Tobacco Harm Reduction significantly saves lives
Kenya has a problem with cigarette smoking. Too many people are dying from tobacco-related diseases as smokers repeatedly try—but fail—to give up the habit.
Although international evidence suggests that Tobacco Harm Reduction (THR) can significantly cut smoking rates and minimise the risks posed by cigarettes, too often this innovative policy is met with suspicion and opposition. How to overcome the obstacles and start saving millions of lives was the focus of delegates at the Global Forum on Nicotine (GFN) in Warsaw, Poland, recently.
THR is a policy of moving adult smokers away from traditional combustible cigarettes, which cause the vast majority of tobacco-related illnesses, towards less risky alternatives such as vaping products and oral nicotine pouches.
In many high-income countries where THR has been embraced, zero-tobacco nicotine products are improving the lives of millions of smokers who failed to quit cigarette smoking. According to the French national Health Barometer, 700,000 cigarette smokers in France have quit thanks to vaping. In the UK, around half as many Britons now vape as smoke cigarettes, and the majority are former smokers. A University College London study funded by Cancer Research UK suggested that vaping may help more than 50,000 cigarette smokers to quit annually.
The effectiveness of ‘Swedish snus’, a type of modified oral tobacco pouch, in reducing smoking incidence and tobacco-related diseases is evident in Sweden, where there is the highest consumption of pouches and the lowest cigarette smoking rates in Europe. Tellingly, the Swedish rate of tobacco-related lung cancer for men is less than half the EU average.
The US Food and Drug Administration has endorsed snus as less risky than cigarettes and allowed it to be advertised as lowering smokers’ risk of “mouth cancer, heart disease, lung cancer and stroke”. It said the benefits of introducing snus outweighs the risks of non-smokers using it.
Meanwhile, Research at Georgetown University in Washington shows 6.6 million lives could be saved over the next decade by switching cigarette smokers to vaping. Public Health England says vaping products are 95 per cent less harmful than cigarettes, and that finding is backed by anti-tobacco groups such as Cancer Research UK , the Royal College of Physicians and Action on Smoking and Health.
Furthermore, some nicotine products have been found to be more than twice as effective at helping smokers to quit as traditional nicotine replacement therapies such as lozenges, gums and patches, which are on the WHO’s list of essential medicines. Yet, despite such compelling evidence, policymakers have shown resistance to THR in Kenya and other low-income and middle-income countries, where about 80 per cent of global tobacco users live.
In many instances, misguided regulation, over-taxation and even prohibitions of THR products are foiling their life-saving potential, delegates at the GFN heard.
In one plenary session, Dr Mark Tyndall highlighted the dangerous contradictions around THR by providing a telling comparison with lessons learned from HIV prevention and care. Tyndall, a former executive director of the British Columbia Centre for Disease Control in Canada, said global HIV mortality rates had fallen sharpy following the introduction of harm reduction methods such as needle exchange programmes for IV drug users and condoms. When it became apparent drug users were getting infected with HIV through sharing dirty needles, healthcare services began to supply them with sterile needles. The transmission of HIV was significantly reduced.
It was a classic example of harm reduction in action—instead of stigmatising drug users, which might exacerbate their addiction, safer alternatives were provided, risks were reduced and lives saved.
Providing smokers with the correct information on safer nicotine alternatives would enable them to make informed decisions. Denying them that information and accessibility is effectively denying them their right to life. In short, Tyndall said advocates of THR are fighting for the rights of cigarette smokers, who have been deprived of a say in own future.
It is a message our public health policymakers would do well to heed here, where too often the official approach to tobacco control amounts to a binary option: quit or die.
Almost two in every three smokers want to quit cigarettes. Yet only a small minority succeed and smoking rates remain stubbornly high.
For our policymakers to use the same methods over and over again and expect a different result is not simply irrational. It is also wasting time and costing lives.
—The writer is a medical doctor who is passionate in impacting the society positively concerning health matters — [email protected]
