Features
Lady Ridgeway Hospital: A haven for sick children in Sri Lanka
125 YEAR BIRTH ANNIVERSARY:
By Dr. B. J. C. Perera
Specialist Consultant Paediatrician
I wrote an article in The Island newspaper, under the aforesaid title, 12 years ago, on Monday 09th June 2008. I have retained that title but content of this article is different. It’s worth looking at this hospital from a more current perspective particularly since the Lady Ridgeway Hospital for Children (LRH) is celebrating its 125-year jubilee in October 2020.
The LRH had very humble beginnings. At the outset, 125 years ago, it was constructed from public donations; rupees 46,000/- to be exact, as a small 50 bedded hospital. Lo and behold, today, this magnificent edifice, with over 1,000 beds, is the largest children’s hospital in the world, I repeat, in the whole world. It has stood the test of time as the final port of call and a veritable haven for sick children of our homeland. It is the National Referral Centre for this entire nation. The hospital functions sans any and every mundane consideration such as ethnicity, caste, creed and wealth of children who are brought there. This glorious medical facility is one that is solely devoted to sick children. If there is anything fanciful that is needed to be done in Sri Lanka for a sick child, it could be done in this hospital. It now caters to every type of malady that affects children. You name any specialty for the care of a sick child; it is available here. Everything is provided entirely free-of-charge and it is the crowning glory and the feather in the cap of the paediatric component of our Free National Health Service, the pride of Sri Lanka.
To date, I have been a doctor for exactly 50 years and a Specialist Consultant Paediatrician for 42 years. Out of that long period of half a century of service to the nation, I have spent 16 years in the hospitals of Kandy, Badulla, Ratnapura, Kurunegala and Kalubowila. Compared to that, and in contrast, I have worked in the Lady Ridgeway Hospital, in different capacities, for a total of 17 years. My service at LRH culminated with my retirement from the Ministry of Health in 2007. In lighter vein, I have been properly ‘themparadufied’ in our health sector, both public and private. I have most definitely, seen it all.
Those really were the days, around half a century ago, when during my medical student apprenticeship and internship, I saw how Mother Nature used to take the lives of our children with all kinds of infectious diseases. The wards at LRH were full with cases of meningitis, pneumonia, whooping cough, diphtheria, polio, diarrhoea, dysentery, cholera, measles, tetanus, tuberculosis, chicken pox, hepatitis, amoebiasis and even rabies. In fact, this is a list of just only a few of them. Add to it, the ravages of under-nutrition leading to marasmus and kwashiorkor, extensive vitamin and micronutrient deficiencies and major uncorrectible congenital heart abnormalities, and what did we have? A hospital bursting at its seams with sick children. It was practically a place that spelt out the real meaning of human susceptibility to disease and even mortality. During certain times it was indeed a bit of a hell on earth. The deaths were totalling up to some very significant numbers. By today’s standards, they had very few things they could do for intractable heart failure, liver failure and kidney failure. All types of paediatric malignancies and cancers were practically untreatable. The doctors and Specialist Consultants, as well as all other grades of staff of yore fought as hard as ever, tooth and nail, to save all those severely ill children who were brought to the LRH. However, most unfortunately and ever so very often, to no avail whatsoever. The dice was dreadfully loaded against those unfortunate children, as well as against the healthcare workers who had to look after them. In those halcyon days, each ward had a Consultant, a Senior House Officer and just two interns; a totally inadequate number of medical personnel to cater to the intense daily needs. Work was absolutely horrendous. It was not unusual to see many dead bodies of ill-fated children being wheeled out of the wards regularly, day in and day out. It was such a distressing and depressing landscape. There was hardly any light at the end of the tunnel. Yet for all that, the staff fought on bravely and relentlessly to save the precious lives of little children. To their eternal credit, they managed to save quite a few of the very seriously ill ones too.
