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By Shobha Shukla
According to the latest WHO Global TB Report 2025, released a week ago, tobacco smoking is among the top 5 risk factors for the deadliest of all infectious diseases worldwide, tuberculosis (TB). In countries with alarmingly high tobacco use, like Indonesia, tobacco use is the biggest risk factor for TB. Tobacco is also among the major common risk factors for a range of other non-infectious (or non-communicable) diseases, such as heart disease and stroke, cancer, diabetes, and chronic respiratory diseases, among others.
If we are to protect people from TB or other deadly diseases and avert untimely deaths, the writing on the wall is clear: end all forms of tobacco and nicotine use. If we can protect human beings and our planet from tobacco and nicotine, we will majorly help governments implement lifesaving health policies and address infectious and non-communicable diseases effectively. Holding the tobacco and nicotine industry liable for the deadly harm they are causing to human life and our planet remains critical, too.
No one should suffer or die from tobacco or nicotine use.
“Tobacco use is the single largest preventable cause of death globally. Over 8 million people die of tobacco use every year in the world. We can entirely prevent this manmade (or tobacco industry propelled) epidemic,” said Dr. Tara Singh Bam, a noted global health leader and tobacco control advocate. Dr. Bam serves as Asia Pacific Director (Tobacco Control) of Vital Strategies and Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT), and till recently led the International Union Against Tuberculosis and Lung Disease (The Union) in the Asia Pacific region.
Dr. Bam is right: The good news is that all 3 TB, nicotine, and tobacco are preventable. We need to support all tobacco and nicotine users and help them quit and become tobacco-free and nicotine-free and protect others from such deadly products. Additionally, we must ensure that everyone is protected from TB and that right and timely diagnosis, correct treatment, care, and support are accessible to all individuals with TB disease in a person-centered manner, said Dr. Bam.
TNT is explosive: Tobacco, Nicotine, and TB
Tobacco smoking increases the risk of developing TB, makes TB treatment less effective, and heightens the risk of many other deadly diseases, too.
Extensive scientific research underlines tobacco smoking’s substantial role in TB, amplifying the risk of infection, death, treatment relapse, heightened clinical severity, and delays in both diagnosis and treatment, said Dr. Bam. He was chairing an important hybrid session at the world’s largest lung health conference, formally known as the Union World Conference on Lung Health in Copenhagen, Denmark.
Delayed diagnosis and treatment also mean that the person with TB suffers more and has a higher risk of TB death while the infection spreads to potentially more people. All of this is so avoidable.
Tobacco use worsens TB outcomes, said Dr. Bam, while calling upon integrating smoke-free policies and tobacco and nicotine cessation efforts into TB programs.
Agrees Dr. Rakesh Gupta, Chairperson of the Tobacco Control section of The Union: There is enough robust scientific evidence to effectively integrate tobacco cessation in TB programs because it will yield very favorable public health outcomes, economic outcomes, and social welfare outcomes. Evidence is there. Time is to really transform the science and evidence into policy and policy into practice.
Nicotine has been proven to be as addictive as cocaine and heroin and could even be more addictive. There is no doubt that if we are to live our lives healthily, we need to stay tobacco-free and nicotine-free.
Dr. Rakesh Gupta recommended an evidence-based strategy that on every visit, a patient should be asked about tobacco use history, along with brief advice on quitting and cessation support as needed. He also recommended that we record this data (of tobacco use history) in TB treatment cards and registers.
We can prevent 15% of TB cases if we help people quit tobacco use.
“We can prevent 15% of the new TB cases if we stop tobacco smoking,” said Dr. Akihiro Ohkado, Head of the Department of Epidemiology and Clinical Research, Research Institute of TB, Japan Anti-TB Association, Japan. He reemphasized that tobacco smoking significantly contributes to TB diagnostic delays, decreases TB treatment success rates, and also increases the risk of TB release.
Tobacco use steals away the gains made in TB control. Likewise, tobacco and nicotine use are also threatening the gains made in addressing major killers like heart disease and stroke, cancer, diabetes, and chronic respiratory diseases, among others.
Passive tobacco smoking is dangerous too.
1 in 10 of tobacco-related deaths are due to passive tobacco smoking every year. Breathing must be smoke-free as a matter of human rights.
Dr. Tara Singh Bam also reminded the delegates of the world conference that, despite tobacco being a major risk factor for several lung diseases (like TB, asthma, and COPD, among others), it is not a major focus area of the world conference on lung health in Copenhagen.
Since TB patients are closely monitored by national TB programs for the duration of the treatment (6 months or more), it is an important opportunity to ensure they remain free of tobacco or nicotine use and alcohol use and to do active health promotion.
We cannot dislocate the #endTB goal from the SDGs
There are a lot of doable science and evidence-based actions that must be implemented locally. Some of these are – raising awareness about “saying no to all forms of tobacco and nicotine use”, screening people for both (tobacco use and TB), early and accurate TB detection and linkage to care, linking those with tobacco use to cessation services, treatment adherence support, ending all forms of TB related stigma, engaging TB survivors meaningfully to make a difference, implementing the full package of evidence-based tobacco control interventions recommended by the WHO (including raising taxes and smoke-free policies), ensuring that effective tobacco cessation services are functional across the healthcare facilities, and, most importantly, protecting public health from tobacco industry interference.
Tobacco industry interference in public health policy is the biggest obstacle to implementing tobacco control policies. That is why the legally binding global tobacco treaty, formally called the WHO Framework Convention on Tobacco Control, has an important Article 5.3 that was adopted by governments in 2008. The preamble of the WHO FCTC Article 5.3 clearly states to protect public health policy from tobacco industry interference because there is a direct and irreconcilable conflict of interest between the two. WHO FCTC Article 19 calls to hold tobacco industries liable for the harm they cause.
“Break the chain of TB transmission and protect all people from tobacco use,” emphasizes Dr. Bam.
Science has proven that it is critically important to screen everyone in high TB burden settings (not just those with symptoms) for TB with WHO-recommended tools and offer them upfront molecular testing and linkage to treatment, care, and support. Not doing so is among the factors responsible for decades of failure in TB response.
The same goes for tobacco control. No one needs to suffer from diseases caused by tobacco use or die from them. Not implementing tobacco control policies effectively and protecting everyone from tobacco use worldwide is another major failure.
