Global public health experts’ question WHO’s campaign against tobacco harm reduction technologies

Urge WHO to adopt a scientific approach to policies; embrace technology & innovation

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Image: Mehdi Imani on Unsplash

Every year, over eight million people die owing to deaths caused by tobacco, accounting for the economic burden of $1.4 trillion (approximately Rs 104,41,578 crore) spent on healthcare and lost productivity. Over the years, the World Health Organization (WHO) has been spearheading varied global awareness campaigns and coupled with traditional nicotine replacement methodologies, yet the number of smokers has remained over a billion since 2000. 

So, the question is ‘Is WHO really doing enough to truly help adult smokers around the globe quit’.

World No Tobacco Day’s (WNTD) initiatives

This year, WHO launched a year-long campaign for World No Tobacco Day’s (WNTD) on the theme of “Commit to Quit”. The campaign aims to empower 100 million tobacco users to quit by attempting to create networks of support and increased access to services to help tobacco users quit successfully. The initiative includes scaling existing services such as advice from health professionals, national toll-free quit lines as well as services like Florence, WHO’s first digital health worker, and chatbot support programs on WhatsApp.

The ugly truth remains that such initiatives rarely help smokers quit. Today, 80% of smokers belong to low- and medium-income countries, wherein the efficacy of national toll-free quit lines or availability of medical staff especially against ongoing pandemic situation is questionable. Over the decades, there is enough data that indicates the limited success of abstinence-oriented tobacco cessation methods or nicotine replacement therapies (NRTs) with many countries struggling to build a successful cessation category. It is unfortunate, most tobacco users and adult smokers even after best treatment go back to limited or previous patterns of tobacco use.

Recent remarks by WHO around WNTD, unfortunately, reflect the rather regressive mindset of the institution. To this, in an open letter, eminent tobacco harm reduction global advocates including David Abrams, Department of Social and Behavioral Science, NYU School of Global Public Health, New York University; Clive Bates, Former director Action on Smoking and Health (UK); Prof. Raymond Niaura, Department of Social and Behavioral Science, NYU School of Global Public Health, New York University; and David Sweanor, chair of the Advisory Board of the Centre for Health Law, Policy and Ethics, University of Ottawa, Canada; responded and presented their differing views.

The letter highlighted WHO misrepresenting risks and denying the value of switching to safer alternatives, ignoring compelling scientific data-backed evidence.

WHO’s Tobacco Product Regulation Report

Additionally, a group of acclaimed experts sent letters to Asia Pacific’s health ministers and secretaries to express their deep concern about the WHO’s Latest Tobacco Product Regulation Report. The Expert Advisory Group of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates warned that WHO’s study group was not acting in public health’s best interests by recommending bans on all aspects of vaping.

Sadly, WHO has often failed to recognize the power of technology and its unquestionable role in creating a positive impact across sectors and instead taken a high moral ground. According to estimates by the Indian Ministry of Health and Family Welfare, at least 2,500 of the 3,750 deaths due to tobacco use every day, are caused due to smoking which could have been easily prevented had we complimented new-age technologies to strengthen cessation categories. 

The role of eCigarettes to assist with cessation is often considered binary is seen with an “all or nothing” lens and its role in enabling smokers to gradually quit is often negated. Tobacco Harm Reduction (THR) technologies are working to enable smokers who are otherwise unable to quit combustible products to switch to safer nicotine alternatives.

Today, there is significant research validating the benefits of THR strategies. Scientists in 2018 said lowering nicotine to minimally addictive levels would result in 5 million smokers quitting within a year and 13 million within five years. The WHO has even ignored the compelling evidence put forward by US FDA and the Public Health UK confirming products such as heated tobacco products and those in the eCigarette space can reduce harm up to 90%. In April 2021, the Royal College of Physicians (London) published a detailed scientific assessment focused on smoking cessation as an effective treatment for tobacco dependence and should be encouraged in all treatment pathways.

Despite the body of science, since 2014, WHO and the FCTC Secretariat’s stance has been negative supporting prohibitions of low-risk alternatives like done in India with stringent regulation and excessive taxation on cigarettes. The proposed COPTA guidelines in India are an example of this aims to curb smokers but with an impetus to illegal trade.

Countries that embraced THR strategies meet tobacco control goals

In contrast, countries that have successfully embraced THR strategies to meet their tobacco control goals. For example, the UK has taken a compassionate approach to safer alternatives/reduced risk products – including groups with high smoking prevalence. Similarly, Sweden has the lowest rate of adult smoking found anywhere (7%) in the developed world, owing to the large-scale adoption of smokeless tobacco instead of smoking. Japan saw an accelerated decline in cigarette volumes in the five years since the introduction of heated tobacco products.

If WHO continues its current approach of choosing dogma over science there will be more disease, premature deaths as well as severe economic losses. Countries choosing extreme policies including bans rather than progressive regulations will be challenged to achieve the Sustainable Development Goal 3.4 to reduce non-communicable disease mortality by one-third by 2030. Smoke-free tobacco and nicotine products displace smoking, and they are part of the solution, not part of the problem. The onus now lies with WHO, it must push innovative, effective, and compassionate solutions to accelerate an end to this global epidemic.

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