A public health milestone
In a cabinet meeting she warned that the 'increasing use of vapes among youth is a major health threat' and ordered provincial and district authorities to launch a province-wide crackdown on vape sales and use.
This decisive action, and a phenomenal step backed by a cabinet resolution, showcases strong political leadership on tobacco control. It represents a clear acknowledgment that new nicotine products are undermining youth health, and that urgent curbs are needed. This ban comes amid an explosion of vaping outlets in Pakistan's cities.
Researchers from the Sustainable Development Policy Institute, note that vape devices and nicotine pouches have 'made rapid ingress' in Pakistani society, making it mandatory for the government to ban all new nicotine products, including vapes, e-cigarettes, and nicotine pouches.
They are openly sold in corner stores, malls and specialty shops in major cities – Karachi, Lahore, Islamabad, Peshawar and Quetta – with no consistent enforcement of age limits. Health surveys find e-cigarettes sold 'to people of all ages in many stores and supermarkets across Pakistan's major cities'. Additionally, the flavors such as candy, chocolate, mango, and other fruity/minty flavors are specifically designed to entice children and youth towards addiction.
In Karachi alone, studies reported that roughly 68% of surveyed college students had tried vaping devices. Similarly, SDPI experts observed that cheap nicotine pouches are available in 'almost every convenience store' and dedicated vape bars, sheesha cafes and cigar lounges are targeting young, urban consumers.
The rapid spread of these outlets – often advertising vaping as a trendy or 'safer' alternative – confirms what doctors and NGOs have warned: without regulation, nicotine products will proliferate unchecked. Punjab's ban builds on earlier provincial efforts. In Khyber Pakhtunkhwa (KP), activists with the NGO Blue Veins and the KP Tobacco Control Cell raised the alarm when youth vaping soared. In January 2024, the KP government imposed a 60-day interim ban on e-cigarette storage, sale, and use that was extended multiple times before entering the process of becoming a provincial law.
The Deputy Commissioners were ordered to ban sales within 50 meters of schools and restrict sales to under-21. Civil society groups (Blue Veins, provincial doctors, the Alliance for Sustainable Tobacco Control) applauded the move as a 'significant victory' for health. They immediately pressed for extension and permanent legislation, pointing out that the ban had protected youth from 'addictive substances' and that comprehensive laws were needed for lasting impact. In Peshawar district, a wider local ban on vapes and nicotine pouches was announced under the 'Live Well' health initiative (Section 144) in mid-2024, prohibiting sales near hospitals and schools and to minors
These provincial actions – paralleled by spot enforcements by Lahore's own and the Federal Tobacco Control Cell – show a clear consensus at the local level that new nicotine products pose unacceptable risks. For example, Lahore authorities have recently inspected and sealed several vape shops, signaling that even the provincial capital recognizes the threat. Health experts have repeatedly sounded the warning about why these steps are needed. E-cigarettes and heated tobacco devices still contain highly addictive nicotine and toxic chemicals, contrary to industry claims of harmlessness. Tobacco control experts from around the globe at the World No-Tobacco Day emphasized that 'none' of the new nicotine products is safe. They noted that e-cigarettes, nicotine pouches, and heated tobacco cause damage not only to the lungs, but also to the cardiovascular, immune, renal, and nervous systems, with equal or more severe repressions replicating that of cigarettes.
In a similar event jointly organized by the SDPI and SPDC, the industry messaging was attributed to false claims of 'risk-free', 'stain-free', 'discreetness', or other children/youth enticing slogans, as a smoking cessation aid, but independent analyses show no evidence of any of these claims. As SDPI reports, the tobacco industry's 'harm reduction' narrative is a ploy to renormalize smoking and evade regulation and attract children and youth to new forms of addiction. The WHO has concluded there is 'insufficient independent evidence to support e-cigarettes as a smoking cessation intervention' and that these products are 'undoubtedly harmful'. Pakistani tobacco control experts point out that nicotine itself is a powerfully addictive drug – vaping can deliver even higher nicotine doses than cigarettes, and that cooling-toxins like formaldehyde, acetaldehyde and novel compounds (e.g., synthetic 'nicotinoids') have been found in e-liquids. The misleading rhetoric of 'harm reduction' by tobacco companies has been discredited by recent developments. Worldwide, governments are stepping in. SDPI notes that 'many countries across the globe have banned the sales and consumption of e-cigarettes'. This list includes dozens of nations from Australia, Brunei Darussalam, Singapore, and Saudi Arabia to Argentina, Bahrain, India, and Thailand.
