Worldwide, tobacco kills more than 8 million people a year. According to the Global Burden of Disease (2019) report, in Pakistan alone, 160,000 people succumb to diseases attributable to cigarette smoking every year, while over 22 million people in the country still continue to smoke – all this despite the widespread knowledge of the harm caused by cigarettes. As a result, the prevalence of cancer, cardiovascular disease, diabetes, and chronic lung disease – four major noncommunicable diseases mostly associated with cigarettes – run high in Pakistan.

Where the awareness of negative health impacts and attendant socio-economic effects of smoking has driven international agencies and countries to expedite their tobacco control efforts, the progress on ground has been rather slow compared to the need of the time. One of the reasons for this slow progress is reliance on the same outdated practices that have failed to elicit any significant result in terms of reducing the number of smokers or supporting smokers in quitting or reducing their tobacco consumption. While urging smokers to completely stop tobacco use is the best way out of the tobacco problem we are facing right now, we see that there are always smokers who continue to smoke regardless of all tobacco control measures. In this situation, instead of letting them smoke and making generic efforts without addressing their specific needs, these adult smokers should be supported in gradually phasing out the consumption of tobacco from their lives. This strategy of tobacco control is known as tobacco harm reduction.

Tobacco harm reduction strategies minimize the negative health effects of cigarettes by providing adult smokers (who would otherwise continue to smoke) the option to switch to less harmful alternatives. Many scientific studies have established that most of the diseases associated with smoking are caused by smoke that is released by the burning of tobacco in cigarettes and not, as some incorrectly believe, by the nicotine contained in cigarettes. Thus, providing these adult smokers with their nicotine fix through an alternate source that is less harmful than a cigarette can help them in reducing the harm to their health significantly. Some of these alternatives that do not involve the burning of tobacco and do not release the associated toxicants include e-cigarettes, heated tobacco products, and oral nicotine pouches, many of which are scientifically proven to be less harmful than cigarettes and have the potential to reduce risks of health compared to continuing to smoke.

Recognizing the science and growing body of evidence regarding the role of these alternatives in bringing down smoking prevalence and reducing harm to smokers’ health otherwise caused by cigarettes, tobacco harm reduction is now being widely recognized as an effective public health strategy for tobacco control.

Countries like the UK, Canada, New Zealand, Japan, and the Philippines are all working to benefit from this strategy and offer their adult smokers a less harmful alternative instead of letting them continue to smoke cigarettes. The UK’s National Health Service is encouraging adult smokers to switch to e-cigarettes as part of its approach to helping smokers to quit. It acknowledges the role these alternatives can play in reducing the number of smokers. A 2020 study by the Committee on Toxicology of Chemicals in Food, Consumer Products and the Environment, the UK government’s advisory body, concluded that smokers who switch completely to smokeless alternatives can expect to reduce their risks of catching smoking-related diseases.

By continuing to take a pragmatic approach and allowing scientific evidence to inform their approach to reducing smoking, authorities are now increasingly recognizing the long-term potential of switching to these products compared to continuing to smoke.

Pakistan also needs to up its game and align its regulations with scientifically-backed and proven technological developments. Our lack of insight on how to modify smokers’ behaviors and what other countries, which are showing progress in containing their tobacco-induced burden, are doing has already cost us a lot of precious lives and economic loss. It is time we rearrange our policies around smokers themselves and make them a part of the discourse so better, targeted efforts can be made to reduce the tobacco burden in a systematic and pragmatic manner.