Tob Control 21:291-292 doi:10.1136/tobaccocontrol-2011-050198
  • Endgame visions

Exploring vector space: overcoming resistance to direct control of the tobacco industry

  1. Neil E Collishaw
  1. Physicians for a Smoke-Free Canada, Ottawa, Ontario, Canada
  1. Correspondence to Cynthia Callard, Physicians for a Smoke-Free Canada, 1226 A Wellington Street, Ottawa, Ontario, Canada K1Y 3A1; ccallard{at}
  1. Contributors Both authors contributed to the development of the ideas. CC wrote the paper.

  • Received 11 April 2011
  • Accepted 22 August 2011

Within the epidemiological framework that describes the relationship of smokers (host), cigarettes (agent), tobacco companies (vector) and environment,1 both the agent and the vector are man-made and, in theory, controllable. Nonetheless, the smoking pandemic is expected to claim one billion lives in this century, even among people who are not yet born.2 With a preventable problem that is not being prevented, our disease strategy is arguably in need of a rethink.

While health science has focused on establishing the link between tobacco products and the diseases they cause, treating those diseases, exploring ways to make cigarettes less harmful and ways to discourage tobacco use, relatively little health research has been focused on analysing the vector of the disease or how to change its course.3 This may explain why there is a global consensus to modify the behaviour of the host, environment and agent, but little pressure in support of vector control.4

Despite opposition to such supply-side approaches,2 5 a number of new vector-related tobacco control measures have been proposed. These include performance-based regulations,6 ending the manufacturer's obligation to increase or at least maintain shareholder value,7 regulating profits,8 banning some or all tobacco products or prohibiting use by some …

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