Irrespective of how the COVID-19 pandemic evolves over time across the globe, our past experiences with comparable zoonotic diseases demonstrate the significance of having resilient primary healthcare systems to successfully respond to public health emergencies. However, literature corroborates that in low-and middle-income countries, the primary healthcare systems are plagued with significant energy insecurity and inadequate built environment. These gaps in reliable energy and responsive built environment in primary healthcare systems are exacerbated during disruptive public health emergencies such as COVID-19. In this letter, we discuss the way forward to address these gaps and the policy and practical implications thereof.
Being the second largest consumer of tobacco in the world and with more than 65% of its population below the age of 35, India would face electronic cigarettes (ECs) as an enormous public health challenge in future. In the absence of established facilities for tobacco cessation in the country, ECs may provide an additional opportunity for the industry to project itself as a harm-reduction crusader. Regulating ECs as tobacco products or as drugs is not a prudent option in the Indian context. Banning ECs seems to be the most plausible approach at present. However, in the long run, India should be open to new research. More significantly, policy makers in India should be wary of the lead time before a ban is implemented-a shorter intervening period could ensure that a well-established, better politically connected and more defiant EC industry, aggressively promoting ECs to Indian youth, never becomes a reality.
Electronic nicotine delivery systems (ENDS) are being marketed to tobacco smokers for use in places where smoking is not allowed or as aids similar to pharmaceutical nicotine products to help cigarette smokers quit tobacco use. These are often flavored to make them more attractive for youth - ENDS use may lead young nonsmokers to take up tobacco products. Neither safety nor efficacy as a cessation aid of ENDS has been scientifically demonstrated. The adverse health effects of secondhand aerosol cannot be ruled out. Weak regulation of these products might contribute to the expansion of the ENDS market - in which tobacco companies have a substantial stake - potentially renormalizing smoking habits and negating years of intense tobacco control campaigning. The current situation calls for galvanizing policy makers to gear up to this challenge in the Southeast Asia Region (SEAR) where the high burden of tobacco use is compounded by large proportion of young vulnerable population and limited established tobacco cessation facilities. Banning ENDS in the SEAR seems to be the most plausible approach at present. In the SEAR, Timor-Leste, Democratic People's Republic of Korea, and Thailand have taken the lead in banning these products. The other countries of the SEAR should follow suit. The SEAR countries may, however, choose to revise their strategy if unbiased scientific evidence emerges about efficacy of ENDS as a tobacco cessation aid. ENDS industry must show true motivation and willingness to develop and test ENDS as effective pharmaceutical tools in the regional context before asking for market authorization.
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