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Nearly 2m lives in selected Middle Eastern countries could be saved by tobacco harm reduction, according to a new report that was launched at the World Vape Show in Dubai this month by one of its authors, Derek Yach (pictured) of Global Health Strategies.
The report, titled “Tobacco harm reduction and better treatment could save nearly two million lives in selected countries in the Middle East”, focused on seven countries: Pakistan, Egypt, Lebanon, Jordan, Kuwait, Saudi Arabia, and the United Arab Emirates (UAE). Of the 390m people living in these countries, 61m adults use tobacco products, and 384,000 die prematurely every year as a result, according to its data.
The authors – Yach, Cheryl Olson, Delon Human and Karl Fagerström – calculated the combined impact on long-term trends in health of embracing tobacco harm reduction, better cessation services and improved lung cancer treatment in the seven Middle Eastern countries.
Their analysis indicated that more than 1.8m lives could be saved by 2060 through these interventions, compared with continuing the current tobacco control efforts directed by World Health Organization (WHO) efforts alone.
Yach believes the way forward is to encourage physicians and governments to embrace tobacco harm reduction products to reduce premature deaths.
“Smoking rates in the Middle East are among the highest in the world,” Yach told ECigIntelligence. “And in many of these countries the cost of healthcare is carried by governments, who are missing an opportunity to reap the economic rewards as well as the health benefits for their populations.”
Governments giving ‘tacit support’ to harm-reduction products
Some governments in the region are relaxing their views of tobacco harm reduction products, according to Yach. He cites as evidence the example of the Philip Morris International (PMI) acquisition of a stake in Egypt’s state-owned cigarette manufacturer, Eastern Company.
Announcing the acquisition, PMI’s president of South and Southeast Asia, Commonwealth of Independent States and Middle East and Africa Region, Frederic de Wilde, said: “We look forward to exploring potential areas of cooperation with Eastern, including opportunities to provide adult smokers in Egypt with better options than cigarettes.”
Yach also noted the UAE’s and Saudi Arabia’s recent investment in smoking-cessation initiatives as evidence of progress, along with the fact that the first locally produced nicotine pouches to be launched in Saudi Arabia were made by the state-owned manufacturer Badael.
“You no longer have the draconian clampdown but tacit support for the product,” he said.
The report calls for governments to revise legislation to improve access to tobacco harm reduction products and invest in science and research to advance technology.
“We need to push faster down the road of innovation and develop products that address smokers’ needs more,” said Yach.
Government support for tobacco harm reduction is critical in three ways, according to Yach. First, by regulating tobacco harm reduction products in a proportionate way to the risk they pose. Second, by developing a culture of advocacy for tobacco harm reduction within dependent science-based nicotine consumer groups. And third, by encouraging physicians to communicate the benefits of tobacco harm reduction to their patients, to counter disinformation about nicotine, and to lead policy development.
Appealing to religious leaders to promote health
Religious leaders also have considerable power to inform consumers in the Middle East compared with other regions of the world, and Yach sees this as a major opportunity.
“Friday evening prayers is an opportunity for religious leaders to leverage the power of gathering together in community to share the value of giving up a deadly habit and to have a positive discussion around harm reduction,” he said. “What does haram mean? Common beliefs across faiths are don’t kill yourself and don’t kill others, and smoking is contributing to both of those actions.”
Remembering his time researching interfaith opportunities to promote health when he was working for the WHO 25 years ago, Yach applauded the success of the Catholic Church’s HIV/Aids programmes in African countries, as well as its promotion of the human papillomavirus (HPV) vaccine.
“I’m really convinced that if we approach religious leaders in this way, we’ll make progress,” he said. “Where do we have high levels of trust? In personal physicians and personal spiritual leaders. These people present huge opportunities.”
On the issues of youth uptake, flavours and the environment
Yach reported that the controversial issue of youth access to e-cigarettes was being addressed by several companies present at the World Vape Show. A wide range of technological solutions for age verification were discussed and on display in Dubai, including leveraging facial recognition to help retailers verify the age of their customers.
“This will go a long way to stopping youth uptake,” said Yach.
He stressed the importance of legislating against the “kidification” of flavour marketing and the benefits of flavours for adults.
“Flavours play a role in enhancing adult medication adherence and in encouraging adult smokers to use nicotine gum,” he said. “Pharmaceutical research has made the case for them to use flavours. The same logic should apply to vapes and nicotine pouches.”
When it comes to concerns about disposable e-cigarettes as polluting the environment, Yach said more technological innovation was required to improve the biodegradability of as many components of the devices as possible. This could work in tandem with more effective recycling programmes for the more disposable elements of the device, such as batteries.
Industry intentions to address key issues
The good news is that Yach reported a unanimous drive among the international industry members who attended the World Vape Show to address these key issues.
“It’s really important because if companies don’t address youth access and the issues associated with disposables, the industry is in long-term danger,” Yach said.
“Even the China Electronics Chamber of Commerce (ECCC) voiced its commitment to implementing codes to address both youth access and environmental concerns,” he added.
Yach said he had no doubt they were drawing on the experience of the UK Vaping Industry Association (UKVIA) in implementing such codes.
“Industry self-regulations work best when lead trade associations set clear guidelines for their members and are willing to act against those who violate codes,” he said.
He cited examples from other consumer goods sectors, such as how the toy industry had addressed lead levels, and the infant formula sector had addressed marketing issues.
Middle East could lead the way in stopping smoking
At the end of the event, Mohammed Agrabawi, senior director of corporate affairs and communications with Alternative Nicotine Delivery Solutions (ANDS), introduced a resolution among the members who committed to the codes.
“Three days of intense engagement with a wide range of industry players and academics has led me to believe that the Middle East could well leapfrog over the traditional slow path of ending smoking,” said Yach.
“Locally led innovation across a range of tobacco harm reduction products, including vapes, nicotine pouches, heated tobacco products and shisha is well underway. Governments are pushing back against prohibition, and consumer demand for cleaner nicotine options is growing.”
– ECigIntelligence staff