Australia now classifies nicotine as 'hazardous poison' and a prescription-only medicine (as per Schedule 4 Poison) adults cannot legally buy nicotine vapes without a doctor's prescription. Singapore and Brunei Darussalam have strict prohibitions on any vaping products for consumers. Even the European Union has seen bans: Belgium and France prohibit disposable vapes, and France has just outlawed nicotine pouches (finding 131 poisonings in 2022 alone)
Alarmingly, French regulators recently discovered a new synthetic nicotine analog (6-methyl-nicotine, or 'Metatin') in some e-cigarette cartridges. Previous studies suggest this compound may be three times more addictive than regular nicotine and even more toxic to lung tissue. The French anti-smoking group CNCT has sued a vape company over this finding and is calling for a ban on all untested nicotine analogs.
These global examples underline that nicotine-delivery devices are inherently dangerous and evolving; a free market approach risks allowing unknown toxins to spread. Importantly, many Pakistani experts and advocates have long argued that such bans are necessary. Think-tanks and NGOs, including the Sustainable Development Policy Institute (SDPI), have been producing evidence and policy briefs on e-cigarettes for years. In SDPI's 2022 analysis, researchers warned that novel products were filling a regulatory vacuum in Pakistan: 'In the absence of a distinct policy, these products are spreading across the length and breadth of the country.' They explicitly called for urgent discussion and policy development to curb e-cigarettes and heated tobacco. Similarly, public health seminars (like the recent events organized by all tobacco control organizations on World No Tobacco Day), brought together doctors and civil society to demand immediate bans on vapes, e-cigarettes, and nicotine pouches, besides the implementation of high taxes on cigarettes to reduce consumption.
Conclusively, both research institutions and practicing clinicians in Pakistan recognize that novel nicotine products, including vapes, e-cigarettes, heated tobacco products, and nicotine pouches, are undermining decades of tobacco control. Punjab's ban is an important breakthrough, but it also highlights a crucial gap: the lack of a national law banning vaping and nicotine pouches. Currently, at the federal level, there is no blanket ban; vapes are illegally sold nationwide as an 'accessible choice for adults'.
The tobacco control advocates in Pakistan urge federal and provincial policymakers to seize this momentum. The Punjab cabinet has shown the way by treating nicotine and vaping as a public health emergency. Now Pakistan's National Command and Operation Centre, Federal Tobacco Control Cell, and parliament should enact a permanent, harmonized ban on vapes and nicotine pouches. Such a law should match Punjab's and KP's provisions, and also address internet and import channels.
This national prohibition would fulfill our commitments under WHO Framework convention on Tobacco Control (FCTC), and demonstrate that Pakistan prioritizes youth health over the tobacco industry's profits. Combined with enforcement and public awareness, a countrywide ban would ensure that the gains made in Punjab (and earlier in KP) protect all Pakistani children and youth. Punjab e-cigarette ban is a milestone won by evidence-based advocacy and leadership. Now is the time to translate this province-wide victory into a federal policy – banning vaping products everywhere in Pakistan. The scientific evidence, global experience, and local advocacy all point the same way: vapes and nicotine pouches are not safe or beneficial, and must be removed from our markets. A unified national ban, supported by enforcement and education, is the logical next step to secure the health of our nation's youth and uphold Pakistan's tobacco control goals.
