Africa: Can Tobacco Harm Reduction Make its Way Through a Powerful and Complex Cultural, Political and Economic System?

The E-cigarette summit – science, regulation, and public health, took place on the 7th and 8th of December, 2021.

A growing number of scientific studies show that heated tobacco and electronic cigarettes among other innovative alternatives are potentially less harmful than traditional cigarettes.

Many consider these as low-risk alternatives to smoking that can prevent millions of premature deaths and cases of major disease.

Clive Bates is a strong advocate of Tobacco Harm Reduction (THR). After years in the public sector in United Kingdom and in the United Nations, he has founded and directed ‘Counterfactual’, a consulting and advocacy practice focused on a pragmatic approach to sustainability and public health. In a session titled: ‘The new tobacco wars’, he lamented what he called a « desperate search for harm », he developed his views on the current situation of THR and shared the main obstacles that prevent what he considers safer alternatives, from prospering internationally.

The biggest problem, according to him, is the abuse of the correlation between harm and those alternative products to cigarettes. He tackled a lack of transparency and professionalism while citing a study published in November 2020 in the ‘American Journal of Medicine Open’ which said that there was a correlation “between electronic cigarette use and fragility fractures among US adults”. However, the study itself recognized a few facts that Clive Bates considered as alarming and questionable flaws. They wrote, “the cross-sectional nature of our study design limits our ability to make causal inferences between e-cigarettes and fragility fractures”. They also stated that “for some individuals, e-cigarette use may have started after fracture occurrence and diagnosis”. Clive Bates qualified the report as absurd. He stated “the real danger was that none of that stopped them making a causal claim in a press release that came out before the paper. We see way too much of that negligence in my view.”

Clive Bates also mentioned the ‘communication war’ that has led to a misunderstanding and misconception of alternatives to tobacco. He said that 34% of the UK population believe that these alternatives are more or equally harmful compared to smoking.
To support his view, he then showed a flyer from an American organization named ‘DrugFreeNJ’. In their visual document they stated in the middle of the page: “Vaping is as safe as skydiving without a parachute.” The flyer also indicated a website where people could “learn the truth about vaping”. The UK expert could not hide his discontent:
“That is obviously wrong. Skydiving without a parachute causes instant and immediate and certain death. That is not what vaping does. But that is the normal form of blatant miscommunication here”.

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The media, as well, was presented as potentially misleading the public as he talked about an article published by The Brussels Times published on the 10th of November 2021, about THR products: “These products are falsely marketed as safer and more sustainable options to deadly cigarettes, misleading consumers, media, and international institutions”.

Clive Bates responded to this statement as follows: “What they are basically saying is that e-cigarettes and heated tobacco are no different than cigarettes. This is accepted by over 40 organizations and professors from all continents according to the authors themselves and it’s a big lie.”

Low-and Middle-Income Countries (LMICs) have the largest number of smokers in the world with 800 million according to the World Health Organization.

Many think that most opposition to vaping and more largely innovative alternatives, is based not on evidence but on “underlying ideological issues, moral positions, vested interests, political considerations and financial considerations to name just a few” as stated on the conference website.
Clive Bates tackled what he called “the lust of prohibition” in countries where means and infrastructure lack dramatically and where abstinence is considered by many as the most effective approach. He often cited the philanthropic organization Bloomberg Philanthropies which has financed a large number of reports which aim at decreasing the number of smokers notably, in LMICs. However, what is harmful for the UK expert, is that this rhetoric denies access to a better health to the majority of smokers who cannot or will not quit.

The main argument of the WHO and other organizations are that those alternatives do not protect youth and could, at some point, be even more dangerous. The youth is “weaponized” against anti-vaping campaigns according to Mr Bates: “if vaping is successful, it will undermine the relevance and prestige of groups who oppose it”, he added.

As a conclusion, Clive Bates stated two main reasons for this strong opposition:

– “Cultural inertia: a large number of people conceive of themselves as warriors against an evil (tobacco) industry. That is a very hard culture to shake off.”
– “Institutional inertia”: “a massive machine constructed to fight smoking consisted of research infrastructures, a whole international treaty, conferences and so on…and also regulators who are deeply involved, and philanthropists who put over a billion dollars into organizations…”
He then added: “You put them together and there you have a formidable complex that was dedicated to fighting smoking which now in my opinion, swivels its guns towards the new thing (alternatives to traditional cigarettes) in order to remain relevant”

Nevertheless, he remained optimistic. For him, the status quo can evolve thanks to technology just as now we have electric vehicles in the automobile industry, fossil fuels are changing to renewable energy, people listen to digital music, …:
“The interesting thing about these technological advances is that each time they are tried the user gets a benefit and therefore there is a rapid uptake and the technology that came before becomes naturally obsolete. I think this is what is going to happen with tobacco… and this is why I think we will prevail in the end”.

Artmotion S.Africa

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