Experts agree: THR is our line of defence against the smoking pandemic

October 11, 2021

It is well known that smoking kills more than 8 million every year, almost twice the number of Covid-19 pandemic deaths to date; between 1999 and 2019 smoking tobacco use accounted for 20.2% of all-cause deaths among males and 5.8% among females (The Lancet, Vol 397, June 19, 2021) . In the 4th Scientific Summit on Tobacco Harm Reduction: Novel products, Research & Policy experts agreed that tobacco harm reduction is our line of defence.

More than 300 participants from 42 countries including 62 speakers from 31 countries[*] from around the globe participated in the 4th Summit organised by SCOHRE, the newly founded International Association on Smoking Control & Harm Reduction, that seeks a new broader approach to smoking control policies that will not neglect smokers. A 360º approach was adopted and covered all aspects with the participation of tobacco harm reduction advocates from diverse research fields to debate issues from basic science to ethics, human rights, health policies and economics.

Read here a summary of selected sessions from the 4th Scientific Summit.

Global progress in tobacco control was catalysed when the WHO FCTC passed in 2005. Despite the progress there are currently 1.14 billion active smokers. As Professor Giuseppe Biondi-Zocai put it “… the smoking epidemic is here to stay unless we do something to prevent it and reduce its burden.” Over the last years many smokers replace conventional smoking with Modified Risk Products, novel nicotine releasing products that bear less harm in comparison to combustible cigarettes. This is “harm reduction”. Professor Ignatios Ikonomidis underlined that harm reduction strategy is a strong weapon that we need to learn to use effectively, yet concerns are raised regarding novel products’ uptake by adolescents. Both Professor Barbouni & Dr. Lund agreed that “we need to set strict rules to avoid use of alternative tobacco products by adolescents” and “find a way to balance the benefits for smokers with the risks for young people.”  Read more on Tobacco control policy: prevention, harm reduction, cessation session.

In 2020, there were 2.7 million cancer incidences and 1.3 million deaths in the EU. In February 2020, the European Beating Cancer Plan was introduced, a political commitment to reduce cancer in response to the growing challenges and an initiative to further reduce the smoking prevalence. In the session The Future of smoking in Europe chaired by the President of SCOHRE Prof. Ignatios Ikonomidis, the Plan was discussed. The Plan did not discuss the evidence that e-cigarettes and novel tobacco products (NTPs) appear to have lower risk of exposure to toxicants compared to conventional cigarettes; yet there is an agreement that although the exact level of risk reduction is inevitably uncertain, there are promising harm reduction agents for smokers that fail or are unwilling to quit smoking. The Plan prioritizes protecting young people from conventional and e-cigarette smoking and proposes measures such as banning non-tobacco flavors for e-liquids and regulatory protection for adolescent use. Prof. Ikonomidis concluded that, based upon global experience, “Beating Cancer Plan” should include harm reduction policies to improve the rates of smoking cessation and contribute to the reduction of smoking consequences. Harm reduction should be the third pillar for tobacco control together with smoking cessation and smoking prevention.

Professor Kenneth Ε. Warner, a “guru” in the field of tobacco harm reduction and public policy, also talked about the need for balancing considerations of the risks and benefits of e-cigarettes, and presented the findings of a recent paper published in the American Journal of Public Health in August 2021 that describes the situation in US, where governmental health agencies and non-governmental medical and health organisations focus heavily on risks to kids and not on the potential benefits for adult smokers. “We can increase smoking cessation through vaping”, Professor Warner concluded. Vaping’s ability to promote smoking cessation is important and deserves more attention, since helping adult smokers to quit is a matter of social justice.

Caitlin Notley, Professor in Addiction Sciences, UK, analysed the UK approach to smoking control and the consequences of social and cultural influences on behavioural and health long term outcomes. Tobacco Harm Reduction strategy is additional and complementary to tobacco control measures, she said. The concept of “nicotine addiction” has been medicalised and eventually accepted, and now is part of treatment strategies in the UK, Prof. Notley added. Also, Royal College of Physicians moved away from abstinence to harm reduction. So, today, there is a consensus among stakeholders in the UK that the main tobacco control goal is to reduce the death and disease caused by tobacco use; there is less concern to reduce addiction to nicotine. However, more needs to be done, the speaker emphasised. The public’s (mis)perceptions of harm that need to be tackled: Around a third of young people think that e-cigarettes are as harmful as smoking tobacco, while adults also have inaccurate perceptions. divides in the field of THR that question the evidence are unhelpful and feed uncertainty to the public about whether e-cigarettes are a safer option than smoking, she concluded.

