s in the rest of the world, approaches to effective tobacco control have faltered in Pakistan. Currently tobacco control efforts are at a standstill. Globally, the World Health Organisation estimates 8.5 million tobacco-related deaths annually. These tobacco-related deaths are projected to increase to 10 million every year before registering a decrease.

In Pakistan, the number of tobacco users is on the rise. It is now estimated at 31 million. Over half of them, 17 million, are smokers.

In Pakistan, the disease burden related to tobacco use is significant. It includes heart disease, chronic obstructive pulmonary disease, lung cancer, stroke and tuberculosis. Additionally, the country faces high levels of oral cancer because of the use of toxic smokeless tobacco and areca nut products.

Pakistan seems to be nowhere near achieving any of the tobacco control targets. The tobacco control approaches appear to be in a time warp.

According to a report on Integrating Harm Reduction into Tobacco Control, authored by various doctors and researchers from different countries including Pakistan, new interventions based on THR products… are gaining traction but have not been embraced as key to cutting premature deaths.

In some developed countries, tobacco harm reduction products are seen as part of the solutions for a smoke-free future. Effective cessation services and tobacco harm reduction products can help Pakistan become a smoke-free country in ten years. However, there has yet to be a movement on these approaches. Around 27 per cent of smokers in Pakistan make at least one attempt in a year. Out of them, 2.8 per cent quit smoking successfully.

Tobacco harm reduction is based on the idea that people smoke for nicotine but die from the tar. The idea is that most of the disease risk attributable to smoking arises from the smoke: the tar particles and the gases that are inhaled from burning tobacco. Nicotine creates dependence, which keeps people smoking. The smoke contains thousands of toxic agents, many of which are formed during combustion. If smokers can find satisfactory alternatives to cigarettes that do not involve combustion but do provide nicotine, they might lessen the disease risk.

If Pakistan continues to oppose tobacco harm reduction products and fails to provide effective cessation services, it will face a surge in disease and deaths among adult smokers by 2060.

The report estimates that if Pakistan embraces the THR, the current prevalence rate of tobacco use – 34.3 per cent – will go down to eight per cent in 2045 and five per cent in 2060. In other words, the 163,000 deaths annually related to tobacco will come down to 114,000 in 2045 if THR products are adopted and sensibly regulated. The number of deaths will drop further by 2060 to 76,000 if smokers in Pakistan get effective cessation services. The combination of tobacco control, THR and early diagnosis and treatment of lung cancer can save 1.2 million lives, according to the study.

Currently, adult smokers are on their own when they decide to quit smoking. Effective cessation services are not available to many. Further, the policymakers have opposed tobacco harm reduction products without looking into their efficacy.

If Pakistan continues to oppose THR products and fails to provide effective cessation services, it will face a surge in disease and deaths among adult smokers by 2060. Middle-aged smokers today may be the main victims of this inaction.

THR products can help save lives – first, by offering adult smokers alternatives that are safer than combustible cigarettes and second, by setting them on the path to successfully quitting this habit.

THR products are being imported and sold legally across the country. However, there is no policy regarding these. From time to time, some organisations working on tobacco control call for banning these. These organisations ignore the elephant in the room – combustible smoking – and call for banning everything else.

There is a need to regulate THR products in proportion to the risks they cause. If these are regulated just as combustible cigarettes are, their efficacy in assisting smokers to switch to safer alternatives will be compromised.

There is scientific evidence that smoke-free alternatives can help adult smokers who might otherwise persist in smoking away from traditional cigarettes. A smoke-free future is achievable by fostering appropriate regulatory incentives.

The writer is a human rights activist based in Islamabad