Tobacco Harm Reduction Network (Thailand)

รวมบทความ ข่าวสาร งานวิจัย เกี่ยวกับเทคโนโลยีใหม่ๆ สำหรับผู้ที่ต้องการลดสารพิษจากการสูบบุหรี่แบบมวน และลดมลพิษให้กับคนรอบข้าง

News Talk

News Talk: minutes 19:00 – 41:37

Host: Nopparat Pruansuk

Guest: Ekkapob Pienpiset (MD), Chiang Rai MP, Future Forward Party

Nopparat Pruansuk: NP

Ekkapob Pienpiset: EP

EP: …We may have a low number of players, a low number of manufacturers, and fewer choices, therefore, we have to choose from Siam BioScience or Bionet-Asia. In the future… we may need to encourage more private companies to enter the market to develop this business together.

NP: I see. We will encourage new industry to emerge in the country to produce medicines and vaccines, turning a crisis into an opportunity. There have been discussions or perhaps, some implementation, I am not sure? It is said that tobacco leaves in Thailand can be used to produce vaccines. Do you have any factual information with regard to this?

EP: In fact, the use of tobacco or plant leaves as a precursor to drug or vaccine production is a technology that has been used around the world for a while – probably for ten years. The institute that has studied tobacco leaves and Covid vaccine production is Chulalongkorn University. They have conducted a study and done research, which has been going well. They have passed tests on animals including monkeys (which are similar to humans) and are now going to human trials in small groups first. They have phase I, phase II trials and so on. They have tested for side effects and will continue to test in larger groups of people. This is the development progress of a vaccine derived from tobacco leaves. The vaccine is created by injecting the disease into the plants, they have a specific method but I will make it simple by saying that the disease is injected into the plants; newly grown saplings.

NP: So, it can grow with the disease inside it?

EP: Yes, and the plant will generate a type of protein. This protein will mimic the pathogen, then they will extract this protein out of the plant and inject this into the human body, which will allow the body to create antibodies.

NP: It is similar to antivenom serum in which we have to get venom from the snake and inject it into a horse and then take the horse to produce antivenom serum, isn’t it?

EP: Yes, it’s similar in a sense. We can simply say that we allow other organisms to produce proteins specific to this virus and allow the body to bind to this protein and the body will remember that this is a virus and if the virus enters the body, white blood cells will destroy it.

NP: Does this mean that we can shift tobacco farmers from growing for cigarette production to growing for vaccine production? Or can the tobacco injected with the virus still be used for cigarette production?

EP: In fact, the tobacco that we use in pharmaceutical production is from Australia; the variety in which Chulalongkorn University is using in its studies. This is not the same…

NP: Pardon me for interrupting; you mean that it is not Virginia Tobacco, which is used for cigarette production?

EP: No, it is not, though, it’s kind of related… Now, if we were to extend further to business, the pharmaceutical industry, etc. we would have a chance to study the possibility to use other varieties of tobacco to produce, if not for a Covid vaccine, then other medicines.

NP: Whether or not other varieties can become a host for this protein the same as the one from Australia, is that correct?

EP: Yes, it is a question that requires research and study. It is an interesting subject.

NP: I believe that there is a high number of tobacco growers in your local area in Chiang Rai.

EP: They grow a lot of tobacco in the North. In Chiang Rai, they mainly grow Virginia Tobacco of which over 90% is usually sold to the Tobacco Authority of Thailand (TOAT). The issues that farmers have been facing are the cigarette excise tax increase and an influx of foreign cigarettes; Thai cigarette sales have dropped and tobacco growers can no longer sell their tobacco to the TOAT, therefore, it has become an issue…

NP: Just to clarify a bit; the current problems that have arisen between foreign cigarettes and domestic cigarettes from the TOAT were due to the fact that the TOAT, who produces various brands of cigarettes, has to pay a much higher tax to the Excise Department. There was also pressure from the Thai Health Promotion Foundation, which aims to lower the smoking rate of Thai people across the country, therefore, the agency always wants to set cigarette prices as high as possible. This is the principle behind their action in order to minimize the number of smokers or encourage more smokers to quit. However, people tend to avoid expensive goods and so the door is open for smuggled goods; illegal cigarettes or foreign cigarettes have flooded into the country. These are better quality cigarettes – Marlboro for example. Now, the TOAT sells fewer and fewer cigarettes because they are 1. expensive 2. unable to compete with foreign cigarettes. This

is impacting agriculture: tobacco farmers are affected as the tobacco leaf prices have been further depressed. We need to find a solution for this. Now back to our conversation, with this problem and if Thailand becomes a source of Covid vaccine production, and we can use tobacco to extract the vaccine, it would be a great solution. It is a hopeful dream for now. What do you think we should do with tobacco farms at the moment?

