is not being learned by the WHO and its NGO allies and paymasters around the world. Their heads are firmly wedged in the hole. So now what?
Tobacco harm reduction (THR) offers a pragmatic, proportionate and complimentary response to a worsening global public health crisis, if delivered following these essential elements – let’s call them the 4 ‘A’s.
The environment around THR has become increasing toxic with politicians and legislators unnerved by a relentless barrage of misinformation from ostensibly credible sources promoting their own agendas, concerning supposed teenage vaping ‘epidemics’, vaping-related deaths and coronavirus. The evidence is overwhelming that vaping devices, heated tobacco products and snus-style smokeless products pose minimal risk to consumers and bystanders compared to smoking. Regulation and control should be geared to making these products as readily available as other consumer goods, given that independent and internationally agreed products safety standards are in place. So no outright bans, no flavour bans, no regulation as medicinal products and no exorbitant tobacco-style taxation. Instead, are there ways to incentivise both industry and consumers to switch instead of trying to stub out safer nicotine alternatives?
This links to the question of consumers ability, especially for lower and middle-income countries, to afford products. This at least demands a supportive legislative landscape and other obstacles need to be overcome. For example, mobile phones are ubiquitous across Africa with presumably the capacity to charge them up, so affordable, rechargeable vaping devices must be a possibility, if the will is there from the manufacturers.
Vaping devices might work to replace cigarettes in many countries but won’t be appropriate everywhere and with all communities. There are many nicotine consumers, especially in India and South East Asia, who don’t smoke conventional cigarettes but instead smoke local varieties or use a range of even more dangerous smokeless tobacco products. It could be hugely beneficial from a public health perspective if these dangerous smokeless products could be replaced by far safer snus-type smokeless products.
However, just because more appropriate safer options could be made available does not mean that the target consumer groups would find them acceptable. Public health and commercial marketing strategies would need to account for long-standing social and cultural custom and practice, the nature of the messaging, who is delivering the messages and by what means.
THR needs to travel a long and difficult road from A-Z. Let’s start with the As.