30 million people currently smoke in Pakistan, but could safer nicotine products such as nicotine pouches succeed where other tobacco control efforts have struggled? Joining us today is Ziauddin Islam, a tobacco control expert and former Technical Representative to the WHO FCTC and ITP, to highlight the direction of Pakistan's tobacco control efforts.
Transcription:
00:04 - 01:31
[Joanna Junak]
Hello and welcome! I'm Joanna Junak and this is GFN News on GFN.tv. Tobacco harm reduction is an approach that has gained significant attention globally as it offers promising alternatives to traditional smoking cessation methods. Dr. Ziauddin Islam, our guest today, is a global public health and tobacco control expert, leading advocate for tobacco harm reduction, former technical head of the Tobacco Control Cell Ministry of National Health Services Pakistan, and former Focal Technical Representative of the Government of Pakistan to the WHO, FCTC and ITP. Together we will explore the current state of tobacco harm reduction in Pakistan, the challenges faced and the potential impact it could have on reducing smoking-related harm in the country. Hello, Dr. Zia, and thank you for joining us today. First, could you tell us how your journey with tobacco harm reduction started and what some of the key initiatives you've worked on are?
01:31 - 02:53
[Ziauddin Islam]
Thank you for having me for this nice opportunity to express the tobacco harm reduction work in Pakistan. Actually, my journey starts with one outstanding goal, to save the lives of millions of smokers with the support of harm reduction. I've been working as a technical head of the Ministry of Health's Tobacco Control Cell for more than a decade. And I'm honored to serve Pakistan's technical representative in the WHO FCTCs and the elicited protocol. Yeah, regarding key initiative, yes, I shape in my long history in the Ministry of Health, national tobacco control policy. We try to follow the empower strategies in the light of FCTC. I always advocate with balanced tobacco control regulation. I publish many articles, blogs for the tobacco control, tobacco taxation. But recently, as you know, I'm a very strong proponent of tobacco harm reduction. So this is my area. I think Pakistan is leaking and we need to work on the tobacco harm reduction. Yeah.
02:55 - 03:01
[Joanna Junak]
And how do you define tobacco harm reduction in the context of Pakistan? And why is it important?
03:04 - 04:22
[Ziauddin Islam]
Tobacco harm reduction is very vital for the tobacco control elsewhere. And like elsewhere in Pakistan, where 30 million users smoke cigarettes. with the health cost burden is more than 615 billion Pakistani rupees, is 1.5 GDP ratio of Pakistan. And this, let me tell you, this was the survey finding in 2019. If I can give a projection, so I can confidently say it's more than 1000 billion Pakistani rupees is the health cost burden of tobacco-related diseases. For many, especially in rural and low-income countries, quitting is tough due to addiction and limited support. THR offers great support, lifeline support by reducing the harm with the help of safer alternatives. I think in the context of Pakistan, I define harm reduction as a public health strategy that can prioritize reducing harm caused by the tobacco by producing safer alternatives like vaping, e-cigarettes, SNAS, nicotine pouches for those who cannot or do not wish to quit the nicotine.
04:23 - 04:27
[Joanna Junak]
So what is the state of education around tobacco harm reduction?
04:29 - 05:43
[Ziauddin Islam]
Well, we are very unfortunate in this arena. I must say, KTR in Pakistan is there for some time, slowly advancing, despite reduced limitation, scarce grant, less support from the government, and, you know, pervasive misinformation like, you know, Billionaire philanthropists are exerting pressure with these grants with the help of their grantees. So, scarcity of the funding, irregularity, uncertainty, misinformation. Actually, these are the main areas which hinders the progress. I am working for advocacy. I'm focusing on promoting the safer alternative nicotine product. and campaign to debunk the myths about this THR, despite without any funding, without any support from elsewhere, I still managing, raising my voice for the support of the THR and for the people of Pakistan.
