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Why banning alternatives to smoking will do more harm than good

The International Network of Nicotine Consumer Organisations (INNCO), a global association advocating for tobacco harm reduction policies, on Monday, March 22, 2021 released a position paper titled: “10 Reasons Why Blanket Bans of E-Cigarettes and HTPs in Low- and Middle-Income Countries (LMICs) Are Not Fit for Purpose.”

Vaping
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The policy report rebukes the “overly simplistic and impractical” bans on electronic nicotine delivery systems (ENDS) and other tobacco harm reduction (THR) products in LMICs, warning organisations and governments that limiting options to reduce harm will only increase the number of people smoking tobacco, inevitably leading to illicit markets and increases in crime.

“The hundreds of millions of people who smoke in these countries should have the ability to make decisions about safer nicotine products, particularly when their own health is on the line,” said Samrat Chowdhery, president of INNCO’s governing board.

“Overly simplistic policy solutions, such as The Union’s proposed ban on all ENDS and THR products, will continue to be offered as a blunt and impractical tool for a situation that requires pragmatism and nuance, making meaningful and sustainable change more difficult,” Chowdhery added.

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A blanket ban in LMICs is a form of philanthropic colonialism, suggesting that these countries and their citizens cannot be trusted with any level of self-determination. Inhabitants are treated as second-class citizens, which is offensive. There is no benefit in limiting choice of safer nicotine products, but only the potential for increasing harm. According to the paper, simplistic solutions to complex public health challenges may appear attractive, but ultimately do not work. In fact, countries like Turkey that have banned reduced harm products actually showed increases in the prevalence of smoking among its citizens.

Very few low- and middle-income countries have adopted even the most basic WHO-suggested MPOWER prevention measures. Policymakers should embrace harm reduction as a valid goal, particularly in LMICs where access to cessation programmes is extremely limited. Replacing combustible tobacco with alternative nicotine products can significantly reduce the risk of harm by at least 95 percent. It works in industrialized nations and can do the same in LMICs.

INNCO’s top 10 reasons against banning safer nicotine products in LMICs are as follows:

  • Bans are an overly simplistic solution to a complex issue and will not work.
  • Prioritizing the banning of reduced harm alternatives over cigarettes is illogical.
  • Reduction and substitution are valid goals for smokers in LMICs.
  • People who smoke have the right to choose to reduce their own risk of harm.
  • Reduced harm alternatives can significantly contribute to the aims of global tobacco control.
  • Lack of research in LMICs is not a valid reason to ban reduced harm alternatives.
  • The prohibitionist approach in LMICs is outdated, unrealistic and condescending.
  • Bans will lead to illicit markets with increases in crime and no tax revenue.
  • Banning reduced harm alternatives leads people back to smoking and greater harm.
  • Blanket bans in LMICs are a form of “philanthropic colonialism.”
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INNCO estimates that that there are scores of LMICs in jeopardy of increasing the number of people who smoke unless pragmatic approaches to tobacco harm control are adopted, including the availability of a wide selection of safer nicotine products. Leveraging the paper’s findings, INNCO will work with its global membership to inform policy makers in these developing nations to help achieve risk-relative regulations and access to safer THR products.

“Africa is home to some of the highest-ranked smoker countries on the planet,” said Joseph Magero, chairman of Campaign for Safer Alternatives, a pan-African non-governmental member organisation dedicated to achieving 100 percent smoke-free environments in Africa.

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“While improving overall public health has made great strides in these regions, efforts to directly address smoking cessation and harm reduction strategies have lagged due to limited or no access to safer, non-combustion nicotine products. By denying smokers access to much safer alternatives while leaving cigarettes on the market, policymakers would leave only two options on the table – quit or die,” added Magero.

INNCO believes that a prohibitionist approach is “patronising and discriminatory,” and does not allow for finding innovative solutions to answer the challenge of decreasing smoking rates. Bans on THR products overlook a significant public health opportunity to encourage people who smoke and are not ready to quit to switch to reduced-harm alternatives, a pragmatic approach that could save millions of lives.

By Joseph Magero; Chair, Campaign for Safer Alternatives

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