India must realise relative harm reduction is a worthwhile goal to pursue, and it must be done at all costs

Next month, it will be three years to India’s knee-jerk and myopic ban on vaping that continues to remain ineffective, anti-people and, actually, does more harm than good. For a billion-plus nation like India, the Ministry of Health and Family Welfare should have found ways to minimize this human and economic loss by lowering risks from tobacco use.

The mandarins in the ministry’s corridors of power should have realised that the ban is useless, and its reversal is an urgent necessity. It can and should never be considered an indulgence. India, in fact, must consider humane, risk-proportionate regulations, while incorporating safeguards to prevent uptake. But it has not happened for the last three years despite the world taking the right kind of steps.

India, sadly, has not changed, not budged. So what is happening? The figures are not encouraging at all. Indians bear an enormous tobacco burden. Worse, nearly a third of the population is dependent on some form of tobacco. This, in turn, leads to nearly 14 lakh deaths, almost the total population of Ranchi or Jabalpur. And then, the World Health Organization (WHO) says the whopping loss of $27.5 billion annually is due to diseases related to tobacco use for persons aged 35 and above.

There are countless laws that the Ministry of Health has initiated to prevent or dissuade people from smoking. But the most controversial one is the irrational decision it took on the vaping industry.

So, there is a growing need for India to understand where it is going wrong despite some solid, established and growing scientific evidence across the world that says vaping is significantly less harmful than smoking, in essence, because it eliminates combustion, the primary driver of the harmful impact on the health conditions.

Vaping involves using a device that vaporizes a nicotine-containing liquid that the user inhales. Now, it is not without a risk, the evidence for vaping does not say that. It merely says cigarette smokers who switch would suffer from far fewer negative effects and live relatively longer, healthier lives.

This is a very vital, scientific evidence India continues to ignore at its own risk and prefers to remain in this clutter of misinformation. Consider the landmark review by the Society for Research on Nicotine and Tobacco (SRNT), the world’s leading body on tobacco research, which has categorically said vaping is a less harmful alternative to smoking, and also an effective cessation tool. The review, which followed a comprehensive analysis of the scientific data available across the world, had the buy-ins of 15 past presidents of SRNT, who all are eminent scientists. You cannot brush them away, saying that they know nothing of the subject. The review said that encouraging current smokers to switch should be part of any sensible mix of policies adopted to control tobacco prevalence across the world.

The real advantage of vaping, as clinical trials across the world show, is that it encourages smoking cessation at almost twice the rates over traditional nicotine replacement therapies such as gums and patches. This is not all. Vaping - across the globe - has also been linked to a decline in the sale of combustible cigarettes. In short, it means it is effective as a smoking cessation tool.

In countries such as the UK, vaping is advised to smokers. The National Health Service (NHS) in the UK has said in clear terms that most smokers are misinformed about the lower risks of vaping compared to smoking.

Hence, India must follow what is considered scientifically sound public health communication. But here, the big tobacco debate in India gets lost between effective communication and ineffective non-communication. So let’s write the rules here once again. If you are a non-smoker, avoid any nicotine-containing product. It is as simple as it can get. And if you are trying to quit smoking, but struggling to give up on nicotine use, you can easily reduce harm by switching to the least harmful options available such as vaping, snus or heated tobacco.

Hence, the need of the hour is to decouple combustible tobacco from nicotine that does not cause cancer contrary to prevailing myth. India, like other nations, must go beyond framing tobacco use as a moral problem. It needs to understand it and study it within the framework of dependence.

The big tobacco debate in India needs a dispassionate, scientific approach. The bureaucrats must understand it. India is still not understanding. The world’s second-most populous nation has adopted a top-down intervention that pushes behavioral change though regulations.

It is not working; it will not work. And actually, it will end up doing more harm, ostensibly because people would try their best as people try to circumvent the ban by adopting even more risky behaviors such as buying cheaper products or goods sold in black-market.

Bureaucrats of the Health Ministry must understand that the need of the hour is to put smokers at the center of policy making. India enacted the ban without interacting with the stakeholders. The interactions should have happened, only then the vaping industry could have told bureaucrats of the Health Ministry what they are doing to help smokers make safer choices.

India must initiate its own studies, especially into vaping e-liquids to ascertain possible harms and to guide policy making, and support the framing of standards that, sadly, do not exist for Indian smokeless tobacco.

So what is the argument here? It is that the mere presence of elements cannot be an indicator of harm. After all, everyday goods, including medicines, also contain many toxic compounds but under the prescribed threshold. And then, is India aware of a study that found toxic exposure from vaping comparable to environmental air, and poses significantly lower passive risk. Well, second-hand smoking kills 800,000 people every year. And then, vaping technology is improving rapidly and would become more safe in future, preventing and even reversing harm from smoking.

But the debate on nicotine and toxicity remains high in India. No one knows why in India, medical professionals are ill-informed of nicotine despite its global impact. Physicians - studies have proved across the world - have mistakenly believed nicotine leads to cancer and heart and respiratory diseases.

So let’s be clear here. Nicotine is not a carcinogen, though it can be said to be a habit forming exercise. So India needs to decouple nicotine from smoking, as both pose significantly different levels of risk. Nicotine is also part of pharmaceutical cessation therapies which the WHO wants to include in the list of essential medicines and has also approved of their long-term use.

India must realise relative harm reduction is a worthwhile goal to pursue. And it must be done at all costs. Why? Global evidence suggests e-cigarette use can increase the odds of quitting smoking and that vaping has the potential to reduce adult smoking-attributable mortality.

This means this can be a huge difference between longer life and near-certain death for millions of Indian smokers.

(The author is a senior journalist)