A stitch in time could save nine amid rising morbidity and mortality being driven by smoking cigarettes. With the World Health Organisation (WHO) data showing that tobacco kills at least 8 million people each year, including 1.3 million non-smokers who are exposed to second-hand smoke, delays by governments to adopt alternative and less harmful Tobacco products could see the world sleepwalking into an irreversible health catastrophe.
Although the general belief is that people who smoke die from Nicotine, scientific studies have proven that while people smoke for nicotine, they die from the tar or the carcinogens that are produced when tobacco burns. When tobacco burns, it produces 7, 000 toxic chemicals, including at least 100 known to cause cancer, and Nicotine is not one of them.
To alleviate the smoking-induced morbidity and mortality burden, Public Health interventions have over the years been advocating for smokers to quit smoking. According to the American Centre for Disease Control (CDC), quitting smoking greatly reduces the risk of developing smoking-related diseases, and since 2002, there have been more former smokers than current smokers.
Despite the decline in smoking prevalence, the world continues to experience high levels of deaths and disease as a result of smoking, and data from the 7th Edition of the Tobacco Atlas shows that although global smoking prevalence has declined (from 22.7 percent in 2007 to 19.6 percent in 2019), the total number of smokers remains high due to population growth. Globally, at least 940 million males and 193 million females aged 15 or older were current smokers in 2019. More than 75 percent of male daily smokers live in a country with a medium or high human development index (HDI), whereas more than 53 percent of female daily smokers live in very high-HDI countries.
While cessation has been flaunted as the alternative of choice for Tobacco Harm Reduction (THR), data from the CDC shows that fewer than one in ten adult cigarette smokers succeed in quitting each year. Several options have been explored to reduce the harm caused by smoking tobacco but still, the unprecedented deaths and diseases continue unabated. This leaves the world with one big question. How best can we reduce the public health burden caused by tobacco?
The best choice for any smoker is to quit tobacco and nicotine entirely. However, for those who don't quit, it is also clear that scientifically substantiated smoke-free alternatives (which provide nicotine and are not risk-free) now exist that represent a much better choice than continued smoking. For THR to help effectively eliminate smoking, adult smokers must be able to choose these lower-risk options. THR should be considered a complementary strategy, and not a replacement for existing efforts to encourage those who smoke to quit and those who don't to never start.
Dr Derik Yach, an Epidemiologist and Global Health Consultant recently told a THR Summit Africa 2023 that was held in Johannesburg South Africa that without providing alternative and safer options for adult smokers, countries will continue recording high tobacco-related mortalities.
"In a country like South Africa, Tuberculosis (TB) is the largest single contributor to tobacco-related deaths with Lung Cancer, COPD, and Cardiovascular diseases being very important. Of the TB Patients and COPD patients, 70 percent of smokers are still unaware of a single major effort to address the smoking stages. [MC1] So as people are treated for TB, they will go on to die of tobacco-related deaths. Those who have the COPD managed, will not have the underlying cause (smoking) managed," said Dr Yach.
He added that the high number of deaths will continue for decades even if no young people start smoking today. He says there is a need to go beyond the WHO recommendations of cessation, advertising bans, and taxes and think outside the box.
"All these need to be the bedrock of any tobacco control program. We need to learn from countries like Japan, Greece, Korea, and Lithuania how the Heat not Burn is displacing combustible cigarettes at numbers that we never achieved in public health. Let's learn from Sweden, Iceland, and Norway about the power of Snus. It has not only displaced cigarettes but has shown that those countries, especially Sweden now have one the lowest Cancer death rates in the world and Sweden will very soon be declared Smoke Free according to the WHO criteria. Let's learn from New Zealand, the United Kingdom, and the United States of America about the value of E-Cigarettes also displacing combustible cigarettes."
He said Tobacco Harm Reduction could address the tobacco-related public health burden faster than the WHO prescription. He however said countries should be armed with their data and be ready to share it with global regulatory bodies. He also said as each category of THR grows, there is evidence of profound drops in combustible cigarette use.
Work on biomarkers, clinical studies, epidemiology, and toxicology show that such declines in combustible smoking prevalence will lead to a reduction in premature deaths and diseases related to tobacco. He said it is such data that needs to be presented before world health governing bodies before they condemn innovations as harmful to the protection of public health.
Speaking on the Sweden experience, Ander Milton said, "The smoking rate of men is 5.6 percent. In Sweden, more women smoke than men. Most recently, a new generation of alternative reduced-risk nicotine products (e.g. vaping and nicotine pouches) has accelerated the decline in smoking rates. These products have been made widely accessible, genuinely acceptable to consumers, and affordable. In the last decade, smoking rates have declined fastest among women."
Compared to the entire European Union (EU), Sweden has 44 percent fewer tobacco-related deaths, 41 percent lower lung cancer rates, and 38 percent fewer cancer deaths. Milton said they are trying to get WHO and EU to accept that alternatives are important and could be the missing puzzle piece in ending the high tobacco-related deaths and diseases.
Dr. Kgosi Letlape, president of Africa Harm Reduction Alliance, said misinformation was derailing efforts to roll out effective Tobacco Harm Reduction programs in Africa and the rest of the world.
"It is not like ARVs [MC1] are without side effects but basically, they reduce harm. The upside is much better than the downside. Part of the problem that we have is that we have people who are in high positions in societies like South Africa, we have been disempowered, and we defer to authority to help us make decisions. When authorities start to lie, it hurts society. When authorities become economic with the truth, it becomes harmful to society. This is the same with Tobacco where people who are at risk of taking up nicotine habits are not being given truthful information about the different ways of getting nicotine and what the risk levels are," said Dr Letlape.
He further said the key issue when it comes to tobacco is combustion and there is a need to tell people the truth that not all smokes are the same. Smoke from combustible cigarettes is harmful compared to smoke produced by e-cigarette. Harm Reduction is not a foreign phenomenon but is prevalent in people's lives daily. To reduce and end premature deaths and diseases, there is a need to adopt Tobacco Harm Reduction strategies and safer nicotine products. ENDS
