Indians bear an enormous tobacco burden, with nearly a third of the population dependent on some form of tobacco, which leads to 13.5 lakh annual deaths – the entire population of Pondicherry. The WHO attributes a loss of $27.5 billion a year due to diseases related to tobacco use for persons aged 35 and above. For a country like India, finding ways to minimise this human and economic loss by lowering risks from tobacco use is therefore a necessity, not an indulgence.
The government has introduced various laws, awareness programs and helplines to dissuade smoking and encourage people to quit.
Among the various government interventions regarding tobacco, the ban on vaping remains the most controversial.
The prohibition completes two years this September, with no measurable positive outcomes and the possibility of increasing harms. This should force a rethink, and eventually a reversal of the decision.
E-cigarettes have taken a hit due to a fear of the new and a range of misconceptions, including a mistaken link to EVALI (a lung injury which caused a number of deaths in the US, later found to be due to black market cannabis products), their perceived attractiveness to youth, a generalised association with big tobacco, and compounded by ill-conceived marketing campaigns by some companies. But in this race to portray vaping as either the bad guy or the in thing, there is no space left for tobacco harm reduction (THR), the idea that it is possible to limit the harms from nicotine consumption by helping users switch to lower-risk alternatives, and the benefits minimising negative health and social outcomes associated with this habit can yield to individuals and at the population level.
Where is the Science At?
There is established and growing scientific evidence that vaping – which involves using a device that vaporises a nicotine-containing liquid the user inhales – is significantly less harmful than smoking, in essence because it eliminates combustion, the primary driver of harm. While not without risk, this means smokers who switch would suffer from far fewer negative effects and live relatively longer, healthier lives.
This stance has been fortified recently by a landmark review by the Society for Research on Nicotine and Tobacco (SRNT), the world’s leading body on tobacco research, which finds vaping is a less harmful alternative to smoking, and also an effective cessation tool. Conducting a comprehensive analysis of the scientific data available, the review supported by an unprecedented 15 past presidents of SRNT, all eminent scientists, concludes that encouraging current smokers to switch should be part of any ‘sensible mix of policies’ adopted to control tobacco prevalence.
The review highlights that the real advantage of vaping, as clinical trials show, is that it encourages smoking cessation at almost twice the rates over traditional nicotine replacement therapies such as gums and patches. Vaping has also been linked to a decline in the sale of combustible cigarettes, showing its effectiveness as a smoking cessation tool.
Numerous surveys, even in countries such as the UK which have the most pro-THR policies and where vaping is advised to smokers though the National Health Service (NHS), show that most smokers are misinformed about the lower risks of vaping compared to smoking.
A Public Health Measure?
In this clutter of misinformation, the scientifically sound public health communication would be that if you are a non-smoker, avoid any nicotine-containing product; if you smoke, try to quit, and if you cannot or are not willing to give up nicotine use, reduce harm by switching to the least harmful options available such as vaping, snus or heated tobacco.
Such advise requires decoupling combustible tobacco from nicotine which does not cause cancer contrary to prevailing myth. We must go beyond framing tobacco use as a moral problem and understand it within the framework of dependence which requires a dispassionate, scientific approach to address.
Top-down interventions to force behavioural change though regulations can also only go so far, and some may end up doing more harm as people try to circumvent them by adopting even more risky behaviours such as buying cheaper products or black-market goods to beat tax hikes. The need of the hour is to put smokers at the centre of policymaking by meeting them where they are and enabling them to make safer choices, while discouraging new smokers. Taking away their agency to choose a less harmful alternative is only going to stunt cessation and perpetuate smoking.
With the world struggling for long with the epidemic of tobacco use, it is time we realise that relative harm reduction is a worthwhile goal to pursue. The authors of the SRNT review state in no uncertain terms – “because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking-attributable mortality”. We can only hope that the authorities are listening.
(Samrat Chowdhery is the Director of Association of Vapers India (AVI). This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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