Lives put at risk as THR is trivialised in Bangladesh

The ongoing amendment of Bangladesh's Smoking and Tobacco Products (Control) Act of 2005 risks repeating past mistakes-exclusion, lack of transparency, and missed opportunities for harm reduction. The amendment process, largely shaped by a select group of non-governmental organizations (NGOs), has sidelined critical stakeholders, including small businesses, industry experts, and proponents of harm reduction. This approach not only threatens economic livelihoods but also ignores global evidence demonstrating the effectiveness of tobacco harm reduction (THR) as a public health strategy. The issue has gained international attention, with two recent letters from global organizations-We Are Innovation (WAI) and the Tholos Foundation-urging Bangladesh's policymakers to reconsider restrictive measures.
Since its inception, Bangladesh's tobacco law has seen revisions in 2013has been further proposed for amendment in 2024-but without substantive dialogue with those most affected. The latest push for stricter regulation could place the livelihoods of 1.5 million small business owners at risk, while failing to consider alternative employment solutions or economic impacts. The interim government's nine-member advisory committee, formed to assess the draft law, is tasked with evaluating revenue, business impact, and health concerns. However, given past experiences, there are concerns that the policymakers are yet to embrace consultation with all relevant stakeholders.
Adding to the tension, in January of this year, the current interim government enacted a ban on the import of e-cigarettes and electronic nicotine delivery systems (ENDS). This decision further restricts access to potentially safer alternatives, despite mounting evidence from international experts about their role in reducing smoking rates and harm. This move exacerbates the already limited scope of the tobacco policy and raises questions about the government's willingness to consider innovative public health strategies.
This insular approach contrasts sharply with international best practices. Countries like Sweden, New Zealand, and the United Kingdom have significantly reduced smoking rates by incorporating harm reduction principles into their tobacco policies. Sweden's smoking rate has dropped to 5.3%, largely due to regulated access to safer nicotine alternatives such as snus and nicotine pouches. Similarly, New Zealand has achieved a smoking rate of 6.8% by promoting vaping as a less harmful substitute for cigarettes.
As previously noted, two letters from WAI and the Tholos Foundation specifically addressed Bangladesh's government, highlighting the dangers of prohibitionist policies. WAI's letter warned that banning safer alternatives could hinder rather than advance public health goals, citing Sweden, Japan, and the UK as examples where innovative nicotine products have driven down smoking rates. The letter referenced findings from its 2024 Effective Anti-smoking Policies Global Index, which noted that Bangladesh ranks in the lower half globally in adopting innovation-driven anti-smoking measures. Research cited by WAI estimated that 920,000 lives could be saved in Bangladesh through a more balanced regulatory framework incorporating reduced-risk nicotine products.
The Tholos Foundation's appeal underscored the risks of an unregulated black market for nicotine products should prohibitionist measures be enacted, warning that such policies could force smokers back to more harmful combustible cigarettes. The letter highlighted that Public Health England, the Royal College of Physicians, and the American Lung Association have all affirmed that vaping and similar alternatives are at least 95% less harmful than smoking. Furthermore, it pointed to Japan's 52% decline in cigarette sales after allowing the regulated sale of heated tobacco products as a model Bangladesh should consider. The Tholos letter also criticized bans as ineffective, stating that in countries where such prohibitions were enacted, consumers turned to illicit markets or reverted to traditional cigarettes, worsening health disparities.
Expanding the discussion to the global stage, a third letter from a coalition of harm reduction advocates was sent to the United Nations, urging recognition of tobacco harm reduction (THR) in international health policy and calling for its inclusion in future public health initiatives. This letter, signed by organizations across Africa, Latin America, and Asia-Pacific, stressed that THR aligns with longstanding global harm reduction approaches in areas such as drug policy and public health. The letter urged the UN to acknowledge studies from the Royal College of Physicians, the New Zealand Ministry of Health, and the National Academies of Science, Engineering, and Medicine in the US, all of which support THR as an effective means of combating the tobacco epidemic. It also noted that the Cochrane Review, a globally recognized source of medical analysis, consistently supports the efficacy and safety of electronic cigarettes and other reduced-risk nicotine products.
Bangladesh cannot afford to ignore these insights. With over 100,000 preventable tobacco-related deaths annually, an alternative path must be considered-one that regulates rather than prohibits safer nicotine products. The Royal College of Physicians, the American Lung Association, and Public Health England have all concluded that vaping and other reduced-risk alternatives are at least 95% less harmful than combustible cigarettes. Instead of outlawing these options, Bangladesh should look to countries that have successfully integrated harm reduction into their regulatory frameworks.
A more inclusive and evidence-based approach to the tobacco law amendment is imperative. Policymakers must engage with scientists, businesses, and consumer advocates, ensuring that harm reduction strategies are part of the national dialogue. The exclusionary nature of the current process risks not only economic hardship but also a setback in public health progress.
As the advisory committee moves forward, it must rethink its stance on reduced-risk nicotine alternatives. A more open, science-driven policy could reduce smoking prevalence, protect businesses, and save lives-aligning Bangladesh with global public health advancements rather than leaving it behind.