Tobacco is considered as the leading risk factor of many chronic diseases. It is, for example, the cause of one-third of all cancers. Without radical treatment, the best way to reduce the highly avoidable associated mortality is to quit smoking.

Lung, bladder, kidney, colon, liver, larynx... Sixteen different cancers, including some of the most aggressive forms of the disease, can be traced to tobacco products. They are also responsible for multiple debilitating if not deadly cardiovascular diseases. The risk of having a heart attack or stroke is doubled for smokers; cigarettes are the leading cause of severe respiratory diseases such as emphysema and chronic obstructive pulmonary disease.

The toll on human life is very heavy, particularly in developing countries. According to the WHO, tobacco use causes more than 8 million deaths per year worldwide. Although they make up seven out of eight deaths, current and former tobacco users are not the only victims of tobacco. Classified as a carcinogen some 20 years ago, second-hand smoke also does a lot of damage, including to children. According to the findings of a meta-analysis published in peer-reviewed journal Tobacco Control1, exposure to second-hand smoke can increase the risk of developing oral cancer by 51%.

A major medical and economic cost

The medical and economic costs of tobacco use are by no means inconsequential, as demonstrated by the findings of the first benchmark study2 conducted four years ago in 152 countries. The costs associated with hospitalisations and treatments were estimated at $422 billion in 2012, i.e. 5.7% of global healthcare spending. Total direct and indirect costs of tobacco use came out at $1,436 billion, i.e. 1.8% of international GDP, with four countries accounting for one-fourth of the total bill: China, India, Brazil and Russia.

For health, economic and social reasons, competent authorities have launched an unbridled war against tobacco. In recent years, media campaigns, illustrated disclaimers, neutral packaging, advertising bans, establishment of a legal minimum age, tax and price hikes, and reduced numbers of smoking areas have proved effective in multiple countries. Some have even decided to take things one step further by permanently banning the sale of cigarettes to persons born after 2004. By implementing this emblematic measure, the New Zealand government clearly announced its ambition of becoming the first tobacco-free nation by 2025.

An incomplete and inadequate arsenal

Even as a public health priority, cession of tobacco use cannot be so easily decreed. According to the WHO, the guidance of a healthcare professional and use of appropriate medications double the chance of successfully quitting. Without adequate support, the failure rate is 96%. The fast-growing smoking cessation market can be divided into two categories: nicotine substitutes and pharmacological treatments. Several medications, such as bupropion and varenicline, are now recommended as treatments. More recently, cytisinicline was added to the existing treatment arsenal, though as-yet incomplete and insufficient to the task of overcoming the multiple failures and limiting relapses over the long term. Used as primary treatments, nicotine gum, lozenges and patches generate significantly inferior results compared to medications, especially among highly-dependent users.  

Homeopathy, hypnotherapy, acupuncture... sometimes unconventional methods are preferred, but on the whole they have proved less effective. Due to a lack of irrefutable evidence, vaping devices (with or without nicotine) are not seen as a viable alternative. Scientific evidence is inconclusive at this point: given the lack of solid data indicating that they are effective and harmless, they cannot be confirmed as without danger.  

New approaches

The discovery of a universal cure against tobacco dependency is the best hope for 1.3 billion smokers. For the last 20 years, researchers around the world have been working to develop an anti-nicotine vaccine. Multiple projects have been undertaken, but none has led to a successful outcome. Innovative avenues are currently being explored. One of the most promising comes from a US team at the Scripps Research Institute3, which claims to have identified an enzyme capable of destroying nicotine in the blood before it gets to the brain. Tested on mice, their prototype is said to be reliable and will soon enter the human testing phase.

Progress is also being made on the technological front. Several mobile apps have been developed to help people quit smoking. One highly successful app, QuitNow!, provides arguments, advice, tips and games to keep the mind busy in moments of weakness. Developed by Spanish studio Fewlaps, it has already been downloaded more than one million times. At the very least, it makes up for one of the flaws often observed in the various treatment methods employed, by providing its users with constant personal support. 

As drivers for change, investors will have a major role to play in the fight against tobacco use. In the interest of promoting public health, Candriam will be making its own contribution to this worthy cause. Relying on its team of experts, Candriam’s ambition is to identify the most innovative companies capable of discovering and manufacturing the most effective developments, projects and solutions for the community.

 

Key figures

  • Tobacco use is the second-leading cause of death in the world;
  • 65,000 children die each year from diseases attributable to second-hand smoke exposure;
  • 70-80% of heart attacks in under-50s are due to tobacco;
  • Tobacco is the leading risk factor of lung cancer. It is 10-15 times higher in smokers.

Source: WHO

 

World No Tobacco Day: a determined movement

The first World No Tobacco Day was held on 31 May 1987, and the event has taken place on the same date each year for the least 33 years. The WHO and its partners systematically use this opportunity to spread information and raise awareness of the multiple risks associated with tobacco use. After focusing on heart disease, lung disease and protecting young people from being manipulated by the tobacco industry, the theme for this year is  “Commit to quit!” In the run-up to the campaign, the WHO set a goal of helping 100 million smokers trying to quit. Under a support programme initiated in December 2020, it provides tools and resources aimed at helping them achieve their goal. In 2020, tobacco was the leading cause of death and debilitating illness around the world, with more than 10 million victims. As such, it was more lethal than AIDS, tuberculosis, maternal death, car accidents, suicide and homicide combined...

 


(1) “Secondhand smoke exposure and oral cancer risk : a systematic review and meta-analysis”, Tobacco Control/British Medical Journal (April 2021).

(2) “Global economic cost of smoking-attributable diseases”, Tobacco Control/British Medical Journal (January 2017).  

(3) “An enzymatic approach reverses nicotine dependence, decreases compulsive-like intake, and prevents relapse”, Science Advances (October 2018).