(The writer is a Senior Research Associate at Sustainable Development Policy Institute)
Copyright Business Recorder, 2025
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Business Recorder
16 hours ago
- Business Recorder
Highnoon Laboratories, Beximco Pharmaceuticals partner to help transform healthcare in Pakistan
Highnoon Laboratories Limited has announced a partnership with Beximco Pharmaceuticals Limited, a pharmaceutical manufacturer based in Bangladesh, stating that the alliance marked a milestone in Highnoon's international expansion strategy, aimed at bringing advanced technologies, therapies, and novel dosage forms to the Pakistani market. Both companies are listed on the stock exchanges in their respective countries. The memorandum of understanding (MoU) was signed at Beximco's headquarters in Dhaka by Dr Adeel Abbas, Co-Chairman & CEO of Highnoon Laboratories Limited, and Mr Rabbur Reza, Chief Operating Officer of Beximco Pharmaceuticals Limited. The partnership will focus on the distribution, marketing, and sales of specialiased pharmaceutical products in Pakistan, with an emphasis on respiratory, diabetes, and cardiovascular therapeutic segments. The collaboration is designed to strengthen Highnoon's portfolio in these high-impact areas, providing a competitive edge through innovative drug delivery systems and clinical advancements, according to the company. Highnoon is listed on the Pakistan Stock Exchange. With cGMP- compliant manufacturing capabilities and a diverse product portfolio across major therapeutic areas, the company continues to position itself as a trusted healthcare partner, both locally and internationally. The collaboration also reflects the strengthening economic ties between Pakistan and Bangladesh, reinforcing a shared vision for regional cooperation in healthcare and trade.
Business Recorder
a day ago
- Business Recorder
Aseefa for united action to prevent breast cancer
ISLAMABAD: First Lady Aseefa Bhutto Zardari has called for united action — involving government institutions, health professionals, media, and communities — to raise awareness to combat breast cancer, the most common cancer among women in Pakistan and the highest in prevalence in Asia. She made these remarks during a meeting with Omer Aftab, Founder and Honorary CEO of Pink Ribbon Pakistan, at Aiwan-e-Sadr Wednesday. Highlighting that one in every nine Pakistani women is at risk, the First Lady warned that delayed detection claimed thousands of lives annually. She noted that survival rates exceeded 90 percent when the disease was diagnosed early and stressed that 'every woman, regardless of where she lives, must have access to timely screening, diagnosis, and treatment.' Aseefa Bhutto Zardari emphasized making women's health a national priority, with targeted efforts on prevention, early detection, and treatment. She called for expanding breast cancer facilities to underserved rural areas, breaking cultural taboos that delay consultations, and promoting mobile mammography units, community outreach, and male family involvement to overcome stigma. She urged all stakeholders — including the media, educators, and religious leaders — to spearhead a nationwide awareness drive, encouraging early detection and timely medical intervention. Commending Pink Ribbon Pakistan for its awareness and screening initiatives, the First Lady lauded its efforts to establish the country's first dedicated Breast Cancer Hospital.
Express Tribune
4 days ago
- Express Tribune
When the body turns on itself
When 28-year-old Sana began to lose clumps of hair and to wake up with stiff, painful joints in her right hand, she told herself it was nothing but stress. Six months later, a rash across her cheeks flared and she developed breathlessness. Multiple doctors offered inhalers, creams, or reassurance that it would go away. It was only after a referral to a tertiary hospital that blood tests and specialist review produced a diagnosis. She had systemic lupus erythematosus (SLE), an autoimmune disease in which the body's own immune system attacks skin, joints, kidneys, and other organs. Sana's story is far from unique. In Pakistan, a growing body of clinical research, hospital case series, and on-the-ground testimony from physicians and patients points to two linked truths that autoimmune diseases are not rare, and they are frequently missed, misdiagnosed, or diagnosed late, often with high financial and health costs for patients and families. Unlike Sana, many children are born with eczema and other skin diseases, and the cure is nowhere to be found. 'When my baby was born, he had no problem, but within a few weeks, he developed several allergies and acne on his face, which kept spreading all over his body,' shared Azra Ramsha, adding that after a few weeks of discomfort, she decided to consult a dermatologist because the rashes were not getting any better. Ramsha faced the same issue with both of her daughters and today lives a lifestyle that requires shampoos, face wash, lotions, and many other expensive creams to prevent the rash from flaring up and causing pain to her 5 and 7-year-old daughters. What are autoimmune diseases? Autoimmune diseases occur when the immune system, whose primary function is to defend the body against diseases, mistakenly targets healthy tissues. The spectrum is wide for it, as some are organ-specific, for example, type 1 diabetes targets insulin-producing pancreatic cells, while others are systemic, for