‘Health vs economy’ is COVID-19 déjà vu all over again with tobacco

Over a hundred years ago, a new strain of human-manufactured “virus” was introduced: the cigarette. It took 50 years to establish that mass-produced and mass-marketed cigarettes were killing people.

The public health response was sluggish, hobbled by the well-funded and ruthless efforts of the tobacco industry. But eventually, effective approaches were developed and over the past 50 years have been gradually implemented, with smoking rates cut by more than half.

A major risk in the next phase of our COVID-19 response is normalizing the ongoing death toll. Hundreds of thousands of deaths each year cannot become an accepted cost of doing business. That was the first mistake, enabling our anemic response to the tobacco epidemic.

Since the 1964 Surgeon General’s Report on Smoking and Health, it has become indisputable that cigarettes remain directly responsible for killing half a million Americans each year. Twenty million Americans have died since its publication. 

Why didn’t the government stop the manufacture and sale of cigarettes in the 1960s once they were proven to kill when used as intended? Primarily because the tobacco industry ran sophisticated public relations campaigns successfully sweeping the death and disease under the carpet. “Doubt is our product,” admitted a tobacco executive in 1969. 

COVID-19 has no direct lobbying arm like the tobacco industry, but a close cousin is emerging: “Health versus the economy” is a refrain being systematically pushed to justify inaction. This is a false choice.

Countries that contained COVID-19 by acting quickly based on science are experiencing less economic damage. They adopted policies and developed infrastructure to support identification, testing, and isolation of cases and mask-wearing and contact tracing. This minimized the need for longer-term restrictive stay-at-home/business closure policies that cause sustained economic disruption. 

The tobacco industry marketed a similar false choice: “Smoking is about jobs and freedom, not death and addiction.” For COVID-19, we begrudgingly accepted the need to temporarily put tens of millions of Americans out of work to “flatten the curve.” What would be the comparable economic costs of fully addressing the tobacco epidemic? They are minuscule in comparison.

The potential economic disruption from sunsetting cigarettes is minuscule compared to our current, justified efforts to contain COVID-19. Although other businesses that sell cigarettes would experience short-term losses, most could quickly adapt by switching sales to other products. We should help with this transition, not prolong the suffering caused by a product that kills its users. 

The savings in terms of avoidable health care and other tobacco-related costs are staggering — more than $1000 per American per year.

The coronavirus is manufactured inside human cells. We cannot yet shut down these living factories. Cigarettes, on the other hand, are made by machines run by a tiny number of humans. We can prevent the massive health and economic costs of tobacco by turning off those machines, either directly or by aggressively limiting the distribution and sale of cigarettes, similar to limiting the spread of COVID-19.

Suppose we can deploy massive resources, shut down segments of the economy, and shelter in place for months in response to a virus to avert several million deaths from COVID-19. In that case, we can do easier and less painful things to stop the entirely preventable half-million deaths a year from cigarettes.

If we have the will, we have the power to sunset the handful of factories employing less than 10,000 people manufacturing addictive nicotine and carcinogen-laden cigarettes. We can learn from our COVID-19 experience and sunset the sale of these death-sticks.

And we must also learn from the lessons of tobacco. We must not allow ongoing deaths from COVID-19 to be hidden away, under-counted, or “baked in” as a cost of doing business. This is especially important to avoid gross inequities in disease suffering in communities of color, service workers, the homeless and those living in nursing homes. As we re-open businesses, houses of worship and schools, we must ensure sufficient funding and resources to support the public health infrastructure fully. 

Tim McAfee, MD, MPH, is an affiliate faculty member at the University of Washington School of Public Health. He also served as the former director and senior medical officer at the Office on Smoking and Health (OSH), Centers for Disease Control (CDC), from 2010 to 2017. McAfee helped found and served on the Board of Directors of the North American Quitline Consortium and numerous state and national tobacco policy advisory groups.

Chris Bostic, J.D., has served as the deputy director for policy at Action on Smoking and Health (ASH) since 2012. He previously served as a clinical instructor at the University of Maryland School of Law and Program Manager at the American Lung Association.