Consumers must have access to healthier alternatives
Hardly anyone would have missed the headline of past few weeks that vaping causes erectile dysfunction. Based on survey responses, the concerned US study at best established association and certainly not causation. It is near impossible to decouple the effects of vaping from past smoking in such cross-sectional studies, and majority of vapers are ex-smokers. The respondents could also well have switched to vaping ‘after’ being diagnosed with the condition.
Instead of relaying this uncertainty and the weak association, the headlines streamed dissuasion to millions of smokers resolving to quit around the new year, most of whom are headed for failure as 95% of smokers who try to quit on their own will relapse, success rates improving marginally with NRT support and counselling. Demonising the most effective cessation tool currently available, e-cigarettes, thus has a major human cost and creates mistrust of media and public health among tobacco consumers.
Honest communication of risks is central to effecting societal change, and yet, a patronising thinking appears to have taken hold of public health such that employing few mistruths to achieve a greater good is considered good strategy, even though it almost always leads to negative outcomes. At the beginning of the pandemic, the US Surgeon General exhorted the public not to wear masks to ensure enough are left for medical workers, which resulted in mask hesitancy that continues to this day. The WHO is currently downplaying the role of boosters in tackling the omicron surge so that developing countries can get the much-needed doses, which is bound to fuel vaccine scepticism.
[box type=”info” align=”” class=”” width=””]Good intentions are therefore no safeguard against the hazards of miscommunicating risks and in fact dents the effectiveness of public health campaigns as people start trusting them less.[/box] Unfortunately, however, this remains the dominant strategy in tobacco control where 1.3 billion users are continually fed inaccurate information to elicit behavioural change – from overstating and conflating the risks of nicotine despite it not being the main cause of harm from smoking, to framing smoking as a choice and overstressing the efficacy of quitting cold turkey.
This extends to vilifying e-cigarettes in face of clear scientific evidence of much lower harm compared to smoking because the WHO is not confident developing nations can successfully regulate them and prevent teen uptake. Unmindful ofcourse that high tobacco use exacerbated by inadequate healthcare infrastructure and cessation support in these countries makes harm prevention through substitution with safer alternatives an effective damage control strategy. Further, lack of enforcement not only renders prohibition like India’s vape ban ineffective but also counterproductive as black markets mushroom which have no regard for preventing sale to minors.
Instead of a top-down approach, it would thus be better to adopt a more collaborative strategy which puts consumers at the centre of policymaking by arming them with accurate and up-to-date information about relative risks so that they can make informed choices, and incentivise the safer choices by makes them more accessible and affordable. New Zealand has taken the boldest step yet in this direction by raising taxes, limiting points of sale and eventually banning the deadliest form on nicotine consumption, cigarettes, while leaving vaping products on the market such that if anyone wishes to engage with recreational nicotine in the future, they will be guided towards doing so in the least harmful ways possible.
India’s 270 million tobacco users deserve no less.
Emulating New Zealand by phasing out the deadliest cigarettes, bidis, zarda, gutka and others through gradually tightening restrictions in favour of the least harmful options such as e-cigarettes, snus and nicotine pouches would prove most effective. It would also substantially shift the burden of reducing tobacco-related diseases and deaths from the overstretched state machinery to consumers themselves, most of whom are aware of tobacco risks and would be willing to manage them given affordable and accessible alternatives.
The pandemic has been a great teacher in the art of effective public health policymaking and in taking citizens along with accurate risk information, reasoned regulations, and harnessing technology. Harm reduction measures such as mask wearing, social distancing and sanitising have been favoured over lockdowns and travel bans, which are reserved as last resorts. There is no reason why similar people-first, harm prevention strategies should not be adopted in addressing tobacco use, which kills more people every year than the pandemic has so far globally.
India faces among the severest tobacco crises in the world, losing 1.3 million people every year and suffering severe economic losses. It is thus imperative we explore the best possible ways to address the problem and expand the current coercion model of price hikes and bans to meet consumers where they are and elicit cooperation by offering them a gamut of alternatives to either quit or switch.
Samrat Chowdhery The author is the director, Association of Vapers India and the past president of International Network of Nicotine Consumer Organisations, which represents 40 national consumer groups focused on tobacco harm reduction strategies.
