BACKGROUND: Tobacco epidemic remains a leading risk factor for non-communicable diseases and economic burdens worldwide. The concept of a "tobacco endgame" envisions a future free from the burden of tobacco use, requiring a systemic shift in structural, political, and social dynamics to phase out tobacco products. India, with over 267 million tobacco users, has made significant strides in tobacco control, yet faces persistent challenges in aligning with global endgame goals. This study examines India's progress, highlights opportunities, and identifies challenges in establishing itself as a tobacco endgame hub.
METHODS: A two-step modified Delphi technique was utilized. Firstly, a comprehensive literature review identified key milestones in India's tobacco control efforts. Subsequently, the Delphi method was applied to gather insights from a panel of experts representing government, NGOs, and academia during a session during a national consultation on Tobacco end game in India. These results were thematically analyzed, incorporating stakeholder feedback, policy reviews, and program evaluations, to develop actionable recommendations for enhancing tobacco control initiatives and advancing India’s endgame objectives.
RESULTS: The Indian subcontinent has been actively advancing the endgame concept and demonstrating remarkable leadership in tobacco control, with numerous national and subnational achievements. India has achieved significant milestones in tobacco control, including the NTCP, bans on e-cigarettes, implementation of Tobacco vendor licensing and graphic health warnings covering 85% of packaging. Over 170 jurisdictions are smoke-free, protecting 400 million people. However, challenges like industry interference, limited collaboration, and low community awareness persist, emphasizing the need for stronger multisectoral efforts and expanded cessation services to achieve endgame goals.
CONCLUSIONS: Achieving a tobacco endgame in India necessitates political commitment, multisectoral collaboration, and community-driven approaches. Strengthening compliance with WHO FCTC guidelines, scaling up cessation services, and addressing industry interference are imperative.