Tobacco controlis one of the top priorities of public health authorities worldwide, given the increasingly high number of smokers who continue to risk their health and the health of people around them with every puff of a cigarette. Smoking cessation and elimination of tobacco use is, thus, undoubtedly the best way out of this problem. However, decades after decades, tobacco control efforts have remained the same in most parts of the world regardless of their relatively slow progress in bringing down the number of smokers. This is becausethese effortssolely and strictly focus on urging smokers to quit their habit completely, leaving those smokers behind who would continue to smoke.

Currently, there are 1.1 billion smokers in the world and according to WHO, there will still be a billion smokers by 2025. This begs the need to provide these billion smokers, who are generally presented with the option to either completely quit their habit or continue smoking, with a third way: a supportive regulatory framework in place to switch to less harmful alternatives. Yes, smokers should quit entirely and those who don’t smoke should never start. But adult smokers who do not quit cannot be overlooked.

Over the past few years, there has been a scientific breakthrough in the form ofproducts that have the potential to reduce the health effects of tobacco consumption otherwise caused by cigarettes. These products are known as reduced-risk products or smoke-free alternatives. Cigarettes, when lit, burn the tobacco which releases smoke containing over 6000 toxins. The majority of these toxins are found to be the main culprit behind most smoking-related diseases. On the other hand, smoke-free alternatives do not produce smoke and are hence scientifically proven to be less harmful than cigarettes. E-cigarettes, heated tobacco products, nicotine gums, and pouches are some common types of these alternatives.

Smoke-free alternatives work on the principle of Tobacco Harm Reduction (THR) – a pragmatic approach to tobacco control which recognizes that while completely avoiding tobacco use is ideal, it is not always possible and that there will be smokers who will continue to smoke. As a result, THR urges smokers to switch to smoke-free alternatives that are less harmful to their health than cigarettes.

A study by researchers from UCLA, UC San Francisco, Boston University, and the University of Texas at Arlington, published in the journal Nicotine and Tobacco Research, assessed the presence of biomarkers that predict cardiovascular risk disease in smokers and people who exclusively consumed smokeless alternatives. The findings showed that levels of these biomarkers among smokeless tobacco users were similar to those of ‘never’ smokers. The researchers proposed that for smokers to reduce the risk of cardiovascular disease to more normal levels, switching to smoke-free alternatives such as chewing tobacco, snuff, or tobacco lozenges can go a long way.

As science continues to point to the benefits of these smoke-free products as less-harmful alternatives to cigarettes, many countries are now coming out with policy and regulatory shifts, stressing the need to provide smokers who would otherwise continue to smoke, with a third option other than the traditional quit or die. For example, the UK has introduced a scientifically substantiated,balanced regulatory system that encourages adult smokers to switch to these products while discouraging their use among youth and never smokers. The initiative is well supported by public health bodies includingPublic Health England and the Royal College of Physicians. Countries like Canada, Sweden, Norway, Iceland, Japan, and Korea are also embracingsmoke-free products as a means of tobacco control and are making significant progress in bringing down their smoking rates by encouraging smokers to switch to these products.

Govts and regulators around the world are increasingly becoming aware of the effectiveness of smoke-free alternatives in helping smokers reduce the harm to their health.It is time that Pakistan also pays heed to this scientific advancement and adopts tobacco harm reduction as a public health strategy, offering adult smokers who would otherwise continue to smoke a third way, a middle path, to reduce harm to their health.



Manzar Abbas