In the realm of cigarette alternatives, there’s a singular goal that unites scientists, doctors, and health officials: the desire to see fewer cigarette smokers. Yet, this shared aspiration is where consensus fades into a cloud of controversy.
Since their emergence in the 2000s, alternatives to cigarettes have ignited a heated schism among scientists, perplexed regulators, and the tobacco industry. This debate, at times caustic, has even fractured once-aligned colleagues, culminating in a perplexing paradox within countries deemed “tobacco control champions.”
Consider the divergent strategies: nations like Brazil and Panama have opted for an outright ban on e-cigarettes, while the likes of the U.K. and Canada have embraced a targeted harm reduction strategy recognizing smoke-free alternatives, such as vapes, e-cigarettes, heated tobacco products and nicotine pouches, are part of the solution for phasing out cigarettes. Amid this policy juxtaposition, a puzzling fact persists – all these countries are deciphering the same evidence.
Jamie Hartmann-Boyce, an associate professor at the University of Oxford specializing in evidence-based policy, suggests that the judgment of vaping’s merits hinges on individual contexts. For some, it’s an effective harm-reduction tool, outperforming traditional nicotine replacements. Her leadership in a comprehensive 2022 Cochrane review, which championed vaping’s efficacy for smoking cessation, underscores this perspective.[1]
However, as Hartmann-Boyce notes, vaping’s story is no linear tale. The vaping and e-cigarette landscape has transformed dramatically since Cochrane’s first investigations a decade ago. Today’s devices offer improved nicotine delivery systems, yielding better outcomes for smokers attempting to quit.
John Britton, a pioneering figure in shaping the U.K.’s vaping approach, laments a disconnect between evolving evidence and entrenched stances. Organizations and individuals, he argues, have at times clung to outdated paradigms, unwilling to adapt in the face of new insights.[2]
The World Health Organization, despite accusations of rigidity, contends that their approach extends beyond the individual smoker. Embracing a societal perspective, they argue they’re not disregarding science but are scrutinizing the bigger picture. However, as per their own estimates, there will still be a billion people who will continue to smoke in 2025[3] – is it not better then to provide them with less harmful alternatives?
As the debate on alternatives to cigarettes rages on, one truth emerges – the quest for a smoke-free world mandates a marriage of evolving science and adaptable policy. It implores decision-makers to transcend inflexibility, fostering a harmonious symphony between individual well-being and the broader health of society.
In this context, Pakistan stands at a crossroads. With a significant smoking population and growing health concerns, the nation has an opportunity to embrace the evolving science of harm reduction, like the UK and Canada.
Tailoring strategies that reflect Pakistan’s unique challenges and embracing alternatives like vaping, underpinned by evolving scientific knowledge, could potentially revolutionize the nation’s battle against smoking-related diseases. Just as the global debate calls for a nuanced approach, so too does Pakistan’s fight for a future without cigarettes.
[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/abstract
[2] https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-e-cigarettes-versus-nicotine-patches-for-smoking-cessation-in-pregnant-women-who-smoke/
[3] WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition
