Smoke from cigarettes causes non-communicable diseases such as lung cancer, peripheral arterial disease, chronic obstructive lung disease and heart disease.
Amir Ullah Khan
India’s tobacco problem is a cause of concern—the number of tobacco users has crossed 267 million, and five people die due to tobacco-related illnesses each minute. An estimated 11.2% of the world’s smokers live in India—the second-largest smoking population after China. With policymakers sounding the bugle for tobacco control with a crackdown on e-cigarettes, the debate has conveniently missed the consumer’s perspective.
Smoke from cigarettes causes non-communicable diseases such as lung cancer, peripheral arterial disease, chronic obstructive lung disease and heart disease. At least 50% of all lifelong smokers die prematurely from a smoking-related disease. Despite these dangers, millions of people smoke, and a large number start afresh every day. Estimates suggest that if current smoking patterns continue, a billion people will die from smoking-related diseases in the 21st century.
Despite the availability of smoking-cessation medications, many smokers do not want to try them. Of those who use them, the majority either fail or relapse within a year. Public health experts have recommended that smokers be encouraged to switch to lesser harmful substitutes. Listening closely to a discussion where smoking alternatives were the subject of the conversation about banning them outright, the one recurring question that remained unanswered was: Can a ban on alternatives help a smoker quit? “Did alcohol ban stop people from drinking?” was the most common argument from those advocating against the ban.
Another friend who was a chronic smoker for 10 years and then moved to vape was worried about the inflation in prices of e-cigarettes, in case of a ban. “They would still be available, won’t they? Only more expensive, and may be duplicated,” he argued. This is not the first time the government has looked at a ban as the ‘big solution’ to tackle a rampant substance addiction. But the question is: Has the scarcity of the banned commodity ever curbed its demand? Bans make for good headlines, but bad policies. Countless efforts to reduce tobacco burden by means of taxation, stringent labelling requirements, etc, have lost the fight to control India’s rising number of smokers. Because it’s a long road from ‘trying to quit’ to ‘kicking the butt’.
At the centre of the problem sits ‘tobacco addiction’. India needs a robust regulatory mechanism to make alternatives available to smokers. The WHO Framework Convention on Tobacco Control recognises ‘tobacco harm reduction’ as a pillar of tobacco control. Policy decisions on issues like this should be based on rigorous scientific evidence and one should consider the relative risks of ENDS (electronic nicotine delivery systems) vis-a-vis combustible cigarettes. As per the available scientific evidence, it is clear that vaping is a fraction of the risk of smoking, at least 95% less harmful and of negligible risk to bystanders.
Moreover, how do you advocate against an e-cigarette, when bidis and tobacco cigarettes are available at every nook and corner of our cities? The needs are satiated by the grey market, leading to unregulated usage, with unsafe options carelessly available.
Let’s take a few examples. Gujarat, which was the first state to implement prohibition in 1958, has alcohol consumption rampant and illegally flourishing. So is the thriving business of supplying illicit and spurious liquor. In Ahmedabad, one can get liquor home-delivered faster than pizza. In Kohima and Dimapur (North-east India), liquor is available in grocery, confectionery and garment shops, restaurants, and even on paan stalls.
If you look at it from a public health gain standpoint, restricting access to a viable alternative like e-cigarettes to people who already have full access to far more harmful conventional cigarettes, the argument is futile. Even if the government is concerned about things such as e-cigarettes being used by youth, quality standards, nicotine content, marketing, promotion and labelling, we should address them by regulating the category instead of banning it.
Many nations have chosen to invest more in researching the public health impact of these devices and develop appropriate regulations for optimising its positive impact, instead of banning. Maybe it’s time to take lessons from over 98 countries that have regulated the category.
With scepticism over e-cigarettes rising, credible data that smokers can trust is needed. It is crucial to consider the relative risks of e-cigarettes and conventional cigarettes while framing regulations. There is mounting scientific evidence to prove e-cigarettes are significantly less harmful than traditional cigarettes. It would be tragic to deny an alternative to millions of smokers. India needs to reassure its smoking population there are choices available with reduced harm.
The author is an economist and director of Research at Aequitas