Published: 09:31 PM, 24 May 2025
‘What Could Have Been a Fire Escape Has Remained a Death Trap’
Tobacco harm reduction (THR) expert Delon Human speaks on Bangladesh’s Import ban on THR Products
Interviewed by Md Mohan Mia
Dr Delon Human, a physician and global expert on harm reduction, was in Dhaka recently amid growing debate over Bangladesh’s recent ban on vape import.
Dr Human has spent over three decades advocating for safer alternatives to smoking. He has advised three WHO Directors-General and former UN Secretary-General Ban Ki-moon, served as secretary general of the World Medical Association (WMA), and now heads the international health consultancy Health Diplomats.
We spoke with him in Dhaka about the implications of the ban and what Bangladesh stands to gain—or lose—from its approach. This is an edited excerpt from our conversation.
Q: Bangladesh has banned the import of certain THR products. Is that an effective policy?
Historically, bans don't work. The demand for nicotine remains — whether in the form of cigarettes or less harmful alternatives. Prohibition has two consequences: first, it denies people access to safer products, and second, it fuels illicit trade. That’s exactly what happened in South Africa during the COVID lockdown. The black market for tobacco exploded, reaching 72% of all combustible and vaping products — with no tax revenue and no consumer protection.
India is another example. After banning vaping, the country still has one of the highest smoking rates in the world, as well as the highest prevalence of oral cancer. What could have been a fire escape has remained a death trap.
Q: But then why do traditional tobacco control advocates argue that we should focus on helping people quit entirely.
I’ve always been an anti-tobacco advocate myself and fully support the WHO’s Framework Convention on Tobacco Control. But THR and tobacco control are not mutually exclusive — they’re complementary. In fact, the WHO framework explicitly includes harm reduction as a tool.
The evidence speaks for itself. Sweden, for instance, has achieved a smoking rate of just close to 5%, compared to 34% in Bangladesh. The demand for nicotine didn't vanish — but consumers in Sweden had safer alternatives. And it worked. Harm reduction helped bring smoking rates down, leading to massive public health benefits.
Q: What might be the impact on Bangladesh’s public health and economic sectors if THR were adopted?
Bangladesh is at a crossroads. Over 20 million people smoke, and tobacco taxes account for around 10–12% of the GDP. A complete shift away from cigarettes would need to account for that economic reality. But we have examples of how this can be done.
In Japan, the introduction of heated tobacco products — which do not involve combustion — has led to over 30% drop in cigarette sales over five years. Sweden has gone a step further by implementing a differentiated tax model: lower taxes on safer alternatives. This gives consumers a clear incentive to switch — and again, it’s driven down smoking prevalence.
Bangladesh could benefit from a hybrid approach, drawing from Sweden, Japan, and the UK. The UK also maintains strong product standards to protect consumers. If Bangladesh follows suit, the country can protect both public health and economic interests.
Q: Critics might say Bangladesh doesn’t have the infrastructure of Japan or Sweden to enforce such nuanced policies. How do you think we can navigate this?
That’s a fair concern, but it shouldn't be a reason to do nothing. Lower- and middle-income countries like Bangladesh often suffer disproportionately from tobacco-related diseases, especially among women and children.
Yes, enforcement will be a challenge, but banning harm reduction outright removes all choice. It’s better to offer consumers safer alternatives and accurate risk information. Bangladeshi consumers are well-informed and digitally connected — they can make rational choices when given the option.
Q: What kind of THR regulation would you recommend for Bangladesh?
There are three key principles: regulation must be risk-proportionate, prioritise consumer safety, and be linked to clear product standards. That means allowing smoke-free alternatives — like vaping, heated tobacco, and nicotine pouches — while regulating them strictly to ensure safety.
It’s also crucial to monitor and evaluate the long-term effects of the policy. The aim is to reduce disease, premature death, and healthcare costs. Countries like the UK and New Zealand, which moved from bans to pragmatic regulation, have shown that this approach works.
If Bangladesh can learn from the best practices of Sweden, Japan, and New Zealand, and incorporate those into its Tobacco Control Ordinance, it could save countless lives.
