Countries realising benefits of safer alternatives, Is India missing a public health opportunity?

e-cigarettes

 

Mumbai: Today, India has the second largest tobacco population in the world. Over the last three decades, the Indian government has been instrumental in implementing tobacco control policies regulating tobacco products. Unfortunately, laws so far have failed to create a comprehensive approach to tobacco control positively skewed towards combustible tobacco products resulting in big health and economic crisis.

In 2014, India ratified the WHO Framework Convention on Tobacco Control which mandates countries to promote measures of tobacco control based on current and relevant scientific, technical, and economic considerations. However, this has often not been followed in India.

Despite this, Indian policymaking has been ineffective in addressing this menace of encouraging combustible cigarettes with unequal implementation and enforcement at state and district levels. Instead of providing adult smokers access to safer harm reduction alternatives, the Indian Council of Medical Research report encouraged the Indian Government to ban e-cigarettes and other electronic nicotine delivery systems.

In sharp contrast, global economies have been embracing safer alternatives and reaping the benefits by complementing them in tobacco policies. Recently, Chaiwut Thanakamanusorn, Digital Economy and Society (DES) Minister, Thailand announced his plans to legalise e-cigarettes to help adult smokers quit real cigarettes.

Legalised in 67 countries, vaping was been banned in Thailand since 2014 with sellers and makers subject to hefty penalties — between 5-10 years in jail and fines ranging from 500,000 baht to 1 million baht. However, the country is now exploring a policy change in the interest of public health backed by scientific studies substantiated by reliable and quality data.

The minister has reportedly said Thailand will also consider producing e-cigarette products and exporting them, giving impetus to the Tobacco Authority of Thailand and tobacco growers.

Despite the ban on e-cigarettes, in reality, the sale of e-cigarettes continued with people vaping through the seller engaging in illicit trade. Amidst this, the big question is why the authority permitted real cigarettes to be sold, not to mention that the Tobacco Authority of Thailand (TAT) is a state-owned body. Yet, e-cigarettes are treated as illegal contraband?

There is an urgent need to re-examine its public policy on smoking. The government should open debate on legalising e-cigarettes. The discussion must look at various dimensions such as health impact, freedom of choice, the issue of the black market, and whether the crime of vaping warrants such hefty penalties.

The issue of e-cigarettes underlines the self-contradictory public policy on cigarette smoking. Largely, public policies adopted by countries are driven by two goals that contradict each other. On one hand, it is a financial interest and on the other, a health issue. Thailand’s policy has tried to pursue both and ended up failing on both issues.

Policymakers agree that cigarettes are a major threat to people’s health. A survey in 2017, showed 72,656 people in Thailand died from illnesses caused by smoking that year. Meanwhile, the Public Health Ministry spends 77 billion baht annually to treat smoking-induced disease and illness. The health advocate camp has campaigned for the Thailand government to hike the cigarette tax to a level that buyers — especially those on low incomes — can no longer afford cigarettes. Many countries — the US and EU countries — have imposed hefty tax rates on cigarettes to deter consumption, especially for young and low-income consumers. On the other hand, the Thai government has made money making and selling tobacco and cigarettes looking at cigarettes and tobacco as a source of tax revenue.

There is an urgent need for government to treat consumers and all players in this industry with maturity and science as a cornerstone for policies. It is incontestable that cigarettes and e-cigarettes are bad for people’s health. But a mature government must let people decide. All policy-makers must do is create fair and effective mechanisms to direct consumers’ behaviour.

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