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Next week, health leaders from around the world will converge on Cape Town for three days of dialogue about how to reduce the death toll caused by cigarettes.
It’s appropriate that the 17th World Conference on Tobacco or Health will be held in Africa because according to the World Health Organisation (WHO), many African nations have smoking rates far higher than the worldwide average. And unlike the West, where smoking rates are declining, smoking in many nations in the developing world is on the rise.
Conferees will hear from several prominent voices, including the World Health Organisation’s recently installed leader, Ethiopian Dr Tedros Adhanom, as well as former New York City mayor Michael Bloomberg, both of whom have declared that countries must do everything in their power to lower smoking rates. Unfortunately, if the past is any indication, much more time at this conference will be spent on policies designed solely to target the tobacco industry rather than on innovative public health strategies to tackle the public health problem of smoking.
If meaningfully reducing smoking-related disease is the goal of leaders meeting in South Africa, conferees should discard their ideology and instead look to effective, science-based harm reduction policies being implemented by governments such as the United Kingdom. In the UK, government officials are actively recommending that smokers switch to e-cigarettes and vaping products, which provide smokers nicotine without the smoke and tar caused by lighting tobacco on fire.
Harm reduction isn’t a new concept in public health. Health leaders have long-recognised its effectiveness in mitigating health problems caused by high-risk behaviours. In fact, the approach being pursued in Britain parallels widely accepted harm reduction policies that have been successfully applied to confront HIV/Aids and tuberculosis across the African continent.
However, when it comes to tobacco, far too many in public health consider it heretical to come out publicly in support of harm reduction strategies. Worse, many are being actively encouraged by organisations like the WHO to place the very same restrictions on vaping products as they are deadly combustible cigarettes.
In South Africa, there has been significant resistance to the emerging evidence supporting harm reduction policies. Last November, South African Health Minister Aaron Motsoaledi announced a wide-ranging plan to update the nation’s existing tobacco laws, including new restrictions on public smoking, advertising bans and graphic warnings on cigarettes. Disappointingly, Motsoaledi announced his intent to also use this tobacco bill as a vehicle to severely restrict the marketing and sale of vaping products, which would destroy businesses in South Africa that are selling products proven to help smokers quit.
Leaders must recognise that promoting access to non-combustible options for smokers who won’t or can’t quit is the key to reducing the lung cancer, emphysema and heart disease that kills smokers. Even organisations that were once doctrinally opposed to vaping have started to come around, with the American Cancer Society recently declaring that smokers who choose to quit smoking with vaping products should be supported in their quest to better their health.
Public Health England and the Royal College of Physicians have comprehensively reviewed the best science from around the world and determined that e-cigarette products are at least 95% safer than cigarettes. Japan is seeing a rapid decline in smoking as smokers switch completely from cigarettes to heat-not-burn products. In Sweden, snus – an oral tobacco product manufactured under strict standards that is also available in South Africa – has led the country to have the lowest smoking rate and tobacco-related disease and death figures in all of Europe. The evidence is there to justify a cautious approach to regulating these alternatives to smoking.
Sadly, far too many public health leaders seem to be mired in outdated groupthink that ignores emerging science. If fighting the death and disease caused by smoking is what the Conference on Tobacco or Health is about, conferees should highlight how smokers in the UK, Japan, and Sweden are harnessing science and technology to leave cigarettes behind.
Scientists have understood for years that it’s not nicotine or even tobacco that kills smokers. It’s the inhalation of carbon-monoxide and tar from burning cigarettes that cause the lung and heart diseases that kill smokers. Applying bans, regulations and taxes to non-combustible nicotine products simply means more Africans will continue to smoke – and unfortunately, more will die.
• Gregory Conley is an attorney and the President of the American Vaping Association, a nonprofit organisation that advocates for sensible government policies towards smoke-free nicotine products.
