Experts call for tobacco harm reduction framework

International health experts speaking at a harm reduction summit stressed the need to regulate less harmful alternatives of nicotine delivery in a risk-proportionate manner, while urging authorities for stricter restrictions on traditional cigarettes.

Notable public health experts, policymakers and media personnel gathered at the Bangladesh THR Summit 2023 on May 27, 2023, to discuss the role of Tobacco Harm Reduction (THR) in achieving the prime minister’s vision of a ‘Smoke-free Bangladesh’ by 2040, reads a press release.

THR is a public health strategy to reduce or minimise the health risks to individuals and wider society associated with the use of conventional tobacco products. THR amplifies the value of smoking cessation, but where smokers are unwilling or unable to quit, the use of innovative smoke free technologies, that deliver nicotine without the harmful bits - smoke or tar.

These are also referred to as Reduced Risk Products or RRPs including the likes of vaping devices, oral nicotine pouches, heated tobacco products and other non-combustible alternatives of nicotine delivery.

Currently, the UK, Sweden, New Zealand, Canada and many other progressive nations of the world are encouraging the use of such products to reduce smoking incidence by regulating them through a risk-proportionate regulatory framework.

Moderated by Dr Delon Human, the event featured globally renowned public health experts such as Dr Derek Yach, Prof Mihaela Raescu, Dr Kgosi Letlape, Dr Marewa Glover, Dr Konstantinos Farsalinos, and other experts such as Michael Landl, Masud-Uz-Zaman, Federico Fernandez with representation in the audience from ministries of industries, finance, commerce, home affairs, and other institutions such as Bangladesh Investment Development Authority (BIDA).

While delivering his keynote speech, Dr Derek Yach, former WHO cabinet director and the person who co-led the development of the Framework Convention on Tobacco Control (FCTC) said, “Harm reduction strategies have always been part of the FCTC and tobacco control, but thus far not fully implemented.

“Bangladesh has the opportunity to translate its economic transformation into accelerating tobacco control through harm reduction. It will save lives."

Dr Delon Human, a former secretary general of World Medical Association and an adviser on global public health strategies to three Directors-General of the WHO and to UN Secretary-General Ban Ki Moon, expressed his concerns at the event.

“The fundamental principle of public health is to prevent and control disease and premature death. With traditional tobacco control, there is little to no hope to achieve the aim of a smoke free world by 2040,” he said.

“Frankly, this is a death sentence for the almost 1.4 billion current smokers in the world, which include 20 million kind citizens of Bangladesh. How can this message of doom be turned into one of hope? By fully integrating harm reduction policies, science and regulated products into tobacco control,” he added.

During her panel session, Dr Marewa Glover, a New Zealand public health academic specialising in smoking cessation opined, “The poor and indigenous people in most countries suffer disproportionately from high smoking rates and tobacco-related disease

“All stakeholders need to work together to improve access to smoking cessation services, including smokefree nicotine alternatives, as has been done in New Zealand, through vaping products."

Dr Konstantinos Farsalinos, a Greek cardiologist and the most cited THR researcher in the world suggested, “The evidence is clear, smoke free nicotine alternatives such as vaping products are at least 95 per cent less harmful than cigarettes and the preferred method of quitting for most smokers.

“Along with oral nicotine pouches, these are gateway products out of smoking and should be made available in Bangladesh within well monitored, risk-proportionate regulatory frameworks.” 

Former president of the World Medical Association and founder of Africa Medical Association, Dr Kgosi Letlape emphasized on ensuring access to harm reduction tools as basic human rights and highlighted the role of health professionals in contributing to the goal.

He said, “Consumers have a human right to receive accurate health information and risk communication. Prohibition has never worked in public health. Rather empower consumers and patients with the truth and accurate risk assessments of products.

“Help them migrate from more to less harmful products, if they can't quit. It is the ethical duty of health professionals to assist consumers in this journey, to help prevent tobacco-related disease and save lives."

According to the speakers present at the event, Bangladesh has been known to be resilient against all odds with the world taking notice of its immense potential – from being a “basket case” to becoming one of the fastest growing economies in the world.

With a practical THR framework in place, Bangladesh too, can become a global role model yet again by achieving the Honourable Prime Minister's vision of a Smoke-Free Bangladesh by 2040.