India can guide COP10 to include science & evidence-based policy to solve for tobacco diseases

Critical questions that can shape COP 10: With over 1 billion smokers, global policies must focus on the science of tobacco harm prevention.

New Delhi (India), September 15: At an eminent ET Edge conference themed, ‘The Need to Adopt Solutions Backed by Science’’ medical experts stressed the need for effective global & local tobacco control public health policies, given the alarming number of tobacco consumers & smokers around the world. The attempt to course correct, backed by scientific data & analysis, should hence be foundational in the upcoming 10th session of the Conference of Parties (COP10) to the WHO Framework Convention on Tobacco Control (WHO FCTC) in November ‘23, the experts opined.

Sharing India’s polio success as an example, Dr. Kiran Melkote, Eminent Orthopedic surgeon and Director of the Association for Harm Reduction, Education & Research, “After sustained efforts by our government and a tailored policy in India, today we’re polio-free. However, even after 20 years of a global campaign, tobacco harm remains the leading cause of premature deaths. Hence, it’s crucial for India and member states of COP10 to prioritise fact-based solutions to mitigate the damage and save over 8 million lives each year.” 

Referring to successful global health policies, Prof. Dr. Rohan Savio Sequeira, Consultant Cardio-Metabolic Physician, Specialist in Non-Invasive Cardiology, Diabetes, Endocrinology and Obesity Management, Hon. Consultant Physician to the Governor of Maharashtra, mentioned, “Safer nicotine alternatives have been proved to be impactful in multiple nations for public health. Sweden is a prime example, with the lowest smoking-related deaths in the EU. Such policy success should be the bedrock of global health solutions. Officials, including Indian delegates, attending COP10 should table scientific, evidence-backed solutions to help reduce the global tobacco-induced disease and death.”

 Bringing in a global perspective, Clive Bates, Director, The Counterfactual, United Kingdom, in his keynote address at the event, said, “India has the second largest number of smokers in the world. There is significant research which indicates that smokers should be encouraged to switch to safer alternatives which are at least 90% less harmful than cigarettes.”

Addressing a recent open letter written to the delegations attending COP10, he further offered advice in the form of four key questions that will help have a pragmatic and evidence-based outlook at the global meet on tobacco control policy.

One: What are the trade-offs? Are the needs of adult smokers being ignored in their respective countries? What are the implications of the suggested measures on young people who would otherwise smoke?

Two: Where is the evidence? Is there a fact-based, scientifically proven reasoning behind what is being proposed?

Three: Who disagrees with this and why? Much of the research and evidence in this field is contested among independent experts. One should be aware of and insist on seeing all sides of the debate.

Four: What are the plausible unintended consequences? Will strict policies reduce smoking, control black markets and safeguard consumers from unregulated options?

Delegates should be clear on their national public health and tobacco policy goals. Governments could set a wide range of objectives as one set policy would not be suitable for all member states.

The priority should be to recommend reliable, evidence-based policies, especially for delegates from low-income and middle-income countries (LMICs). WHO promotes the prohibition of certain categories of alternatives while more dangerous tobacco products are freely available. Certain facts promoted by the agency are inaccurate, limiting the possibility of a balanced view.

The selective representation by civil society & nongovernmental organizations as observers at COP confines the otherwise unbiased approach at other multilateral forums. 

When finalized 20 years ago, the convention’s purpose was to contain and reduce the health and welfare harms from smoking. However, today, COP10 is focused on limiting the third tobacco control approach, harm reduction, which has resulted in harm increase. While U.S. Food and Drug Administration (FDA) approves certain categories of alternatives based on scientific data deeming appropriate for the protection of public health, the WHO has a conflicting stance.

Despite global & country-specific interventions, there are still over one billion smokers today – the number largely remaining stagnant over the last decade. India itself has more than one hundred million smokers, with no reduction in recent years. This sadly reflects, in spite of best efforts by countries at large, the inefficiency of the current tobacco control policies. By including better and safer alternatives and focusing on reducing smoking prevalence, WHO can make progress towards its goal of reducing the global burden of tobacco-related diseases and deaths.

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