An effective Tobacco Harm Reduction (THR) framework is crucial to achieving a tobacco-free Bangladesh, according to the speakers at a recent roundtable discussion.
Dhaka Tribune in collaboration with the Asia Harm Reduction Alliance arranged the roundtable session, titled “The role of Tobacco Harm Reduction (THR) in achieving Hon'ble Prime Minister's Smoke-free Bangladesh vision by 2040,” in Dhaka on Saturday.
The panel consisted of distinguished experts, including international public health advocates, policymakers, academics, and consumers. The objective of the roundtable was to discuss the concept of THR, the science-based evidence in harm reduction tools, global best practices, and how Bangladesh can become an international role model by adopting a THR framework in its upcoming National 9th Five Year Plan to achieve the honourable prime minister's vision of a smoke-free Bangladesh by 2040.
Harm Reduction is a widely accepted framework endorsed by progressive nations around the world, to reduce smoking-related issues and deaths. The THR framework has proven its efficacy in encouraging policymakers to develop and enact risk-proportionate regulations for less harmful alternatives of nicotine delivery such as vaping devices, e-cigarettes, oral nicotine, heated tobacco products and others to achieve their smoke-free ambitions.
Dr Konstantinos Farsalinos, a cardiologist and the most cited tobacco harm reduction researcher, began with the importance of general harm reduction techniques like seatbelts and helmets, which don't offer complete protection when driving, but still significantly reduce the risks. With smoking affecting over a billion people worldwide, he underlined the difficulty in quitting and the low success rate of traditional smoking cessation methods.
He argued that THR should be “actively endorsed as the solution” to achieve a smoke-free Bangladesh as it is “Bangladesh's last and only option.” The THR framework addresses the key cause of smoking related health issues by focusing on eliminating combustion and the harmful effects of smoke and tar
Dr Marewa Glover, director at the Centre for Research Excellence: Indigenous Sovereignty and Smoking, shared insights on New Zealand's experience with the reduction of smoking. She stressed the importance of education as the first step, as smoking is highly addictive and simply urging individuals to quit is insufficient.
She advocated for a holistic perspective, and the importance of comparing relative risks; focusing on where the harm is greatest. Furthermore, she mentioned that solutions like vaping have been around for 20 years with very little evidence of harm, suggesting that longer-term reduced-risk products like vapes should be considered.
Dr Delon Human, a former secretary general of World Medical Association, said: According to the World Health Organization (WHO), achieving "smoke-free" status requires a country to have a smoking prevalence of 5% or less among the adult population. Currently, Bangladesh faces a considerable hurdle with a smoking prevalence of approximately 20.9%, reaching 40% among adult males.
Dr Human pointed out, “Transitioning towards a smoke-free nation becomes not only a public health imperative but also an economic one. According to Centre for Economics and Business Research, the UK government has earned £310 million in 2021 as tax revenue from the vaping industry alone.”
He stressed that “the tobacco harm reduction policy framework should be made part of Bangladesh's macroeconomic planning strategy -- the National 9th Five Year Plan in 2024” as public health policies and economic policies cannot be “decoupled.”
Prof Dr Mohammad Mizanul Haque Kazal, secretary general of Bangladesh Agricultural Economist Association said the three key steps to achieving a smoke-free Bangladesh are agriculture product diversification, increasing social awareness and support, and implementing proper regulations.”
Syed Zain Al-Mahmood, Executive Director, Center for Communication Action Bangladesh moderated the roundtable discussion.
“If we wish to regulate tobacco, there also needs to be multifunctional things. It's not enough to warn how harmful it is, we also have to think about the economics side of things, ensuring youth access prevention, responsible marketing, and accessibility of alternative products,” he said.
Speakers at the roundtable reiterated that less harmful alternative products should be brought, so that consumers have the option of reducing the harm caused by conventional tobacco. In that case, vaping is being prioritized in diverse ways around the world. But there is also a big debate whether vaping is an alternative or is equally harmful for health.
Prof Dr Lutful Hassan, Vice-Chancellor, Bangladesh Agricultural University said: “Vaping or e-cigarettes are 95% less harmful than the traditional cigarettes. But we should conduct enough research to see how the concept can be implemented. If we want to be free from tobacco and vaping can help as a less harmful alternative, then we should have government regulation to allow for vaping.”
Major (retd) Dr AKM Mahbubul Haque, put the scale of the tobacco problem in Bangladesh into perspective, emphasizing that relying solely on legislation is insufficient to tackle this issue. We need a comprehensive approach which encompasses broader social interventions to effectively combat this crisis.
He said: “We need smoke-free households, peer support, and social awareness. I believe local public health advocates, doctors and experts need to play a crucial role to help consumers in their quitting journey.”
Prof Dr Md Abdur Razzaque, Director (Research), Sher-e-Bangla Agricultural University Research System said: “The government must focus on the science-based evidence before taking any decision.”
Representing consumers, Masud-Uz-Zaman, convener, Voice of Vapers Bangladesh, drew from personal experience and said: “Vaping should be encouraged for people to stop smoking, and I say this from my own experience. I used to smoke for 27 years before I stopped in the last 10 years as I took vaping as an alternative form of nicotine consumption. It is simply not possible to stop suddenly, it is lengthy process.”
Prof AKM Zakir Hossain, vice-chancellor, KAU, reiterated the need for sensible policies, product safety standards, social and cultural awareness, and a progressive framework of government regulation for less harmful alternatives like vapes, oral nicotine and others to ensure the protection of public health.
