Today, tobacco addiction remains a global scourge, with its effects remaining particularly acute in Asia. To turn that tide, government officials will need to be able to parse science from dogma. They need to understand what works, and what doesn’t, to minimize the catastrophic health effects of smoking.
So, how can well-intentioned policymakers distinguish wisdom from folly? Fortunately, countries around the globe have been trying to wean smokers (and would-be smokers) off cigarettes for decades — and those campaigns have worked to very different effects.
Some campaigns have been remarkably effective: The U.K., the U.S., New Zealand, Canada, and Japan have seen unmistakable drops to the point that cases of lung cancer and emphysema have fallen in almost miraculous ways. But at the same time, several countries in Asia have struggled to stem the tide.
In 2019, tobacco was responsible for 4.7 million deaths in the Asia Pacific region. There are still 10 million smokers in Thailand, 100 million smokers in India, and even more in China. So, what exactly distinguishes those countries succeeding on these fronts from those wallowing in failure? What can science teach us?
This much is clear: The difference in national outcomes is decidedly not born from Asia’s failure to adhere to high standards. Rather, many of the countries that have had some of the worst outcomes — Thailand and India, for example — have adhered to the tenets of the World Health Organization’s (WHO) “Framework Convention on Tobacco Control,” or FCTC. But Thailand has seen only a 1% decline over 20 years of effort while the U.S., by contrast, which is not even a signatory to the FCTC, has had much more success. Policymakers need to understand why.
A closer look reveals that the most important factor distinguishing policy success and failure is the clarity with which governments understand that smoking cigarettes is the core of the problem — a behavior that must be distinguished from other forms of tobacco consumption. It would be ideal, of course, if policymakers could convince smokers to abandon tobacco and nicotine consumption altogether. But insofar as some people are simply not able to kick the habit of consuming the nicotine that laces tobacco, there are still enormous health advantages to encouraging smokers to switch to e-cigarettes or other non-combustible alternatives. And that’s the problem with the FCTC. It serves to encourage countries to ban cigarette alternatives.
In fact, the WHO has adopted a policy that encourages countries to ban what is perhaps the most important tool available to thwart the epidemics of lung cancer and emphysema that remain a targeted, but global scourge. Consider the difference. The U.K. recently embraced a program termed “swap to stop,”
designed explicitly to wean nicotine addicts off cigarettes — and the program has contributed to Britain’s success in driving down cigarette consumption. Thailand and India, by contrast, have embraced the dogmatic preaching from the WHO leadership by outlawing e-cigarettes, and yet smoking in both countries remains a growing scourge. Correlation may not be causation, as many researchers frequently remind the public. But, in this case, the science provides a compelling explanation. Policymakers are being induced to put dogma ahead of harm reduction. Better to have millions of people consume products that are much less likely to kill than remain steadfast in a dream that they will abandon nicotine sight unseen. Today, Bangladesh, Bhutan, Maldives, and Nepal are all considering how to approach this same problem. Will they follow the successful models on display in the U.K. and elsewhere — or else be convinced to follow a different path? The good news, in this realm, is that we have at our disposal tools capable of saving millions of lives.
But to deploy them — to meet the entirely reachable goal of ending the use of combustible cigarettes by 2035 — government will need to separate wisdom from rhetoric. By the miracle of modern innovation, smokers and would-be smokers can address their nicotine addiction with products that are 95% less harmful than cigarettes, cigars, and pipes. Policymakers around the world need to display the courage to follow a path almost sure to save millions of lives. As the health policy leaders from across South Asia head to COP-10 in Panama, they should embrace the science and join a global alliance to end the use of combustible cigarettes by pushing back against the dogmatic prohibition crowd at FCTC. If the WHO really wants to end the scourge of smoking it must use innovative new products to get smokers off cigarettes. Leaders from the Maldives Islands, Bhutan, Sri Lanka, and Bangladesh can help the region join the U.K., U.S., and Japan in switching smokers to scientifically less harmful nicotine devices. The failure of tobacco control in Thailand and India is banning these products. The adult smokers in your region deserve better.
Lindsay Mark Lewis is the Executive Director at Progressive Policy Institute (PPI), a Washington, D.C. based think tank with offices in London, Brussels, and Kyiv.