WITH rising numbers of smokers in sub-Saharan Africa, concerns regarding risk exposure to tobacco have been well documented. The impact on the entire industry, from farmers to consumers has always been a source of concern: who will support the farmers earning a living through their trade? This could change after a landmark decision in the industry.
Following 43 months of evaluation, the U.S. Food and Drug Administration (FDA) recently authorised the marketing of electrically heated tobacco system called IQOS by Philip Morris International (PMI) as a modified risk tobacco product (MRTP).
This decision by the US FDA marked the first time the agency has granted marketing orders for an electronic alternative to cigarettes. It found IQOS to be “appropriate to promote the public health and is expected to benefit the health of the population as a whole.”
Considering that cigarette smoking kills more than seven million people worldwide each year, the US FDA decision opens a public health opportunity in the fight against the global tobacco epidemic. Encouraging the rapid shift from smoking cigarettes to alternatives such as IQOS – for adult smokers who have been unable or unwilling to quit – could save many lives.
While the FDA does not endorse IQOS, its decision followed a scientific review of more than one million pages of evidence submitted by PMI and took into account independent studies. The federal agency concluded that non-combustible tobacco products such as IQOS differ from cigarettes in reducing the body’s exposure to harmful or potentially harmful chemicals.
This is consistent with earlier conclusions of regulatory and scientific bodies, that the product emits lower levels of harmful toxicants than lit cigarettes.
The finding recognizes the harm-reduction effects of the “heat-not-burn” technology, which provides smokers with nicotine, while substantially reducing the risks associated with the combustion of conventional cigarettes.
While rates of smoking have decreased in wealthy countries, they have grown in poorer nations. In sub-Saharan Africa, cigarette consumption increased by over 50 percent between 1980 and 2016. Of deaths among African adults caused by second-hand smoke, over 60 percent are among women who live and work with smokers.
There are lessons to be learned from the decision by the US FDA and similar regulatory bodies in Europe. A dogmatic approach to tobacco control, which condemns all tobacco products as equally injurious to public health, has little chance of reducing the harm of cigarettes in today’s world.
It should lower the cost of reduced risk products and make them available to adult smokers in Africa. Countries should move to include harm reduction in their arsenal of tobacco-control measures and engage the tobacco industry to find the best ways to make the new products widely available to adult smokers unable or unwilling to quit, possibly including raising taxes on conventional cigarettes, while significantly lowering them on reduced risk products;
Across Africa, where the median age is under 25, very strict measures must be put in place to protect under-age youth from gaining access to the new products, considering that they have been shown to be only better alternatives but are not risk free.
In an ideal world, humans would avoid all unnecessary substances that have negative effects on their health. Unfortunately, that is not the case and will likely never be. It will require courage and political will, but it is a public health imperative to adopt measures to reduce risks to the more than one billion smokers worldwide.
