WATIMA: Why the tobacco debate is heating up

Globally, tobacco is the leading cause of preventable deaths and illnesses. It is also the leading cause of cancer. It is estimated that eight million people are killed by tobacco-related diseases worldwide every year.

Despite attempts by many countries to reduce smoking incidents, tobacco continues to be one of the main factors for many diseases. If nothing changes, it is estimated that overall, more than eight billion people will die. This is a monumental global public health problem. With about 80 percent of the 1.3 billion tobacco users coming from the Least and Middle-Income countries, this means tobacco use is a serious public health problem in Africa.

Currently, the global discussion around tobacco use is centred around tobacco harm reduction strategy, reducing tobacco-related morbidity and mortality even if tobacco-emitted toxins exposure continues with the goal being to lower the health risks to individuals and wider society associated with using tobacco products.

First is introducing smoke-free products to smokers who would otherwise continue to smoke. Tobacco companies for years have deceived the public through advertising strategies that some cigarettes are better than others in relation to the harmful effects. Doctors agree that the best advice to smokers on eliminating exposure to tobacco-related risks is to simply quit smoking. But that has not been working in many countries because nicotine, though it is non-carcinogenic, is responsible for keeping smokers from quitting.

It is the combustible tobacco products that are harmful because a significant number of toxicants associated with burning are emitted and are the primary cause of smoking-related disease. These toxicants damage cells and many are carcinogenic, with the most dangerous being carbon monoxide. So, the alternative has been introduction of non-combustible tobacco products to reduce risks

Second, public health policies in tobacco and nicotine are simply about reducing the number of smokers and the disease related with tobacco. Tobacco smoke is made up of thousands of chemicals, including at least 70 known to cause cancer.

France is a good case on how public health policies can help in harm reduction. It implemented several measures to protect the 1.8 million smokers and after two years cigarette sales went down from 10 billion to 55 billion.

The current alternatives for smoking cessation as heating tobacco products are leading the way to meet the needs of people who cannot quit smoking by reducing their exposure to toxic substances in a high proportion.

Latest scientific evidence backs smoke-free products as better choices for smokers, public health policies in tobacco and nicotine. Smokers switching completely from smoking to vaping conveys substantial health benefits over continued smoking.

Third is regulation of non-combustible tobacco products or smoke-free products. Recently, the US FDA released an authorisation to modified product against heated tobacco product. Aerosol which means suspension of toxics into the air produced by modified product's tobacco heating system contain fewer toxic chemicals than cigarette smoke. Though they deliver nicotine in levels close to combustible cigarettes suggesting a likelihood that users may be able to completely transition away from combustible cigarettes and use non-combustible alternatives exclusively.

But these alternatives cannot be said to be safe because toxins are simply at lower levels than cigarettes. So modified risk tobacco products simply reduce exposure claim and appropriately promote public health.

In conclusion, there is no single formula or method to implement harm reduction and modifiable tobacco products as a solely harm reduction strategy is unlikely to succeed in significantly benefiting population's overall public health. So, the policy issue about the regulatory approaches towards accelerating the transition towards becoming smoke-free remains a big conversation. This year, the PMI Global Tobacco and nicotine forum will be an event to look out for on the latest scientifically backed long-term tobacco harm reduction strategies.