Banning is not always the answer.

Cigarette smoking remains the leading preventable cause of high morbidity and mortality around the globe, leading to more than 8 million deaths each year.

Various measures have been employed all over the world to reduce the burden of smoking, cigarette bans being the major one of them. However, there are still 1.3 billion smokers in the world today and if the trend continues, this number is expected to increase to 1.6 billion by the year 2025. Major stakeholders and activists, when asked regarding a solution to this problem, simply resort to encouraging bans and implementing heavy taxes. If the solution were that simple, wouldn’t we have tackled this menace already? While it may be possible for bans to reduce the uptake of smoking in people who have never tried it before but let us not forget that there are more than1 billion smokers who struggle to quit. A paradigm shift in thinking is required to improve the health of these individuals and simple reactionary knee-jerk responses of banning and raising taxes will not be sufficient.

Encouraging people to quit smoking altogether and helping them to do so is the right approach to combat the harm caused by smoking but smoking cessation is one of the weakest links in the fight against tobacco use – not just in Pakistan, but as has been proven world over. According to research conducted studying experiences of young smokers attempting to quit smoking in the twin cities of Pakistan, 24.7% smokers attempt to quit each year but 97.4% among them fail to quit successfully. The study also highlights those smokers who during their experience of quitting smoking get entrapped in several overlapping cycles of smoking & quitting attempts, leading to relapses. Another reason is the lack of information regarding cessation services. A survey conducted in 2014 showed that almost half of the quit attempts are unaided in Pakistan due to lack of knowledge about, and access to, smoking cessation services. These statistics highlight the need for taking swift action to help smokers which can be made possible by employing modern strategies of reducing tobacco harm.

Harm reduction strategies include equipping smokers with the awareness regarding the harm caused by cigarettes and creating awareness of less harmful tobacco alternatives. The less harmful alternatives differ from combustible cigarettes as there is no burning of tobacco involved, hence they do not produce smoke – which has been proven to be the root cause of most of the smoking-related harm. These alternatives, including e-cigarettes, vapes and heated tobacco products (HTPs),heat the tobacco/liquid inside them instead of burning it, effectively eliminating the emission of hazardous tobacco smoke. Public Health England has deemed these products as 95% less harmful than combustible cigarettes. A safety review by the Committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment (COT) came to a similar conclusion. A Cochrane review, regarded as the highest standard of scientific evidence, of 61 scientific studies including a total of 16,759 adult smokers concluded that more people probably stop smoking (for at least six months) using nicotine e‐cigarettes than using nicotine replacement therapy, or nicotine‐free e‐cigarettes. Nicotine e‐cigarettes may help more people stop smoking than no support or behavioral support only. Both the COT report and the Cochrane Review make it sufficiently clear that vaping has clear harm reduction potential in people who smoke. A study conducted in Pakistan by “Foundation of a Smoke-free World” also indicated that smokers noticed improvement in their health after switching to vaping/e-smoking from smoking. Research published in the Journal of the American College of Cardiology concluded that there was a significant improvement in vascular health of individuals within 1 month of switching from Tobacco cigarettes to E-Cigarettes. Public Health England recommend that a combination of vaping products with a smoking cessation service support should be an option available to all people who want to quit smoking.

A study assessing the knowledge, attitudes, and practices of cigarette smokers and the use of alternative nicotine delivery systems in Pakistanrevealed that majority smokers are unaware of the dangers of combustible smoking and the availability of less harmful alternatives. However, majority of the respondents partaking in the study strongly believed that people should stay away from this addictive habit and claimed wanting to quit. After learning about the products that help in reducing cigarette harm, 60% of the respondents said they were willing to use an alternative product if it was easily available.

In conclusion, there is a clear and urgent need to create awareness regarding harm-reducing alternatives to cigarette smoking along with the development of necessary policies and frameworks to regulate their use. While the goal remains eliminating smoking altogether, there is an unmet need to address the health of those individuals who struggle to quit smoking. For them, a comprehensive multi-pronged strategy including education, access to smoking cessation advisory services and the use of various alternatives to traditional tobacco cigarettes should all be accessible.

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