A brief review of the need to research tobacco control initiatives
Tobacco control is not working for most of the world, it is not progressing and maintains status quo. Interestingly, four out of five of the world’s smokers are in low-income and middle-income countries. There are a few countries who are attributing to this number and death rates linked to tobacco consumption in these countries are almost the same. Most of the eight million deaths caused by tobacco occur each year, however rates of tobacco use are falling only slowly. Globally, the overall number of tobacco users has barely changed. This is empirical evidence which proves that tobacco control is a failing and requires an urgent overhaul to be effective.
This is cemented by data which suggests that only 30% of countries are on track to achieve WHO’s (World Health Organization) target of a 30% reduction in prevalence by 2030 in adult tobacco usage. Most nations will miss this target of achieving the Sustainable Development Goal 3.4 for non-communicable diseases, which will require a much more ambitious tobacco target.
In a recently published article penned by Robert Beaglehole and Ruth Bonita published in Lancet Journal, the authors stress the need for greater compliance with the WHO Framework Convention on Tobacco Control (FCTC). The FCTC is no longer fit for purpose, especially for low-income countries. Neither WHO nor the FCTC are grounded in the latest evidence on the role of innovative nicotine delivery devices in assisting the transition from cigarettes to much less harmful products. Equally, the focus on youth vaping, most of which is experimental, detracts from the crucial public health goal of reducing cigarette-caused deaths in adults.
The missing strategy in WHO and FCTC policies is harm reduction. Most people smoke because they are dependent on nicotine. Tobacco harm reduction reduces the harm caused by burnt tobacco by replacing cigarettes with much less harmful ways of delivering nicotine; these alternatives have great potential to disrupt the cigarette industry.
Unfortunately, despite the vast repository of emerging research and evidence, WHO and the FCTC Conference of Parties rejects harm reduction. This opposition is not grounded in 21st-century technological advances, and instead is unduly influenced by vested interests of groups who promote nicotine abstinence. This opposition privileges the most harmful products—cigarettes.
There is an urgent need for global like-minded public health practitioners to recognize and acknowledge the benefits of harm reduction as a crucial strategy for reducing the health burden caused by tobacco. Additionally, parties to the FCTC need to take a more questioning and assertive approach to WHO’s advocacy for a smoke-free alternative to smoking, especially in LMIC countries. The Lancet should also add its voice and call for an independent review of WHO’s tobacco control policies to reimagine a better future for millions of lives.
India has the second-largest tobacco consuming population in the world. These global recommendations provide valuable inputs for low- or middle-income countries such as India, to embrace science-backed regulations to address its smoking problem. A sincere intervention by policymakers is required to look at safer alternatives and not having that is another strong element in failed tobacco control ecosystem. The current policy with effective ban on safer tobacco alternatives deprives millions of adult smokers of the right to choose safer alternatives raising the risks of a larger health crisis.
While experts recognize the uncertainty of the benefits and risks associated with the evolving marketplace of non-combustible tobacco products over the longer term, there is a need to consider the substantial body of evidence instead of excessive caution to deny smokers promising alternatives. Such advancements in public health science will not only benefit countries to control the smoking menace but will also converge on a common purpose to meet the SDGs and reduce the global burden of tobacco-related disease and premature mortality.