Last week was hot in Seoul. Not just with the outdoor temperatures exceeding 30oC, but also with clear voices of over 100 experts from 18 countries gathered at the 3rd Asia Harm Reduction Forum (AHRF), calling to use the opportunity we have to save 20,000 people dying each day from smoking.
Asia-Pacific is home to the largest population of smokers in the world, and at the same time it is home to many innovative enterprises. According to one of the keynote speakers, Professor David Sweanor from Canada, these two features give the region a huge potential to introduce changes that will make real impact, and may become epicentres of global change. Detailed stats provided by another keynote presenter, Professor Tikki Pangestu from Singapore, confirm this diagnosis. The highest numbers of smoking-related deaths per year occur in China (1.8 million) and India (0.74 million). The smoking prevalence among men in these countries is several times higher than in Europe or North America (at 48% and 76% respectively). These two countries are responsible for approximately a third of all smoking related deaths globally, and adding other countries in Asia would increase that figure to almost 50%. As a result, introducing and promoting safer nicotine delivery systems to replace smoking in these countries would have a profound effect that cannot be ignored by policy makers around the world.
Presenters at AHRF highlighted that it is not only the consumption of tobacco, but also its production, that is centred in Asia. Professor Pangestu pointed out that half of global tobacco production takes place in in China, India, Indonesia, Pakistan, Bangladesh, Korea, Thailand, Vietnam and Philippines. Governments in these countries may thus focus on protecting their economy, rather than on public health, even though research shows that agricultures that switch from producing tobacco to other crops tend to produce higher income.
Dr Konstantinos Farsalinos from Greece highlighted that tobacco harm reduction is an absolute necessity, given that so many attempts to quit smoking without it simply fail. Dr Farsalinos, as well as several other presenters, highlighted that access to harm reduction measures is simply a basic human right.
Data clearly shows that modern nicotine delivery systems are much safer than smoking, and lack of long-term data (i.e. longer than the existence of e-cigarettes on the market) is not a valid argument in the discussion, for several reasons. First, snus - a Scandinavian version of smokeless tobacco, responsible for the lowest smoking prevalence and lowest number of smoking-related diseases in countries like Norway and Sweden - has almost a century of data to prove its public health value. despite this, the European Union still bans its availability, proving that lack of long-term epidemiological data is not the key issue. Second, as pointed out by one of the participants of the AHRF, that line of reasoning would force doctors worldwide to stop using almost 80% of all drugs - including all modern, life-saving drugs, as these also do not yet have data available for more than a decade or so. Finally, even overshadowed by the recent death caused by misuse of e-cigarette devices in US (the case of contaminated THC oil & cannabis vaping), e-cigarettes have proved to be extremely safe products; 10 years on the market, over 10 million users in USA alone, and with the exception of the above case of clear misuse of a product, no deaths recorded resulting from their use. Very few consumer products have such an excellent safety record, even those specifically designed to protect lives, like car airbags, of which over 100 million faulty units are on the streets worldwide these days (https://www.autonews.com/automakers-suppliers/honda-16th-us-death-confirmed-takata-airbag-rupture)
Participants also raised issues of the high cost of e-cigarette, compared to traditional smoking, as a barrier of entry for the most affected, poor populations. As pointed out by Professor Sweanor, an adoption of the new, innovative technology on a massive scale, made possible by huge market sizes in the Asia-Pacific countries, should spark further innovation and bring new companies and new technologies, which will certainly decrease the cost of the devices. Furthermore, adoption of low-tech snus may be a solution in the regions where cost or access to electricity may be an inhibiting factor, or where - as in India - prevalence of using non-combustible tobacco of low quality is very high.
Harm reduction is clearly not a silver bullet. Instead it should be perceived as one of three pillars to end smoking and start saving lives now: demand reduction, supply reduction, and harm reduction.
See the presentations from AHRF'19 here: https://asiaharmreductionforum.com/pages/presentation_2019