T obacco use is the leading preventable cause of deaths worldwide. It is reported to kill an estimated seven million people every year. On average, tobacco users lose 15 years of their life. Up to half of all users will die prematurely due to tobacco-related causes by any year or time estimation. Most of these deaths will be in middle- and low-income nations, accounting for almost 80% of all tobacco-related deaths. India is the third largest tobacco producer and the second largest consumer of tobacco worldwide. Tobacco-related mortality in India is estimated at upwards of 1.3 million people, with one million being attributed to smoking and the rest to smokeless-tobacco use.
Traditionally, people have been using conventional products such as cigarettes, bidis and chewable tobacco. In the last decade, tobacco control in the form of restrictions and curbs being imposed by governments across the globe has taken centre stage, which in turn has affected the profits of tobacco firms. The tobacco industry is also attempting to maintain profits and keep people addicted by introducing new high-tech “heated tobacco products”, or HTPs, sticks of tobacco that are heated and look very similar to conventional cigarettes. These are being targeted at youth, who are being fed with the idea that they are less harmful than cigarettes because they do not burn tobacco and so produce lower levels of multiple toxicants (the main cause of smoking-related diseases).
For example, the product, IQOS, is now available in 38 countries with the backing of a large transnational tobacco firm. And to sell it, there are boutique stores that have opened globally. The imagery used is of a clean, white and modern product with a suitable logo and tag line. While the claim is that the levels of harmful chemicals are much lower when compared to cigarette smoke, it must be noted that all the evidence supporting these claims is being driven by the tobacco lobby. Historically, there is strong evidence that studies backed by tobacco companies cannot be trusted, and former employees have already detailed irregularities in the clinical experiments using heated tobacco products.
The World Health Organisation says “there is no evidence to demonstrate that HTPs are less harmful than conventional tobacco products”. The European Respiratory Society is clear that heated tobacco products are “harmful and addictive; undermine smokers’ wish to quit, and are a temptation for non-smokers and minors”. An expert scientific panel has advised the Food and Drug Administration to vote against applications by the tobacco giant to sell IQOS in the U.S. because there is no evidence that it is less risky than smoking cigarettes.
The company now wants to bring IQOS to India, by marketing it as an aspirational product. It is designed and packaged to resemble a sleek smartphone and is to be sold in boutique stores. India is a very young country. Half of its population is under the age of 25; two-thirds are less than 35 years. The promotion and marketing of HTPs is with the clear intent of attracting new tobacco users and not just to get smokers to swap. Some of those new users will inevitably be young people.
India has been a pioneer in tobacco control, having enacted the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, and launched a dedicated National Tobacco Control Programme in 2007-08.
Choosing between two evils is still an evil. On the one hand you have traditional tobacco products readily available in the market while on the other you are introducing a new tobacco product with the aim of attracting youngsters. The bottom line is to keep margins and sales up in a market which is young and has immense business potential.
Central and State governments need to prevent the sale and marketing of HTPs just as many States have prohibited the sale of electronic cigarettes.
Vandana Shah is Director, South Asia Programs for the Campaign for Tobacco-Free Kids, a non-profit organisation that works globally to reduce tobacco use