Action needed to halt two million smoking-related deaths by 2065

Middle East falls behind in bid to curb smoking and switch towards less harmful nicotine alternatives

Of the 390 million people living in the region, about 61 million adults use tobacco, with 384,000 dying prematurely each year as a result. Reuters

The Middle East is lagging other regions in attempts to reduce smoking with a switch to less harmful nicotine products potentially saving almost two million lives by 2065, a report shows.

Global analysis looked at the impact of smoking across seven nations – Pakistan, Egypt, Lebanon, Jordan, Kuwait, Saudi Arabia and the UAE.

Of the 390 million people living in the region, about 61 million adults use tobacco. About 384,000 die prematurely each year as a result.

The World Health Organisation predicts smoking will only decrease slightly in the Middle East from 33.3 per cent in 2020, to 31 per cent in 2025.

Data published in the report forecasts tobacco-related deaths to increase over the coming decades, including cases of lung and oral cancer, lung condition COPD, heart disease and strokes, unless action is taken.

Experts said antismoking measures across the GCC have stalled, with less harmful alternatives including nicotine patches, gum, snus and electrical devices offering potential quitting aids to reduce deaths.

Although long-term studies on tobacco harm reduction (THR) products are scarce, research on biomarkers of future disease on THR users is promising, the experts said.

“Embracing THR, cessation, and improved lung cancer treatment represents a major opportunity for the Middle East to dramatically improve the health of its populations,” said Derek Yach, lead author of the report, global health consultant and former senior WHO official.

“The prevalence of smoking is projected to only decrease by less than two per cent. This preventable disaster should engender outrage and immediate action, while the report aims to provide an alternative vision of what is possible.”

Toxic exposure

Experts made several assumptions when calculating the number of lives potentially saved by smokers switching to THR products.

They include, an 80 per cent reduction in toxic exposure, increased lung cancer survival rates by 2050 through improved diagnosis and treatment, more effective cessation services and an overall trend of decreasing cigarette use already being reported.

The report’s authors called on policymakers across the region to improve access to THR products and invest in national science and research to replace tobacco with more nicotine alternatives.

They also supported development of an independent science-based consumer group to advocate for their needs in the region, and for religious leaders to guide communities to quit smoking and support tobacco harm reduction.

The Ministry of Health and Prevention in the UAE has a robust anti-tobacco strategy, and recently re-emphasised the rules on smoking in the workplace.

While it has been illegal to smoke tobacco products in a public place under federal law since 2009, the ministry released a workplace guide outlining the benefits of quitting, how to handle violations and steps to establish a smoke-free environment.

“The Tobacco-Free Workplace Guide will be used as a key resource and tool to assist both government and private entities in fostering a workplace free from the use of all tobacco products,” said Dr Hussain Al Rand, assistant undersecretary for the public health sector.

“It also comes in line with the UAE's commitment to the WHO Framework Convention on Tobacco Control (WHO FCTC), ratified in 2005, aiming to implement effective measures that protect against exposure to tobacco smoke in workplaces, public transportation, and public places."

Dr Al Rand said government policy had effectively reduced smoking in the population from 11.1 per cent of the population in 2010, to 9.1 per cent in 2018, according to the National Health Survey.

Despite that, the region as a whole is the worst performing in antismoking measures, according to WHO benchmarks.

European success

In Sweden, where THR has been embraced in public health policy, smoking rates have plummeted to just 5.6 per cent. The nation is on course to to be declared ‘smoke free’ by 2040, an EU target of a population of smokers under five per cent.

Lower taxes on products like snus, compared to traditional cigarettes, have encouraged smokers to seek out cheaper alternatives for nicotine delivery, that are also less harmful.

Meanwhile, in New Zealand, the Ministry of Health stated vaping products were not without risks, but significantly less harmful than smoking and contributed to smoking rates falling to 6.8 per cent of the population.

Alexandre Ghanem, general manager for BAT Middle East Cluster, covering Saudi Arabia, Kuwait, Qatar, Bahrain, the UAE, Iraq, Lebanon, and Jordan, said THR products offer a potential pathway away from cigarettes.

“Tobacco Harm Reduction is a public health opportunity, representing a pathway for hundreds of millions of adult smokers who would not otherwise quit, to transition from combustible tobacco products to reduced risk alternative nicotine products,” he said.

“We’ve seen examples in the UK, the US, Sweden and New Zealand witnessing striking success in reducing their smoking rates through endorsement of THR.

“Such strategies were driven by the Government-backed campaigns to promote the reduced risk alternative nicotine products to smoking and accepting consumer behaviours to switch.”

Biggest killer

According to the Institute for Health Metrics and Evaluation, tobacco is the leading cause of death, disease, and disability in Lebanon, and the third-biggest factor in Egypt and the UAE.

In Jordan and Kuwait, it is the fourth leading cause and the fifth-biggest contributing factor in Pakistan.

Alternative nicotine delivery systems, such as patches and gums, are significantly less harmful than combustible cigarettes, but the perception of vaping and e-cigarettes is mixed.

A recent IPSOS survey found two-thirds of smokers polled around the world considered vapes to be as harmful, or even more damaging than cigarettes.

In the UAE, e-cigarettes and heated tobacco were legalised and regulated in 2019 and have become a fast-growing market for novel nicotine, while in Egypt since a ban on vapes ended in 2022, the market has grown by 43 per cent.

In Jordan, heated tobacco products are taxed at 150 per cent, and at 200 per cent for e-cigarettes, and in Saudi Arabia a Tobacco Endgame 2030 strategy could see higher taxes on all products.

Another expert explained how not all countries in the Middle East were quick to embrace alternatives to traditional cigarettes.

“Since 2019, the UAE lifted the ban on e-cigarettes and other nicotine products but in some of the other GCC countries, it’s still not allowed,” said Dr Roshan Koshy Jacob, a consultant oncologist at Zulekha Hospital Sharjah.

“That may be the reason why [their use] is still on the lower side. The use of oral tobacco is quite low here, and in some of countries it's banned altogether.

“The WHO has been trying to create awareness about cancer and the hazards of smoking, but there’s not been a significant decline in this region.

“People need to know what is harmful and to be educated, the switch to alternatives is not 100 per cent safe, but it is much safer than tobacco.”

Dr Swati Prasad, an internal medicine specialist at Aster Royal Clinic, in Downtown Dubai, said public awareness campaigns about switching to healthier alternatives can be hugely beneficial.

“By combining stricter regulations on tobacco products with support through healthcare systems, including counselling and smoking cessation programmes, it is possible to create an environment that encourages smokers to consider less harmful alternatives,” she said.

“Community events and workshops focused on smoking cessation and healthy lifestyles can help – as can smoking cessation programmes in schools and workplaces. Ultimately this can reduce the prevalence of smoking in this region.”