No excuse for inaction: #EndTobacco to prevent epidemics of diseases and deaths

Shobha Shukla, Bobby Ramakant *

Tobacco kills over 80 million people worldwide every year. Tobacco remains a deadly, and yet entirely preventable, risk factor for a host of diseases-from the world's biggest infectious disease killer tuberculosis to major non-communicable diseases (NCDs) that account for over 70% deaths globally,

Whether it is the world's biggest killer cardiovascular diseases (heart disease and stroke) or cancers or diabetes or chronic respiratory diseases, it is tobacco which is a common risk factor to all. More alarmingly, it is also linked to COVID-19.

unimaginable devastation

The UN chief called upon governments to act now on COVID-19 or face "unimaginable devastation". Tobacco increases the risk of serious outcomes of COVID-19, including death. One immediate step the governments must take is to ban all forms of tobacco (including e-cigarettes, vaping or other heated tobacco products, hookah etc) and take strongest possible measures to hold the industry liable (legally and financially) - it is now a human rights imperative.

COVID-19 and tobacco pandemics

Governments have promised to end infectious diseases like TB and prevent untimely deaths due to NCDs by one-third in the next 126 months - but one of the biggest roadblocks to progress on these goals is tobacco. COVID-19 pandemic has made us all realize how challenging it could be to eliminate an infectious disease like COVID-19 (or TB). But tobacco is an industry-propelled disaster causing havoc that is entirely avoidable. It is possible to end tobacco, now.

Tobacco also jeopardizes our progress on a range of sustainable development goals, including a crippling economic loss of US$ 1.4 trillion every year. With the looming threat of economic toll that COVID-19 pandemic may have on our economies, we can help salvage this financial crisis by averting unnecessary economic (and health) catastrophe caused by tobacco.

Industry on the other hand is bent upon protecting its markets: the tobacco industry is selling new products such as e-cigarettes and heated tobacco products to create new generations of addicts, revealed a new report of the Southeast Asia Tobacco Control Alliance (SEATCA), "Today's teens, tomorrow's customers: Baiting youths with new tobacco products to create a new generation of addicts".

"Like they did with cigarettes, the tobacco industry is targeting youths with slick advertising, flavours, and technology of e-cigarettes," said Dr Ulysses Dorotheo, Executive Director of SEATCA.

Dr Tara Singh Bam, Deputy Regional Director for Asia Pacific, International Union Against Tuberculosis and Lung Disease (The Union) shared that in its 2019 report on the global tobacco epidemic, the World Health Organization (WHO) noted that there is insufficient evidence to support the use of e-cigarettes as a population-level tobacco cessation intervention to help people quit conventional tobacco use and also noted that these products are undoubtedly harmful.

Several government leaders are worried of the industry tricks to deceive and lure children, youth and adults alike. "The sale of vaping devices might increase the number of young people who smoke, as vaping among non-smoking youth can be a gateway to traditional cigarettes" said Dr Bima Arya Sugiarto, Mayor of Bogor City, Indonesia and Co-Chair of APCAT (Asia Pacific Cities Alliance for Tobacco Control and NCDs Prevention).

"Tobacco use has been de-normalised in Balanga and a generation of young adults are growing up in a smoke-free environment. The aggressive marketing of these new products threatens the health of the community" said Francis Garcia, Mayor of Balanga City, Philippines, and APCAT co-chair.

Former Health Minister of Nepal, Khagraj Adhikari who is a senior Member of Parliament and Chair of APCAT Parliamentarians (Asia Pacific Parliamentarians' Caucus for Tobacco Control and NCDs Prevention), alerted: "Vaping has gained popularity among the youth in Nepal. It was introduced to the market with no evidence as a healthy alternative and a way to quit smoking. Awareness about its potentially harmful effects is still low. We must enact policies to ban e-cigarettes and heated tobacco products to prevent more unnecessary death."

With a devastating impact on health security globally of the pandemic, there is no excuse anymore for not banning all forms of tobacco, including e-cigarettes, heated tobacco products, hookah, chewing tobacco, etc.

Tobacco was already an epidemic, now fueling COVID-19

Tobacco was already an epidemic if we look at the preventable disease burden and death toll since years – year after year. But the association of tobacco as a life-threatening risk factor for a range of conditions that can result in serious outcomes of COVID-19, including death, must become the tipping point to hold the industry liable, ban all forms of killer tobacco products, and strictly enforce all evidence-based health policies on the ground.

Prof (Dr) Surya Kant, Head of Respiratory Medicine Department of King George's Medical University (KGMU) said that according to Ministry of Health and Family Welfare, Government of India, 86% of deaths due to COVID-19 have exhibited comorbidity related to diabetes, chronic kidney issues, hypertension and heart related problems. Tobacco is a common major risk factor for all these conditions. Tobacco spitting in public places could enhance the spread of COVID-19.

According to Indian Council of Medical Research (ICMR), "Chewing/ smokeless tobacco products (Gutkha, 'Paan masala' with tobacco, 'Paan' and other chewing tobacco products) and areca nut (supari) increase the production of saliva followed by a very strong urge to spit. ICMR has urged to refrain from consuming smokeless tobacco products and spitting in public places. State Government of Uttar Pradesh in India had banned the sale of 'paan masala', in view of the alarming COVID-19 pandemic in March 2020.

The recent release of a report by the National Institute of Health in Italy stated that more than 99% of those who have died from COVID-19 had pre-existing medical conditions, including high blood pressure, heart disease, Chronic Obstructive Pulmonary Disease, and diabetes. Tobacco is a major common risk factor for all these listed conditions, said Prof Rama Kant, WHO Director General's Awardee and noted surgeon and tobacco control leader.

Recent COVID-19 deaths in Delhi show that 45.28% of those who died due to COVID-19 were less than 60 years of age (54% were above 60). An important factor which can cause serious outcomes of COVID-19 including death is co-morbidities. In Delhi, 86.79% of those who died of COVID-19 had high blood pressure, diabetes, heart ailment or kidney disease. Again, tobacco is a major common, yet entirely preventable risk factor for all these conditions.

Moment of truth is here, now!

If we are to deliver on sustainable development where no one is left behind, then we need to eliminate disaster-causing risk factors like tobacco, alcohol, etc and have to hold these corporations liable for the irreparable damage they have caused over the years. These are the roadblocks that must be removed before we can accelerate progress towards all other sustainable development goals and targets.

Governments must consider stronger life-saving measures towards preventing tobacco caused epidemic of diseases, which is now also linked to COVID-19. The cost of inaction is very high and will threaten progress on health and other sustainable development goals.