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In June, The Union, a Bloomberg-funded tobacco control organization, released a position piece entitled “Where Bans Are Best.” That paper was the topic of discussion for this panel on why bans are not the best approach when dealing with issues of tobacco consumption and harm-reduction in India.

The panel consisted of Senior Correspondent Dom Garrett, Samrat Chowdhery, Dr. Nimesh D. Desai, M.D., Ph.D., and Dr. Sree Sucharitha M.D.

Samrat Chowdhery, President of the International Network of Nicotine Consumer Organisations (INNCO), has a personal stake in this topic, as a previous tobacco user. He said his transition to vaping was smooth, but when bans of vaping began to surface, he felt the need  to speak out and formed the Association of Vapers India (AVI.)

Sree Sucharitha, MD, is a Professor at the Department of Community Medicine within Tagore Medical College Hospital. Over the years, she has collected data on tobacco harm reduction and vapers within India. Her research was triggered by watching external drivers dictate policies in low- and middle-income countries (LMICs) facing a lot of health inequalities.

Dr. Nimesh D. Desai, MD, Ph.D., is a Professor of Psychology and Director of the Institute of Human Behavior and Allied Sciences. He sees how external actors focus on what’s right for their organizations instead of what’s suitable for the countries in which they are implementing policies.

Dr. Desai stated that these outside driving forces have zeroed in on one approach and only one strategy – abstinence. He believes consumers should be given a variety of options, given that abstinence has proven ineffective. He thinks the solution is the option for choices in partner with collaborative decision-making between the provider and consumer. It is the consumer’s right to have a set of choices for which they can then decide or consult with their provider. 

Samrat Chowdery said that the goal is to reduce the number of deaths, and the people most affected by these policies, those living in LMICs, do not have a voice. The necessary solution, in his opinion, is to create a platform for consumers to have a say in these policies. 

According to Dr. Desai, consumers don’t even realize that they should have a choice in the matter. He says that consumers will ask their healthcare providers for their opinion and that we need to broaden the base of the consumers who should be looking for choices.

Tobacco control has focused solely on banning vaping devices, instead of educating people on harm reduction, said Chowdhery. Once people know that harm-reduction devices work and that they are an effective way to quit, they’ll be more inclined to try safer nicotine products. He believes that banning the devices will only take choices away from the consumers, which is in direct conflict with the goal of reducing tobacco-related deaths.

Dr. Desai believes it comes down to three important takeaways: keeping oneself informed of the choices, exercising that option, and asserting the right to choose. 

Chowdery stated that many tobacco users in India aren’t even aware that it’s possible to reduce the risk of tobacco use. Course correction is possible and would help save a lot of lives moving forward. 

There are also a lot of regional factors in LMICs that are not being considered when developing these policies, according to Dr. Sucharitha. She emphasized the fact that Malawi, another LMIC, has seen tremendous progress while India has not. Therefore, not all LMICs are compatible. She believes that a collective network, which would serve as a tobacco harm reduction alliance for LMICs, needs to be formed so that everyone can work together. Each chapter can develop their own long-term goals and plans and share that information within the network.

The issues are connected, said Chowdhery. But the issues within LMICs are different than higher-income countries because LMICs have limited access to healthcare. Therefore, LMICs have to find a way to work together and move forward as a group.

Dr. Desai believes that idealism and extremism reign supreme, which is why they won’t accept pragmatism. He believes what is currently a top-down approach from the West and policymakers, needs to be slowly flipped upside down. A mix of top-down and bottom-up approaches is the solution, in his opinion. 

The focus is on addiction over choice for Chowdhery. He said it’s unrealistic to expect consumers to abstain entirely and therefore any approach that contributes to tobacco control while reducing deaths, should be considered.

As the conversation came to a close, Dr. Desai left the group with one final thought: is it time to review and examine the Framework Convention on Tobacco Control again.

“The landscape has changed,” he said. “Perhaps it is time to consider changing the FCTC as well.”

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