While the coronavirus pandemic, which has been raging for the past two years, has claimed more than 4,5 million lives around the world so far, smoking still remains relatively fatal, as it is killing more than eight million people annually.

Health authorities are still grappling to come up with appropriate policies to reduce fatalities.

In 2005, the World Health Organisation came up with the Framework Convention on Tobacco Control (FCTC) as a response to the “tobacco epidemic”.

It currently has 168 signatories, including Zimbabwe.

Scientists, however, claim that although the FCTC has managed to reduce the prevalence of smoking, the rate of decline has recently begun to stall, which essentially calls for new additional measures to deal with the scourge.

“In terms of regulation in Africa, most of our governments were being informed by what comes from the WHO’s policy framework,” said Dr Kgosi Letlape, the current president of the Africa Medical Association (AMA) and co-founder of the Africa Harm Reduction Alliance (AHRA), at the recent 4th Scientific Summit on Harm Reduction that was held virtually.

“But what we need to note and understand is that framework convention for tobacco control was clearly focused on combustible cigarettes and the entire regime that it prescribes was to deal with combustible cigarettes. The nations that are signatories; that have adopted those mechanisms and are implementing them have seen a reduction in the prevalence of smoking in their nations.”

Difficulties

Dr Letlape, however, noted that the FCTC has inherent limitations since it focuses solely on combustible cigarettes and does not take into consideration the efficacy of safer alternatives that significantly reduce the harm caused by tobacco.

While the focus was on reducing the prevalence of smoking, evidence suggests that there are smokers who are finding it increasingly difficult to quit tobacco. Experts, therefore, believe encouraging them to switch to alternative products such as e-cigarettes and heat-not-burn products, among other non-combustible alternatives, was advisable.

“Studies have shown that some people that are diagnosed with cancer will quit for three months and more than half of them will be back to smoking, if they are still alive, despite being on treatment. So it is something that is difficult to quit,” added Dr Letlape.

“There were no alternatives to combustible cigarettes when WHO FCTC was adopted in 2005, except nicotine-replacement therapy . . .

“But now we have many other alternatives based on technology; that are alternate supplies of nicotine without combustion. Now here is what most of us need to be aware of: Snus has been used in Sweden for more than 200 years; snuff has been in our environment for as long as I can remember, but the FCTC was not even written to be appropriate to the non-combustible products that were available even prior to 2005.”

In Sweden, for example, the increased use of snus, which is an oral smokeless tobacco product that is usually placed behind the upper lip, has been linked to the decline in tobacco-related diseases.

It is one of the countries that reportedly has the lowest incidence of disease and morbidity related to tobacco use. Scientists believe

Scientists believe that policymakers, especially in African countries such as Zimbabwe, could be better served through interventions that focus on making harm-reducing alternatives to combustible cigarettes cheap and readily available, instead of disproportionately focusing on WHO’s recommendations that emphasise on banning tobacco.

“WHO was more about prohibition,” said Dr Letlape, adding: “Banning does not work!”

Policies meant to ban tobacco also put countries such as Zimbabwe, which is one of the major producers of tobacco in the world, in an invidious position.

During this year’s marketing season, cumulative tobacco sales exceeded 210,9 million kilogrammes, with export earnings rising to US$590 million.

Quitting

In her presentation at the 4th Scientific Summit, Mrs Uta Ouali from Tunisia’s Razi Hospital La Manouba’s department of psychiatry said quitting tobacco was a difficult proposition.

The quit rate among smokers with no history of psychiatry disorder or SUD (substance use disorder) was 42,5 percent.

Rates are, however, significantly lower among people with alcohol use disorder (17 percent).

“Substance use disorders are important contributors to the high rates of tobacco addiction, and smokers with these comorbidities demonstrate lower rates of quitting compared to smokers in the general population,” she said.

“A unified harm reduction approach for both SUD and tobacco addiction could therefore be an effective means to reduce risks linked to both types of addiction . . .

“Harm reduction strategies have been implemented and have shown to be effective in injectable drug users and people with alcohol use disorders. Harm reduction strategies often replaced strategies for complete abstinence in certain sub-groups of users: poly drug users, people with psychiatric co-morbidities, socially and economically marginally groups.”

Dr Gizelle Baker from Philip Morris International indicated that “novel products have the potential to have a huge impact to public health”.

“Harms are caused by smoking and combustible cigarettes; smoking-related diseases is where the journey of tobacco industry’s transformation started from. Novel products have the potential to have a huge impact to public health, moving people to less harmful alternatives and reducing the burden of smoking-related diseases,” she said.

The 4th Scientific Summit on Tobacco Harm Reduction: Novel products, Research & Policy was organised by SCOHRE, the newly founded International Association on Smoking Control & Harm Reduction.

SCOHRE is an association of independent experts on smoking control and harm reduction, scientists from all sectors such medical doctors, policy experts, behavioural experts, academics and other professionals.

Its thrust is to help to come up with a new broader approach to smoking control policies through constructive dialogue.