The Principle of Harm Reduction Should Apply Across the Board to Achieve Public Health Objectives

A paper by the National Center for Biotechnology Information states that harm reduction is a public health strategy that was developed initially for adults with substance abuse problems for whom abstinence was not feasible. In recent years, harm reduction has been used to lower the spread of HIV and address alcohol abuse, to name a few. The principle of harm reduction is premised on the notion that you cannot completely control human behaviour, however, there is a need to provide the necessary tools to minimise the harm caused by those behaviours to the individuals themselves and others. It is also accepted that every behaviour presents its own unique set of harms, therefore, the strategies to minimise those harms will differ accordingly.

Within the context of road safety, for instance, harm reduction approaches consider that no rules or policies can make road accidents completely disappear, instead, safety car features and mandatory seatbelt wearing is legislated to save lives. To reduce the risk of HIV infection, government provides free condoms and educational programmes. In understanding that it is harder to make people quit the use of hard drugs, government works with civil society groups to provide clean needles and opioid substitution drugs to reduce chances of overdosing.

It then beggars belief as to why the harm reduction approach is not universally considered to deal with smoking. Instead, the World Health Organisation (WHO) is stubbornly sticking to harm elimination strategies, which have proven to be ineffective. This is because quitting smoking is not easy. The introduction of Electronic Vaping Products (EVPs) into the tobacco harm reduction arena presents a huge opportunity to effectively deal with the harms related to smoking. Though not risk free, institutions such as Public Health England (PHE) and Royal College of Physicians (RCP) have proven that vaping is less harmful than smoking, whilst the Cochrane Library has concluded that vaping is an effective smoking cessation tool.

Despite the scientific evidence in support of EVPs in playing a role in tobacco harm reduction and the Framework Convention on Tobacco Control (FCTC) acknowledging that tobacco control ought to include harm reduction strategies, the WHO has adopted a negative posture towards these products. The argument that EVPs are used by tobacco companies to keep and attract new consumers, shows that the WHO has taken a political, instead of scientific, position on EVPs. Unfortunately, its position will only serve to harm the millions of smokers, who can have the opportunity to lessen the harm caused by smoking by being encouraged to switch to less harmful alternatives such as EVPs.

It is also unfortunate that many countries follow WHO guidelines without consideration of scientific evidence to the contrary. South Africa is one such country and has proposed a bill that will introduce stricter laws to deal with smoking and vaping. As witnessed in Australia, the proposed bill will not achieve its intended purpose. Instead, it should focus its energies on tobacco harm reduction methods, similar to its approach to drug use, and also embark on educational campaigns on the dangers of smoking.