In the session entitled To what extent scientific data drive political decisions? chaired by Dr Dimitri Richter, Eva Kaili, MEP, and Chair of EU Committee STOA said that policy makers are given options so they can decide based on scientific data and not just on the news or non-verified sources. It is true that the transition to less harmful tobacco products is a difficult discussion for politicians, Ms. Kaili noted. The target is to have tobacco-free societies, we need scientific data and to participate more in discussions with scientists, be open-minded, listen and understand that we cannot ignore the fact that we have 25% of tobacco users in the EU population. So, we must be able to explore all the solutions, she concluded.

Professor Konstantinos Farsalinos in the panel discussion with Professors Giovanni Li Volti and Massimo Caruso, entitled Independent verification in industry data for novel products and interventions stressed the importance of independent verification of data as a vital tool to understand THR products and how study replication is key for transparency, restricting prejudice, avoiding future mistakes of novel products and for research quality enhancement.

Clive Bates led a panel discussion “Transformation of the tobacco industry: strategy, competition, and ethics” with representatives from research and development units of the tobacco industry. All panellists agreed that consumer needs are the driver and science is the compass. Dr Gizelle Baker, PMI, said “Harms are caused by smoking and combustible cigarettes; smoking-related diseases is where the journey of tobacco industry’s transformation started from. Novel products have the potential to have a huge impact to public health, moving people to less harmful alternatives and reducing the burden of smoking-related diseases”. Mrs. Sharon Goodall, BAT, underlined that “Innovation is driven by consumers’ needs, human needs. Consumers’ needs, regulations and of course innovation are also evolving. The harm reduction purpose drives and accelerates the need for transformation.” Dr Ian Jones, JTI, said that the transformation of science is the cornerstone in the transformation of the tobacco industry. It is really worrying―he added―that although industry in our days provides excellent scientific data, there is a lot of suspicion about industry science. The most important aspect of transformation is the consumer, Mr. Joe Murillo, JUUL Labs, pointed out. Consumers, smokers, are demanding different products, and are driving the innovation, the competition, and the transformation of the tobacco industry, he explained. A common conclusion was that industry, regulators, and public health should all work together to have the best possible outcomes.

The subject of Economic dimensions of smoking control and harm reduction was also discussed. Prof. Andrzej Fal, chair of the session, stressed that the newest tool to improve the quitting efficacy, limiting health loss and financial burden is Tobacco Harm Reduction. The available financial tools, prices, differential taxation based upon potential harm, were extensively discussed. The financial burden of smoking is enormous. If we manage to reduce smoking by 1% in Europe, we will save 40 billion euros that could be invested in other areas said Tomas Drucker, former Minister of Health, Minister of Interior of the Slovak Republic. Numbers are indicative of the significance. We need to employ all available tools to decrease smoking. Differential taxation of innovative potentially less harmful products was what the panel suggested. This was also put forward by Professor M. Pesko’s lecture “Is differential taxation a means to promote public health strategies?”, who concluded that from an economic perspective, products should be taxed according to their externality and internalities, according to the cost and benefit they bear. Other alternative policies are also necessary to help keep e-cigarettes away from the youth, which is a major concern.

David T. Sweanor J.D., led the panel discussion on “Ethics & people’s rights” with renowned panellists, and stressed that it is really disturbing to deny rights to consumers. He underlined that people do not receive adequate information or even receive inaccurate information; therefore, we should not blame the people, people are to be held responsible only for the information given to them. Professor of Community Health and Health Behavior Lynn T. Kozlowski made the distinction between the right for a tobacco-free world and the right for a tobacco-smoke-free world. There is no need to establish that there are nicotine-containing products that are much less harmful than tobacco cigarettes. The data presented showed that smokeless tobacco is dramatically less dangerous than smoking cigarettes.

In three unique sessions, dedicated to Asia, Africa, and Latin America respectively, experts from different countries shared their country policies and experience in implementing Tobacco Harm Reduction as well as relevant ethics and people’s rights issues. The experts’ panel for Asia was led by Sharifa Ezat Wan Puteh, the Africa panel by Fares Mili & Solomon Rataemane, and the Latin America panel by Monica Gorgulho, all four founding members of SCOHRE.

Dr Joe Kosterich in his keynote lecture successfully demonstrated the superiority of New Zealand’s tobacco control policies, which included THR in decreasing smoking prevalence vis a vis Australia’s strategy and underlined that there is a lot of work still to be done to achieve uniformity in global strategies.

The Declaration of the 4th Summit can be found here.

[*] Australia, Brazil, Bulgaria, Canada, Colombia, Cyprus, Czech Republic, Ecuador, Germany, Greece, Hungary, India, Indonesia, Italy, Japan, Kenya, Malaysia, Mexico, Morocco, Norway, Philippines, Poland, Portugal, Slovakia, Spain, South Africa, Sweden, Switzerland, Tunisia, UK, USA.