Pandemics: Smoking versus Covid-19

Have you considered the Covid-19 and smoking pandemics together? Are there lessons learned from the Covid-19 pandemic management that may be useful to smoking control?

Ending the global tobacco epidemic is a defining challenge in global health. This is the opening of the Lancet review article[1] published in May 2021. Presenting the effects of tobacco control policies on smoking prevalence during the last three decades, 1999-2019, data on global prevalence of smoking shows that in 2019 there were 1.14 billion active smokers, almost 8 million deaths were attributable to smoking, 1 million of them never smoked, while smoking tobacco use accounted for 20.2% of all-cause deaths among males and 5.8% among females. What an account! 8 million deaths every year…

Checking on the numbers of Covid-19 casualties since the Covid-19 pandemic broke out we have 4,812,836 deaths since January 2020 from the coronavirus COVID-19 outbreak (as of October 03, 2021, 08:57 GMT). 4,812,836 people have died in 22 months. If you check different sources over the internet, you will find all sort of statistics depicting facts and figures. Throughout the day when listening or watching the news there is always an update. Frightening most of the times… ??Yet, if you compare it with the numbers of deaths attributable to smoking the covid deaths seem low!! Approximately 2,6 million deaths due to Covid-19 in one year (a proxy calculation) compared to 8 million deaths from smoking: Covid annual deaths during the pandemic accounts for only one third of the deaths of smoking epidemic.

There is so much worry about the Covid-19 pandemic, rightly so, yet I haven’t seen the same concern about the control of smoking. ?

Ending the global “tobacco” epidemic is a defining challenge in global health. But is it the “tobacco” epidemic or the “smoking” epidemic that needs control? It is well established that nicotine that provides the pleasure to smokers is not the cause of disease, including cancer. ?It is the tar from burning the tobacco leaves that causes harm. People find it very difficult to quit smoking. It is difficult. It is an addiction, hard but not impossible to get rid of. Not all people seem to achieve to quit smoking although they very well know its deadly effect. However, there is mounting evidence that novel tobacco or nicotine products do not bear the same risk as combustible cigarettes. Over the last years many smokers around the world replace conventional smoking with novel nicotine releasing products. Actually, there are a few innovative countries like UK and New Zealand that have adopted strategies to replace combustible cigarettes with novel products! This is “harm reduction”. When you cannot eliminate the risk altogether you reduce it.

Scientists around the world debate. We do not have enough data to support harm reduction. We need more time to study the new products, we need long-term trials to make sure that the products carry no harm… Who says these products are harmless. Nobody claims they are harmless. They are less harmful, in fact a lot less. Time will show. But do we have the time to wait?

What about similarities and differences with Covid-19?

Similarities:

-They are both pandemics.

-They both kill a lot of people. In fact, smoking three times as much. We hope the Covid-19 will be contained in the next few years. I do not see that coming for the smoking pandemic…

-They are both a major concern for WHO, national governments, medical and scientific societies.

-They both affect the most vulnerable people and deepen inequalities around the globe.

-Many scientists work to find ways to contain them.

I am sure there are many more similarities.

What about differences?

-Scientific collaboration! Science has never seen before such quick response of the global scientific community to solve the “Covid-19” threat through collaboration of hundreds of thousands of scientists, researchers, engineers, institutes etc. The knowledge generated in a relatively small time period is unsurpassed. Protective vaccines were produced and put to action in only a fraction of the time of any previous vaccines. There were initially some concerns about safety but in the cost benefit analysis the benefit largely outweighed the risk. This is not the case for Tobacco Harm Reduction. Scientists and scientific organizations debate whether we have “enough data” to support the new products when millions die every year and there is no sign that this may change for the better. ?

- WHO, National governments, Global, Regional, National Health authorities, and the industry collaborate in a common fight against Covid-19. Together before the global threat of wiping humanity, they all collaborated with common protocols, global agreements, and contracts. An admirable effort that has produced results. Do you see any concerns about the profits that the industry will secure by selling its products, vaccines, and hopefully soon, pharmaceutical treatment? Not really. This is not the case for smoking control. The WHO holds an adamant position against tobacco harm reduction, choosing to neglect evidence that organizations like the FDA or Public Health England consider as valid and valuable. National authorities differ in approach. Other adopt harm reduction and other, like Australia, sell freely everywhere cigarettes that is known that cause death but, prescribe the less harmful electronic cigarettes as they do for pharmaceuticals, to avoid uptake from the youth. As for tobacco industry, their scientific work is discredited because they are profitable businesses… Indeed, smoking is causing death but if the industry based upon research data produce less harmful products why not build on their evidence, or verify it, or double check it, and assist in generating novel products to contain the global pandemic in the same way we try to eliminate the Covid-19 pandemic? ???

So much discussion about the Covid-19 pandemic. So much effort. ?Let’s do the same for “smoking”. It seems that we have come to terms with the death toll of smoking, and we have abandoned smokers in their doom…

The idea for this article came to me following the 4th Scientific Summit on Tobacco Harm Reduction Research and Policy organized earlier this week and the very interesting presentations from distinguished speakers from around the world. www.nosmokesummit.org

[1] www.thelancet.com Vol 397 June 19, 2021