With more than 1 billion users world-wide, tobacco claims nearly 8 million lives a year. The estimated cost of tobacco use on the world’s economy is equally staggering, with an estimated 2% of total annual GDP, or nearly $2tn channelled towards the burden of smoking-related diseases every year.
The study emphasises the role of decisive regulation and policy based on science.
Though numbers of tobacco users have fallen since they peaked in the 50’s, they are not falling fast enough. Furthermore, over 80% of tobacco users now reside in LMICs, in some of which, levels of smoking are not actually dropping at all.
“In South Africa, which is considered the second most stressful country to live in, with commensurate rates of depression and anxiety, there are almost 12 million smokers, notes ophthalmologist and healthcare leader Dr Kgosi Letlape.
He served as one of the panel of experts that contributed to the report.
The study also considers the complicating factor of the (sometimes decades-long) time-lag between commencement of tobacco use, and the eventual onset of disease and ill-health.
Dr Letlape observes that tobacco-industry stakeholders including users, manufacturers, healthcare workers and government must take swift decisive action given the public-health consequences of tobacco use, and the figures of tobacco-related deaths.
“There is a dire need for intervention from civil society and government, as well as the industry itself In LMICs like SA,” Letlape suggests. “The findings of our extensive study indicate that a technology-driven approach, backed by logical governance, based on scientific data, rather than emotional or cultural sentiment, holds the key to drastically reducing the harmful effects of smoking and reducing preventable deaths.”
“The tobacco industry has earned a poor reputation through decades of deceit and malfeasance. Furthermore, many nations who are current signatories of the UN’s Framework Convention on Tobacco Control (FCTC) own or partly control state-run tobacco companies, which gives rise to a conflict of interest in which tobacco parastatals must agree to curtail an activity from which they themselves profit,” says Letlape.
Nevertheless, Letlape believes that the tobacco industry is now needed as a key stakeholder in the struggle to end tobacco smoking.
“We must recognise that the tobacco industry has the expertise necessary to drive innovation in the field of tobacco cessation and disruptive THR (Tobacco Harm Reduction) technologies.”
Among his recommendations is that all companies should publish a fully transparent plan with measurable outcomes and targets, for phasing out combustible products entirely.
Another is the sharing of intellectual property around less harmful technology, to increase affordability and access to THR technologies in LMICs, where R&D capacity is diminished, but where there is nevertheless potential for local manufacture.
Letlape also stresses the role of partnerships, especially public-private partnerships (PPPs), in improving access, affordability and acceptability of new cessation and THR technology.
“One possible focus-area where PPPs could prove crucial, is [dissemination of information], education and awareness campaigns that combat the misinformation that persists around the relative risks of tobacco products [relative to] their alternatives.
On the role of policy and regulation, Letlape says that global tobacco policy is confused, hindered by misinformation, and not based on the best available scientific data.
He notes that, as with regulation, the taxation of products should be proportionate to their relative risks and potential harms. By this logic, alternatives to combustibles, like ‘vapes’, could become less expensive, thus affording more LMIC smokers the opportunity to switch to safer alternatives.
In essence, the paper calls on stakeholders to engage in a rational conversation that must include grounded science-based regulatory oversight; risk-appropriate regulation and taxation of the various products and alternatives; transparent collaborative research; and clear communication with the public.
Dr Letlape says that the support of international public health agencies, like the WHO is critical to the fight against smoking by introducing regulation, acknowledgement of THR technology’s potential and obliging cigarette manufacturers to publish ingredients on the product packaging.
“These interventions together with a concerted push towards non-combustion THR devices could save millions of lives each year, especially in LMICs and amongst high-risk and marginalised communities.”
