Dr Altamash Mahmood, a Bangladeshi public health expert, was one of the authors of the recent "Lives Saved" report, which studied the potential impact of adopting Tobacco Harm Reduction (THR) strategies in four low and middle-income countries (LMICs), including Bangladesh.
Written by international and local experts, the report projects that over the next four decades, more than 900,000 lives could be saved in Bangladesh alone through the adaptation of THR policies.
The study also included Kazakhstan, Pakistan, and South Africa, predicting that over 2.5 million lives could be saved across these countries. The report highlights the significant benefits of integrating THR into tobacco control strategies, with contributions from experts worldwide and each surveyed country.
In our discussion, Dr Mahmood delves into the findings, challenges, and potential benefits of implementing THR in Bangladesh.
How did you come to work on the 'Lives Saved' report? What sparked your interest in Tobacco Harm Reduction?
I was asked to co-author the "Lives Saved" report by the organisers of the study. As a public health specialist, I see THR as crucial in reducing health hazards, and smoking-related illnesses, and ultimately saving lives.
THR promotes using less harmful substitutes like nicotine replacement therapies, e-cigarettes, and smokeless tobacco products, aiming to lower exposure to harmful chemicals and reduce diseases such as lung cancer and heart disease.
Could you elaborate on the specific findings related to the adoption of tobacco harm reduction (THR) strategies in Bangladesh? How does the study project the potential impact on smokers' lives over the next few decades?
Despite Bangladesh's efforts following the 2004 Framework Convention on Tobacco Control, progress has been slow, and the country is unlikely to meet its tobacco-free goal by 2040. In 2022, an estimated 40 million Bangladeshi adults used tobacco.
The "Lives Saved" report by international and local experts, of which I was a part, highlights that current global tobacco control approaches haven't curbed the death toll, with WHO estimating 8.5 million annual tobacco-related deaths, potentially rising to 10 million.
In Bangladesh, adopting THR strategies could prevent 920,000 premature deaths over the next four decades. Addressing the needs of middle-aged smokers now could significantly reduce premature tobacco deaths by 2060.
Can you shed light on the challenges that Bangladesh might face in implementing a comprehensive THR plan into its regulatory framework, considering the current absence of a tobacco harm reduction policy in the country?
Bangladesh faces several challenges in implementing a THR plan. These include developing and enforcing safety and quality standards for THR products, combating misinformation, managing conflicts of interest with the tobacco industry, and balancing promotion to adult smokers while preventing youth uptake.
The evolving science of THR products complicates evidence-based regulation, and funding independent research can be difficult. Integration with broader tobacco control strategies and alignment with international guidelines are also challenging but crucial for effective implementation.
The report points to successful examples of reduced-risk alternatives in countries like Sweden, the UK, Japan, Lithuania, and the USA. How applicable are these international success stories to the unique challenges and circumstances faced by Bangladesh in the realm of tobacco harm reduction?
Implementing THR strategies in low- and middle-income countries like Bangladesh poses unique challenges. However, adapting international success stories through tailored approaches can be effective.
Developing a comprehensive regulatory framework with stakeholder engagement, public perception management, affordable access, and integration with existing tobacco control measures is essential. International collaboration can provide valuable insights and best practices for Bangladesh to follow.
We know India banned e-cigarettes instead of adopting regulations for them. Has the policy been effective in curbing vaping? Or has it simply resulted in a rise in the illegal market with users buying illegal products?
Bans on vaping often lead to an illegal market. In India, despite the 2019 ban under the Prohibition of Electronic Cigarettes Act, vaping products remain available online and through local vendors.
This suggests that demand persists and shifts to unregulated sources, complicating enforcement and potentially increasing health risks associated with unregulated products.
The proposed draft amendment to the "Smoking and Tobacco Products Usage (Control) (Amendment) Act" in Bangladesh faced criticism for its harsh provisions and lack of stakeholder consultation. In your opinion, how crucial is it for policymakers to engage with experts and the community when formulating tobacco control policies, especially those related to harm reduction?
Engaging with experts and the community is vital for formulating effective tobacco control policies. Experts provide evidence-based insights, while community engagement ensures policies are culturally appropriate and socially acceptable. This collaboration can identify implementation barriers and ensure policies are practical and widely supported.
The number of lives saved through expanding access to THR is substantial and likely dwarfs almost any other single health intervention governments can implement. Significant additional premature deaths will be prevented if a wider range of interventions are implemented.
Engaging stakeholders can highlight practical considerations and unintended consequences that might not be evident from a purely theoretical perspective, leading to better health outcomes and reduced suffering from tobacco use.
