Model country for tobacco harm reduction

It seems government’s efforts at discouraging, if not stopping, smoking among Filipinos is not working if we take into consideration the cost being incurred to implement its current strategy.

According to a report from statista.com 29.7 percent of men and 8.6 percent of  the ageing population in the Philippines in 2019 were smokers.

There are two strategies being used by the Philippine government to stop smoking or at least reduce the number of smokers. First is by imposing a ban on smoking in public places, and second by increasing taxes on tobacco. Government believes that smoking is a matter of affordability of cigarettes. The DOH is saying that with cigarette prices in the Philippine still one of the lowest among ASEAN member-countries, tobacco products still remain affordable even to the poor. So they think that by drastically raising excise taxes on tobacco products,  the smoking incidence will decline.

But even the DOH will admit that the Sin Tax Reform Law of 2012, which raised taxes on tobacco and alcohol products, while effective at first in reducing smoking among Filipinos, was not in the long run. According to Health Secretary Francisco Duque, the effects have plateaued and as a result, the Philippines still has the third highest smoking prevalence in the region.

The government has implemented another round of increase in cigarette taxes. Under Republic Act 11346 or the Tobacco Tax Reform Act, which was signed into law in July 2019, excise taxes on tobacco products increased to P45 starting last year, and will be raised by  P5 per pack thereafter until the rate reaches P60 per pack in 2023. By  2024, the tax rate will be increased by five percent each year.

The law also introduced a new tax on electronic cigarettes, specifically electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs).

On Jan. 22, 2020, President Duterte signed into law RA 11467, which further increased excise taxes on alcohol, HTPs, and vapor products. As a result, taxes on HTPs were raised by P25 per pack in 2020, increasing to P27.50 in 2021, P30 in 2022, P32.50 in 2023, and five percent yearly thereafter. A tax of P45 per 10 ml of conventional freebase vapor products was imposed last year, increasing to P50 this year, P55 next year, and P60 in 2023, followed by an increase of five percent every year.

Meanwhile, for salt nicotine vapor products, the tax of P37 per ml will be imposed on the first year, and an additional P5 per ml per year until the rate reaches P52 per ml in 2024. Thereafter, the tax will be increased by five percent yearly.

Government’s strategy to end to smoking among Filipinos unfortunately runs counter to measures taken by other foreign governments to allow ENDS and HTPS in lieu of cigarettes.

The high excises tax rates on tobacco products has also resulted in the growth of the underground market, with billions of pesos worth of illicit cigarettes being smuggled into the Philippines to evade payment of taxes.

Why does our government, the DOH specifically and the World Health Organization  want smokers to quit smoking? This is because they still insist in the belief that if a smoker does not quit, he or she will die, or the so-called “quit-or-die” mantra.

They simply refuse to acknowledge growing scientific research and conclusions by health experts that, yes, it is better if a smoker of traditional tobacco products that burn quits smoking altogether because tar, which is produced by burning tobacco and other plant material, is toxic and damages a smoker’s lungs over time and can be harmful to those who inhale it. Unfortunately, not all smokers can quit altogether and that there are more effective alternatives. 

R Street Institute, a non-profit public policy research organization, conducted a study September last year on the differences in the tobacco control policies between the United Kingdom and Thailand. 

The UK is recognized as an exceptional example of tobacco use surveillance and monitoring as it measures smoking prevalence and demographics annually via nationally representative surveys, while Thailand has implemented many tobacco control policies supported by international public health organizations, including the WHO.

The study showed that the UK saw a faster decrease in smoking rate from 20 percent in 2011 to 15 percent in 2018, compared to Thailand’s smoking rate decline from 21 percent in 2011 to 19 percent in 2017.

R Street Institute said the availability of ENDS such as e-cigarettes and HTPs in the UK offers a plausible explanation as to why its smoking rate was lower than in Thailand, where similar products are banned. E-cigarettes are considered to be 95 percent less harmful compared to combustible cigarettes.

It concluded that UK’s approach to cessation, which endorses harm reduction through the use of safer alternatives to combustible cigarettes, stands in contrast to Thailand’s policy of banning e-cigarettes and messaging against their use.  The UK’s approach  is likely the differentiating factor that lowered the smoking rates in the country.

How do e-cigarettes work? Basically, via a battery-operated device, it emits a vaporized solution that contains nicotine. The aim is to provide the sensation of inhaling tobacco smoke without the harmful smoke coming from burning tobacco leaves. Another benefit of course is that there is no harmful second-hand smoke and the vapor that is exhaled has minimal impact on air quality based on scientific studies. One study published in the prestigious journal Nicotine and Tobacco Research in 2018 revealed that exhaled e-vapor product particles are actually liquid droplets that evaporate within seconds, unlike those released by conventional cigarettes which linger in the air for longer periods of time.

This is the reason why our Food and Drug Administration (FDA) is now being questioned for having issued Administrative Order 2020-0055 or the guidelines on the regulation of vapor products and HTPs without completing the public consultation and answering allegations that it received grants from foreign lobby groups such as Bloomberg Philanthropies, a private international group that has been advocating worldwide against all forms of tobacco products, including e-cigarettes and HTPs.

Nueva Ecija Rep. Estrellita Suansing described the issuance of the AO by the FDA as premature and deplorable as it was done without any prior notice or resolution.

About 800,000 to one million Filipinos are reportedly using e-cigarettes and HTPs which saved them from the risks caused by combustible cigarettes.

Interestingly, Japan – another country in the Asia-Pacific region, saw its smoking population decrease by a third when it introduced HTPs, which like vapor products, provide smokers better alternatives than combustible cigarettes.  

Isn’t it about time that our government consider these alternatives and dump its antiquated way of thinking if it really wants to save Filipinos from the harmful effects of traditional tobacco products once and for all?

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