Cigarettes with ultralow nicotine levels are now being called the game-changer in the fight against smoking. If you are having trouble in quitting smoking, then, it is for you, that soon the Biden White House is expected to formally propose a plan that will order cigarette nicotine levels to be reduced, reports The Washington Post. For now though, it has been a failure, as these cigarettes, also known as VLN cigarettes that stands for very low nicotine are only available in 5,100 stores in 26 states. This is a very small fraction of the overall market for cigarettes. The company that makes it, 22nd Century, is struggling not because of the low supply, but also from the advocates who have long believed slashing nicotine levels altogether.

The Advent and ideation

Nicotine is a chemical that is produced naturally from tobacco that makes the cigarette and also keeps people hooked. While it is believed that it makes people alert, and get the "hit" to keep them going, it exposes the users to harmful substances, carcinogens, and increases the risk of heart disease, lung cancer, and other illness.

Ultralow-nicotine cigarettes, like the VLN brand, contain about 95% less nicotine than the regular cigarettes. The idea is quite simple: without the addictive grip of nicotine, smokers will find it easier to quit. Research too has shown some promise. For instance, the studies funded by the National Institute on Drug Abuse revealed that very low nicotine cigarettes reduced addiction potential significantly without having users to increase their smoking frequency. However, the problem is, why would anyone choose for a low-nicotine that does not make them feel the same way, when the high-nicotine cigarette is right next to it, making them feel the same way, with the same alertness, sold at the same price.

“It’s very hard to imagine someone actively choosing to continue to use a low-nicotine product for the same price when a high-nicotine product is right next to it,” said Eric Donny, a Wake Forest University School of Medicine nicotine researcher.

No wonder, the experiment with low nicotine product by Philip Morris' Next cigarettes in the 1980s and Vector Tobacco's Quest brand in the early 2000s, flopped.

FDA's Role in the Push

The Food and Drug Administration (FDA) has supported the development of such products, even allowing VLN cigarettes to be marketed as lower-risk options. However, these products remain a niche market, available in only a fraction of U.S. stores.

Recently, the Biden administration has considered a bold step—mandating a dramatic reduction in nicotine levels for all cigarettes sold in the United States. Supporters believe this move could save millions of lives, while critics, including tobacco companies, warn of potential unintended consequences.

What Could Be The Challenges?

Resistance from Big Tobacco Companies: They could argue that slashing nicotine levels could backfire. Their claim is, smokers will turn to black markets or smoke more to satisfy their cravings, which may lead to greater exposure to harmful substances.

Consumer Reluctance: History is proof to the instances of smokers being hesitant to embrace the low-nicotine products.

Political Hurdle: It may face political roadblocks, as under the Trump administration, plans to cut nicotine were shelved.

Could Low-Nicotine Cigarettes Be The Solution?

Advocates believe that ultralow-nicotine cigarettes could be a game-changer, comparing them to decaf coffee or non-alcoholic beer—products that reduce harm while offering a similar experience.

Some experts warn that a black market for traditional cigarettes could undermine these efforts. They also stress the need for safer alternatives, such as vaping products, to support smokers transitioning away from traditional cigarettes.

A government-owned Indian vaccine manufacturer has questioned a December 22 health advisory issued by Australian authorities that warned of “counterfeit batches” of an anti-rabies vaccine circulating in India since November 2023, and has formally requested that the notice be reviewed.

Abhayrab Rabies Vaccine Makers Say It Reported Single Counterfeit Case

Indian Immunologicals Limited said it had already reported a counterfeiting incident involving one batch of its anti-rabies vaccine, Abhayrab, in January, and cautioned that the Australian advisory risked creating “anxiety and mistrust” among both the public and medical professionals.

However, India’s central drug regulator has not made public whether it carried out an investigation, how widely the fake vaccine may have spread, or how many people might have received it. As a result, the scale of the incident and its possible consequences remain uncertain.

Australian Warning Highlights Risk to Travellers

The Australian advisory stated that although Abhayrab is not sold in Australia, individuals who were vaccinated while travelling in India might not be fully protected against rabies, a viral infection of the central nervous system that is almost always fatal if treatment is delayed or missed.

Abhayrab Rabies Vaccine: Details of the Australian Advisory

“Counterfeit (fake) batches of rabies vaccine Abhayrab have been circulating in India since November 1, 2023,” the advisory directed at travellers and healthcare workers said. “People who have received Abhayrab, or an unknown rabies vaccine brand in India from November 1, 2023, onwards are advised to consult their healthcare provider to assess whether replacement doses are required.”

