View: The answer is tobacco harm reduction

India has the second-largest tobacco-using population in the world and the consumption of different forms of tobacco has only resulted in fatal diseases. According to National Cancer Registry Programme, the use of tobacco led to over 27 percent of cancer cases in the country in 2020, and the number is expected to increase by 12 percent by the year 2025.

Combustible cigarettes have been considered the most harmful products because more than 7000 chemicals are present in cigarette smoke, of which more than 70 are linked to cancer. Smoking combustible cigarettes have been precariously killing half of those who do not quit. Meanwhile, saving smokers with the help of effective cessation methods has been a challenge since time immemorial.

Against the backdrop of consistent tobacco use and the apparent failure of tobacco control policies, imposing a ban on e-cigarettes and heat-not-burn products did not prove to be a wise decision.

A recent clinical trial in the UK showed that e-cigarettes are more effective than nicotine replacement treatments in achieving long-term smoking reduction and cessation. A survey undertaken in India found that after initiating e-cigarette use, 30 percent of participants quit smoking and 38.8 percent quit using smokeless tobacco products. Another 41 percent of participants reported reduced smoking while 30 percent reported that they reduced their smokeless tobacco use.

Therefore, it would be prudent to say that by preventing access to alternative nicotine delivery systems, we eliminated the chance of effective tobacco harm reduction in our country.

A recent policy study, undertaken by R-Street Institute, examined India’s complex tobacco landscape and shed light on the lack of sensible and consistent regulation that focuses on safer alternatives to combustible cigarettes. The author remarked, “In a country where tobacco use rates are declining by about 2 percent every two years, allowing the use of e-cigarettes and other reduced-risk products could help boost these rates.”

The study concluded that reversing the ban on electronic nicotine delivery systems and reduced-risk oral products is paramount to advancing harm reduction in India and that a regulatory framework should be set up to prevent use by youth and non-tobacco users.

Since the tobacco cessation methods advocated by the government have failed to help consumers, it is imperative to embrace reduced-risk products that could help prevent over one million annual deaths that are caused by smoking. There has been a strong body of evidence that validates the efficacy of e-cigarettes and heated-tobacco- products. Therefore, adjusting the regulatory framework to encourage healthier alternatives to combustible tobacco products holds the potential to promote consumer safety and aid the reduction in the overall number of tobacco users.

Given the large proportion of the population that uses tobacco, India needs a sound tobacco harm reduction strategy that looks beyond awareness campaigns and quitline facilities. The need of the hour is to mitigate the risks caused by tobacco consumption. We need a more effective tobacco control direction that relies on well-researched and scientifically-backed products that are safer and more effective for consumers who have been denied adequate means to quit smoking combustible cigarettes.