Pakistan’s public health and economic systems continue to carry the high cost of cigarette smoking while the country still lacks a coherent regulatory framework for tobacco harm reduction, speakers at an Express Tribune podcast said.
The discussion, organised with the Association for Smoking Alternatives Pakistan (ASAP), brought together ASAP Chief Executive Mirza Abeer, lawyer and senior economist Anwar Kashif Mumtaz, and family physician and public health expert Dr Aftab Ahmed Khan. They argued that complete cessation remains the best outcome, yet millions of adult smokers who repeatedly fail to quit are left without structured, regulated pathways that could reduce harm.
Aftab Ahmed Khan described harm reduction as a practical public health principle used across medicine: when a risky behaviour cannot be eliminated at once, the immediate task is to limit the damage it causes. He compared it to seat belts and helmets, measures that do not prevent accidents but reduce the severity of injury. The same logic, he said, applies to smoking. The primary goal must remain preventing people from starting and helping current smokers quit. For those who cannot stop immediately, the next priority is to reduce exposure to the toxic products of combustion.
Mirza Abeer stressed that the greatest harm from cigarettes comes from burning tobacco at high temperatures, which releases thousands of chemicals, including numerous carcinogens. Tobacco harm reduction, he said, seeks to remove combustion from the equation for adult smokers who have tried and failed to quit through conventional methods.
Nicotine replacement therapies such as patches and gums have existed for years but have not worked for everyone. Regulated alternatives that do not involve burning tobacco sit on a risk continuum between combustible cigarettes at the high-risk end and complete abstinence at the low-risk end. The continuum is not a claim of safety; it is a tool for doctors, regulators and policymakers to distinguish relative harm.
Anwar Kashif Mumtaz highlighted the economic dimension. Pakistan’s healthcare facilities are already overstretched and expensive for ordinary families. Smoking drives repeated hospital visits and multi-morbidity. At the same time, a large illicit and undocumented tobacco sector operates outside taxation and quality control, while the organised industry pays federal excise and sales taxes. The imbalance, he said, leaves the state with the healthcare bill and lost revenue. Affordability also matters: if regulated alternatives are priced far higher than illicit cigarettes because of duties and taxes, smokers who want to switch may return to combustible products.
Speakers repeatedly returned to the problem of weak enforcement and missing services. Aftab Ahmed noted that Pakistan has specialised clinics for diabetes and heart disease but almost no dedicated, accessible smoking-cessation programmes. Relapse is common once social triggers and daily routines return. Age restrictions are inconsistently enforced, and products can reach minors through informal retail and delivery platforms with little verification. Mirza Abeer warned that an unregulated market prioritises profit over public health and that sales to children should be treated as a serious offence.
International experience was cited with caution. Sweden’s low cigarette-smoking prevalence and the sharp decline in Japanese cigarette sales after regulated alternatives entered the market show that policy design matters. Outright bans without enforcement, however, often expand the illicit market and remove government oversight. Pakistan cannot simply copy foreign models; it needs product standards, age controls, licensing, monitoring and risk-based taxation adapted to local conditions.
Coordination between federal and provincial governments remains another gap. Health is largely a provincial subject after the 18th Amendment, yet taxation, customs, imports and product standards remain federal. Without alignment, policies risk remaining fragmented. A national framework setting common objectives, combined with provincial implementation suited to local realities, was described as essential.
Looking ahead, success would mean a measurable drop in smoking rates and cigarette sales, far fewer young people starting nicotine use, a documented and controlled illicit market, and open discussion of tobacco in homes, schools and clinics. Education must begin early so that children understand addiction and its consequences before experimentation starts.Latest News, Breaking News & Top News Stories | The Express TribuneOur CorrespondentRead More