Then, over many a decade, especially over the last few of them, the tide gradually turned. Successful vaccination almost totally removed some of the deaths and disabilities caused by a plethora of nasty infections. Many medical advances provided ways and means of dealing with former killer diseases. Improvements in heart surgery made it possible to treat at least a majority of congenital heart defects. When I finally reached the out-and-out hub of Paediatrics, which LRH was, in 1995, as a Specialist Consultant in charge of a unit, just about 25 years after my own internship at LRH, the scenery and settings had changed so much and well beyond belief that it was almost unrecognisable. In my ward I even had the absolute luxury of the services of a Senior Registrar, one who just needed two further years of training abroad before becoming a Consultant, four Postgraduate Registrars waiting to sit for the Final MD in Paediatrics Examination and four intern house physicians. The academic level of all those individuals who cared for my patients was absolutely top-class. They were right up-to-date in the sphere of scholarly paediatrics. They were all very fine and dedicated young doctors who would never ever allow a child to die without a steadfast and committed fight.
The advances in surgery were almost unbelievable. To top it all, around the time that I finally reached LRH as a Specialist Consultant, we had the services of several very fine Paediatric Surgeons whose handiwork in the Operating Theatres were almost too good to be true. Some of the recoveries from incredible surgical tragedies were really like those from the pages of volume of fiction. They were the work of gifted artists who wielded the scalpel with telling effect. One little anecdote that comes to mind is the surgical prowess of one particular general surgeon in lung operations. He was, and still is, quite a maestro at it. In those days that I was in charge of a unit, because of my personal interest in childhood respiratory disorders, we used to get quite a number of children with major lung problems which sometimes needed expert surgery. The usual practice was to send them off to the Colombo General Hospital Thoracic Unit for surgery. Lung surgery in children is a very tricky business. Things could go wrong at the drop of a hat. I somehow got to know that this particular young surgeon at LRH was so very good at it and I used to plead with him to get the surgery done at LRH itself. I used to say “Aney, please, please, PLEASE.., do it for me as a personal favour”. The very fine man that he was, and still is for that matter, he never ever refused. He has surgically taken off lobes of lungs and even the whole lung sometimes of my ill patients. True to life, those children recovered without any problems in about a week to 10 days. We never had even a single death after extensive lung surgery. They went home to a normal fruitful life and an entirely normal life-span. Just for the record, one could remove a major portion of the two lungs and still be able to lead a normal life with even a well-functioning half a lung. When I used to thank the surgeon profusely for doing it for me, he used to just smile and even feel a bit embarrassed.
It was all in a day’s work for him but for us, it was an absolute life-saver for our patients. In fact, that surgeon is still in active service at LRH. That is the quality of the Paediatric Surgeons that we have even today, with no exceptions whatsoever. Their commitment is truly wonderful. They will not let an unfortunate child suffer unnecessarily. They will fight on with every available means, daytime as well as well into the middle of the night, to save the lives of children to whom they had practically committed their professional lives. I have seen with my own eyes, these surgical colleagues leaving their families and their own little children at home to come to LRH in the middle of the night to perform life-saving surgical operations on our little patients.
Now, fast forward to 2020!!!! After my retirement in 2007, I now work only in the Private Sector and there are several instances where I have had to send patients to LRH for further investigation and treatment. One particular little tale comes to mind rather forcefully. A frantic mother of one of my regular patients telephoned me around mid-day, just about a couple of weeks ago because her little pre-schooler had taken an overdose of some medicines. My immediate advice over the phone was “please do not take the child anywhere other than to LRH. Do not go to any other place but rush him to LRH. Do not even bring him to me. I am just asking you to take the child to the very best place in the whole island”. They rushed him there and the staff attended to him pronto. He had what we call a stomach-wash performed on him, then they instilled some activated charcoal into the stomach, did some baseline blood tests and kept him in the ward. He did not turn even a hair and recovered within a couple of days. Incidentally, I think the mother threw my name around a bit and when the Consultant of the ward got to know, he had said “I trained under Dr BJC and we have done exactly what he would have done in the circumstances”. He was one of my Postgraduate Registrars and it was extremely nice of him to say those things. Of course, the mother and the relatives of the child were ever so pleased.
