Failure to introduce tobacco harm reduction harms public health

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POLICY experts said the failure to adopt tobacco use reduction (THR) strategies negatively impacts public health and disproportionately targets those in low- to middle-income countries, as eight million people die from tobacco use each year and 80 percent of the more than 1 billion tobacco smokers come from developing countries.

THR is recognized as an international best practice for Asian countries aiming to reduce smoking rates, according to researchers and experts who discussed the benefits of THR as a public health strategy during the recent Property Rights Alliance (PRA) policy webinar, in which the white also the paper “International Best Practices for Tobacco and Nicotine Public Policy” was presented.

The PRA is an international research and advocacy organization founded in 2005 to promote innovation, free-market intellectual property rights and free trade. Prof. Adam Hoffer and Dr. Carmelo Ferlito’s white paper examined tobacco nicotine policies in Asia, with a focus on Indonesia, Malaysia, the Philippines, South Korea and Japan, to illustrate that following international best practices on tobacco will lead to harm reduction and smoking cessation.

Less harmful alternatives

THR refers to a public health strategy that aims to mitigate the harm caused by a product like a cigarette by using less harmful alternatives like smoke-free vapor products and heated tobacco products (HTPs).

In 2020, the local Philip Morris International PMFTC Inc. subsidiary in the National Capital Region made the IQOS HTP device and its tobacco-filled consumable sticks wrapped in a paper called HEETS. Recently, its e-commerce website IQOS.com expanded delivery coverage in northern and central Luzon, including Baguio City and La Trinidad; Calumpit, bulacan; Town of Cabanatuan, Santa Rosa, Aliaga, Jaen, Peñaranda, Palayan, Zaragoza in Nueva Ecija; and San Fernando City, Bacolor, Santa Rita, Guagua, Apalit, Mexico, Santo Tomas, Santa Ana, Arayat, Floridablanca, Minalin and Clark Freeport Zone in Pampanga.

A keynote speaker, Dato ‘Sri Idris Jala, a former Malaysian official and one of Asia’s leading innovation processing experts, said THR is offering Asian countries an opportunity to reduce smoking rates.

He said countries like Malaysia are unlikely to meet their smoking reduction targets with current restrictions and tax policies. On the other hand, the use of electronic nicotine delivery systems or vapes and HTPs had promising results – 60 to 70 percent of smokers who tried them eventually quit.

“There is a lot of research that has shown that when you burn a particular cigarette, about 10,000 harmful chemicals are released, but when you use a heated tobacco product, 90 percent of those harmful chemicals are eliminated. Research shows that you are looking for less harmful alternatives can. So we need to look very carefully into a less harmful strategy and approach for the future, “he said.

Reduce smoking rates

He said while other countries continue to take the idealistic or black and white approach, others have been more successful in reducing smoking rates through the pragmatic approach.

“These countries just take the approach that if you don’t smoke, don’t start. If you smoke, quit. But if you can’t stop, switch to a less harmful alternative product. This is called a pragmatic approach, ”he said.

“So you can see clearly that if you take a less damaging, more pragmatic approach, you will be far more successful,” Jala said.

“The harm reduction strategy is a very good example of how to reduce tobacco prevalence. Second, we need differentiated rules for the less harmful alternatives to smoking, known as non-flammable nicotine products, I am convinced that we will follow the path of Japan, New Zealand and the UK too, “he said, referring to countries that use less more harmful alternatives to flammable cigarettes.

The White Paper cites international tobacco policy best practices, including three principles: 1) Change should be encouraged through rewards, not restrictions like tariffs and taxes; 2) Policy should focus on reducing the consumption of harmful, flammable products such as cigars and cigarettes rather than less harmful products such as heated tobacco and electronic cigarettes; and 3) Tobacco reduction efforts should encourage innovation to create safer and better products than before and increase consumer choice.

A restrictive policy has had catastrophic consequences, as can be seen in Indonesia, the second largest global cigarette market. When the Ministry of Finance set a maximum excise tax rate of 57 percent on e-cigarettes, this led to increased consumption of cigarettes among young people.

“Illegal trade”

The paper concludes that tobacco taxes disproportionately affect those with a lower socio-economic status and that taxes increase black market activity. In Malaysia, for example, black market sales of tobacco products rose from 24 percent in 2008 to 65 percent in 2019, making the country the world’s largest black market for tobacco in terms of proliferation.

“The illegal trade in cigarettes is dangerous as these products are likely to be of poor quality and could harm or even kill consumers. The sale of illegal and counterfeit products also benefits criminal syndicate groups, ”it says.

Meanwhile, the Philippines have introduced different excise duties between tobacco products and e-cigarettes. Taxes on 20s cigarettes will increase by 5 pesos each year through 2023, while tax on heated tobacco will only increase by 2.50 pesos per year.

“This policy is in line with the harm reduction framework,” the paper says.

The paper recognizes Japan as a leader in ex-smokers switching to tobacco alternatives, with 25 percent of the national market doing so. This rate is attributed to the different excise duties between cigarettes and heated tobacco products.

In South Korea, e-cigarette use is declining as the government treats electronic cigarettes like traditional cigarettes. The consumption of e-cigarettes fell from 4.7 percent in 2011 to 4 percent in 2015, which can be attributed to the high taxation of abstinence aids.

“Other countries in East Asia and ASEAN have not adhered to the international best practice approach. E-cigarettes and heated tobacco products are either banned or unregulated, ”the newspaper said.


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