Let’s find a single solution to cut tobacco prevalence

All eyes are on the global e-cigarette summit taking place in Washington next month. It is the 7th summit, a well laid thought-provoking agenda that will have global experts and interactive panel debates.

The opening keynote will be delivered by David L. Ashley RADM (rtd) US Public Health Service – Research Professor, Department of Population Health Sciences, School of Public Health, Georgia State University. And the closing keynote will be given by Dr Vaughan Rees, director of the Center for Global Tobacco Control, Harvard TH Chan School of Public Health.

This will be another round of conversations about known harms from smoking and combustible products that have aligned public health and tobacco control communities to a common goal. It is to end the smoking epidemic.

It is clear to everyone that the emergence of e-cigarettes and novel nicotine products has created an often-binary debate of youth versus adults, industry versus public health and absolute versus relative safety. In short, the current status quo hasn’t pleased anyone.

But 2022 will be a pivotal moment. Why? There is a new Food and Drug Administration (FDA) commissioner in place. All eyes will be on the FDA. And then, the need for the implementation of a comprehensive regulatory framework that will unify these competing visions by protecting kids and helping adults has never been more urgent. The million-dollar question is: Can it be achieved?

The summit has a single aim of facilitating respectful dialogue and thoughtful analysis of the latest evidence and an opportunity to explore how this should be interpreted to deliver the most effective public health and regulatory strategies.

But the big question remains high on everyone’s agenda across the world. Have the tobacco control and regulation efforts in addition to multiple preventive measures been effective enough? And more importantly, should there be a more pragmatic approach to reducing tobacco prevalence?

When it comes to high-end policymaking, it is clear that idealism versus pragmatism has always been a long, ongoing debate. It has found no definite results, no definite answers.

Now, in an effort to put a full stop to smoking, tobacco control authorities across the world are exploring the implementation of alternative tobacco products, including heated tobacco products and e-cigarettes. In short, this is called harm reduction, which includes policies and programmes that try to lessen the harm caused by addictive behaviour towards individuals, communities and societies. It is a part of a big concept.

Experts say abstinence may be a preferred objective but not always feasible. Helping people switch to less harmful options could point them toward a step in the right direction. In the context of tobacco harm reduction (THR), it refers to reducing morbidity and mortality among smokers. THR recognises that while completely avoiding tobacco use is ideal, it is not always possible and that users may not be able or ready to quit. As a result, THR urges smokers to switch to other nicotine product varieties which offer a risk reduction in contracting the smoking-related disease, like vapes, e-cigarettes and heated tobacco products.

It is now widely known that heated tobacco products eliminate the process of burning tobacco to deliver nicotine to the user, avoiding the inhalation of tobacco smoke which contains tar and carbon monoxide – two of the primary causes of smoke-related disease.

WHO agrees there is a need to reduce the number of smokers across the world. It estimates that the smoking population worldwide has reached one billion, a number which will remain at that level at least until 2025. Smoking is a long-running problem that the WHO has attempted to tackle, with significant public health and economic consequences.

It is clear to experts that product characteristics and rate of adoption can both impact population harm reduction. How? A product that can reduce the public health risk associated with smoking needs to be acceptable to smokers for consumers to switch. The goal is to get as many smokers to switch to these alternatives, multiplying its harm reduction effect on the population.

Consider the case of New Zealand. The nation, keeping in mind its 2025 Smoke-Free goal, encourages the use of vaping products as a stop-smoking device.

And the evidence that vaping can help people quit smoking is mounting, vaping devices pose a lower risk than smoking cigarettes, but they are not risk-free. However, the users are not at risk of nicotine poisoning while using vaping goods as instructed and vaping products release negligible levels of nicotine and other toxicants into the air with no identified health risks to bystanders.

Everyone agrees kicking the smoking habit is not always that easy – there are a few psychological and social barriers that smokers face, making it difficult to quit. Factors such as socioeconomic disadvantages, lack of family support, and even cognitive impairment play a major role in why smokers find it hard to stop using cigarettes.

That is where tobacco harm reduction may come in handy, as it provides smokers an alternative route that eases them into a better lifestyle.