There were many other patients whom I had sent to LRH over several years and I have always asked them how it was at LRH when they came to me again. Every single time the mothers have said “It was a bit inconvenient for us but the child got star-class treatment and that really is what matters” or something basically to that effect. It has always warmed the cockles of my heart to hear such complimentary statements. My heart and soul have always been with LRH and anything unsavoury and disparaging said about that hospital would really hurt me to the core. We did care so much for the little children admitted under us and it is so good to see that those who have come after us do care as much, and are dedicated to the cause of providing the very best possible care for the patients as well.
Well, the Lady Ridgeway Hospital for Children, the mother of all hospitals in our resplendent isle, is 125 years old. If walls could talk, the walls of LRH would have all kinds of stories to tell. She would say how she had seen the worst of many diseases that affected children and also how things have changed over a century and a quarter of her existence. She would have a perpetual smile on her face in view of the progress achieved in caring for sick children, especially over the last few decades.
The lady needs to be feted and acclaimed on her 125th Birth Anniversary. The administrative staff, the doctors and all other grades of workers of LRH have planned a fitting celebration for her on the 01st of October 2020. In a glittering ceremony due to be graced by Prime Minister Mahinda Rajapaksa and Minister of Health of Sri Lanka Pavithra Wanniarachchi MP; they will acknowledge the priceless role played by LRH towards the healthcare of Sri Lankan Children. The ceremony will include the laying of the foundation stone for a new nine-storey building, opening of the new bone marrow transplant unit, opening of the new Operation Theatre Complex, official issuing of the hospital logo, formal release of the hospital song written by Dr. Rathnasri Wijesinghe with music compiled by Dr. Rohana Weerasinghe, and the commissioning of the new website for the hospital. These latest developments would help to make an excellent place for sick children, even a little bit of a better place for them.
All these would be a fitting and splendid accolade to an illustrious medical facility that is absolutely like no other. May she go from strength to strength and continue to be a dazzling beacon of excellence in healthcare for our children in this Pearl of the Indian Ocean.
Viva Lady Ridgeway Hospital, please do take a bow on your 125-year Birth Anniversary. It is the very least you so richly deserve, for the commitment that you have shown for the sick children of our beautiful Motherland. You are indeed a majestic haven of excellence for them.
Features
NASA’s Epic Flight, Trump’s Epic Fumble and Asian Dilemmas
Three hours after the spectacular Artemis II flight launch in Florida, US President Donald Trump delivered a forlorn speech from Washington. Thirty three days after starting the war against Iran as Epic Fury, the President demonstrated on national and global televisions the Epic Fumble he has made out of his Middle East ‘excursion’. It was an April Fool’s Day speech, 20 minutes of incoherent rambling with the President looking bored, confused, disengaged and dispirited. He left no one wiser about what will come next, let alone what he might do next.
There was more to April Fool’s Day this year in that it brought out the nation’s good, bad and the ugly, all in a day’s swoop. The good was the Artemis II flight carrying astronauts farther from the Earth’s orbit and closer to the moon for the first time in over 50 years. The mission is a precursor for future flights and will test the performance of a new spacecraft, gather new understanding of human conditioning, and extend the boundaries of lunar science. It is a testament to humankind being able to make steady progress in science and technology at one end of a hopelessly uneven world, while poverty, bigotry and belligerence simmer violently at the other end.
Terrible Trump
The four Artemis II astronauts, three Americans, Reid Wiseman, Victor Glover, and Christina Koch, and one Canadian, Jeremy Hansen, are also symptomatic of the endurance of America’s inclusive goodness in spite of efforts by the Trump Administration to snuff the nation’s fledgling DEI (Diversity, Equity and Inclusion) ethos. To wit, of the four astronauts, Victor Glover, a Caribbean American, is the first person of colour, Christina Koch the first woman, and Jeremy Hansen of Canada the first non-American – to fly this far beyond the earth’s orbit. All in spite of Trump’s watch.