example, rheumatoid arthritis RA and lupus, and can affect multiple organs. Globally, estimates suggest 5–10% of the population may be affected by one of the 80–100 recognised autoimmune conditions; women are disproportionately affected, making up roughly 4 of every 5 cases for some diseases. While some autoimmune disorders are chronic but stable with treatment but others, left untreated, cause irreversible organ damage, disability, or life-threatening complications. Early recognition, specialist referral, and access to appropriate immunomodulatory therapy can substantially change outcomes. Delayed diagnosis often increases the risk of permanent damage. The Pakistani dilemma Pakistan lacks a single national registry for autoimmune disease, and comprehensive population studies are few. Nonetheless, hospital-based studies, specialist surveys, and international reports that include Pakistani cohorts paint a worrying picture. Rheumatoid arthritis (RA) prevalence in Pakistan is estimated at around 0.5% of the population in some studies, comparable to or slightly lower than global figures, but still representing hundreds of thousands of people. On the other hand, Type 1 diabetes and other autoimmune issues are increasingly reported in the younger generation. Screening studies in Pakistani diabetes clinics have found significant rates of additional autoimmune disorders in people with type 1 diabetes. Autoimmune liver diseases and autoimmune hepatitis have been diagnosed in tertiary hospitals in Pakistan. While uncommon, they require specialised testing and early immunosuppression to avoid progression to cirrhosis. Perhaps the most shocking statistic comes from workforce data, published international reporting, and Pakistan-focused pieces which estimate that there are only a few dozen trained rheumatologists in the country. One article cited roughly 24 practitioners, an alarming, inadequate number given Pakistan's population and the burden of rheumatic and autoimmune disease. That imbalance compounds diagnostic delay and limits ongoing specialist care. Sana, a primary school teacher from Lahore, first noticed hair loss and fatigue. Her family doctor treated it as chronic stress and prescribed vitamins. When a facial rash appeared and she began to have joint pain, she visited multiple clinics. Blood tests at a public hospital finally revealed positive ANA and anti-dsDNA antibodies; a nephrology workup then showed early kidney involvement. 'By the time I reached a rheumatologist, I had already lost good weeks of treatment,' she said, adding that early immunosuppression led to further kidney damage, but the delay increased anxiety, medical costs, and the issue of time away from work. Farzana, in her early twenties, developed persistent joint swelling and morning stiffness. Family members advised time, rest, and local remedies. Tests ordered only after the pain became disabling showed elevated inflammatory markers and anti-CCP antibodies. A Pakistani study looking at diagnostic delay in RA patients reported median delays measured in months to years; practitioners point to cultural attitudes that normalise pain and to lack of specialist access as major causes. With early DMARD (disease-modifying antirheumatic drugs) therapy, Farzana's disease was controlled, but many patients in less fortunate circumstances continue to deteriorate. Bilal was diagnosed with type 1 diabetes at age 12. Routine screening later revealed hypothyroidism due to autoimmune thyroiditis, a familiar pattern in pediatric diabetes clinics in Pakistan. 'No one realised until I fainted in school one day, because having diabetes as young as 12 is something no one can accept in my family,' Bilal shared, adding that he and his family had a history of diabetes, but even then, no one bothered to get it checked earlier. Structural and cultural causes Several overlapping factors explain why autoimmune diseases are under-recognised in Pakistan, such as a limited specialist workforce and diagnostic capacity. With very few rheumatologists and constrained laboratory services in many districts, patients are often managed for months or years by general practitioners without specialist tests (e.g., autoantibody panels). Studies documenting diagnostic delays and reports from clinicians confirm this bottleneck. Many autoimmune disorders begin with fatigue, body aches, or intermittent rash symptoms commonly attributed to stress, ageing, or infection. 'Cultural tendencies to downplay pain or to seek traditional remedies can delay biomedical evaluation,' shared Shahmeer Ahsan, practicing dermatologist, adding that most of the time patients come to them is after wasting years in general physician clinics. Infectious diseases, maternal health, and non-communicable disease programmes (diabetes, cardiovascular disease) receive the bulk of public health attention, but autoimmune conditions sit between specialties and lack targeted national programmes or surveillance. 'Testing for autoantibodies, imaging, and specialist visits are expensive for many families. Travel to tertiary centres concentrates care in large cities, leaving rural populations underserved,' Ahsan shares. A cross-sectional study of diabetic patients in Rawalpindi highlighted financial strain and treatment compliance challenges that echo across chronic disease care. Diagnosing autoimmune disease requires a combination of clinical and targeted testing. Careful history and examination to detect patterns (e.g., inflammatory joint pain, photosensitive rash, sicca symptoms of dryness). 