Exploring vector space: overcoming resistance to direct control of the tobacco industry.

Within the epidemiological framework that describes the relationship of smokers (host), cigarettes (agent), tobacco companies (vector) and environment, both the agent and the vector are man-made and, in theory, controllable. Nonetheless, the smoking pandemic is expected to claim one billion lives in this century, even among people who are not yet born. With a preventable problem that is not being prevented, our disease strategy is arguably in need of a rethink. While health science has focused on establishing the link between tobacco products and the diseases they cause, treating those diseases, exploring ways to make cigarettes less harmful and ways to discourage tobacco use, relatively little health research has been focused on analysing the vector of the disease or how to change its course. This may explain why there is a global consensus to modify the behaviour of the host, environment and agent, but little pressure in support of vector control. Despite opposition to such supply-side approaches, 5 a number of new vector-related tobacco controlmeasures have been proposed. These include performance-based regulations, ending the manufacturer ’s obligation to increase or at least maintain shareholder value, regulating profits, banning some or all tobacco products or prohibiting use by some people, imposing targeted reductions on supply, 13 penalising manufacturers for youth smoking, forcing tobacco companies to internalise the costs of smoking through fees or liability, resisting the privatisation of state-owned tobacco companies and other strategies. None of these have yet been adopted into policy, except in Bhutan. A New Zealand legislative committee recently proposed ‘annually reducing (by a set percentage) the amount of imported tobacco, the number and quantity of tobacco products for sale at each outlet, and the number of retail outlets,’ but the official government response leaves open whether or how this might be accomplished. Exploratory research into resistance to supplyside tobacco control interventions suggests that existing mindsets may hinder the adoption of these measures, including the ‘ingrained, widespread and pervasive’ acceptance of free market thinking and a preference for change to be evolutionary or incremental. These mindsets may result from gaps in knowledge and experience that can be filled through specific actions by vector control proponents.