Tobacco Control 3.0 in India: The road is through Science, Technology and Collaboration

Countries including India are following the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). However, they are free to exercise their own judgement on timelines given their relative compulsions. Incidentally, in a recent article by former WHO officials, Prof. Robert Beaglehole and Prof. Ruth Bonita have said that current tobacco control strategies are not working, highlighting the missing strategy of harm reductions and the technological advancements available.

According to the ‘Human-Centric Approach for Tobacco Control’ report, it is estimated that by the year 2030 more than 80 per cent of tobaccorelated deaths are likely to be among the low and middle-income countries (LMICs). One third of all deaths due to tobacco use are anticipated to bebecause of CVDs. Hence, India may consider to look at a redefined approach to save lives due to tobacco consumption.

The report further states that 27% per cent of Indian adults engage in tobacco consumption and the country is ranked second in tobacco usage, globally. Also, 38% of adult males in India consume tobacco, compared to 9% adult females, 1% of GDP lost every year to diseases and early deaths from tobacco use; and 5% of total healthcare expenditures attributes to the direct expenses for treating tobacco related diseases.

Public health experts agreed that cessation remains the quickest way to lessen deaths from tobacco. Policies such as tax increases, smoke-free spaces, advertising bans and educational programs have been emphasised by FCTC. Clinical and medicated solutions have not been fully integrated inthe public policy mitigating the tobacco challenge.

A diverse array of alternative products and cessation techniques have proven to be effective in aiding individuals in their journey towards quitting tobacco. Several strategies have been designed to permeate the usage of these products, such as government incentives, awareness campaigns and support from health professionals.

To further reduce death and disease rates, there is a need to consider new strategies for fast-tracking adult cessation and providing alternatives for those struggling to quit. Dr Moitreyee Kalita, consultant-pulmonary medicine at Dispur Polyclinic and Hospitals Pvt Ltd, said, “Alternatives should be allowed only for serious smokers, providing scientifically proven options to those who genuinely want to quit but struggle due to lack of availability. We need to merge effective global strategies from countries like Japan, Sweden, the UK, and the USA, and consult experts to introduce safer novel alternatives like HTP for quitting smoking”.

Addressing current tobacco use and creating a harm reduction plan for consumers is crucial as tobacco imposes significant health burden and economic impact. Thus, providing less harmful alternatives and promoting safer practices, for those unable to quit, should be part of a holistic harm reduction approach, aiming to reduce the broader impact on the population.

Individuals who are unable to quit smoking should be encouraged to switch to less hazardous alternatives, minimising their overall health risks. Additionally, there can be an enhanced focus on making nicotine reduction techniques (NRTs) affordable and accessible to the general population. These should include plans and policies to monitor and maintain an exhaustive database of listed and unlisted manufacturers and retailers of tobacco products. Use blockchain to track the trade of illicit cigarettes and gutka.

There is also a need to increase investment in nationwide mass media campaigns, supported by targeted regional media, aimed at educating smokers, dispelling myths about tobacco use and encouraging their support for cessation. This campaign could draw inspiration from the Pulse Polio campaign that led to the country being declared polio-free.

Besides, there is a clear case to increase investment in innovation funds to support research, data collection and impact monitoring. Public investment in science-based solutions for tobacco control and strengthening the regulatory framework and introducing subsidies for solutions and policies that can help to reduce the use of tobacco are the need of the hour.

There is also a need to provide incentives to manufacturers to develop products that reduce exposure to tobacco toxicants while delivering similar consumer experiences. Offer subsidies to manufacturers of tobacco alternatives for creation of affordable harm reduction options and conducting research to understand their health impact.

There should also be a system to promote collaboration between the government, public health experts, regulators, consumers, healthcare practitioners, among other stakeholders to develop innovative and effective harm reduction methods and alternatives.

It is imperative and critical for India to have a holistic roadmap towards tobacco harm reductionand cessation because it plays a key role in controlling tobacco addiction by reducing consumption of cigarettes and risky oral tobacco products. Introduction of less harmful alternatives aligns with the government’s goal of reducing tobacco-related harm and encouraging cessation. Offering smokers less harmful alternatives provides them with a potentially effective tool to withdraw from combustible tobacco.

Evaluating alternative products creates an opportunity to empower individuals to make informed choices about their tobacco use and reduce the harm associated with it. For individuals who are not willing to quit tobacco, switching to less harmfulnicotine products could offer huge benefits. Hence, consumers, industry players and the government can together come forward to facilitate tobacco harm reduction policies for a healthy future.

The way forward in the battle against tobacco consumption entails a holistic and collaborative approach. Taking cognisance of the long-term irreversible consequences induced by tobacco consumption, it becomes imperative to design a human-centric harm reduction strategy encompassing all stakeholders - producers, consumers, regulatory agencies, public health professionals and support groups.

By persistently addressing the multidimensional challenges posed by tobacco, India can pave the way for a healthier smoke-free future for individuals and communities across the nation.