Time to look beyond tobacco cessation; here’s how
A case, therefore, needs to be made that in a country with such a large tobacco-using population, consuming a wide variety of products, and inadequate quit support, maintaining complete cessation as the only goal is unrealistic and should give way to an expanded and more pragmatic mission of reducing tobacco-related death and diseases through substitution and harm reduction measures.
In this context, a recent paper by Chelsea Boyd on tobacco and harm reduction in India makes an interesting case for reversing the ban on ENDS in India.
She delves into our tobacco ecosystem with a nuanced take on the health burden of tobacco (4% of our population are cigarette smokers, 7.7% smoke bidis and 21.4% are smokeless tobacco users), the breakdown of the tobacco marketplace (ITC sells 80% of cigarettes, with ~30% of it being owned by the government), the various pieces of tobacco legislation, and the pitfalls and shortcomings therein.
Boyd then makes a strong argument for the importance and need of tobacco harm reduction. “Given the large proportion of the population that uses tobacco, India is a prime location for applying tobacco harm reduction strategies… by preventing access to alternative nicotine delivery systems, the Indian government has eliminated the chance of effective tobacco harm reduction in a country that needs to use all available means to decrease its smoking and tobacco use rates,” she notes, concluding,
“Paramount to advancing harm reduction in India is reversing the ban on electronic nicotine delivery systems and reduced-risk oral products.”
The paper also makes interesting observations about the unintended but de facto ban on snus, a significantly harm reduced smokeless tobacco product from Sweden, which has been misclassified as a “food product” and falls afoul of the Drug and Cosmetics Act 1940 and Food Safety and Standards Act 2006 which were intended to ban tobacco from toothpaste and tooth powders, and nicotine as a food additive. Snus can be a successful low-risk substitution for India’s 200 million smokeless tobacco users.
Boyd’s paper is restrained when it tries to address the glaring contradictions in India’s tobacco control programme. For instance, bidis are smoked by a larger portion of the population and are deemed far more dangerous, and yet unlike cigarettes, they are not mandated to carry pictorial warnings, as a recent notification was withdrawn after the protest by a powerful political group.