India's Tobacco Control Program is Unimaginative

India's fight against tobacco addiction has been a long and costly one. Despite massive spending by the central government on tobacco control programs, the cessation rate remains minuscule, with little to show for the decades of investment. According to the Global Adult Tobacco Survey (GATS) 2016-17, the tobacco cessation rate in India stands at a mere 2%, a rate that speaks to the inadequacy of current strategies in helping individuals quit. The government's spending on tobacco control programs has steadily increased in the form of public awareness campaigns, regulations, and the imposition of various tobacco taxes. However, these efforts have not translated into meaningful success in reducing the number of tobacco users.

The problem lies in the conflation of two very distinct objectives: tobacco control and tobacco cessation. Tobacco control measures, such as policing supply, restricting access, and imposing higher taxes, are necessary for limiting the spread of tobacco use, particularly among younger and vulnerable populations. However, tobacco cessation, the process of helping current users quit, requires a different approach altogether. Addressing addiction through punitive measures alone overlooks the fact that smoking is not just a habit but a deeply ingrained addiction for many. As per GATS data, 55 percent of smokers were either planning or thinking of quitting, but the absence of science-based practices and cessation products remains a hindrance, as evidenced by the country's extremely low cessation rate.

Tobacco cessation is a complex behavioral process that requires tailored, science-based interventions. Simply curbing access to tobacco or raising prices through taxation does little to address the physical and psychological addiction that millions of tobacco users suffer from. What India urgently needs is a comprehensive cessation strategy that incorporates the latest scientific advancements in nicotine addiction management. Effective cessation pathways include Nicotine Replacement Therapies (NRTs), heat-not-burn (HNB) devices, and alternatives like snus, a smokeless tobacco product popular in Sweden. Unfortunately, these alternatives are either underutilized, overregulated, or outright banned, leaving millions of smokers without viable tools to quit.

Cessation programs need to be based on science and behavioral health principles. One of the most effective methods globally is the use of Nicotine Replacement Therapies (NRTs), which include products like patches, gum, and lozenges that gradually reduce nicotine dependency. These therapies have proven to increase the likelihood of quitting by 50-60% in various studies. Unfortunately, awareness and access to these therapies in India remain limited, and they are not widely promoted as part of the government's cessation strategy. The proposal to restrict access to NRTs without a prescription will only make things worse.

Another innovation that has shown success internationally is the use of heat-not-burn (HNB) devices, which heat tobacco to a lower temperature, reducing the harmful chemicals inhaled. These devices offer a middle-ground solution for smokers who struggle with complete cessation. While they are gaining acceptance in countries like Japan, India has yet to consider them as a viable option for harm reduction and cessation.

One of the most remarkable examples of a successful alternative is snus, a smokeless tobacco product used predominantly in Sweden. Unlike combustible tobacco, snus is placed under the lip and does not involve inhaling harmful smoke. Sweden's adoption of snus has contributed to one of the lowest smoking rates in Europe. The Swedish government has reported that the use of snus has significantly reduced smoking rates, and its citizens now enjoy the lowest tobacco-related mortality rates in the EU. Sweden's success demonstrates the potential of alternative nicotine products like snus in helping smokers quit, a strategy that could be replicated in countries like India to make meaningful progress in tobacco cessation.

The path forward for India's tobacco control policy must involve a clear distinction between control and cessation. While continuing to regulate and control the availability and marketing of tobacco products, the government must also focus on providing effective, science-based cessation tools to those who are trying to quit. Tobacco addiction is a complex issue that cannot be solved solely through punitive measures or raising prices. Smokers need access to a range of cessation products that are proven to help them reduce or eliminate their nicotine dependence.

Incorporating scientifically backed cessation methods, such as NRTs, snus, and HNB devices, can offer a more pragmatic and effective solution to India's tobacco problem. Without this shift in focus, the government risks continuing its unimaginative approach to tobacco control—one that, while helpful in restricting access, does little to support those who are already addicted. It's time for a more nuanced and effective policy, one that recognizes the difference between controlling tobacco use and providing pathways for cessation.

Content by: Dr. Manorama Bakshi, Director and Head of Healthcare and Advocacy at Consocia Advisory

Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information in this article. All information is provided on an as-is basis. The information, facts, or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.