Mission Harm Reduction: Innovative Approaches to Save Lives at The ET Consumer Freedom Conclave

MUMBAI, India, April 6, 2023 /PRNewswire/ -- India is committed to a 25% relative reduction in tobacco use by 2025. According to the latest WHO trends report, it is among the 60 nations likely to achieve this target. Despite stringent tobacco control policies by the Government, the use of harmful tobacco products remains high at 267 million with 42% of men and 12% of women using tobacco in some form. Further, India has the second-lowest quit rate among the 30 developing nations surveyed.

Tobacco harm reduction is a polarizing issue that has been at the forefront of tobacco control efforts worldwide. This addiction is a complex and widespread health issue in India and across the world. Tobacco consumption causes over a million deaths annually in India, with addiction among the low-income population leading to a vicious cycle of poverty caused by inadequate tobacco harm control measures.

While the government is working towards reducing the harm, it is time for an effective and compassionate re-evaluation of India's tobacco policy grounded in scientific evidence, rather than solely based on repression.

In a recent event organized by ET Edge, A Times Group Company on mission harm reduction, an array of experts shared their views on the subject. Highlighting the need for effective harm reduction strategies, Dr. Kiran Melkote, Orthopedic Surgeon focused on the importance of considering the views of tobacco users. According to Dr. Melkote, as a signatory to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), India has an obligation to incorporate harm reduction into its tobacco control policies. Additionally, he challenged the current approach to tobacco cessation, which he mentioned has an average success rate of only 0.5% per year. Instead, he advocated for exploring alternative cessation options that have worked in other countries.

Commenting on the ban of electronic nicotine delivery systems (ENDS) in 2019 due to concerns about potential health risks and the possibility of non-smokers becoming cigarette smokers, Dr. Kiran Melkote acknowledged these concerns as valid but also reiterated that all the reasons for the ban of ENDS in India have been debunked. Regarding research on ENDS, Dr. Melkote explained that while there is no India-specific research, there have been many studies from other countries that have embraced these products. He mentioned a recent meta-analysis of 78 different studies, including 40 randomized controlled trials (RCTs), which found high certainty evidence that non-combustible alternatives to smoking can double the quit rate.

Prof Dr. Nimesh G Desai, Senior Psychiatrist & Public Health Professional; Former Director, Institute of Human Behavior and Allied Sciences, and a renowned psychiatrist with 40 years of experience in tracking substance use, highlighted the importance of harm reduction approaches in addressing substance abuse and addiction. Dr. Desai elaborated on the issue of bio-behavioral disorders, stating that they are not just about the application of medical science through technology, but also about human behavior. He emphasized the need for pragmatism over idealism and cited the example of needle exchange programmes as an effective harm reduction approach. Dr. Desai also explained that history has shown that it is better to regulate a product than to ban it altogether. He holds that when a product is banned, it is pushed underground into the unregulated grey market, which only exacerbates the problem.

In a separate conversation with ET Edge, Dr. Rohan Savio Sequeira, Consultant Cardio-Metabolic Physician, Hon. Consultant Physician to the Governor of Maharashtra mentioned that science and industry must innovate to modify people's behavioral patterns and provide them with the benefits of harm reduction. He mentioned, "Our society requires immediate attention for damage reduction and have a socio-political and economic impact." He further mentioned that counselling or harm reduction programs based in the community with anonymity as the highest priority have proven to be helpful.

Dr. Bharat Gopal, Senior Pulmonologist & Director, National Chest Centre, New Delhi, said, "The challenge with smoking is that while 70% of smokers are willing to quit and over 54% do attempt to quit, only 8% of them succeed in doing so. Considering the policy constraints in the prevention of initiation, immediately on the agenda should be assistance with cessation, and protection from environmental tobacco smoke. We see many cardiology patients who find it utterly difficult to be able to quit smoking. There is plenty of evidence showing that continued smoking will cause harm, for sure. But if we replace it with a product that is less harmful, there is data to suggest that the impact on their heart and circulation is significantly eased."

It is confounding when scientifically supported products that clearly demonstrate customer desire are outright forbidden rather than scientific review and suitable regulation. A progressive public policy should prioritize informed customer choice over entrenched interests, enabling access to innovative products. This is best evidenced by the case of Japan, a country that has successfully adopted harm reduction policies and witnessed 35% of the population switching to safer heated tobacco products.

With the introduction of HTPs in Japan, smoking prevalence reduced by 1% between 2013 and 2016. However, between 2016 and 2019, the Japanese smoking rate reduced by a further 5.2%, as almost three in every ten Japanese smokers stopped smoking cigarettes. This coincided with the national roll-out of HTPs. While in 2013, Japan had a higher smoking rate than Australia, England, and NZ and Australia had the lowest rate by a clear margin (1.8% lower than New Zealand, 2.6% lower than England, and 3.5% lower than Japan), however in  2019, Japan's smoking rate was the lowest, and Australia, the only one of the four to prohibit the sale of HTPs (and, until recently, e-cigarettes) had the highest, despite being first to implement plain packaging and pursuing a policy of steep annual tax increases.

To develop effective solutions that minimise the harm caused by smoking and other harmful products, large corporations and other stakeholders must work together. By adopting these ideas, everyone can move forward with compassion and empathy, creating meaningful change in the realm of tobacco harm reduction. India's G20 presidency provides an opportunity to advocate for sustainable public health by setting an example for emerging economies. This can accelerate adoption of science-backed solutions for a chronic global public health challenge. It's a challenging but necessary journey that requires society to remain open-minded and committed to collaboration for the greater good.

About ET Edge

Times Strategic Solutions Ltd., functional under the brand name ET Edge, is an Economic Times initiative founded to empower multiple industries and segments by sharing critical business knowledge through strategic conferences and summits.