Last month, Pakistan was among the recipients of a WHO (World Health Organisation) award to observe No World Tobacco Day 2021. The country’s Ministry of National Health Services, Regulations and Coordination (NHSRC) was recognised for its tobacco control efforts. While this is to be appreciated, the latter still has to tackle the lack of cessation services in public health facilities. This is the only way to target smokers who wish to kick the habit but neither have the means nor access to facilities to help them. The only aid to quit smoking available in Pakistan are Nicotine Replacement Therapy (NRT) medications, added to the National Essential Medicines List in 2018. To date, these remain unavailable and unaffordable, especially for the under-privileged class. This is a gross oversight given that quitting smoking at any age can increase life expectancy six years on average. However, due to the addictive nature of nicotine – medical support is almost exclusively required. The WHO remains committed to anti-tobacco initiatives. In 2019, it released a report on the global tobacco pandemic under the ‘offer help to quit tobacco use’ tag line while last December saw it launch a 12-month campaign to help 100 million people quit tobacco. Sadly, Pakistan’s National Health Vision 2025 has virtually ignored cessation services while offering no practical measures. This has led to a complete absence of tobacco addition rehabilitation centres as well as national helplines. In addition, healthcare infrastructure (primary, secondary or tertiary) does not provide such programmes. TheWHO notes that the world is home to 1.3 billon tobacco users, some 60 percent of whom say they want to quit while less than than 30 percent have access to appropriate tobacco cessation services. In Pakistan, the Global Adult Tobacco Survey (2014) found that 22.2 percent of men and 2.1 percent of women are smokers. Meaning that there is a need to provide cessation facilities to 15.6 million people in order to prevent 160,000 tobacco-related illnesses deaths annually. In Pakistan, GATS found that 22.2 percent of men and 2.1 percent of women are smokers. Thus, there is an urgent need to provide cessation facilities to 15.6 million people in order to prevent 160,000 tobacco-related illnesses deaths annually Countries like New Zealand are now embracing newer tactics. In 2018, the country reversed its ban on Electronic Nicotine Delivery Systems (ENDS) – e-cigarettes and vaping devices – as part of its Action for SmokeFree 2025 (ASH). Indeed, the Ministry of Health released a statement in October 2017 saying: “Vaping has the potential to help people quit smoking and contribute to New Zealand’s SmokeFree 2025 goal. It’s not about banning smoking. It’s about taking action against tobacco so that by 2025, hardly anyone will smoke.” Similar initiatives were adopted in the United Kingdom based on scientific evidence from a review of 185 studies. Public Health England (government agency) concluded that vaping is 95 percent less harmful than smoking regular cigarettes. In 2016, the Royal College of Physicians reaffirmed this figure, estimating the risk of long-term inhalation of e-cigarette aerosol to be unlikely to exceed 5 percent of the risk associated with long-term cigarette smoking. Therefore fast-paced technological innovation is obsoleting regular cigarettes and disrupting tobacco control. This is being proactively pursued in countries like Japan, Korea, England, New Zealand, Canada, and Iceland. Others will likely follow suit. Renowned Pulmonologist Dr Riccardo Polosa from the University of Catania, Italy, conducted extensive research on Chronic Obstructive Pulmonary Disease (COPD) among patients with a five-year follow-up on smokers showing improvements in lung function if they switched to vaping. ENDS can thus significantly impact society through smoking reduction. A study published in medical journal The Lancet was found to be consistent with the findings of a Cochrane review of e-cigarettes. Both concluded that the latter represents an effective tool; resulting in 5-10 more people per 100 smokers quitting in the longer-term. E-cigarettes may potentially reduce the risk for current smokers who completely transition from using traditional tobacco products to vaping devices. The US Centres for Disease Control and Prevention has moved away from its initial broad recommendation that people consider refraining from vaping altogether. The WHO similarly reversed its earlier position, stating that e-cigarettes are generally thought to be safer than traditional cigarettes. “As more and more people realise the levels of harm caused by tobacco products across the board, and how preventable it all is, we slowly see more governments embrace tobacco control to save lives and the environment,”said Dr Vera Luiza da Costa e Silva, the head of the tobacco-control Convention Secretariat back in 2018. The WHO in 2020 emphasised that more than seven million people die every year due to tobacco use. In addition, more than a trillion US dollars are spent annually on tobacco-related medical expenses and lost productivity, while environmental degradation and pollution resulting from its production cannot be overstated. The Economic Cost of Tobacco-Induced Diseases in Pakistan report was published in 2020 by the Pakistan Institute of Development Economics (PIDE). It found that smoking-attributable direct and indirect expenditures related to cancer, cardiovascular and respiratory diseases in 2019 totalled Rs 437.76 billion ($2.74billion); with 23 percent direct cost and 64 percent indirect mortality cost. Spending on tobacco also crowds out health and education expenditures in Pakistan, especially among lower-income groups. Total revenue collected from tobacco (primarily cigarettes) taxation FY 2018-19 amounted to Rs120 billion. The financial cost of smoking tobacco consumes approximately 1.15 per cent of the country’s GDP. Taking the GDP in 2019 to be 278.2 billion USD, assuming that all smokers switched e-cigarettes, the vast savings become clear. For Pakistan, e-cigarettes may provide a window of opportunity to accelerate its progress in controlling the tobacco epidemic. However, regulating e-cigarettes may yield a negative fallout as too much regulation could see consumers return to traditional cigarettes. In addition, levying taxes on e-cigarettes raises retail prices, thereby excluding certain groups from the market. The writer is a medical doctor with specialisation in public health and health services management from Griffith University Australia. She can be reached at drmariaqureshi@gmail.com