EP: I believe that we have to look at the future of tobacco. Of course, smoking cigarettes is a health threat. As a doctor, I am well aware that people who smoke have health risks; higher risk of heart disease and cancer than non-smokers. Therefore, not smoking is the best way to avoid these health risks. However, there are people who choose to smoke and the cigarette business still exists in the world. What should we do about that? Looking at global trends… besides cigarettes, cigars, or pipes, or others that we know of, there are also e-cigarettes.

NP: A new innovation that has emerged.

EP: E-cigarettes are divided into those that use e-liquid and those with a cigarette shape but that do not burn tobacco. These products still use tobacco leaves in their production. Therefore, if the TOAT sells fewer cigarettes and buys fewer tobacco leaves from farmers, this could be a solution. If related parties come together and discuss this matter, it could be a way for this new type of tobacco product to be produced as it is being used all over the world. We can export it or open a channel to talk about e-cigarette matters? This is something we have to discuss; certainly, there is research and there are studies averring that e-cigarettes are likely to be safer than cigarettes on a certain level. I’m not saying that e-cigarettes are safe and everyone can use them, I am saying that e-cigarettes are safer … as an alternative. Around the world, they use the term ‘Harm Reduction’; it is a safer option to reduce the impact.

NP: I see it like this: large cigarette companies (I won’t mention the names) produce innovative e-cigarette products based on the principle of avoiding harm to the users’ health because society does not accept anything that is a threat to their health; they tend to steer away from it. Am I right? Cigarette companies have realized this fact and want to shift away from traditional combustible cigarettes as cigarette smoke contains more than 400-500 toxic chemicals. Therefore, they aim to shift to e-cigarettes. However, in Thai society… they [e-cigarettes] have been opposed by the public health authorities in the country and that’s why you, as Public Health Commissioner, have proposed this subject to be studied. Can you share more about this?

EP: It has been a topic to discuss in multiple commissions including the parliament. The Public Health Commissioner has prepared proposals that scientific evidence should be considered; how e-cigarettes and conventional cigarettes or other forms of cigarette products affect people’s health. Should we review whether

or not the reasons why we have to ban e-cigarettes still exist? Banning e-cigarettes means that you let them stay in the underground or dark markets and when these products are available there, we cannot control them. There are people saying that legalizing e-cigarettes may allow easy access for young people and more people will use them. In fact, when these products are underground, we cannot control them at all but it would be otherwise if they were legalized and regulated. We have to look into academic information and finalize what regulations we want for these products; it requires discussions and studies and not dogmatic opposition without considering new and growing academic information.

NP: There are currently no studies that compare new and old cigarette products?

EP: There are study results from foreign countries.

NP: No…, I mean in Thailand, with regard to the ban or legalization, do we have any studies?

EP: The discussion platforms in Thailand are focused mainly on cigarette bans and no-smoking measures. If we look at the current number, Thailand has approximately 10 million smokers out of total population of 70 million. The number of smokers has remained unchanged for over ten years; therefore, we can see that the same campaigns and the same implementations are no longer able to reduce the number of smokers.

NP: Are we talking about the failure of the Thai Health Promotion Foundation?

EP: I have to say that previously…

NP: The agency receives 4 billion baht per year from ‘sin taxes’; don’t you think it is a failure if they cannot reduce the number of smokers? They receive more ‘sin taxes’ as people continue to purchase more cigarettes and drink more liquor?

EP: ThaiHealth’s earlier work was effective. However, in the past 10-20 years; we probably have to adapt to new academic information and a changing society, therefore, the old ways of campaigning, spending 4 billion baht per year on campaigns, may no longer effective. We have to aim for a smoke-free society based on the scientific evidence of e-cigarettes as well as new management methods in addition to the campaigns. This is an important point. One more thing that smoke-free society movements in other countries refer to is the rights of smokers. Of course, the rights of non-smokers, we will continue to preserve, but how about those who still smoke, do we have alternatives for them to reduce their health risks?

NP: You mean that we are asking them to change from old cigarettes to new types of cigarettes?

EP: That’s up to them. However, we should have alternatives for them. We should provide academic information to the public. The new medical approach is that we give them options, provide accurate

information, then the people decide for themselves what kind of life they want, what kind of health they need? We should not block alternatives and force them to use one thing. We can’t aim for zero smokers; do you think it is possible to cut the number of smokers to zero? It would be really difficult. Now, what should we do to reduce the number of smokers? For example, let’s say that we have a target: the current number of smokers is 10 million and we want to reduce this to 5 million. We can’t do the same thing we have been doing because in the past ten years, we can see that by doing the same thing, [the number of smokers] has not reduced. We need to find a new way. In the UK, e-cigarettes are part of quitting help. In Japan, quit-smoking clinics are using non-combustible e-cigarettes to help people quit. This could help reduce the number of smokers. We also have to stop new smokers; we have to ensure that e-cigarettes or other cigarette products are under similar regulations to ensure new smokers or youth do not have access to these products.

