Nicotine Misinformation Is Threatening Lives In Central Asia

By Dr Delon Human

‘First do no harm’ is the most fundamental principle guiding healthcare professionals worldwide.

It is disappointing therefore that health authorities across Central Asia are instituting policies that will expose millions of their citizens to harms that could easily be reduced, or even eliminated.

This apparent dereliction of duty is the direct result of misguided opposition and hostility that is being promulgated in the region against alternative nicotine products, such as vapes and modern oral pouches.

These innovative products, which are proven to be significantly less risky than traditional combustible cigarettes, are already saving thousands of lives in countries that recognise their potential for tobacco harm reduction.

But in Kazakhstan, Uzbekistan and the wider region, they are subject to a rampant misinformation campaign that will condemn millions to an unnecessary premature death due to continued smoking or the consumption of traditional Naswar products.

Despite an independent expert report demonstrating that 165,000 lives could be saved in Kazakhstan alone through an approach allowing non-combustible alternatives, authorities there have proceeded to outlaw vaping products, in addition to an existing ban on much safer oral nicotine pouches.

This retrograde step, which endangers the lives of Kazakhstan’s 3.2 million smokers, has unfortunately now been copied by Kyrgyzstan (1.5 million smokers) and is being recklessly championed in Uzbekistan (more than 3 million smokers and 2 million naswar users).

Because of their inevitable outcomes, these prohibitions are effectively pro-smoking measures. They are not based in any science or evidence, but rather echo an anti-vaping activists’ playbook which has been criticised in the leading Lancet journal.

Baseless claims about vaping, such as recent reporting by Uzbekistan’s national media that states “vaping contains thousands of chemicals… and is more harmful than smoking”, will cost lives and fly in the face of recent publications by the UK’s National Health Service, and leading anti-smoking body ASH UK.

Contrary to the propaganda, and unlike tobacco, nicotine does not pose a cancer risk. Furthermore, nicotine is similar to caffeine in that it is dependence-forming and not addictive. 

The UK Health Security Agency and Office for Health Improvement and Disparities, (previously Public Health England), amongst others, has recognised vapes to be at least 95% less harmful than combustible cigarettes.

The US Food and Drug Administration (FDA) says replacing cigarettes with nicotine pouches such as snus (a traditional oral tobacco product widely used in Scandinavia) reduces smokers’ risk of mouth cancer, heart disease, lung cancer and stroke.

A recent report by the Cochrane network of researchers confirmed that alternative nicotine products are the most effective tool for helping smokers to quit.

But perhaps the most compelling evidence of nicotine alternatives’ beneficial impact can be witnessed in Sweden, which is set to celebrate its success as the first country in the world to become officially ‘smoke-free’.

The Royal College of Physicians has credited Sweden’s rapid reduction in smoking rates to its policy of making vapes and pouches available, acceptable and affordable to adult smokers. As a result, Sweden has the lowest rates of tobacco-related diseases and the lowest rate of male lung cancer in Europe.

Sweden has pointed the way for other nations, such as the United Kingdom and New Zealand, where health services now provide free vape products to smokers to help them quit.  

It should also be a template for how Central Asia can save millions of lives by giving smokers an escape from deadly cigarettes. 

As a rule, prohibitions in public health have limited value. Attempts to bully authorities in the region into ineffective prohibitions must be rejected, or at the most – be directed to clearly toxic substances (e.g. some of the unregulated smokeless oral tobacco use in Uzbekistan, like Naswar). Instead, tobacco harm reduction should be integrated into public health strategy via risk-proportionate regulation.

Reducing smoking and saving lives can be achieved by emulating proven successes like Sweden and offering reasonable access to vaping and nicotine pouches.