Abhayrab Rabies Vaccine: Similar Alerts Issued by Other Countries

The Australian notice followed similar warnings elsewhere. On November 25, the US Centers for Disease Control and Prevention reported a rabies case in a traveller returning from India and referred to the circulation of counterfeit Abhayrab vaccines. A UK travel health authority had also released an alert about the falsified vaccine on October 29.

Abhayrab Rabies Vaccine: Indian Firm Warns of Public Confusion

In a communication dated December 25 to Australian health officials, Indian Immunologicals Limited said the advisory could be misunderstood and weaken confidence in vaccines, and asked that it be reconsidered to prevent confusion among healthcare providers.

The manufacturer said it has supplied more than 210 million doses of Abhayrab in India and overseas, describing it as “the most trusted brand” in the country and stating that it accounts for around 40 per cent of India’s anti-rabies vaccine market.

Abhayrab Rabies Vaccine: Details of the Counterfeit Batch

The company said the counterfeiting involved a single batch, KA-24014, which was manufactured in March 2024 and is due to expire in February 2027. This was reported to India’s Central Drugs Standard Control Organisation on January 13, 2025.

According to Indian Immunologicals Limited, the counterfeit vaccine carried the same batch number but listed a manufacturing date of November 2023 and an expiry date of October 2026. The counterfeit packaging also omitted the ₹ symbol before the printed price of 397.62.

The firm said it had urged the CDSCO in January to investigate the counterfeiting, seize the fake vaccines, and work with law enforcement agencies to identify and prosecute those responsible for manufacturing and distributing them.

Abhayrab Rabies Vaccine: No Response From CDSCO

Questions sent by this newspaper to the CDSCO on Saturday seeking updates on the status or findings of any investigation did not receive a response. Without official information from the regulator, experts say it is difficult to determine how widely the falsified vaccine may have circulated or how many people could have been affected.

Concerns Over Wording of Advisory

A scientist specialising in rabies research in India said the Australian advisory’s reference to “counterfeit batches” and circulation “since November 2023” could alarm many people who have received anti-rabies vaccines, as per The Telegraph.

“Abhayrab is a reliable vaccine and is used extensively across the country,” said Reeta Mani, professor and head of neurovirology at the National Institute of Mental Health and Neurosciences in Bengaluru. “Public advisories need precise language. People should not lose faith in vaccines.”

Rabies Burden in India

A 2022 report by the National Centre for Disease Control estimated that nearly 2.3 million people in India receive post-exposure rabies vaccines each year after animal bites, most commonly from dogs.

Research published earlier this year by the Indian Council of Medical Research estimated that rabies causes about 5,700 deaths annually in India, a reduction from earlier estimates of nearly 20,000 deaths per year.

Peer-reviewed studies have shown that thousands of people worldwide have received counterfeit rabies vaccines. This includes more than 1,600 recipients in a single Chinese province in 2010, and over 1,13,000 falsified rabies vaccine doses reported by Chinese regulators in 2018.

Although the Medicines and Healthcare Products Regulatory Agency has cleared Tofersen for use, NHS patients are still unable to receive the motor neurone disease treatment because of administrative hurdles and related problems, The Telegraph has reported.

What Is Tofersen?

Tofersen targets the underlying cause of MND in patients with a specific inherited mutation. It prevents harmful proteins from clumping together in the brain and spinal cord, a process that damages motor neurones. Doctors have reported that some patients have seen their symptoms ease after starting the drug.

MND Drug Denied On NHS

The Medicines and Healthcare products Regulatory Agency approved Tofersen for use in the UK in 2025. The drug is already available to patients in Europe and the United States. However, it is still under review by the National Institute for Health and Care Excellence, which decides whether medicines should be routinely funded by the NHS based on benefit and value for money.

While this assessment continues, Biogen, the biotechnology company behind Tofersen, has agreed to an early access arrangement with the NHS. Under this deal, the drug is being supplied free of charge on compassionate grounds.

Despite the free supply, dozens of patients are missing out. Several NHS trusts are unwilling to fund the additional costs linked to administering the treatment, such as staffing and hospital resources.

MND Drug Denied On NHS: At Least 20 Patients Denied Treatment

Data shared with The Telegraph shows that at least 20 patients have been refused access to Tofersen. The MND Association has described the situation as one where the drug could mean the “difference between life and death”.

Charity Calls for Government Action

Alex Massey, head of campaigning, policy and public affairs at the MND Association, said everyone with this form of MND should receive the drug, as per The Telegraph.

“We are talking about a small amount of extra resource for something that could be the difference between life and death,” he said. “People with MND do not have time to wait, so we urge the Government to step in and break the deadlock.”

How Common Is MND In The UK

Around 5,000 people in the UK are living with MND at any one time, and about one in 10 has a family history of the condition. Most diagnoses occur in people in their 60s, with average life expectancy ranging from two to five years.