NP: If you are under 18 years of age, you can’t buy it?

EP: Correct.

NP: In the current law…, the new cigarette products or e-cigarettes are categorized as baraku, is this correct? They are banned for general use. The law added these products to the category of baraku; therefore, e-cigarettes are in this banned group of products. Would you say that this is not appropriate?

EP: They are completely different products. I think it’s a good idea to review the law based on academic principles and look into the future in terms of the economy, new businesses and the management of tobacco. This way, we will find ways to manage tobacco in order to reduce the number of smokers and help those who are still smoking to quit more effectively. We will better manage the related burden, improve business opportunities and the economy, and may develop new industry for exports.

NP: Old cigarettes are about to be disrupted, yet the government’s TOAT can’t see which direction they are going in.

EP: Every group and agency in our country (or as far as I have experienced) is knowledgeable and knows how should we study e-cigarettes or the future of tobacco but the problem is that we have not yet received the green light that we are allowed to study this matter. There are people that actively oppose these products without reviewing all the available study results.

NP: They do not look at them because… (as I’ve seen on the news), they claim that these reports are non-official and have people behind them. Cigarette companies support these reports to be created. What would you say about that? Those who oppose these products say that those reports are unacceptable.

EP: Actually, when you review published medical reports, they usually state ‘Conflict of Interest’ to clarify where they have received funding and we can select reports based on that. As a doctor, I find that this is easy to identify… Before continuing with the conversation, I have to say this to the audience and you as the host: 1. I have no ‘Conflict of Interest’; I have no interests from any tobacco company whatsoever. I have to say this because every time someone comes out to speak about tobacco or e-cigarettes, they are usually attacked by [someone] alleging that he/she receives money from a tobacco company. Some people accuse others without any evidence, therefore, academics who used to study e-cigarettes have retreated; 2. I have not received any money from anti-cigarette agencies such as ThaiHealth either. I have not received any money or benefits from either party. I am a man of the people; a representative of the people and I used to take care of people’s health as a doctor. I have to declare right here that I have no interests in this whatsoever; we will talk about academic information only. I have been in the review commission that considered the cancelation of three agrochemicals, and we had similar arguments: companies or various sectors said that the research results confirming the effects on human life were unreliable. One party said that research results from chemical companies were unreliable too. The solution was that all parties came to sit and look at the research results together. At that time, we saw clearly which chemical was the problem and decided to ban it. We need to open a space for discussions; let’s take a look at the research data together. There is a way to read the research data to measure how reliable it is. Let’s take a look at this together.

NP: Don’t look at it separately and then criticize the results outside of the discussion session.

EP: I’ve never pointed out… “Hey opposers or those who criticize e-cigarettes; you show only negative study results about the products, what benefits did you receive to attack these products?” I’ve never done anything like this but rather suggest that both parties should come and sit together to discuss the matter. This is the reason why we are proposing this matter to the parliament; we are submitting a proposal to discuss related issues and problems as to why can’t we reach the goal of a smoke-free society. If we ask about the target for Thailand’s smoke-free society; what target percentage of the population does Thailand want for smokers? This single question has no answer. We don’t have an answer from ThaiHealth or other related agencies about their target and timeline. If you keep working without a goal or a finish line, it is not a correct approach. It is not right to continue spending 4 billion baht without any goal. We have to re-discuss and review the whole system and reorganize that goal; for example, in the next ten years, we will reduce the number of smokers to 5 million or 8 million people, etc. and how will it be done? Which technology, method or research results will support our approach? What additional laws are required? I think that this is something we can discuss constructively with each other….

NP: It is time for the ThaiHealth to review its own roles and duties, right? Currently, with regard to the study of e-cigarettes, in addition to submitting proposals to the commission, is there anything else that must be studied together?

EP: In addition to submitting to the Commission and waiting for the filing as an agenda item, we also have the subject of the study of tobacco problems and e-cigarettes waiting to be discussed in the General Assembly, though there are many urgent agenda items in the queue so it is still waiting to be considered. This is what we are working on. Another aspect that we are dealing with is reviewing and evaluating the performance of the past attempts at creating a smoke-free society from different departments and organizations. We are currently monitoring and working on the evaluations.