*This blog was originally posted at the World Bank Group's Investing in Health site on May 30, 2021.  See: https://blogs.worldbank.org/health/ominous-fact-world-no-tobacco-day-2021-smoking-kills-more-people-covid-19

                                                                 Patricio V. Marquez

The COVID-19 pandemic has hit an unprepared world hard. The public health, social, and economic toll has been unprecedented in recent decades. As of mid-May 2021, more than 168 million people have been infected and 3.5 million have died of the disease. Based on estimated excess mortality for 2020, the World Health Organization (WHO) recently indicated that the death toll is likely higher.

While this global crisis has unraveled social life across countries, the equally devasting decades-old pandemic of tobacco use has continued unbated to claim lives and make people sick as it is causally linked to diseases of nearly all organs of the body.  Around 25% of all heart disease deaths and 80% of lung cancer deaths are caused by smoking, and many others are caused by exposure to secondhand smoke, for example.

A different, but devastating pandemic

Cigarette smoking is not only the most common form of tobacco use but one of the leading preventable risk factors for premature mortality worldwide, killing more than 8 million people a year, including users and non-smokers being exposed to second-hand smoke.

Country evidence from China, Italy, and other countries suggests that smokers have higher odds of progression in COVID-19 severity and death compared to non-smokers. There are also significant health care costs for treating the diseases caused by tobacco use as well as the indirect economic costs that result from tobacco-attributable morbidity and mortality--on average, smokers die 10 years earlier than nonsmokers, which represents a major human capital loss in countries. 

The above numbers point to an inescapable reality: tobacco use kills more people yearly than COVID-19.  Far worse, tobacco smoking is estimated to have killed 100 million people in the 20th Century, and estimates suggest one billion people could die from smoking this century if no action is taken.  

Although with delays and inadequacies, and after much suffering this past year, governments, international agencies, and communities have come to the realization that to suppress the spread of SARS-CoV-2, the coronavirus that causes COVID-19 disease, and overcome the social and economic disruption it brought, a coordinated, well-organized, and sustained global response is the only way out of this crisis.  

Addressing tobacco scourge with urgency

Similarly, based on the painful lessons of the COVID-19 pandemic, we cannot remain complacent in thinking that tobacco use is just another “endemic” condition in our communities and that this addiction will never go away.  We must recognize, however, that this challenge is not an easy one to tackle and will require a sustained effort over the medium-term, given the economic power of the tobacco industry. This becomes clear when one understands that in nominal terms the worldwide sales revenue of all tobacco products is forecast to increase on average by 2.5% per year between 2012 and 2025, eventually reaching US$888 billion by 2025, generating gigantic profits for the tobacco industry. It is not surprising to learn then, from a Credit Suisse report, that one dollar invested in tobacco stocks in 1900 was worth $6.3 million by 2010, 165 times greater than the average industry.

As Prof. Chris Whitty, England’s chief medical officer, observed in a recent lecture, “tobacco companies get people addicted in young age and then keep them addicted to something which they know will kill them” to maintain their profit shares. But we know how to address the tobacco scourge.

Indeed, the 2005 Framework Convention on Tobacco Control (FCTC), the first global treaty negotiated under the auspices of the WHO that has been ratified by 182 countries with more than 90% of the world population, offers a menu of effective demand and supply reduction measures.

Key measures range from raising taxes on tobacco products to increase prices and reduce consumption and health risks while mobilizing additional tax revenue that enhances fiscal capacity of countries to fund  priority investments and programs that benefit all; regulations to protect people from exposure to tobacco smoke in public places; comprehensive bans on tobacco advertising, promotion, and sponsorship; to interventions for strengthening governance arrangements to deal with illicit tobacco trade across the supply chain.

While the FCTC is a solid framework for tobacco control, full implementation of some of its provisions at the country level continues to lag behind.   

Commit to quit

I think that to celebrate this year’s World No Tobacco Day under the theme “Commit to Quit”, it is apt to raise our collective voices to demand that countries worldwide support at the highest political levels the adoption and the full implementation of FCTC provisions to end the scourge of tobacco use and nicotine addiction.  To this, I would add the support that needs to be provided to initiatives such as Tobacco Free Portfolio, which involves working collaboratively with the world’s largest financial organizations to implement tobacco-free finance policies—spanning lending, investment and insurance.

The World Bank Group (WBG) has also been assisting countries to confront the development threat posed by tobacco use.  The unambiguous Operational Directive 4.76 of 1999 mandates that the WBG does not lend directly to tobacco production, processing, or marketing; provide grants for investment in these activities; or guarantee investments, loans, or credits for these industries. WBG policy advice, technical assistance, and operations support tobacco tax increases to protect the population from health risks and to mobilize additional public revenue to aid in the post-pandemic recovery.

There is no time to lose. The COVID-19 pandemic has exposed the potential devastating impact of unattended public health, social, and environmental risks and their spillover effects in a fast-changing, interconnected world. The sobering experience bestowed upon all of us by the still ongoing pandemic clearly illustrates the high price that societies pay for inaction in dealing with global challenges, old and new. Tobacco use is a decades-old pandemic that needs to be suppressed once and for all across the world as a moral, public health, and development imperative. 

For those, like me, who have lost loved ones due to lung cancer and other tobacco-related diseases, preventing smoking and the use of e-cigarettes by young people to make the next generation tobacco free is not only the right thing to do; more importantly, it represents the type of concerted global effort that is required to confront major societal risks that could undermine the development of healthy, productive, and more inclusive and equitable societies.