Better to let them smoke and die? Bloomberg funded major international NGO’s logic for LMICs is baffling and worrying
| 12 Aug 2020
By Derek Yach | 12 Aug 2020
Imagine the outrage if an international non-governmental organization (NGO) focusing on drug abuse called for naloxone manufacturers to not sell their products in low- and middle-income countries (LMICs) on grounds that it would confuse regulators and the public, suggesting instead that they focus on ending opioid abuse using only regulatory and educational approaches? How would NGOs in these countries react if this international NGO went further and called on governments to ban the use of naloxone?
Recall that naloxone is about 85-95% effective in preventing death from an opioid overdose.
There is no doubt that if this were the case, governments in LMICs would vigorously oppose such calls and terminate any relationships they had with the NGO. They would argue that effective means of preventing death and improving health should be made universally available. More importantly, they would work to ensure affordability in the poorest countries and communities. This has been the logic applied to access to essential medicines for decades and is underpinned by human rights laws enshrined in several United Nations (UN) resolutions taking into consideration domestic law in many countries.
The Union, a major international NGO well financed by the United States (US) -based Bloomberg Philanthropies, recently called on LMICs to ban e-cigarettes and heated tobacco products on grounds that governments need to first strengthen their tobacco control policies, and not get distracted by these tobacco harm reduction (THR) products. The logic is baffling and worrying.
They seem to believe that it is better to let smokers of combustible cigarettes or beedis, or users of a range of toxic smokeless tobacco products in India continue to die from their use, than have access to a range of THR products deemed as less harmful by the US FDA (in the case of snus and IQOS) or Public Health England (in relation to e-cigarettes). Further, they believe that only when tobacco control has reduced all tobacco use should these products be allowed.
Let’s take a step back and remember the stakes. In India, there are 267 million users of tobacco, nearly 200 million people use smokeless tobacco products, nearly 72 million use beedis and 37 million use cigarettes. Tobacco use results in one million premature deaths annually from a range of diseases that include oral cancer, lung cancer, tuberculosis, heart disease and chronic lung disease or 9.5% of all deaths in India.
Millions more suffer with ill health caused by these conditions. Further, in the context of India, tobacco use is higher in rural areas, among those from poorer households, and those with lower levels of education.
Having spent decades in global health, including at the WHO, I find it tough to accept that there has not been a serious and concerted demand that the Union’s position be questioned and rejected. It sets a terrible precedent if a US-based philanthropy’s effort to adversely influence the policies of governments in ways that may cost millions of lives is allowed to go unopposed.
Derek Yach is President, Foundation For A Smoke Free World, USA.
Disclaimer: Views expressed in the blog are the author's own
10 thoughts on “Better to let them smoke and die? Bloomberg funded major international NGO’s logic for LMICs is baffling and worrying”
Need to see concerted effort to allow all smokers and users of smokeless tobacco access to the full range of scientifically validated reduced risk products as a means of lowering their risks.
The sooner that happens the better.
Global conference for a renewed collective opinion by experts utilising mcda framework (and possibly Chatham House rules) Sweden is key and remains key in that discussions on Tobacco Harm Reduction don’t take their intellectual starting point in a correct estimate of how harm reduced compared to smoking and toxic smokeless – can a tobacco product be and still be in the reach of all income brackets? The answer to that question has been available in Sweden since 1973: Below any detection levels relevant for public health. In effect >95% harm reduced compared to smoking. The only 2 scientific questions were 1) where in the 96%-99.999% range would we end up if we had to place the needle at a fix point? and 2) What does the traffic look like between the similar products, but having vastly different outcomes in terms of health? No effort has been spared since 1973 to ensure these questions have not been adressed . Neither during drafting of the FCTC nor the subsequent EU directives, or at any other policy/legal framework that i know of around the world has anyone from Sweden, sanctioned by the Government and health agencies bothered to mention the 95% harm reduction minimum that we know of very well. The same cannot be said to the opposite effect sadly, just recently materially last minute influencing the proposal put and passed in New Zealand.
Atakan is correct
For decades governments (Sweden being one) and WHO have studiously avoided using the powerful evidence that snus users substantially reduce their risks compared to those who use combustible cigarettes or a range of smokeless tobacco products (STPs). That has been costly in terms of potential lives lost prematurely. It took the FDA to finally rule that “completely switching from cigarettes” to several general types of snus “lowers certain health risks’. The health risks listed by the FDA include: mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis. These are the major diseases caused by the use of cigarettes. The implications for India and other Asian countries where a range of toxic smokeless tobacco products are used by millions of the poorest people in these countries, could be profound. It is long overdue that Indian innovators develop a snus-type product for the market priced to compete with STPs, and flavored to the Indian palate. That would remove the major cause for India having among the highest death rates from mouth cancer in the world.
I believe your example of naloxone is missing one key element.
While the opioid pandemic has not a global legal framework for action under a treaty, for the tobacco pandemic countries have to comply with the first public health and corporate accountability treaty: the World Health Organization Framework Convention on Tobacco Control.
Therefore, the Union´s document guides countries on how to strengthen the implementation of such a treaty.
If governments heeded the recommendations of the Union, millions of people currently using combustible cigarettes would simply continue to smoke and die prematurely; while millions of ex smokers now using ecigs or heated tobacco products, would return to combustibles and their journey to premature death and considerable disease. It’s as simple as it sounds. The Union’s call is one that maintains an unacceptable status quo.
What is becoming clear from the conversations is that India could move from being the global capital of oral cancer to the leader in using science, public demand and industrial innovation to eliminate this dreadfully painful disease. By doing this many other health conditions, especially among poor people and women, would be reduced leading the way for a new generation of innovators to be born and lead.
Agree with Chitra. Adversity drives innovation. We need to deem oral cancer death unacceptable and preventable as we did with smallpox and polio. And then act accordingly.