Yet Trump managed to showcase his commitment to America’s ugliness, on the same day, by presenting himself at the Supreme Court hearing on the constitutionality of his most abominable Executive Order – to stop the American tradition of birthright citizenship. He keeps posting that America is Stupid in being the only country in the world that grants citizenship at birth to everyone born in America, regardless of the status of their parents, except the children of foreign diplomats or members of an occupying enemy force. In fact, there are 32 other countries in the world that grant birthright citizenship, a majority of them in the Americas indicating the continent’s history as a magnet for migrants ever since Christopher Columbus discovered it for the rest of the world.
And birthright citizenship in the US is enshrined in the constitution by the 14th Amendment, supplemented by subsequent legislation and reinforced by a century and a half of case law. Trump wants to reverse that. Thus far and no further was the message from the court at the hearing. A decision is expected in June and the legal betting is whether it would be a 7-2 or 8-1 rebuke for Trump. In a telling exchange during the hearing, when the government’s Solicitor General John Sauer quite sillily dramatized that “we’re in new world now … where eight billion people are one plane ride way from having a child who’s a US citizen,” Chief Justice John Roberts quietly dismissed him: “Well, it’s a new world. It’s the same Constitution!”
Trump’s terrible ‘bad’ is of course the war that he started in the Middle East and doesn’t know how to end it. Margaret MacMillan, acclaimed World War I historian and a great grand daughter of World War I British Prime Minister Lloyd George from Wales, has compared Trump’s current war to the origins of the First World War. Just as in 1914, small Serbia had pulled the bigger Russia into a war that was not in Russia’s interest, so too have Netanyahu and Israel have pulled Trump and America into the current war against Iran. World War I that started in August, 2014 was expected to be over before Christmas, but it went on till November, 2018. Weak leaders start wars, says MacMillan, but “they don’t have a clear idea of how they are going to end.”
There are also geopolitical and national-political differences between the 1910s and 2020s. America’s traditional allies have steadfastly refused to join Trump’s war. And Trump is under immense pressure at home not to extend the war. This is one American war that has been unpopular from day one. The cost of military operations at as high as two billion dollars a day is anathema to the people who are aggravated by rising prices directly because of the war. Trump’s own mental acuity and the abilities of his cabinet Secretaries are openly under question. There are swirling allegations of military contract profiteering and selective defense investments – one involving Secretary of War Pete Hegseth.
Trump’s Administration is coming apart with sharp internal divisions over the war and government paralysis on domestic matters. There are growing signs of disarray – with Trump firing his Attorney General for not being effective prosecuting his political enemies and Secretary Hegseth ordering early retirement for Army Chief of Staff Randy George. In America’s non-parliamentary presidential system, Trump is allowed to run his own forum where he lies daily without instant challenger or contradiction, and it is impossible to get rid of his government by that simple device called no confidence motion.
Asian Dilemmas
Howsoever the current will last or end, what is clear is that its economic consequences are not going to disappear soon. Iran’s choke on the Strait of Hormuz has affected not only the supply and prices of oil and natural gas but a family of other products from fertilizers to medicines to semiconductors. The barrel price of oil has risen from $70 before the war to over $100 now. After Trump’s speech on April 1, oil prices rose and stock prices fell. The higher prices have come to stay and even if they start going down they are not likely to go down to prewar levels.
There are warnings that with high prices, low growth and unemployment, the global economy is believed to be in for a stagflation shock like in the 1970s. Even if the war were to end sooner than a lot later, the economic setbacks will not be reversed easily or quickly. Supplies alone will take time to get back into routine, and it will even take longer time for production in the Gulf countries to get back to speed. Not only imports, but even export trading and exports to Middle East countries will be impacted. The future of South Asians employed in the Middle East is also at stake.
In 1980, President Carter floated the Carter Doctrine that the US would use military force to ensure the free flow of oil through the Strait of Hormuz. Trump is now upending that doctrine – first by misusing America’s military force against Iran and provoking the strait’s closure, and then claiming that keeping the strait open is not America’s business. Ever selfish and transactional, Trump’s argument is that America is now a net exporter of oil and is no longer dependent on Middle East oil.
