The Tobacco Endgame: Is It Possible?

May 31 is World No Tobacco Day 2015. The day raises an interesting question: is a tobacco endgame possible? The answer, of course, is “it depends.”However, the event provides a reflective opportunity to see just where we are in the extraordinary global battle against the world’s most important preventable health risk. A great deal is in fact happening in pursuit of the endgame, and these efforts are becoming very interesting indeed. As background, keep in mind these grim statistics: there are more than 1 billion smokers globally, tobacco kills about 6 million of them and their secondhand smoke (SHS)-exposed contacts a year, and, if unchecked, it will kill perhaps a billion people in the 21st century [1]. Could the endgame possibly be near? In 2012, Professor KenWarner assembled a group of tobacco control experts in Ann Arbor, Michigan, to discuss this endgame dream and what it would take to make it a reality [2]. The discussion was informed by two précis: that the status quo is unacceptable and that reducing smoking substantially will require something new, bold, and completely different from what is currently in place. In other words, what is being done at present, despite remarkable progress on many fronts, will not be enough to end the epidemic of tobacco-related diseases any time soon. Now, however, rather than thinking only about “tobacco control,” which implies that humanity should settle for the tobacco epidemic being permanent in some populations or at least at some lower hazard level overall [3], experts are discussing new strategies that are necessary to greatly reduce the global tobacco-related disease burden. These out-of-the box ideas include the following: removing the profit incentive from selling tobacco products by changing the ways in which the market is administered; reducing the level of addictive nicotine to nonaddicting levels in all tobacco products; addressing the supply side of tobacco use by imposing a “sinking lid” on the industry to gradually reduce quotas on sales and production of tobacco products, similar to proposed reductions on greenhouse gas production [4]; establishing truly smoke-free generations by prohibiting possession of tobacco products by all persons born in 2000 or later; and the heretofore unthinkable abolition of tobacco product manufacture and sale. At the same time, considerable global energy has developed around the world’s first multinational health treaty, implemented under the auspices of the World Health Organization (WHO): the Framework Convention on Tobacco Control (FCTC) [5]. This treaty has been in force for ten years and calls for signatory countries (currently 180) to enact science-based interventions to reduce tobacco use through the six components of the WHOMPOWER tobacco control rubric [6]: