Tobacco use remains one of the leading causes of preventable deaths and illnesses worldwide, and Bangladesh is no exception. Recognizing the urgent need to address this public health crisis, Prime Minister Sheikh Hasina has set a bold vision to make Bangladesh smoke-free by 2040.
Achieving this ambitious goal requires innovative strategies and evidence-based policies, and one approach that has shown remarkable success in many countries is the adoption of Tobacco Harm Reduction framework.
Understanding Tobacco Harm Reduction
Tobacco Harm Reduction (THR) is a public health strategy aimed at reducing or minimizing the health risks associated with the use of conventional tobacco products. Harm reduction recognizes that, while the preferred goal is abstinence, this is not always achievable. Helping people change to less harmful alternatives is a more effective approach.
People smoke primarily because they are addicted to nicotine, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness. This “spectrum of harm” ranges from conventional combustible tobacco (cigarettes) at the top as most harmful, followed by heated tobacco products/heat not burn (about 60-65% less harmful than cigarettes), vapes/e-cigarettes (95% less harmful than cigarettes), oral nicotine pouches (99% less harmful than cigarettes), and medicinal nicotine (nicotine replacement therapy, or NRT) at the bottom, as the least harmful form.
Many progressive nations, including the UK, Sweden, New Zealand, and Canada, are encouraging the use of RRPs by regulating them through risk-proportionate regulatory frameworks.
Science-based evidence on the efficacy of THR
The harm from traditional cigarettes is associated with the tar generated from the burning of tobacco. According to the Royal College of Physicians, people smoke for nicotine and die from tar. THR supports tools that provide adult smokers with a quitting route by ensuring access to less harmful forms of nicotine delivery. Research by the UK Health Security Agency (previously known as Public Health England) has also showed vaping is 95% less harmful compared to conventional cigarettes.
The Guardian reported, citing Action on Smoking and Health (Ash), that the number of vapers in the UK increased from about 800,000 to an estimated 4.3 million in the last ten years alone -- helping almost 2.4 million adult smokers successfully quit smoking and shift to vaping. Hazel Cheeseman, Ash's deputy chief executive, said the increase in smokers switching to vaping was great news in terms of reducing harm of tobacco use.
“They can be lifesaving tools for those struggling to quit. At the same time, we can't rely on vaping to fully solve the problem of smoking. The time for government action is now,” she said.
Smoking is becoming less popular in the UK. Data from the annual population survey found smoking prevalence among adults aged 18 and over in England declined from 20% to 14% between 2011 and 2019.
More recently, the UK government announced giving away one million free vaping kits -- supporting 1 in every 5 adult smokers in quitting conventional smoking and shifting to vaping.
Success stories and what it could mean for Bangladesh
Sweden is on track to become the world's first smoke-free country, achieving this milestone 17 years ahead of the target set by the European Union. The country has witnessed a sharp decline in smoking incidence from 15% to 5.6% in just 15 years, meeting the World Health Organization's target of a 5% adult smoking incidence to achieve “smoke-free” status.
On the other hand, New Zealand's Ministry of Health acknowledges the potential of vaping products to contribute to the smoke-free 2025 goal, projecting that offering less harmful alternatives could help approximately 550,000 people to quit smoking. Former New Zealand Prime Minister Jacinda Ardern has publicly recognized the contribution of vaping to their smoke-free ambition and advocated for sensible and risk-proportionate regulations for less harmful alternatives.
Bangladesh has been known to be resilient against all odds with the world taking notice of its immense potential -- from being a “basket case” to becoming one of the fastest growing economies in the world. With a practical THR framework in place in its macroeconomic policies, Bangladesh too, can become a global role model yet again by achieving the honourable prime minister's vision of a Smoke-Free Bangladesh by 2040.
Dr Delon Human is a physician and a former secretary general of the World Medical Association (WMA) and a former adviser on global public health strategies to three Directors-General of the WHO and to UN Secretary-General Ban Ki Moon