To fill in the void, and perhaps responding to Trump’s call to “build up some delayed courage,” UK has hosted a virtual meeting of about 40 countries to discuss modalities for reopening the Strait of Hormuz. US was not one of them. While Downing Street has not released a full list of attendees, European countries, some Gulf countries, Canada, Australia, Japan and India reportedly attended the meeting. Which other Asian countries attended the meeting is not known.
British Foreign Secretary Yvette Cooper has blamed Iran for “hijacking” an international shipping route to “hold the global economy hostage,” while insisting that the British initiative is “not based on any other country’s priority or anything in terms of the US or other countries”. French President Emmanuel Macron now visiting South Korea has emphasized any resolution “can only be done in concert with Iran. So, first and foremost, there must be a ceasefire and a resumption of negotiations.”
Prior to the British initiative focussed on the Strait of Hormuz, Egypt, Pakistan and Türkiye have been playing a backdoor intermediary role to facilitate communications between the US and Iran. Trump as usual magnified this backroom channel as serious talks initiated by Iran’s ‘new regime’, and Trump’s claims were promptly rejected by Iran. There were speculations that Pakistan would host a direct meeting between US Vice President JD Vance and an Iranian representative in Islamabad. So far, only the foreign ministers of Egypt, Pakistan, Saudi Arabia and Türkiye have met in Islamabad, and Pakistan’s Foreign Minister Ishaq Dar flew to Beijing to brief his Chinese counterpart, Wang Yi, of Pakistan’s diplomatic efforts.
The Beijing visit produced a five-point initiative calling for a ceasefire, the opening of the Strait of Hormuz and diplomacy instead of escalation. The five-point pathway seems a follow up to the 15-point demand that the US sent to Iran through the three Samaritan intermediaries which Iran rejected as they did not include any of Iran’s priorities. The state of these mediating efforts are now unclear after President Trump’s April Fool’s Day rambling. In fairness, Pakistan’s Ministry of Foreign Affairs has announced that his country intends to keep ‘nudging’ the US and Iran towards resuming negotiations and ending the war.
While these efforts are welcome and deserve everyone’s best wishes, they have also led to what BBC has called the “chatter in Delhi” – “is India being sidelined” by Pakistan’s intermediary efforts? Indian Foreign Minister Jaishankar’s rather undiplomatic characterization of Pakistan’s role as “dalali” (brokerage) provoked immediate denunciation in Islamabad, while Indian opposition parties are blaming the Modi Government’s foreign policy stances as an “embarrassment” to India’s stature.
The larger view is that while it is Asia that is most impacted by the closure of Hormuz, with Singapore’s Foreign Affairs Minister Vivian Balakrishnan calling it an “Asian crisis”, Asia has no leverage in the matter and Asian countries have to make special arrangements with Iran to let their ships navigate through the Strait of Hormuz. There is no pathway for co-ordinated action. China is still significant but not consequentially effective. India’s all-alignment foreign policy has made it less significant and more vulnerable in the current crisis. And Pakistan has opened a third dimension to Asia’s dilemmas.
In the circumstances, it is fair to say that Sri Lanka is the most politically stable country among its South Asian neighbours. Put another way, Sri Lanka has a remarkably consensual and uncontentious government in comparison to the old governments in India and Pakistan, and even the new government in Bangladesh. But that may not be saying much unless the NPP government proves itself to be sufficiently competent, and uses the political stability and the general goodwill it is still enjoying, to put the country’s economic department in order. More on that later.
by Rajan Philips
Features
Ranjith Siyambalapitiya turns custodian of a rare living collection
From Parliament to Fruit Grove:
After more than two decades in politics, rising to the positions of Cabinet Minister and Deputy Speaker of Parliament, Ranjith Siyambalapitiya has turned his attention to a markedly different arena — one far removed from parliamentary debate and political intrigue.
