Opinion: Policy Consistency Key To Curb Tobacco Consumption - by Shantanu Guha Ray

India's health authorities have issued an advisory to halt all research related to e-cigarettes. This development coincides with the upcoming Conference of the Parties (COP 10) to the WHO Framework Convention on Tobacco Control (FCTC) scheduled for this year.

The decision by the health ministry has raised eyebrows, primarily because it goes against the standard practice of encouraging research to get new insights. Research serves as the cornerstone of any product's evolution.

However, Health Ministry officials seem to be deviating from this norm. E-cigarettes are officially banned in India, but they remain widely available on various e-platforms. This ban has drawn criticism, as these products seem to have been effective in reducing smoking rates in other countries.

If further research unveils promising findings, it could benefit individuals opting for e-cigarettes or other tobacco consumption alternatives, as seen in Sweden.

Around the time when the Indian government issued the ban directives, Kolkata-based ITC, deriving approximately 75% of its EBIT from cigarettes, announced the identification of a potential $500 million market in the tobacco business by exporting high-end nicotine and derivative products to Asian markets, as reported by The Economic Times. The daily further stated that ITC maintains a 75% volume share in India's cigarette industry and quoted analysts affirming that a substantial portion of ITC's profits stems from its cigarette business, which has room for growth through gains in market share.

What is particularly noteworthy is that this potential market pertains to vapes and e-cigarettes. The government holds nearly 8% stake in ITC.

In the light these developments, it is crucial to assess India's progress in tobacco control and shed light on the strategy and supporting evidence for tobacco harm reduction. The COP serves as the governing body of the FCTC, and COP meetings provide a platform for sharing best practices, adopting new guidelines, and addressing challenges in tobacco control.

India is home to one of the world's largest populations of tobacco users, with roughly one in three adults using some form of tobacco, whether through smoking beedis or chewing. India's history with tobacco is deeply ingrained in its culture and economics, making it a significant producer and consumer for centuries. This widespread use raises substantial concerns for public health, primarily due to its association with cancer, cardiovascular diseases, and respiratory illnesses. Over one million adults in India succumb to tobacco-related illnesses annually, accounting for 9.5% of all deaths.

New Delhi has implemented measures to curb tobacco consumption, including graphic warnings on packaging, advertising bans, and high taxes on tobacco products. However, these efforts have not yielded the desired results, and the battle against tobacco continues.

India is currently undergoing an epidemiological transition, as indicated by the Global Burden of Disease (GBD) study, which reports a significant increase in non-communicable diseases (NCDs). WHO estimates reveal that nearly half of India's tobacco-related deaths are linked to cardiovascular diseases, with 16% of all cardiovascular disease deaths attributed to tobacco. Notably, individuals aged 30 to 44 years face a higher risk of tobacco-related cardiovascular diseases. India carries a substantial burden when it comes to oral cancer, accounting for a third of global cases, ranking sixth in prevalence worldwide.

Tobacco is estimated to be the primary cause of 40% of all cancers in India. Research has established that factors like chewing betel nut quid, smoking, and using smokeless tobacco products increase cancer incidence. Nicotine, an addictive chemical found in tobacco, is the primary driver for smoking or chewing tobacco. However, while nicotine itself is not carcinogenic, tobacco products contain numerous other carcinogens and toxicants.

WHO estimates that India ranks second globally in tobacco consumption, with an estimated 266.8 million Indian adults aged 15 and above using tobacco, including smokeless products like khaini, gutka, zarda, as well as beedis and cigarettes. More concerning statistics reveal that tobacco use has reduced women's life expectancy by 11 years and men's by 12 years in India.

Combustible cigarettes pose even greater harm due to the toxins released when tobacco is burned. Approximately 4% of Indians smoke combustible cigarettes, with beedis being the most popular choice, producing five times more tar compared to manufactured combustible cigarettes.

It is evident to many that India needs to take a more assertive stance in regulating tobacco products, given the modest results achieved through traditional control measures.

India's regulatory approach to various aspects of tobacco and nicotine products reveals certain shortcomings, primarily arising from a failure to fully understand the distinctions among various products in the market, leading to the sweeping ban.

A wide range of definitions exists for novel, non-conventional, non-traditional tobacco products. Most regulators and health organizations make a clear distinction within the broad category of novel tobacco and nicotine products. Electronic Nicotine Delivery Systems (ENDS) encompass a variety of products, including vapes, e-hookahs, electronic cigarettes, and e-pipes. Electronic cigarettes, the most common prototype, do not burn or use tobacco leaves but vaporize a solution for inhalation by the user.

In the preamble of COP8 in 2022, parties to the WHO FCTC recognized that "heated tobacco products are tobacco products and are therefore subject to the provisions of the WHO FCTC." Finance Bill of 2021 acknowledged the classification of novel tobacco and nicotine products as outlined by the World Customs Organization Council, differentiating between traditional cigarettes, e-cigarettes, and HTPs for taxation purposes. However, this distinction has not been applied in the context of the ban on e-cigarettes.

To effectively reduce the prevailing morbidity and mortality associated with tobacco use within the population, the optimal approach is complete tobacco abstinence. For individuals already addicted to nicotine, who smoke or use smokeless tobacco to satisfy their cravings, it is imperative to provide counseling, information, and support to facilitate tobacco cessation. Policy consistency is key to achieve that.

(Shantanu Guha Ray is the Asia Editor of Central European News, UK. His book on coal, Black Harvest, will hit the stands soon)

Disclaimer: These are the personal opinions of the author.