World No Tobacco Day 2021 Shows Tobacco Control at a CrossroadsDr. Derek Yach
President of the Foundation for a Smoke-Free World and former World Health Organization (WHO) cabinet director for noncommunicable diseases and mental health.
Back in 1988, the World Health Organization launched World No Tobacco Day (WNTD) to highlight the dangers of combustible smoking, strengthen global efforts to get smokers to quit and provide an international platform for new anti-smoking policies. The idea was for the organization’s member states to present a united front in the fight against tobacco, and their message was stark: quit, or die.
Since then, the development of tobacco harm reduction (THR) technologies has led to a schism between those who support the science and those who reject it as unproven and dangerous. The result is that some of the most effective tools available to reduce health risk, among them e-cigarettes and heated tobacco products (HTPs), are ignored or misunderstood, with many smokers unable to make an informed choice or even access these products at all.
If we are to remain true to the spirit of WNTD, to its principles and initial goals, we must embrace THR and its promise to save at least 3 million lives each year over the next few decades as we work to eradicate toxic combustible smoking for good.
Missing the mark
In an article to mark WNTD for the China Daily News, longtime anti-tobacco activist Judith Mackay expanded on this year’s theme, ‘Commit to Quit,’ stating that all forms of tobacco are deadly, even as the industry is “pushing the new products as the answer to cessation.”
As executive director of the Hong Kong-based Asian Consultancy on Tobacco Control and a senior policy advisor to the WHO, Mackay is a respected authority whose words contain no nuance. Instead, she spins them to fit a political stance in a world that is either black or white, with no shading in between, akin to an advertisement that lists all the possible side effects of a drug without ever saying what condition it treats in the first place.
In that same article, Mackay continued to spin, claiming that millions of smokers now want to quit because there is evidence they are more likely than non-smokers to develop severe side-effects from COVID-19 and die — this despite the fact that any links between the disease and smoking are still not fully understood and the only studies so far have concentrated on smokers who have already been hospitalized.
Other media outlets followed suit. “WHO says Covid-19 forced millions to quit,” claimed one misleading headline. “No bigger motivation for quitting tobacco than current health crisis,” blared another.
Throughout, there was nary a nod to the benefits THR can potentially provide, or that nicotine, the addictive chemical in both cigarettes and THR products, is not what makes tobacco use so deadly. There was no acknowledgement that quitting combustible smoking is one of the hardest things people will ever attempt and that even if they do not succeed the first, sixth or nineteenth time, they can still greatly reduce their risk by switching to a product that does not combust.
Worse, there was no recognition, not by the WHO, by Mackay or any other media outlet, that THR products, while adopted to some extent in more affluent countries, are priced out of reach or banned altogether in much of the developing world, where 80 percent of the world’s smokers live.
Instead, the WHO offers smokers a digital avatar called Florence, which is programmed to talk only of quitting and the challenges therein; on the most recent WNTD, the organization honored people such as Harsh Vardhan, India’s Minister of Health, who two years ago banned e-cigarettes and HTPs, and Princess Dina Mired of Jordan, whose country has the highest rate of smoking in the world.
Conversation Starting to Shift
Even as the WHO, Mackay, and others perpetuate an unempirical status quo, there are those who argue that ignoring innovation puts lives in peril, plain and simple. In India, where about 120 million people smoke, Vardhan’s opposition to THR was described as scoring a goal in his own net and Dr. Sree Sucharitha called for THR to be incorporated into programs that target low-income and marginalized groups. On the CNBC website, an editorial asked how the WHO can use harm reduction to fight HIV/AIDS and drug addiction, yet continue to resist it as a tool to help the majority of smokers who want to quit but cannot. In Australia, authorities were taken to task for emphasizing tax increases and plain packaging over THR — an opinion echoed over and again on social media. As one Twitter user asked: “Why is your concern about my addiction to nicotine more important than my concern about getting lung cancer?”
The science is in: harm reduction works. Now, the challenge is to transform the scientific innovation into widespread cultural understanding and acceptance — to create, in effect, a new conversation in which policies under discussion reflect the science. The WHO should acknowledge the benefits of THR. Countries should increase the accessibility of such products by regulating them proportionate to risk and develop strategies that communicate all effective cessation and harm reduction options. In the wake of this year’s WNTD, there is no better time to take the all-important first steps in that direction.