Today, Siyambalapitiya spends much of his time tending to a sprawling 15-acre home garden at Vendala in Karawanella, near Ruwanwella, nurturing what has gradually evolved into one of the most remarkable private fruit collections in the country.
Situated in Sri Lanka’s Wet Zone Low Country agro-ecological region (WL2), Ruwanwella lies at an elevation of roughly 100–200 metres above sea level. Deep red-yellow podzolic soils, annual rainfall exceeding 2,500 millimetres, and a warm humid tropical climate combine to create conditions that make the region one of the richest areas in the island for fruit tree diversity.
Within this favourable ecological setting, Siyambalapitiya has become what may best be described as a custodian of a living collection—a fruit grove that now contains around 554 fruit trees and vines, many of them rare or seldom seen in contemporary agriculture.
Of these, 448 varieties have already been properly identified and documented with the assistance of agriculturist Dr. Suba Heenkenda, a retired expert of the Department of Agriculture. Together they have undertaken the painstaking task of cataloguing the plants by their botanical names, common Sinhala names, and the names used in ancient Ayurvedic and indigenous medical texts, assigning each species a unique identification number.
According to Siyambalapitiya, the Vendala estate is possibly the only single location in Sri Lanka where such a large number of fruit varieties—particularly rare and underutilized species—are maintained within one property.
“This garden came down to me through my grandfather, grandmother, mother and father,” he says. “It is a place shaped by three generations.”
The estate, he explains, began as a traditional home garden where crops such as tea, coconut and rubber were cultivated alongside fruit trees planted by family members over decades. Over time, however, it evolved into something much larger: a carefully nurtured grove preserving both common and obscure fruit species.
Siyambalapitiya recalls with affection one of the oldest trees in the garden—a honey-jack tree known locally as “Lokumänike’s Rata Kos Gaha.”
The story behind it has become part of family lore. According to village elders, his grandmother had brought home the sapling after visiting the Colombo Grand Exhibition in 1952 many decades ago and planted it near the house.
The tree soon gained fame in the village. Its tender jackfruit proved ideal for curry and mallum, while the ripe fruit was renowned for its sweetness.
“Ripe jackfruit from this tree tastes like honey itself,” Siyambalapitiya says. “Even the seeds are full of flour and can be eaten throughout the year.”
Yet age has not spared the venerable tree. It now shows signs of disease, and Siyambalapitiya and his staff have had to treat old wounds and monitor unusual bark damage.
“Once lightning struck it,” he recalls. “The largest branch began to die. Saving the tree required what I would call a kind of surgical operation.”
Such care, he says, reflects the deep attachment he feels toward the collection.
His fascination with fruit trees began in childhood. While attending Royal College in Colombo and living in a boarding house he disliked, Siyambalapitiya would insist that the family procure new fruit saplings for him to plant during his weekend visits home.
“That was the only ‘price’ I demanded for going to school,” he laughs.
Over the years the collection expanded steadily as he encountered new plants in forests, nurseries, and rural landscapes across the island.
The result today is a grove that includes traditional Sri Lankan fruit species, underutilized native varieties, forest fruits, and plants introduced from overseas.
Some species originate in Arabian deserts, while others thrive naturally in cooler climates such as Europe. Certain plants require greenhouse-like conditions, while others are hardy forest trees.
Managing such diversity is no easy task.
“One plant asks for rain, another asks for cold, and yet another prefers heat,” Siyambalapitiya explains. “Too much rain makes some sick, too much sun troubles others. The older trees overshadow the younger ones. You cannot feed or medicate them all in the same way.”
He compares the task to caring for a household filled with people from many nations and ages—each with different needs.
Despite the challenges, he believes the effort is worthwhile, particularly because many of the trees are native species that have become increasingly rare.
“If things continue as they are, some of these plants may disappear from our lives,” he warns.
To preserve knowledge about them, Siyambalapitiya is preparing to launch a book titled “Mage Vendala Palathuru Arana” (My Vendala Fruit Grove), which serves as an introductory guide to the collection.
