Lancet article spotlights global successes in tobacco harm reduction

As Bangladesh addresses its smoking prevalence challenge, a recent Lancet article sheds light on effective tobacco harm reduction (THR) strategies adopted in different countries and how it helped their smoking cessation strategy. It has been studied that lower-risk nicotine products are credited with significant reductions in smoking rates across these nations.

A recent article published in the world-renowned and influential medical journal The Lancet has showcased success stories in Tobacco Harm Reduction (THR) from across the globe. 

Titled "Harnessing Tobacco Harm Reduction," published in February and authored by Robert Beaglehole and Ruth Bonita, the article underscores the pivotal role of harm reduction in public health. Advocates urge countries, including Bangladesh, to closely examine successful THR policies as they aim to reduce tobacco consumption, reads a press release. 

As per the study, harm reduction products have been shown to be significantly less harmful compared to traditional tobacco consumption. It is also the 'fastest and the fairest' method to reduce smoking prevalence. Vapes or e-cigarettes, for instance, are 95% less harmful than traditional combustible cigarettes.  

No scientific justification for treating vapes and cigarettes as the same

The Lancet article notes that The FCTC does not prohibit harm reduction approaches but leaves it up to countries to decide how to regulate e-cigarettes and other novel nicotine products. 

It argues that the WHO's rigid position on safer nicotine delivery devices is not based on science: "There is no scientific justification for WHO's position that e-cigarettes and other novel nicotine products should be treated in the same way as tobacco products. This position overlooks a risk-proportionate approach," the Lancet article reads.

The Lancet article emphasises the responsibility of providing support to adults who would like to quit smoking, meaning there should be a sustainable cessation strategy. It highlights success stories from countries such as New Zealand, Sweden, Norway, England, and Japan, where harm reduction measures have significantly contributed to a decline in smoking prevalence. 

The article suggests that WHO should play a crucial role in supporting cessation efforts globally, acknowledging the need for positive leadership and technical support for countries considering the use of lower-risk nicotine products, such as vapes, snus, pouches, and heated and smokeless tobacco.

New Zealand: Remarkable decline in smoking

The Lancet details New Zealand's impressive drop in smoking prevalence from 13.3% in 2017-18 to 6.8% in 2022-23. This success is attributed to the widespread availability of e-cigarettes (more commonly known as vapes) and other lower-risk nicotine products. New Zealand's strategic measures, such as a tobacco-free generation initiative, have played a pivotal role in promoting harm reduction. The recent decline occurred without major tobacco control policies, emphasising the effectiveness of harm reduction strategies.

Sweden: Lowest daily smoking prevalence

With a tradition of snus use, Sweden boasts the world's lowest adult daily smoking prevalence at 6% in 2022, showcasing the potential of harm reduction through culturally embedded practices. Smoke Free Sweden reports that embracing smoke-free alternatives, including vaping products, saves over 3,400 lives annually. If the EU had followed Sweden's example, an estimated 2.84 million lives could have been saved.

Norway and England: Embracing snus and vape

Norway's increased snus and vape use, highlighted in the Lancet, successfully led to a reduction in smoking rates, demonstrating the substantial impact of harm reduction. England's experience emphasises the transformative effect of vaping on smoking cessation, supported by empirical evidence.

Japan: Innovations in tobacco consumption

The Lancet draws attention to Japan's decline in cigarette consumption linked to innovative products that heat, rather than burn, tobacco. A 2020 study cited in the Lancet found that the introduction and growth of heated tobacco products (HTPs) corresponded to a decline in cigarette-only sales from 2016 to 2019.

"Fastest and fairest way"

While THR successes worldwide offer valuable insights, concerns about their applicability in lower-middle-income countries like Bangladesh persist. However, the Philippines, with similar socio-economic conditions, enacted pro-consumer vaping legislation, legitimising vaping as a harm reduction strategy. The approach for any country who wants to reduce their smoking prevalence is to have a balanced regulation that meets the needs of adults who require support to quit.

The Lancet article emphasises the urgency of integrating harm reduction into national strategies globally, calling it the "fastest and fairest way to lower smoking prevalence." Whether Bangladesh's policymakers heed this call remains to be seen.