Former WHO officials highlight science-backed solution to reduce tobacco harm

According to the article published in Lancet by Prof. Robert Beaglehole and Prof. Ruth Bonita, only 30% of the countries are on track to achieve WHO's target of 30% reduction in adult tobacco usage by 2030

MUMBAI, India , March 21, 2023 /PRNewswire/ — Globally, tobacco control measures are not yielding the desired outcomes exacerbating the challenges for policymakers. WHO statistics indicate that 8 million deaths occur every year due to tobacco and an additional 1.2 million deaths are caused due to second-hand smoke. An article by two former WHO officials Prof. Robert Beaglehole and Prof. Ruth Bonita published on Lancet, a global medical journal, suggests that only 30% of the countries are on track to achieve WHO's target of 30% reduction by 2030 in adult tobacco usage. The number of tobacco smokers worldwide is reducing at a much slower rate than expected. India with close to 100 million adult smokers – has a critical public health concern.

In fact the article further highlights the missing strategy of harm reduction in WHO's global treaty, Framework Convention on Tobacco Control (FCTC), causing its failure to meet goals. Globally, many nations will miss the target of achieving the Sustainable Development Goal 3.4 for non-communicable diseases. This paints a rather grim picture of the future especially for low-income countries that are more vulnerable.  With over 1 in 4 adults consuming tobacco, India continues to have the world's second largest tobacco using population. Tobacco consumption claims over a million deaths every year in the country. Tobacco addiction, especially in the low-income population results in this vulnerable group falling into a vicious cycle of poverty induced by lack of tobacco harm control. Further, the economic costs arising out of addiction-induced diseases cause an impediment to the economic growth of the nation.

Unfortunately, WHO and the FCTC Conference of Parties reject harm reduction as a concept. Their approach is not taking into account the 21st century technological advances that are available. As an autonomous country, India needs to consider an independent assessment on new age harm reduction technologies and form evidence based progressive policies on its own merits.

It is confounding when scientifically supported products that clearly demonstrate customer desire are outright forbidden rather than scientific review and suitable regulation. A good and progressive public policy must allow customers to obtain innovative products based on informed choice rather than entrenched interest.

In recent panel discussions experts like Dr. Kiran Melkote, Orthopaedic surgeon, and a member of AHRER and Dr. Nimesh Desai, Senior Consultant Psychiatrist & Former Director, IHBAS – collectively opined that there's a public health opportunity in regulating reduced risk, scientifically proven safer alternatives. Tobacco control and reduction require regulation not a ban– this will significantly help the Indian government's efforts to reduce comorbidities associated with Tobacco.

Additionally legal experts like Upendra N Sharma, Partner, JSA Advocates & Solicitors and Supratim Chakraborty, Partner Corporate/Commercial, Tech/Data Protection, Khaitan & Co echoed, that in the case of new technology or a healthcare-based solution, there must be adaptive, outcome-oriented, risk-weighted and collaborative views that need to be considered before narrowing down on a regulation.

As a sovereign leadership, the government of India took an informed independent position to fight the crucial pandemic of COVID-19 in the country in line with global learnings, not restricting itself to solely WHO's guidance. Similarly, India needs to take a unique solutions'-oriented approach towards harm reduction – with insights from countries like UK, Japan and New Zealand who have benefitted from a progressive science-backed harm reduction approach by minimizing harm and decreasing total mortality and morbidity. Japan, a country that has successfully adopted harm reduction policies has witnessed 35% of the population switching to safer heated tobacco products.

Recently, economies like Thailand and Egypt are positively looking at adopting Tobacco harm control. A study under the house standing committee on public health of Thailand suggests that the government should adopt a policy of Tobacco Harm Reduction and revisit relevant laws towards safer alternatives.  Similarly, in Egypt, experts associated with the government have voiced their opinion about novel nicotine products.

India's G20 presidency provides an opportune moment to advocate sustainable public health by setting an example for emerging economies. This can certainly help in accelerating the adoption of science-backed approach to mitigate a chronic global public health challenge.

Prohibition on reduced-risk products have the opposite effect of increased tobacco usage. Hence, India also needs to adopt a rather nuanced, progressive, and evidence-based approach to policymaking by making available access to better alternatives. A reduced risk approach will benefit millions of legal age smokers who find it difficult to quit and will also help reduce the public health burden of the Government.