What MND Does to the Body

MND causes the nerve cells that control movement to fail, leading to progressive weakness and mobility problems. Early symptoms often include weakness in the hands, legs or feet, making tasks such as climbing stairs or gripping objects difficult.

As the disease advances, patients may experience muscle twitching, spasms and cramps. Many develop difficulties with breathing, swallowing and speech, along with changes in mood or personality. In later stages, walking and movement can become extremely limited.

Limited Treatment Options Available

About 1,500 people are diagnosed with MND each year, yet treatment choices remain scarce. Only a small proportion of patients currently qualify for therapies that target the disease process itself.

Roughly two per cent of MND cases involve a mutation in the SOD1 gene, which causes a form of the disease known as amyotrophic lateral sclerosis. This mutation leads to faulty proteins that build up in the brain and spinal cord instead of breaking down harmful substances, damaging nerve cells.

Why Tofersen Is Different

Tofersen is designed to target this genetic fault. Clinical trials showed that the drug reduced levels of the toxic protein in spinal fluid and lowered markers of nerve damage in the blood.

The MND Association says 44 patients are currently receiving Tofersen, but at least 20 eligible patients have been refused. Only eight of the 24 specialist neurology centres capable of delivering the treatment have opted to do so.

NHS Response

An NHS spokesperson said some hospitals have worked hard to find extra staff and resources to take part in the early access programme and provide Tofersen safely to eligible patients.

They added that the NHS is encouraging Biogen to complete the Nice appraisal process, which is the only way the drug can be formally recommended as a safe, effective and cost-efficient treatment for all eligible patients in England.

"Papa, I'm in pain," said the 44-year-old Indian origin man, Prashant Sreekumar to his father, before he died at a Canadian hospital's ER due to delay. He had a cardiac arrest and was rushed to the Grey Nuns Community Hospital in Canada's Edmonton. He had been complaining of severe chest pains at work on December 22. The 44-year-old was also father of three, and was kept in the hospital's emergency room waiting area for over eight hours. This has now sparked serious questions on Canadian healthcare system.

His father, Kumar Sreekumar told the Global News that he was checked in at triage and then seated in the waiting room. When his father reached the hospital, he told him, "Papa, I cannot bear the pain."

The father said that his son felt the pain was a '15 out of 10'. The staff had given him some Tylenol for his pain, but his blood pressure kept increasing.

"It went up, up, and up. To me, it was through the roof," his father said. He was finally called for treatment after more than eight hours of wait."After sitting maybe 10 seconds, he looked at me, he got up and put his hand on his chest and just crashed," his father said.

Nurses raised the alarm and attempted to revive him, but their efforts were unsuccessful. Prashant Sreekumar died from what is believed to be a cardiac arrest. He is survived by his wife and three children, aged three, 10 and 14.

Grey Nuns Hospital, which is part of the Covenant Health network, said it could not comment on individual patient care. In a statement to Global News, the organization confirmed the death is being reviewed by the Office of the Chief Medical Examiner.

“Our thoughts are with the patient’s family and friends. The safety and care of our patients and staff remain our highest priority,” the statement said.

External Affairs Ministry spokesperson Randhir Jaiswal in New Delhi, said that the person who died was a Canadian citizen and the government must look into the matter. “The person is of Indian origin but he happens to be, I understand, a Canadian national. So the Canadian government should take responsibility in the matter,” he said at a media briefing.

What Is A Cardiac Arrest?

As per the Heart Organization, a cardiac arrest is the abrupt loss of heart function in a person who may or may not have been diagnosed with heart disease. It happens because of an electrical issue that makes your heart stop beating. Your heart stops pumping blood and you become unconscious.

Symptoms Of Cardiac Arrest

• Fatigue
• Dizziness
• Shortness of breath
• Nausea
• Chest pain
• Heart palpitations (fast or pounding heart beat)
• Loss of consciousness

Who Are At More Risk Of A Cardiac Arrest?

If you follow a lifestyle heavily indulged in alcohol or drug abuse, or have a family history of heart disease or cardiac arrest, or have a heart disease, high blood pressure, high cholesterol, low potassium or magnesium, obesity or indulge into smoking, you make be more prone to having a cardiac arrest.

The phrases “heart attack” and “cardiac arrest” are often used as if they mean the same thing, but they refer to two distinct heart conditions.

A heart attack happens when a blockage in one or more arteries cuts off blood flow to the heart. This lack of blood and oxygen damages the heart muscle. A heart attack can raise the risk of cardiac arrest because it may disrupt the heart’s electrical signals. When cardiac arrest strikes suddenly in someone without known heart disease, it is often triggered by a heart attack.