Tobacco Harm Reduction (THR) can play a transformative role in public health, particularly in countries like Bangladesh, where smoking prevalence is high. Bangladesh has an enormous number of smokers, many of whom are transitioning to Alternative Nicotine Products (ANPs) such as e-cigarettes, vapes, and other heat-not-burn products. These products are considered safer on the risk spectrum, with toxicological evidence indicating they are less harmful than traditional cigarettes.
However, for THR to be effective, comprehensive regulations are essential. These regulations should monitor and set minimum standards for e-liquids and e-cigarette pods sold in the country. Without such regulations, the country risks being plagued by bootleggers and illegal vape products, which may be adulterated with illicit substances. Curtailing free consumerism among youth is also critical to prevent nicotine addiction and potential health risks associated with unregulated products.
When used responsibly, these products can be a safer option for smokers, especially those who have not succeeded with Nicotine Replacement Therapy (NRT) or have little to no intention to quit smoking. Proper access to these products, combined with regulatory oversight, ensures that smokers can transition to less harmful alternatives without the associated risks of illegal products.
Integrating THR in Bangladesh can significantly uplift public health by reducing the prevalence of smoking-related diseases and deaths. By providing safer alternatives and enforcing strict regulations, Bangladesh can promote a healthier population while addressing the challenges posed by traditional tobacco use.
However, implementing effective THR strategies in socio-economically diverse populations presents several challenges. Many existing smokers belong to socially or economically disadvantaged groups with lower disposable incomes, which limits their ability to purchase safer, regulated products. This financial constraint often leads them to resort to illegal cigarettes or low-quality vapes, exacerbating their health risks. Additionally, these populations often face barriers in accessing NRT due to cost and availability, making it harder for them to quit smoking.
To address these challenges and ensure equitable health outcomes, it is crucial to make safer alternatives more affordable and accessible. This could include subsidizing and regulating THR products, ensuring widespread availability, and providing targeted education on the benefits of harm reduction.
Responsible vaping can decrease exposure to harmful compounds, thus offering a viable harm reduction option. By prioritizing affordability, accessibility, and education, THR strategies can help reduce health inequalities and improve outcomes for disadvantaged populations. Appropriate risk proportionate excise tax can be imposed on e liquids and become a viable income and substitute to tobacco tax for the nation.
But policymakers must consider several key factors during formulating and implementing policies for Alternative Nicotine Products (ANPs) to effectively balance the health benefits these products offer against their potential risks.
Government regulations are paramount, requiring the establishment of a dedicated body to oversee the quality of inbound e-liquids, ensure proper labelling, and manage the registration of sales and vendors. This regulatory framework is crucial for maintaining product safety and transparency.
Another critical factor is deterring youth smoking and vaping. Alternative Nicotine Products (ANPs), such as e-cigarettes, are intended for established smokers seeking to quit smoking or reduce harm. It is essential to communicate that these products are not for individuals who have never used nicotine, particularly adolescents. Enforcing age restrictions and preventing the initiation of vaping or smoking among youth is a significant public health goal. Governments must also address the illegal use of tobacco and vaping products within their populations.
Adhering to World Health Organization Framework Convention on Tobacco Control guidelines is another essential consideration. This includes measures like point-of-sale deterrence, plain packaging, and regulating the types and flavours of vape pods to minimise their appeal, similar to regulations for combustible tobacco products. Implementing a risk-proportionate tax system is also crucial; products that pose less harm should be more affordable and accessible compared to traditional combustible tobacco. This economic strategy encourages smokers to switch to less harmful alternatives.
Lastly, training healthcare providers is vital. Medical professionals should be equipped with the knowledge to assist smokers who have not succeeded with nicotine replacement therapy and might benefit from Alternative Nicotine Products (ANPs). This includes understanding appropriate dosages, nicotine concentrations, and usage recommendations to support patients in their smoking cessation journey effectively.
By addressing these factors, policymakers can create a balanced approach that maximises the health benefits of Alternative Nicotine Products (ANPs) while minimising their risks, ultimately fostering a healthier population.
Writer: President, Malaysian Society for Harm
Reduction (MSHR)