The book, scheduled for release on April 18 at the Vendala estate, will be attended by Ven. Dr. Kirinde Assaji Thera, Chief Incumbent of Gangaramaya Temple,
Uruwarige Wannila Aththo, the leader of the Indigenous Vedda Community,
a long-serving former employee who helped maintain the plantation, and Sunday Dhamma school students from the region, who will participate as guests of honour.
The publication will also mark Siyambalapitiya’s eighth book. Previously he authored seven works and wrote more than 500 weekly newspaper columns offering commentary on politics and current affairs.
While working on the fruit catalogue, he is simultaneously writing another volume reflecting on his 25-year political career, including his tenure as Deputy Finance Minister during Sri Lanka’s most severe economic crisis.
For Siyambalapitiya, however, the fruit grove represents more than a hobby or academic exercise.
“The fruit we enjoy is the result of a tree’s effort to reproduce,” he says. “Nature has given fruits their taste, fragrance and colour to attract us. All the tree asks in return is that its seeds be carried to new places.”
That simple cycle of life, he believes, has continued for tens of thousands of years.
“And those who love trees,” he adds, “are guardians of the world’s survival.”
by Saman Indrajith
Pix by Tharanga Ratnaweera
- Four workers in charge of the four zones of the plantation
- Siyamabalapitiya explaning the evolution of plantation
- A foreign berry plant
- A Bakumba plant
- A rare jackfruit tree
- Siyambalapitiya pruning Pumkin Lemon plant
- Siyamabalapitiya explaning the evolution of plantation
Features
Smoke Free Sweden calls out to WHO not to suggest nicotine alternatives
It has been reported by the international advocacy initiative, ‘Smoke Free Sweden’ (‘SFS’) that many International health experts have begun criticizing the World Health Organization (WHO) for presenting safer nicotine alternatives rather than recognizing its role in accelerating decline in smoking.
As the world’s premier technical health agency, the WHO is empowered to support strategies that reduce morbidity and mortality even if they do not eliminate the underlying behaviour. Furthermore, it should base its guidance on evolving scientific knowledge, which includes comparative-risk assessments. Equating smoke-free nicotine alternatives with combustible cigarettes, is essentially putting lives at risk, according to the health experts contacted by SFS.
The warning follows recent WHO comments suggesting that vaping and other non-combustible nicotine products are driving tobacco use in Europe. This narrative ignores real-world evidence from countries like Sweden where access to safer alternatives has coincided with record low smoking rates.
A “Smoke-Free” status is defined as an adult daily smoking prevalence below 5% and Sweden is on the brink of officially achieving this milestone. This is clear proof that pragmatic harm-reduction policies work. Sweden’s success has been driven by adult smokers switching to lower-risk alternatives such as oral tobacco pouches (Snus), oral nicotine pouches and other non-combustible products.
“Vapes and pouches are helping to reduce risk, and Sweden’s smoke-free transition proves this,” said Dr Delon Human, leader of Smoke Free Sweden. “We should be celebrating policies that help smokers quit combustible tobacco, not spreading fear about the very tools that are accelerating the decline of cigarettes.”
It is further reported by health experts that conflating cigarettes with non-combustible alternatives risks deterring smokers from switching and could slow progress toward reducing tobacco-related disease.
Dr Human emphasized that youth protection and harm reduction are not mutually exclusive.
“It is critically important to safeguard against underage use, but this should be done by targeted, risk-proportionate regulation and proper enforcement, not by sacrificing the right of adults to access products that might save their lives,” he said.
Smoke Free Sweden is calling on global health authorities to adopt evidence-based policies that distinguish clearly between combustible tobacco – the primary cause of tobacco-related death – and lower-risk nicotine alternatives.
“Public health policy must be grounded in science and real-world outcomes,” Dr Human added. “Sweden’s experience shows that when adult smokers are given legal access to safer nicotine alternatives, smoking rates fall faster than almost anywhere else in the world.”
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