Noting the lack of any significant reduction in smoking prevalence worldwide through the years, two public health experts and former World Health Organization officials, Professor Robert Beaglehole and Professor Ruth Bonita, have called for a review of WHO’s existing tobacco control policies, urging inclusion of harm reduction for addressingthe health burden caused by tobacco use effectively.

In a recent correspondence published in The Lancet titled “Tobacco control: getting to the finish line”, the two health experts highlighted that four out of five of the world’s smokers are in low-income and middle-income countries. In these countries where most of the eight million deaths caused by tobacco occur each year, rates of tobacco use are falling quite slowly. The case is same elsewhere as the number of smokers globally has barely changedsince the Framework Convention on Tobacco Control (FCTC) policies were implemented 17 years ago.

They are of the view that the missing strategy in WHO and FCTC policies is harm reduction.

Harm reduction is an essential public health strategy that works on reducing harm from harmful substances where abstinence is not a viable option. The same strategy is gaining popularity in tobacco control efforts as well as many scientific studies and public health experts have identified it as an efficient method to reduce harm to adult smokers’ health who would otherwise continue to smoke.

Most people smoke because of nicotine. While nicotine is not risk-free, it is not the main culprit behindthe harms of cigarettes. Instead, scientific evidence shows that it is the cigarette smoke that contains over 6000 toxic chemicals, 100 of which are proven to be the cause of majority of smoking-related diseases. Thus, Tobacco Harm Reduction reduces the harm caused by tobacco smoke by eliminating the process of burning of tobacco, presenting adult smokers who would continue to smoke with non-combustible alternatives. These alternatives, such as e-cigarettes, heated tobacco products, nicotine pouches, and snus, are less harmful as they do not produce smoke and only deliver nicotine, enabling adult smokers to easily phase out the use of cigarettes.

However, while countries like the UK, Japan, Netherlands, Canada, and Philippines have already endorsed Tobacco Harm Reduction as an effective tobacco control strategy and some of them have even started seeing positive results with its adoption in terms of their cigarettes sales and number of smokers, the WHO and FCTC remain blind to the science and such developments. As a result, low-income and middle-income countries mostly suffer from these agencies’ outdated approach to tackling the smoking problem.

It is high time our public health agencies and authorities look objectively at all the evidence. It makes no sense to deny adult smokers access to alternatives that are scientifically substantiated to be less harmful. Of course, complete cessation is the best possible option, but in cases where adult smokers would continue to smoke cigarettes, it only makes sense to provide them with an alternative that can at least reduce the harm to their health otherwise caused by cigarettes.



Manzar Zaidi