Commentary

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Previous to the COVID pandemic, CAPHRA had been making plans to rent a room at a nearby hotel to the FCTC COP9 meeting and then have THR consumers, and any experts who were available for press calls, meetings and question and answer sessions. This was to be our response for being shut out, once again, from the proceedings yet being available to the media, who inevitably, would also be shut out. 

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Within the U.S. public health community, the American Journal of Public Health (AJPH), published by the American Public Health Association, is a leadership bellwether. On August 19 2021 the AJPH published online an important article that may indicate a shift in the current tobacco war. Balancing Consideration of the Risks and Benefits of E-Cigarettes (https://ajph.aphapublications.org/doi/10.2105/AJPH.2021.306416) was also presented as a paper at the May 2021 E-Cigarette Summit: Science, Regulation and Public Health.

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Annoyance was building in me as I watched my daughter’s weekend netball game. The Centre was everywhere at once, yelling for the ball to be passed to her. Her teammates would turn to throw, then stop, confused – why call for the ball when you’re not clear? Luckily, they assessed that a pass to their Centre would be a pass to the other team.  Just before earning a penalty for holding the ball too long they find someone else to pass to and the game moves on. It was a short distraction but repeated too often and it can cost more than a few goals. 

Clearly, I’m working too much if even a netball game presents a metaphor for what’s happening in tobacco control!

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Def. Sea change or sea-change is an English idiomatic expression which denotes a substantial change in perspective, especially one which affects a group or society at large, on a particular issue.

Some time ago I wrote an opinion piece titled: Dirty Words: Smoker, Vaper, Harm Reductionist? In the article I expressed my frustration that in government and NGO leadership circles publicly embracing harm reduction policy in the U.S. was still politically dangerous. Unfortunately, demonization of smokers, vapers or clean needle exchange programs is more likely to resonate with the public than nuanced discussions of proportional risk or the benefits of tobacco harm reduction strategies.

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A new Australian Parliamentary Inquiry into Tobacco Harm Reduction has been established to review the future of vaping nicotine in Australia. International and Australian vaping supporters are invited to make submissions which are due by 5 November 2020. The Inquiry is critical for reversing the increasing restrictions on vaping being imposed by the federal Health Minister, Greg Hunt. In stark opposition to the rest of the western world, access to liquid in Australia is being reduced even further.

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I confess to having always enjoyed party conference season. This is an annual ritual where the main UK political parties gather at a major city with the aim being to enthuse their membership and map out a vision attractive to the voting public.  When I was a Civil Servant, they often provided a useful insight into the direction of future policy.  Away from the main platform you could, on occasion, discover events where politicians would stray from their doctrinaire trenches and engage in meaningful debate. 

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Australia’s 300,000 vapers were shocked, angry and frightened last week when the Health Minister announced a ban on importing nicotine liquid into Australia with two weeks’ notice and a penalty of AUD$220,000 per offence.

Vapers who had struggled to quit smoking for years and finally found a safer alternative faced the repulsive choice of going back to smoking or purchasing nicotine on the blackmarket. Chat groups were flooded with distressed vapers and panic buying was unprecedented. Retail shops were expected to close.

This was a potential disaster for public health. I saw 15 vapers the next day. Thirteen said they would revert to smoking if they could not get nicotine. Some would try to quit and the rest would seek nicotine on the blackmarket.

Australia has long been the only western democracy to ban the sale and use of nicotine for vaping. Importation for personal use has been allowed if the user has a doctor’s prescription. However, prescriptions are very hard to get and vapers have been illegally, but safely, importing personal supplies for years.

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Covid-19 has surely been challenging for all, and though we have now hopefully crossed the peak, we will be seeing its implications for many months or even years to come. We are already seeing the negative impact of the lockdown and economic uncertainty on society’s mental health. Stress and boredom are known triggers for increased smoking and this is likely to predispose people to more addictive behaviours such as smoking and drinking alcohol. In these unprecedented times, we need to pre-emptively support smokers stay away from smoking more, and ex-smokers from relapsing back to smoking.

Despite the UK being at the forefront of global tobacco harm reduction policies, the gap between policy and practice remains massive, from even before the Covid-19 pandemic. Though UK’s national guidelines support long term use of safer nicotine to help people stay away from smoking, clinicians hesitate to recommend the use of stop smoking aids like dual NRT therapy or e-cigarettes for tobacco harm reduction.  In times when media stories often don’t give the real picture of safety of these stop smoking aids, people usually rely on influencers like their doctors to give a final verdict on the safety of a product. Multiple surveys have shown that significant number of health care professionals are still confused about the role of nicotine and tobacco harm reduction in smoking cessation. If healthcare professionals are confused then that translates into creating a doubt in smokers’ minds. This in turn can result in smokers not trying a quitting tool like e-cigarette, and vapers constantly being at a risk of relapsing back to smoking, especially in stressful times like the Covid-19 pandemic.

As a practising GP and a firm believer in preventive medicine, I have been involved in upskilling GPs and other clinicians on smoking cessation around the world. I have seen that when accurate information reaches them in a practice-friendly way from another clinician, they are very receptive and supportive of helping their patients quit smoking and manage cravings using the harm reduction principle.

In these times of global emergency, I know how busy the healthcare professionals are. Hence, I and my team at the Centre for Health Research and Education (CHRE, www.chre-uk.com) have been working overtime to empower clinicians by creating easy-to-use infographics and starting telephonic smokefree advice lines for mental health staff. The infographics were recently published by the Royal Society for Public Health on their website for wider dissemination and are already very well received by clinicians across the UK.

https://www.rsph.org.uk/about-us/news/covid-19-and-smoking-act-now-to-prevent-a-health-calamity-from-happening.html

We continue our work in this, mindful that whether a harm reduction tool is a prescription medication or not, if health care professionals are not empowered with the scientific evidence, there will always be a risk of a country’s policy not translating into practice.  Smoking will continue to take its toll globally unless this is addressed. As healthcare systems and professionals continue to buckle under the pressure of Covid-19, lets ensure that going smokefree does not get forgotten!

Dr Pooja Patwardhan
GP, and Clinical director
Centre for Health Research and Education
www.CHRE-uk.com

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Over half a billion smokers live in Asia, and Asian countries have some of the highest per capita smoking rates – and some of the highest numbers of smoking-related deaths – in the world.

Given the staggering damage to its citizens’ health that smoking is responsible for you’d think that regional governments would be eagerly embracing any less harmful alternatives such as vapes and heat-not-burn (HNB) devices to encourage people to wean themselves off conventional tobacco products.

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Last week was hot in Seoul. Not just with the outdoor temperatures exceeding 30oC, but also with clear voices of over 100 experts from 18 countries gathered at the 3rd Asia Harm Reduction Forum (AHRF), calling to use the opportunity we have to save 20,000 people dying each day from smoking.