Recognizing the COVID-19 transmission threat of smokeless tobacco use and spitting in public, Ahmedabad – the largest city in India’s western state of Gujarat known for its cotton textiles, street food and diamond cutting – took the decision to close stores selling paan and other chewing tobacco earlier this year.
During the COVID-19 pandemic, smokeless tobacco has become an even greater public health concern than usual. Chewing tobacco products such as gutka, khaini, zarda, paan and paan masala, induce salivation and trigger the urge to spit. The act of spitting can facilitate the spread of infectious diseases, potentially including COVID-19. Another risk associated with smokeless tobacco, is the contact of fingers with the lips or nose during use, which may increase the possibility of virus transmission.
The decision was made not only to reduce the spread of COVID-19 but also to improve the health of the population through reduced use of tobacco products.
Like many countries, India’s urban centres have faced the largest COVID-19 outbreaks across the country. In May, five cities: Mumbai, Delhi, Ahmedabad, Chennai and Thane, made up almost 50% of the national total case count.
On 15 March, before the first reported case in Gujarat and well before the existence of the national directive on smokeless tobacco to contain COVID-19 issued under the Disaster Management Act, Gujarat Chief Secretary Anil Mukim introduced a ban on spitting on roads and in public places. The action was punishable by fine of 500 rupees and once the new order was implemented by the Amdavad Municipal Corporation (AMC), it resulted in 1244 persons fined on the very first day of enforcement. The AMC built on this measure by increasing the fine to 1000 rupees from 23 March, and issuing police FIRs (first information reports) to those who refused or failed to pay the fine.
“With over 200 million smokeless tobacco users in India, the pandemic presents an opportunity to further strengthen tobacco control policies and interventions to prevent avoidable diseases and deaths,” says Dr Roderico H. Ofrin, WHO Representative to India.
These measures follow efforts in recent years to prioritize prevention of tobacco-related cancers and other noncommunicable diseases (NCDs) in Ahmedabad. As one of 70 cities in the Partnership for Healthy Cities—a global network supported by Bloomberg Philanthropies in partnership with WHO and Vital Strategies—the city had already conducted a population-based household survey of NCD risks prior to the onset of the pandemic. The data from the survey will allow the city to target highly prevalent preventable diseases with evidence-based programs.