As the world moves to embrace Tobacco Harm Reduction (THR) interventions through adopting novel nicotine products such as electronic cigarettes, nicotine patches and others, there is a need to adopt clear and specific THR strategies to ensure the correct market is reached with the products.
Of late, there has been an outcry over the sudden increase in youths who vape or use e-cigarettes in the United States and the United Kingdom, creating a moral panic within the public health sector and the community at large. This has in some instances seen public health players calling for a total ban on e-cigarettes as well as enforcing stringent tobacco control measures to restrict vaping. The World Health Organisation (WHO)/FCTC defines tobacco control as resting on three pillars: tobacco demand reduction, tobacco supply reduction and tobacco harm reduction (THR).
Speaking at the E-Cigarette Summit in the United Kingdom (UK) Pascal Diethelm, President of OxySuisse said there is a need to clearly define the market for THR products as the market is not homogenous.
“There will be no one size fits all in THR solutions. For public health, the solution is a well regulated market. The first step in reducing the public health burden of smoking is through prevention and cessation by reducing the size of the population exposed to smoking. For those who smoke and are unable to quit, reducing the risk is the way to go,” said Diethelm.
“To assess whether the market can be part of the solution, I propose first looking at the target population. Public health says the smokers who are unable to quit should be allowed to switch to safer alternatives, but if you look at the advertising, it’s visually and socially attractive to people.”
He added that there must be high specificity of the target market as a matter of priority. The motivation for public health is to reduce the harm associated with tobacco addiction.
“Basically, there is no problem with Tobacco Harm Reduction (THR) except that when the use of less risky alternatives increases in the population, then we have a problem. This is what is happening in the United States where we see that smoking has been decreasing at a rate of 1 percent per year and vaping has increased since 2011 at a much higher rate.
“For public health, the goal is first to reduce prevalence of smoking by prevention and cessation and also to aim at the least harmful alternatives to cigarettes, and to limit the use of alternatives to cigarettes because although they are less harmful, they are still harmful.”
Tobacco Harm Reduction efforts in South East Asia are facing capricious levels of acceptance with some countries such as Singapore, Thailand, Brunei, Cambodia and Laos having banned any form of THR intervention. In Indonesia, Malaysia and Philippines, THR is allowed with some regulation while in Myanmar and Vietnam, THR is allowed.
Professor Tikki Pang, former Director, Research Policy & Cooperation for the World Health Organisation said THR faces numerous challenges in South East Asia.
“Currently there is very strong opposition to THR, strident calls for more restrictions and policy enforcement driven by economic and political factors and influential tobacco control lobbies. There are also inconsistencies as risk is proportionate and fragmented policies are reflecting a continuing conflation of arguments between the gateway effect (youth uptake) and adults quitting smoking.” said Prof Pang.
He added that there was a lack of high-level leadership and credible, independent and respected scientific body of experts (like PHE, RCP), coupled with a lack of technical capacity to objectively assess evidence to inform and develop rational policies.
“WHO holds a hostile position on THR “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures”. There is also polarised, acrimonious, and unproductive dialogue fuelled by misinformation, disinformation and biased, selective use of evidence which is also founded on an ideological and fundamental disconnect in mindsets in other parts of the world where Tobacco Harm Reduction is banned.”
He however recommended that there be continued mobilisation of the scientific community, more collaboration between scientists in the West and those in SE Asia, more quality local research to generate evidence on key THR issues. He is also said there is need to continue political outreach and ‘lobbying’ of influential countries (e.g. the UK, Japan) to lead efforts to change the WHO’s position on THR (regional, HQ, COP10).
He also said there is need for ‘regulation not prohibition’, and the focus should be on risk- proportionate regulations and policies which improve access for adult smokers to healthier alternatives while limiting youth access. There is also a need to strengthen grass roots, community-based movements for a stronger voice on the value and potential benefits of THR in a bid to combat and mitigate misinformation and disinformation with effective communication and education strategies.
