Dr. Waseem Janjua & Qamar Nasim
Tobacco industry interference has been a persistent challenge in global public health efforts to curb smoking and its associated health risks. In recent times, a concerning trend has emerged wherein the tobacco industry is seeking ventilator support for continuing profits through its electronic products in low- and middle-income countries (LMICs). This maneuver raises ethical and public health questions, as it appears to be a strategic move to gain favor while diverting attention from the detrimental effects of electronic tobacco and nicotine products.
However, an examination of various facets of tobacco industry interference, and the motives behind seeking this ventilator support, reveals “uninterrupted profits” with potential detrimental consequences for public health.
The rise of electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes continue to present new challenges to global tobacco control efforts. The tobacco industry, recognizing the potential for profit in the emerging market of LMICs, has aggressively marketed these products in regions with fewer regulations and weaker public health infrastructures. ENDS are often promoted as safer alternatives to traditional cigarettes (although there is no scientific evidence for that), despite growing evidence suggesting their own set of health risks. In recent years, the tobacco industry has adopted a strategy, presenting itself as a “public health conscious” entity by championing the cause of tobacco harm reduction. Under the guise of mitigating the health risks associated with traditional tobacco products, the industry is actively promoting alternative products such as electronic nicotine delivery systems (ENDS) and heat-not-burn devices.
In face of the growing awareness and many countries banning these electronic products, and others strictly regulating, tobacco industry has sought ventilator support for its electronic products in LMICs. This move raises eyebrows as it appears to be a calculated effort to present the industry as a benevolent force trying to reduce the harmful effects of tobacco use during a global health tobacco epidemic. By aligning themselves with pharmaceutical industry and promoting tobacco harm reduction strategies, the tobacco industry aims to divert attention from the health hazards associated with their products and position themselves as contributors to the better public health.
Tobacco harm reduction is a controversial concept that advocates for the substitution of traditional tobacco products with purportedly less harmful alternatives. While the idea has gained attention in the realm of public health, the tobacco industry’s embrace of harm reduction is viewed with extreme skepticism. The industry’s history of deceptive marketing practices and opposition to evidence-based tobacco control measures raises concerns about its true motives.
Low- and middle-income countries, with their challenged regulatory landscapes and often limited resources for robust tobacco control measures, have become prime targets for the tobacco industry’s harm reduction agenda. Seizing upon legal loopholes and lax regulations, the industry has aggressively marketed ENDS and other alternative products as safer alternatives to traditional cigarettes. This has created a complex scenario wherein the industry portrays itself as a champion of harm reduction while capitalizing on regulatory gaps to expand its market.
The rapid evolution of new tobacco and nicotine products poses significant challenges for regulators in LMICs. The lack of comprehensive research on the long-term health effects of these products makes it difficult for authorities to establish evidence-based regulations. The tobacco industry exploits this uncertainty to influence policymakers and advocate for the legalization and widespread availability of their products, presenting them as a viable harm reduction strategy. For example, nicotine pouch products were launched in Pakistan without any regulation and the government is completely baffled about its admissibility. The indecisiveness to regulate, ban, or allow these products has left the masses completely confused about the impact of these pouches.
Research indicates that some alternative products continue to pose serious health risks, and the industry’s track record of prioritizing profits over public health necessitates caution. The push for harm reduction could inadvertently lead to increased nicotine addiction, especially among youth, and undermine existing tobacco control efforts. Nicotine (classified as poison in Australia) is the messiah of reducing harm caused by tobacco. When nitrosamines, additives, humectants, flavorings are added to nicotine (these are added in many of the nicotine products) it becomes a potent carcinogen. However, this fact is always masked in promotional gimmicks.
The tobacco industry’s promotion of harm reduction introduces an ethical quandary. By positioning itself as a proponent of public health, the industry attempts to legitimize its presence in the discourse surrounding tobacco control. This strategy may serve as a Trojan horse, allowing the industry to infiltrate public health policymaking and influence regulations in its favor.
The tobacco industry’s efforts to promote tobacco harm reduction and advocate for the legalization of alternative products in LMICs should be viewed with a critical lens. Policymakers, public health professionals, and advocates must carefully evaluate the industry’s motivations and prioritize evidence-based strategies to protect public health. By remaining vigilant and resisting the industry’s deceptive tactics, it is possible to safeguard vulnerable populations from the potential harms associated with the exploitation of harm reduction as a means to further the tobacco industry’s agenda.
