Low-and-middle-income countries, where 80% of the world’s smokers live, are the new battleground in a war between the world’s top anti-tobacco outfits and a burgeoning tobacco harm reduction lobby, writes Chris Bateman for MedicalBrief.
This emerged during a session on “Obstacles to Harm Reduction in LMICs” at the eighth Global Forum on Nicotine 2021, cyber-broadcast from Liverpool in the United Kingdom from 17-18 June. More than 2,000 people from 100 countries registered for the diverse forum.
Leading advocates for safer nicotine alternatives, tobacco harm reduction and health related initiatives from Mexico, Kenya, the Ukraine, India and South Africa took part in a cyber panel discussion during which the silent war emerged.
Panel members spoke of government-controlled tobacco monopolies – in China, Korea and India – blatant anti-harm reduction propaganda, tobacco policy manipulation and victimisation of harm reduction advocates.
The panel discussion was chaired by India’s Dr Sree Sucharitha, of the Association of Harm Reduction Education & Research (AHRER), a pan-India body of medical professionals integrating harm reduction measures into public health policy.
He was assisted by Dr Delon Human, a South African family physician and president of Health Diplomats, a global consulting group that facilitates innovation, access to care, harm reduction policy, science and products.
Among the most powerful of those singled out as undermining the tobacco harm reduction cause were Bloomberg Philanthropies, the social responsibility arm of Bloomberg LP, a global media and financial data and analytics conglomerate, and the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
The FTCT is a supranational United Nations agreement that seeks "to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure.”
Joseph Magero, Chair of Kenya’s Campaign for Safer Alternatives and holder of a Global Tobacco Harm Reduction scholarship, said he was “kicked out” of his country’s top tobacco control body last year for “thinking out of the box”.
Magero said Kenya had outlawed heated tobacco products and vaping. He recommended oral tobacco pouches as probably the most effective and pragmatic harm reduction alternative in his country.
He said these were introduced into Kenya some two years ago, “but there were a lot of claims by those in tobacco control that it was affecting kids’ brains and it was suspended. It was finally allowed back onto the market, but the government taxed it so highly that it has become unaffordable,” he said.
Magero was responding to a question from Human after he and two other panellists spoke about manipulation of government policy and alleged ‘attacks” by Bloomberg-funded anti-tobacco advocacy groups.
A recent survey in Kenya showed that 83% of former smokers used oral tobacco pouches, which were cheap and accepted across Africa. “It would cause a big health shift if they were more readily available,” Magero said.
Among the biggest challenges in Africa were the affordability of safe alternative nicotine products, inadequate support of effective policies, or poor policies driven by misinformation, plus a glaring lack of research. “There’s also no support from the FCTC,” he added.
Anti-harm reduction propaganda
Ukraine-based Nataliya Toropova, head of the Healthy Initiatives International Think Tank, said countries in her region – including Uzbekistan and Kazakhstan – had banned tobacco harm reduction products.
“Massive lies” were spread by the anti-tobacco lobby in the Ukraine, she added, citing government approved billboards recently erected all over Ukraine’s capital, Kiev, saying that electronic cigarettes were as dangerous as combustible cigarettes – and claiming they caused ‘black lungs’.
“We face lies and manipulation every single day,” she said.
Toropova described the regional situation as “very grim – it’s complex and diverse but most countries have adopted the Framework – tobacco harm reduction is absolutely missing.
There’s a lack of objective, solid information and simply no data available to policy-makers and the public. Trust is absent – they tend not to believe any harm reduction information because it comes from the tobacco industry. This is a huge issue and needs to be tackled.”
Ignorance about harm reduction at government and societal level was responsible for safer alternative tobacco products being banned. Toropova said the Russia Federation had banned snus, a chewable tobacco that has hugely reduced cigarette-related morbidity and mortality in Sweden, and nicotine pouches.
Dangerously skewed perceptions
Mexico’s Tomás O’Gorman, a board member of the International Network of Nicotine Consumers Organisations(INNCO) and a Co-founder of Pro-Vapeo, said misinformation regarding safe tobacco alternatives in Mexico was rife.
“For example, people don’t believe e-cigarettes are safer alternatives. O’Gorman alleged that some NGOs funded by Bloomberg only talked about prevention and cessation. “There’s certainly not enough effort to help smokers quit,” he complained.
There are 16.1 million smokers in Mexico, with one study showing that 85% of people who wanted to quit during the survey period, tried to do it cold turkey.
“People don’t consider themselves patients or suffering from some disease. They don’t want to go to doctors or to therapy to quit,” O’Gorman added. Only 3.5% in a large survey were willing to try pharmaco-therapy.
India’s Dr Sree Sucharitha said there was “huge funding from other shores into our health policies, especially tobacco”.
“There was an opportunity to adopt new trends and evidence but then there was a sudden change in policy and the ban was not just on harm reduction products, but extended into the academic corridors,” she said.
“It’s unheard of that research on a medical topic [tobacco harm reduction] was prevented from being used in a medical institution. There was some kind of top-down approach with certain philanthropic funding going in this policy direction,” she charged.
Sucharitha said similar-minded scientists had suffered this kind of interference before.
“We were taken aback – it was a bit like PTSD. We’re not delivering what they want.”
India has 300 million tobacco users, with the major barrier to harm reduction being political will. There was no application of harm reduction principles in clinical practice. The government’s goal was to reduce tobacco use by 30% by 2030, but without harm reduction awareness and better education among children, this was unlikely.
Speaking as part of an expert commentary panel after the session Martin Cullip, of the UK’s New Nicotine Alliance, said of the FTCT: “It’s like people at the top are not listing to their own people. There are elements imbedded in the FTCT stuck in a time warp and unwilling to engage with the tobacco industry at any level.”
‘Big tobacco’ speaks
Sarah Cooney, Head of Scientific Collaboration and Communication for British American Tobacco, said that unless the technological revolution was able to drive an ideological one, an estimated billion lives would still be lost by the end of the century due to smoking related diseases.
“We need some US$28 billion that can only come from FTCT signatory countries to achieve the optimal life-saving interventions – and I can’t imagine that happening anytime soon, with the pandemic and the global economy.
“Smoking in many countries has hardly changed, so it does feel like an attack on science and new products – and could be viewed as a deflection away from the fact that the standard initial tobacco control measures have failed.”
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