Smoking is still winning. It’s time to rethink the fight

Cigarette packs in Pakistan carry stark health warnings. Millions of smokers see them every day, yet many ignore the message, slip the pack back into their pocket and light another cigarette.

Around the world, countries have raised tobacco taxes, tightened regulations, printed graphic health warnings and invested in anti-smoking campaigns.

Pakistan has adopted each of these measures, yet millions of people continue to smoke, and tobacco remains one of the country’s leading causes of preventable death. Despite decades of effort, the public health response has changed little.

Tobacco harm reduction doesn’t ask the smokers to quit, but to be more realistic and at least choose to reduce the damage.

This is not an argument against tobacco control. Taxes, advertising bans, and warning labels still matter and should stay. But they were never going to be enough on their own, and the evidence has pointed to that for years. Harm reduction is the missing piece that Pakistan is still reluctant to discuss.

Most people assume that nicotine is what makes smoking deadly. Science says it is not. Nicotine is addictive, but it is the smoke and the thousands of toxic chemicals released when tobacco burns that cause lung cancer and heart disease. This is the foundation of the harm reduction argument because it means that delivering nicotine without burning tobacco puts a product into a meaningfully different risk category.

Tobacco harm reduction doesn’t ask the smokers to quit, but to be more realistic and at least choose to reduce the damage. For millions of smokers who have tried to stop and have failed or have never had access to proper cessation support, this is not a compromise. It is the only practical option on the table.

Addiction is not a knowledge problem. Smokers in Pakistan know cigarettes are harmful. Yet they are stuck because quitting is genuinely hard, and telling people to simply stop, without offering them anything to switch to is not a public health strategy. It is an instruction with no follow through.

The international evidence on alternatives is no longer limited. New Zealand, where vaping has become widespread, has embraced e-cigarettes as a substantially less harmful alternative to smoking and incorporated this thinking into its national tobacco harm reduction strategy.

Sweden took a different path. With the widespread use of snus - an oral tobacco product that carries far lower risk than cigarettes - Sweden was able to achieve the lowest smoking rates in the world. These contrasting approaches show that a one-size-fits-all policy won’t work as different products and approaches do well in different contexts around the world. So, the measures taken around tobacco related harm need to be tailored accordingly.

Existing smokers should be given regulated alternatives, clear age restrictions should be set, and there should be honest conversation about the risks.

Pakistan has yet to take this step. Tobacco claims more than 163,500 lives in the country each year, while millions continue to smoke across every province, income group and demographic. The scale of the problem demands a broader public health response.

The country’s smoking cessation infrastructure remains limited, and there is little public discussion of alternatives for those who are unable or unwilling to quit. A public health strategy that offers only one option - complete cessation - is unlikely to reach every smoker. Expanding the conversation to include harm reduction could help reduce the health risks for those who would otherwise continue smoking.

The concerns around harm reduction should not be dismissed; they are worth taking seriously. There is a genuine risk that alternative nicotine products could attract young people who have never smoked before. Instead of using these concerns to stay silent, they should be used as reasons to regulate. Existing smokers should be given regulated alternatives, clear age restrictions should be set, and there should be honest conversation about the risks.

But what happens without any of that? These products are already available. People are buying them and using them. Quitting still is the goal. However, for those who aren’t able to reach this goal yet, regular alternatives with honest safeguards should be put into place.

The evidence is there for Pakistan to learn from. International experience offers valuable lessons, while early data from within the country suggests that many smokers are already switching to alternatives on their own, without any public policy to guide them. What remains missing is a willingness within the public health establishment to seriously engage with harm reduction. That must change, because the cost of inaction is measured each year in the death toll that remains unacceptably high.

The article does not necessarily reflect the opinion of Business Recorder or its owners.