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World No Tobacco Day: Here's why WHO’s approach to tobacco cessation needs an overhaul

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Tobacco harm reduction is an approach to mitigate the health risks of tobacco for even those who are unable to completely quit, by helping them to transition to less harmful methods of getting nicotine with an eventual goal of tobacco cessation.

World No Tobacco Day: Here's why WHO’s approach to tobacco cessation needs an overhaul
The first World No Tobacco Day (WNTD) was held 34 years ago in 1988 and over three decades, little has changed in terms of mindsets or strategy at the World Health Organization (WHO).
Certain shibboleths define the WHO’s approach: the certainty that quitting tobacco is a ‘choice’ every smoker can make, a deeply held conviction that they alone are the arbiters of tobacco cessation, a childlike belief that addiction can be abruptly reversed by sloganeering, larger pictorial warnings, punitive taxation, and above all, positive thinking.
Even though decades of this core strategy has yielded little to justify more of the same—the number of smokers has remained over a billion since 2000—and yet, the WHO has decided to stick with the formula this year as well.
This year’s theme, Commit to Quit, complete with a slick “tool-kit” of information: counselling, nicotine replacement, mobile apps, hotlines and text message support hopes to achieve what the previous 33 WNTDs could not.
This strategy, while commendable, ignores the reality of nicotine addiction, which is that even though almost 70 percent of smokers wish to quit, only 7 percent manage to. This single piece of information should be alarming all by itself to those who see smoking as simply a choice, or view smokers who cannot quit as being less committed to quit.
Further, despite the hard truth that it may take most smokers more than 30 attempts to quit smoking, and the likelihood of quitting decreases with each attempt, WHO’s ‘quit or die’ approach to cessation continues to ignore the fate of the large majority of smokers who cannot wean off, who are then erased from the discussion.
Harm reduction is not an alien concept to the WHO and it has been successfully used in battling HIV/AIDS, drug addiction etc. But there is continued resistance to tobacco harm reduction as a viable strategy in addressing or mitigating tobacco damage to the 90 percent of smokers who want to quit but cannot. In the face of mounting evidence to the contrary, the WHO continues to vilify electronic cigarettes and vaping as ineffective tobacco cessation strategies, even going so far as to broadcast disproven hypotheses like the ‘gateway to smoking’ theory, overblown concerns about second-hand vaping and equating vaping with Vitamin E Acetate-linked lung injuries.
Tobacco harm reduction is an approach to mitigate the health risks of tobacco for even those who are unable to completely quit, by helping them to transition to less harmful methods of getting nicotine with an eventual goal of tobacco cessation.
Yet, the information page on e-cigarettes by the WHO refuses to give a clear answer on which is more dangerous—smoking or vaping, despite clear evidence-based stands taken by respected bodies like Public Health England and The Royal College of Physicians that vaping is 95 percent safer than smoking tobacco.
The WHO has also subscribed to the view that nicotine, while addictive, is also a very dangerous substance, yet the fact that this casts doubts on their own nicotine replacement stratagem seems to have been overlooked.
The past year and a half have been very damaging to the world and particularly to the WHO—the need for pragmatism, for evidence-based leadership and a change of strategy has never been more evident.
This is also a time for inclusion. A time to end the apartheid faced by nicotine-dependent people. The world does not consist solely of non-smokers or those who have quit smoking. The World Health Organization should remember that they have a duty, an obligation to also serve the disenfranchised 90 percent of tobacco users who do not manage to quit.
They are the WHO. They must do better.
—The author, Dr. Kiran Melkote is an orthopedic surgeon based in New Delhi and a member of AHRER, a body of medical professionals focused on harm reduction as public health strategies. The views expressed are personal
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