Tobacco control efforts failing millions

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Former WHO officials Prof. Robert Beaglehole and Prof. Ruth Bonita have sounded the alarm with an article published in the Lancet Journal, which states that tobacco control is not working for most of the world. Rather, it maintains the status quo. The Lancet report highlights that the overall number of tobacco users globally has seen little change, indicating a lack of significant progress in reducing tobacco use.

Interestingly, four out of five of the world’s smokers are in low-income and middle-income countries. Their verdict is damning, especially for countries like Pakistan, where the majority of tobacco-related deaths occur amidst sluggish declines in smoking rates. Shockingly, only a paltry 30% of countries are on track to meet the WHO’s target of slashing adult tobacco use by 30% by 2030, demanding a seismic shift in approach.

The authors stress the need for greater compliance with the WHO Framework Convention on Tobacco Control (FCTC) and argue that the FCTC is no longer fit for purpose, especially for low-income countries: neither WHO nor the FCTC are grounded in the latest evidence on the role of innovative nicotine delivery devices in assisting the transition from smoking to less harmful products. Equally, the focus on youth vaping, most of which is experimental, detracts from the crucial public health goal of reducing smoking-related deaths in adults.

Further, the authors criticize the opposition to harm reduction strategies by the WHO and the FCTC Conference of Parties and identify this as the missing strategy in their policies. Harm reduction strategies focus on reducing the harm caused by burnt tobacco by replacing smoking with less harmful ways of delivering nicotine.

A recent study titled ‘Integrating Harm Reduction Into Tobacco Control,’ conducted in London, aligns with the recommendations of Prof. Beaglehole and Prof. Bonita. The study suggests that Pakistan could potentially save 1.2 million lives over the next four decades by embracing harm reduction strategies to tobacco control.

In the quest for effective tobacco control strategies, evidence from countries like Sweden sheds light on the potential of harm reduction approaches. Over the past 15 years, Sweden has remarkably reduced smoking rates, plummeting from 15% in 2008 to an impressive 5.6% today. This success is attributed to Sweden’s embrace of harm reduction through alternatives such as e-cigarettes, nicotine pouches, and snus.

The findings and recommendations of Prof. Beaglehole and Prof. Bonita, based on their extensive experience within the WHO, shed light on the urgent need for innovative approaches to tobacco control. Collective action, a sincere commitment from all stakeholders and embracing harm reduction strategies are essential steps towards reducing the burden of smoking-related diseases.


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