Bans are an overly simplistic solution to a complex issue and will not work. The dangers associated with smoking are well known. It is the leading cause of preventable death worldwide, causing more than 8 million deaths per year.
However, progress in tobacco control has been limited. Smoking prevalence remains high, with around 1.3 billion tobacco users worldwide – and over 80% of those live in LMICs, Africa included.
Even in a country like Turkey – an LMIC that is often cited as a success story for having implemented all of the W.H.O MPOWER strategies – the prevalence of smoking has in fact increased, from 27.1% in 2012 to 31.6% in 2016.
Global tobacco control policies such as MPOWER are unworkable in many LMICs due to a lack of access to smoking cessation services and other resources. This puts the onus on individuals to make choices to improve their health. There is no benefit in limiting these choices, only the potential for increased harm.
In this context, it is clear that pragmatic approaches are needed, including the availability of a wide selection of products proven to reduce harm. Conversely, simplistic solutions to complex public health challenges may be attractive, but they do not work in the long run. Any move to ban harm-reduction products, and the almost certain subsequent increase in illicit markets, needs to be evaluated carefully, including openminded consultations with stakeholders, including consumers, before being implemented.
While smoking is well known to cause harm, nicotine does not itself cause smoking-related diseases.
This has been verified in a number of clinical trials of nicotine replacement therapies. It is exposure to the toxic chemicals released when tobacco is combusted and the fumes from burning tobacco leaves are inhaled that primarily cause life-threatening diseases and premature deaths.
But today, safer non-combustion nicotine products, such as e-cigarettes and nicotine pouches are available and are significantly less harmful than smoking. An expert independent evidence review published by Public Health England concluded that e-cigarettes are at least 95% less harmful than smoking.
Similarly, the U.S. FDA has concluded that completely switching from smoking cigarettes to using certain snus products lowers health risks. With this in mind, it seems illogical to apply a ban only to reduce harm to alternative products and not to cigarettes, which are significantly more harmful.
By denying smokers access to a much safer alternative while leaving cigarettes on the market, policymakers would leave only two options on the table – quit or die. With a wide range of safer nicotine products readily available, this approach is unnecessary and makes little sense. It should be noted that most African countries are already quite familiar with non-combustible tobacco products in the form of various oral smokeless tobacco.
It is important not to forget users of smokeless tobacco when we talk about harm reduction. Smokeless tobacco consumers using high-risk forms of oral tobacco should be given information about, and access to, reduced harm products too.
