Tobacco harm reduction must have 'a balanced and informative approach'

The tobacco industry and experts say perceptions on harm reduction need to be challenged and barriers tackled.

Global Forum on Nicotine Ltd director Paddy Costall said the forum chose this year’s theme, “Challenging perceptions – effective communication for tobacco harm reduction”, because they believed tobacco harm reduction has the potential to play a major role in combating non-communicable diseases.

The forum is an international event focused on nicotine science and harm reduction. According to its website, it does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies.

“We face continued challenges from often well-resourced organisations and individuals who remain implacably opposed to it,” Costall said. “Communication is a key issue and the importance of honesty and accuracy cannot be overstated. Ill-informed and often misleading representations can be seriously damaging to individuals and communities at large.

“A balanced and informative approach, rather than a polemic, enables people to make better decisions and thus improve their health. Critical, inquisitive and responsible journalism can play a major role in public understanding and can really help create the conditions where individuals’ decisions are more informed. However, misrepresentation – whether accidental or deliberate – does not serve individual or public health.”

British American Tobacco (BAT) global medical safety officer Hugo Tan said there are 1.3-billion smokers across the world, with eight million deaths due to complications related to smoking recorded annually.

“Covid-19 amounted to about seven million deaths. If Covid-19 was a pandemic, if it was a public health crisis, then what about the eight million deaths from smoking?

“Not too long ago, when I was in medical school, we were taught about the harmful effects of smoking, but we learnt nothing about the science, about alternative nicotine products. How we teach medical students needs to change.”

Malaysia Society for Harm Reduction chairperson Sharifa Ezat Wan Puteh said in Malaysia and other low and middle-income countries, tobacco control is “very traditional”.

“It’s a prohibitionist approach, which tries to ban everything under the sun, not only tobacco, but now also alternative nicotine products.”

Mark Tyndall, author and University of British Columbia professor of medicine at the school of population and public health, said he got into harm reduction because it became a big part of his work in HIV prevention.

“I quickly learnt that with behaviours and exposures that had inherent risk, the only approach would be to offer interventions that reduce risk, because we couldn’t eliminate the risk. Most importantly, these interventions are enthusiastically supported by people who will benefit from them,” he said.

“This is not a nanny state type thing that we’re trying to foist on people. This is what people want and what people need. People who know that they could get HIV are happy to use a condom. People who inject drugs are happy to use a clean needle. And people using nicotine are generally happy to find alternative sources.

“The history of harm reduction is controversial mainly because of the people it’s designed to help. Generally, people who choose risky or socially unacceptable behaviours are frowned upon in society. We discriminate against people who are the most vulnerable and most in need of our help. There’s a lot of discrimination and stigma that’s attached to our responses.”

Tyndall said there was a medical system in place in some countries around smoking and around treating chronic illnesses caused by smoking, but nobody’s in a big hurry to change it.

“Tobacco control organisations aren’t in a big hurry to change things, either,” he said. “They’ve had decades of working on abstinence-based programmes ... When safer products became available, they were cautious, but now, instead of starting to discuss the possibilities of how these could help people and help people’s health, they just continue to double down.

“And now, 10 or 15 years into it, it’s hard for these tobacco control organisations to take a big breath and say maybe we were wrong all along. Tobacco companies are also not pushing hard for change. There are a lot of new products. The websites of PMI [Philip Morris International] and BAT are forward-looking and [they] want to go smokeless, but they seem to be in no hurry ...

“We need to use the legal justice system better. With other harm reduction [efforts], taking cases to the courts has been successful. Supervised injection sites, needle exchanges – all have gone to Canadian courts and they’ve ruled in favour of access to these things.

“It’s hard from a justice perspective to say that people who want a safer product can be denied. The policies that make vaping and safer nicotine products harder to get for people who smoke are equivalent to denying people HIV treatment.”

The World Health Organisation (WHO) says the tobacco epidemic is one of the biggest public health threats the world has ever faced. It states that it is responsible for over seven million deaths annually, disability and long-term suffering from tobacco-related diseases.

“All forms of tobacco use are harmful,” the WHO says, “and there is no safe level of exposure to tobacco.”

Mashaba was invited to the Global Forum on Nicotine