'Not everything is an infection and not every rash is eczema, it has types and kinds,' Ahsan explained, adding that patients take everything as the same and mostly follow the layman's word and not believe the doctors. Multiple studies in Pakistani hospitals highlight that delays at each step from GP visit to specialist referral to confirmatory testing are common. One Pakistan study of rheumatology clinic patients found that only about a fifth are presented to a rheumatologist within 12 weeks of symptom onset; such delays can close the window of opportunity for optimal response to therapy in conditions like early RA. Manageable, not curable For most autoimmune diseases, there is no cure; the goal of therapy is to control immune activity, prevent organ damage, and maintain quality of life. Therapeutic tools include symptomatic agents such as NSAIDs, analgesics, and short courses of corticosteroids for flares. Conventional DMARDs and immunosuppressants for severe disease, biologic agents, and targeted therapies are also highly effective in many cases but costly and often unavailable in public hospitals. In Pakistan, clinicians say the cost and supply of biologics and long-term immunosuppressants remain serious barriers for many patients. Even when drugs exist in the market, affordability and monitoring for infection risk, blood counts, and liver function add complexity. 'We have a huge mismatch between burden and workforce,' says a rheumatologist involved in training programmes that are slowly expanding rheumatology capacity. A profile of rheumatology in Pakistan noted fewer than three dozen trained specialists caring for millions of people, a situation that extends waiting lists and delays care. Clinicians in tertiary hospitals report that late presentations, for example, patients coming with already advanced lupus nephritis or erosive RA, are common and that psychosocial consequences job loss, family stress, and depression, are underappreciated. A Pakistani study showed depression was overlooked in nearly half of RA patients in some tertiary settings, arguing for integrated mental-health screening in chronic autoimmune care. The rheumatologist also calls for education of general practitioners, scaled-up diagnostics in district hospitals, and the establishment of referral pathways so patients are seen by rheumatology, endocrinology, hepatology, or neurology teams when appropriate. Exact national economic figures for autoimmune disease in Pakistan do not yet exist, but international analyses show chronic autoimmune conditions carry high lifetime costs due to medications, hospitalisations, lost productivity, and disability. In low and middle-income settings, out-of-pocket costs and the absence of social safety nets often push families into financial distress. Local cross-sectional research among diabetic patients demonstrates how treatment costs and compliance challenges interact in a pattern likely mirrored across autoimmune care. Experts and clinicians interviewed suggested scaling up training and the workforce, expanding rheumatology, clinical immunology, and allied specialty training programmes, leveraging telemedicine, and visiting specialist clinics for rural districts. 'Developing short symptom-recognition toolkits for family physicians and medical officers, and creating clear referral pathways to specialists, can help in coping with the menace,' Ahsan suggests. He also suggested that we subsidise core autoantibody testing and inflammatory markers at district hospitals, and develop regional labs to reduce travel and delay can help. Other than that he also proposed that public awareness campaigns, symptom checklists, when to seek care and establish patient support organisations in major cities to reduce stigma and improve self-management. While creating a national registry for autoimmune diseases and standardising case reporting across tertiary hospitals to inform policy and resource allocation. Where early recognition and coordinated care exist, outcomes improve. In tertiary centres across Pakistan, multidisciplinary clinics that combine rheumatology, nephrology, and dermatology have demonstrated better monitoring and faster initiation of disease-modifying therapy for conditions like lupus. Specialist training programmes often run with international partners are producing the next generation of clinicians. But scaling these pilots into nationwide systems will require political will, financing, and public engagement. Bringing it out of the shadows Autoimmune diseases are not exotic rarities; they are chronic, often disabling conditions that affect tens or hundreds of thousands of Pakistanis. Yet the current system too often allows these disorders to fester undetected until organ damage or functional loss becomes evident. What Sana, Farzana, and Bilal's lives experienced makes clear is that early recognition makes a difference, it saves function, reduces long-term cost, and preserves quality of life. To achieve that in Pakistan will take better data, wider public understanding, stronger primary care, more specialists, and fairer access to diagnostics and medicines. This is a public-health and human-rights issue as much as a clinical one. As clinicians and patient advocates here say, it's time to move autoimmune diseases from the clinic's margins into mainstream health planning before the next set of patients lose precious months or years to diagnostic delay.