05:45 - 05:53
[Joanna Junak]
Based on what you've said, do you think people in Pakistan are properly informed about alternatives to traditional tobacco products?
05:55 - 07:06
[Ziauddin Islam]
Yeah, it's a beautiful question. I'm encouraged that Pakistani people, Pakistani youth, especially those living in the urban areas, in the Polish area, they are getting information. They are themselves recreating what is the THR going on elsewhere in the world. Like we have the good example of UK, New Zealand, We have witnessing the good success in the USA, which was witnessed by the CDC data that it is good progress over there. But growing media exposure and public interest, yes, they are the positive step. But we are lagging behind the rural areas, an unprivileged population. There we need to do work for advocacy, for awareness. And this is not only advocacy for the people. Actually, we need to focus for the regulatory framework. Unfortunately, THR is not in the context of tobacco control policies or regulation. All is focused on FCTC-related regulation of Pakistan with regards to tobacco control.
07:06 - 07:13
[Joanna Junak]
So what non-combustible tobacco products are used and what safer alternatives can people access?
07:14 - 08:38
[Ziauddin Islam]
We have the range of series. I mean, starting from traditional smokeless products, we have the Naswar. I mean, many, many parts of the Pakistan, especially in one of our KPK province in the Punjab, in the same, they use Naswar, putting something inside the cheek, like this, or the nicotine pouch. This is a modern presentation of this Naswar. We have local pan masala type things which they use to put inside the mud. Yes, regarding novel nicotine product, we have everything available in Pakistan, ranging from the oral nicotine pouch, Velo, Zain, and these are easily available around Pakistan. We have the webting, we have the HTTP products. We have a long range of these products, but still they are not in the regulatory framework. we need to make some regulatory framework to make this product with certain standards. Standards like the case of Evali in US a long time ago, which there is adulteration of this vaping product. We can understand that if there is no regulation in Pakistan, there can be the chances of adulteration of these products.
08:40 - 08:44
[Joanna Junak]
And do you see any barriers to the adoption of reduced risk products?
08:46 - 10:03
[Ziauddin Islam]
Yeah, there are a lot of barriers. We have the limited awareness of their benefits. As I earlier mentioned, there is no government support, no civil society working for promoting the benefit of the THR. We have the grey area, we have inadequate regulatory measures, insufficient government. High cost of vaping product is the main concern as compared to combustible cigarettes. Yes, they are really not in the part with the cigarette. So we need to consider how we are going to have this vaping product alternative. for those who are using combustible cigarettes cheaper than vaping. Culture resistance and definitely misinformation we cannot rule out is a very important barrier. And, you know, prohibitionists, tobacco control, traditional advocate, like everywhere in the world, they also exist in Pakistan. So they are actually one of strong barriers for getting people to understand the reduced risk products efficacy.
10:05 - 10:12
[Joanna Junak]
One last question, Dr. Uzziah. How is tobacco harm reduction connected to tobacco control policies in Pakistan?
10:14 - 11:23
[Ziauddin Islam]
Actually, we have two laws of tobacco control in Pakistan. One is 2002 ordinance and the other one is 1979 ordinance. At that time, THR was not existing. I can say it's not formally integrated in the Pakistan Tribunal Control Policy, which basically focuses on the Empower strategies and FCTCs. Although we ratified FCTC in 2004 and we developed RDNS in 2004, but it's all related and comes past the FCTC and Empower. Lately, in 2020-22, Ministry of Health, which is overseeing body for the tobacco control, passed a statutory regulatory order in favor of STTP, first of its kind in Pakistan. But still, I mean, although it allows, but we need to have more THR incorporation in the existing tobacco control laws of the Pakistan for proper information and dissemination of information.
11:25 - 11:43
[Joanna Junak]
Thank you, Dr. Zia. That's all for today. Tune in next time here on GFN TV or on our podcast. And make sure to check out our social media pages for the latest updates on this year's Global Forum on Nicotine conference. Thanks for watching or listening. See you next time.