International governments intensify support towards science-backed reduce risk tobacco alternatives
Uruguay joins the list of progressive countries like Japan, the US and the UK, as it reverses the ban on the import and sale of heated tobacco products
The World Health Organisation (WHO) predicts a staggering over 1 billion smokers into 2025 and beyond, indicating that tobacco control measures which are aimed at curbing adoption and encouraging quitting are proving to be not as effective. Countries are hence rethinking their traditional tobacco control policies; by adding a ‘harm reduction’ approach, to offer adults who would otherwise continue to smoke, scientifically substantiated less harmful products as alternatives.
The US has always led the way in supporting an ‘appropriate regulatory framework for new product innovations’ taking a scientific approach. It requires manufacturers to file a premarket tobacco product application (PMTA) with the FDA, providing scientific data to demonstrate the product is appropriate for the protection of public health. The US laws also allow a manufacturer to submit applications for the FDA to evaluate whether a tobacco product may be sold for use to reduce harm or the risk of tobacco-related disease associated with tobacco products already in the market.
Similarly, in 2017, the UK Department of Health released its five-year tobacco plan for England, to reduce the smoking rates amongst adult smokers to 12 per cent by 2022. The government acknowledged the role that science-backed innovations can play in helping adult smokers switch completely from cigarettes, and actively encourage smokers to consider using less harmful alternatives. Subsequent annual evidence reviews by Public Health England validate the important role that alternatives can play in moving adults away from cigarettes.
Today, progressive tobacco control policies are also being adopted by both developed and emerging countries. Before 2016, electronic cigarettes were banned or effectively banned across nearly half of the EU. From there on, things have progressed and ideologies have advanced.
Recently, Uruguay, transitioned from a ‘Nanny State’ with restrictive tobacco control laws to a progressive state; giving the consumer, freedom of choice. In 2005, the Government announced a series of mandates to reduce tobacco consumption resulting in a multi-decade effort to significantly increase industry regulation. Some of these measures included prohibiting smoking in all public and private enclosed areas, explicit prohibition of ads, stringent health warnings to eventually prohibiting “the commercialisation, import, registration as a trademark or patent and advertising of electronic cigarettes.
In March 2021, in a historic decision, the Government of Uruguay reversed the ban on the importation and sales of heated tobacco products recognising that tobacco products exist with “distinguishable risks” and noted that the industry can play a role in reducing the impact of smoking. The new decree recognizes the role of the state to ensure the health of its population and seeks tools to respond to the tobacco epidemic by offering alternatives based on scientific research.
Japan too represents a model example, known for its high adult smoking population. In 2014, the introduction of non-combustible alternatives in Japan helped reduce the smoking rate in the world’s largest market of heated tobacco products (HTPs) by nearly a third in a span of three to four years. While the Government struggled with various nicotine replacement therapies (NTP), however with the introduction of heated tobacco products (HTPs) and through progressive regulations the country found success. By differently regulating heated tobacco products as compared to cigarettes, smoking rates reduced by over 30 per cent between 2015-2019. A study by researchers working for the American Cancer Society reinforced the success of HTPs with combined sales of all tobacco products also declining.
While countries like Japan and Uruguay have embraced this change, some countries face resistance and foul play by global anti-tobacco organisations. In the Philippines, the FDA admitted to foreign influence and hiring of people in drafting regulations advocating a ban on HTPs & vapes using anti-tobacco money based on international public health experts filing a resolution directing the House Committee on Good Government and Public Accountability to conduct an inquiry on the “questionable” receipt of private funding by Bloomberg Foundation. This discrediting development has found serious backlash from global public health experts, reinforcing the need for regulatory entities to operate without any interference or influence; to ensure consumer rights and welfare is not compromised.
Countries like Thailand, continue to adopt stringent tobacco control measures without considering technological innovations and scientific alternatives. Through 2005-20, 15 tobacco control measures were enforced, including eight tax increases, comprehensive bans on public smoking and advertising, total vaping ban, and plain packaging. According to a study by BMC Public Health  in 2019, consisting of open access, a peer-reviewed medical journal, while Thailand reduced the overall smoking prevalence rates from 23 per cent to 19 per cent (2003-17) – the tobacco policies haven’t been effective enough to achieve WHO’s 2025 voluntary global target of 30 per cent relative reduction in tobacco consumption, also cautioning challenges about growing illicit tobacco trade impacting the country.
Closer to home, India represents the second-largest smoking population in the world. While there has been a significant drop in smoking prevalence aligned to Global Adult Tobacco Survey (GATS), it is far from globally agreed to targets to protect people from death and suffering from cardiovascular and other non-communicable diseases (NCDs).
Even with that, in 2019, the Indian Government banned alternatives in Electronic Nicotine Delivery Systems (ENDS). The ENDS Prohibition Act bans production/manufacturing, imports, export, transfer, sale, distribution, stocking and advertising of any such product. Two years into the ban, there is a sharp rise in illicit trade, black marketing of ENDS and worst of all, ENDS users switching back to the consumption of conventional cigarettes. These stark outcomes need to be critically assessed by regulatory authorities before issuing blanket bans, as such – so, informed consumers can exercise their freedom of choice by having lesser harm alternatives available to them. Here, India is missing a sizeable public health opportunity.