The WHO and Bloomberg-funded anti–tobacco harm reduction (THR) campaigns impose Western ideologies that ignore local socioeconomic and cultural realities—echoing a modern form of colonial paternalism. Nowhere is this more apparent than in India, home to one of the world’s largest populations of tobacco users. As a medical professional, I’ve seen firsthand the devastating effects of tobacco—and how Bloomberg-backed bans and taxes have failed to meaningfully reduce use. As Indian delegates prepare for the WHO’s Framework Convention on Tobacco Control (FCTC) 11th Conference of the Parties this November, it is imperative that they push back against prohibitionist strategies that have failed our country and instead advocate for a harm reduction approach.
Roughly 80 percent of the world’s tobacco users reside in the Global South—a geopolitical grouping of low- and middle-income countries (LMICs), including nations such as Fiji and also countries in the Northern Hemisphere like Bhutan, China, India, and Russia.
India is home to an estimated 253 million tobacco users. In 2022, approximately 7.1 percent of adults aged 15 and older were smoking, while 21.4 percent used smokeless tobacco products—among the highest rates globally. Of the more than 360 million global users of smokeless tobacco, 199 million are Indian, making up over half of the world’s total. Although India has increased taxes on these products and several states have banned items like gutkha, enforcement remains weak and policy design flawed—violations are common and penalties ineffective.
Tobacco was introduced to India by the Portuguese in the 16th century. Within decades, it was incorporated into royal courts, religious rituals, and daily life. Both nobility and commoners engaged in smoking and chewing tobacco. Over time, India developed its own diverse forms of tobacco consumption—from cigarettes, bidis, and hookahs, to khaini, gutkha, and snuff products like naswar. Each of these products carries distinct cultural and social meaning.
Policies imposed by Western institutions fail to account for this deep-rooted cultural context.
Since joining the FCTC in 2004, India has adopted WHO- and Bloomberg-endorsed measures such as raising taxes and implementing bans. Yet, smoking rates have not seen a dramatic decline. A 2022 study on “hardcore smokers”—those smoking 10 or more cigarettes a day with no intention of quitting—found that prevalence dropped only slightly from 3 percent in 2009–10 to 2.1 percent in 2016–17.
Even more concerning, since 2019, India has banned the sale of tobacco harm reduction products, including e-cigarettes and heated tobacco products—significantly undermining efforts to reduce tobacco-related harm.
Despite the rhetoric, nearly two decades of research shows that e-cigarettes are substantially less harmful than combustible cigarettes and are more effective at helping adults quit smoking compared to traditional nicotine replacement therapies. Countries like Canada, New Zealand, and the UK encourage their use among adults. In the U.S., the FDA has authorized several e-cigarette products as “appropriate for the protection of public health,” and has even allowed one heated tobacco product to be marketed as reduced risk.
Still, Bloomberg’s influence lingers in India. In June, India was awarded the Bloomberg Philanthropies Award for Tobacco Control in the “O” category, recognizing “outstanding efforts to offer support for quitting tobacco use.” These efforts include tobacco cessation clinics, a national quitline, and integration of cessation services in medical and dental colleges. But absurdly, the 2019 e-cigarette ban is also cited as a success—despite overwhelming evidence of these products’ public health potential.
It is long overdue for India to reevaluate its tobacco control strategy and scrutinize the impact of Western-led prohibitionist policies on its own people and culture. India must stop ignoring the robust body of evidence supporting tobacco harm reduction and the lifesaving potential of safer nicotine alternatives. By regulating and promoting access to THR products, India could make meaningful progress in reducing its staggering burden of tobacco-related death and disease.