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.