Dr Murad Ali Afridi
THE post-Covid world has seen rapid technological advancement in public health.
Many countries are turning to science-backed research and evidence-driven innovations to strengthen their healthcare systems. Pakistan, however, faces an urgent challenge. Our resources are stretched thin and geared towards reactive measures rather than proactive policies. We need an overhaul which focuses on long-term improvements over short-term wins. Global evidence has shown that Harm Reduction has proven effective in addressing complex public health challenges, particularly in reducing smoking-related diseases. In Pakistan, tobacco control policies remain largely focus on awareness rather than providing meaningful alternatives. By incorporating scientifically proven reduced-risk products in tobacco control efforts, Pakistan could unlock incredible improvements in public health.
As technology and science reshape tobacco control worldwide, Pakistan has a unique opportunity to learn from global best practices and avoid the pitfalls of prohibition. Burning tobacco releases over 7,500 chemicals, around 150 of which harm human health. The real danger lies not in nicotine but in combustion. Professor John Newton, Director of Health Improvement at Public Health England confirms that, “thousands of chemicals in tobacco smoke are responsible for almost all of the harm caused by smoking”. While nicotine is indeed addictive, it is the act of smoking burning tobacco that produces the toxins responsible for cancer, heart diseases and stroke. Understanding this distinction is crucial for shaping effective public health policies.
It is important to recognize that no nicotine product is entirely risk-free. However, adults unable or unwilling to quit smoking, regulated alternatives offer far safer options. Oral nicotine and vapor products contain 99% less toxicants than cigarettes. National Health Service UK recently published, “Nicotine vaping is not risk-free, but it is less harmful than smoking. People who switch completely from smoking to vaping have reduced exposure to toxins associated with risks of cancer, lung disease, heart disease and stroke.” It also confirms that “while nicotine is a highly addictive drug, it does not contain toxic chemicals found in cigarettes”. The Food and Drug Administration of USA issued a statement confirming the reduced risk efficacy of the oral nicotine products saying, “the data shows that these nicotine pouch products meet that bar by benefiting adults who use cigarettes and/or smokeless tobacco products and completely switch to these products.”
Countries like Sweden and New Zealand are saving lives by regulating safer nicotine alternatives. Sweden stands out with its smoking rate falling to just 4.5%, becoming the first country in the world to achieve the WHO status of smoke-free. This success stems from science-based harm reduction policies that made lower-risk, regulated products accessible and appealing. Modern oral nicotine options have been central to this shift, helping smokers quit or move to less harmful choices. Sweden simplified retail laws, allowed awareness campaigns and introduced proportional taxation, making reduced-risk products both understandable and affordable.
Similarly, in 2019, the Ministry of Health of New Zealand in a bid to curb smoking, launched the ‘Vaping Facts’ website which started providing reliable, science-based information to promote harm reduction. A nationwide campaign soon followed, encouraging smokers to switch to vaping. As a result of these initiatives, New Zealand, like Sweden, is now on track to become smoke-free, with most former smokers either quitting entirely or moving to reduced-risk alternatives. In contrast, New Zealand’s neighbour Australia, has kept a prohibitionist stance on vapour products. The country in October 2021 passed laws only allowing adults with prescriptions to legally access vapour products from a pharmacy. However, a 2024 government review found this policy strains both the health system and fuels a thriving illegal vape market, costing over USD 100 million in tax losses while smoking rates continued to remain high.
Pakistan can learn valuable lessons from these global experiences. The government must create an unequivocal narrative based on facts to educate people on tackling tobacco harm and associated issues. Harm reduction should be integrated into our public health policy frameworks, not sidelined. We must ensure that adults who wish to switch from smoking have access to safer, high-quality alternatives that meet strict safety standards. The facts are clear and the opportunity for change is real. It’s time to turn panic into policy.
—The writer is a public health practitioner in KP with over 25 years of experience in child protection, health planning and humanitarian programme management.
