Tobacco harm reduction advocates call for science-based regulations

Tobacco harm reduction (THR) advocates participating in the 2020 Global Tobacco & Nicotine Forum (GTNF) called on governments and regulators to come up with science-based, innovation-driven regulations to help reduce tobacco-related sickness and deaths.

“Regulations must be based on sound science and not be driven by politics, which unfortunately is not always the case. Regulations must be progressive and allow innovation as new facts emerge,” said Chris Allen, chief scientific officer at Broughton Nicotine Services.

“Seven million people every year die due to tobacco-related diseases. There are 1.3 billion people using tobacco products, most of them in a toxic, combustible form. The goal of a regulator should primarily be to reduce that harm in the fastest possible time,” said Derek Yach, president of the Foundation for a Smoke-Free World.

“There’s an evolving set of state and local tobacco regulations in the U.S. that are based more on emotion than on science. These are almost evolving towards a 50-country approach rather than a unified federal approach,” said Elaine Round, senior director of scientific and regulatory affairs at RAI Services.

The European Tobacco Products Directive (EUTPD) is “an inclusive process” and “evidence-based approach” that other countries can look to for guidance, according to trade law consultant Abrie du Plessis.

The EUTPD is a directive of the European Union which places limits on the sale and merchandising of tobacco and tobacco-related products in the EU. It aims to improve the functioning of the internal market for tobacco and related products while ensuring a high level of health protection for European citizens.

“It is important to be able to critique the way governments have responded to COVID-19 so we can learn and strive for strategies that will cause as little harm as possible to as many people and equitably across our society,” said Marewa Glover, director of the Centre of Research Excellence on Indigenous Sovereignty and Smoking. She spoke on lessons from tobacco control for rebuilding society post-COVID lockdown.

Light at the end of the tunnel

“The debate on the value of THR interventions remains controversial, ideological and often emotional, [which] continues to [hinder] constructive dialogue,” said Prof. Tikki Pang, visiting professor at the Yong Loo Lin School of Medicine at the National University of Singapore. He was previously director for research policy and cooperation of the World Health Organization, a post that he held for 13 years.

Prof. Pang expressed disappointment at how THR policies continue to vary greatly between countries.

“There is at this point no unanimous agreement on what are the best policies. For example, there are countries where e-cigarettes are allowed/regulated or banned, countries where there is pending legislation on e-cigarettes, countries with no specific law on e-cigarettes and countries with no information about e-cigarettes.”

On the positive side, Prof. Pang noted “some progress” in the acceptance of alternative tobacco products (ATPs), citing recent developments at the WHO and the U.S. Food and Drug Administration (FDA).

“Since I used to work for the WHO, I was very heartened by a WHO report released earlier this year, the ‘WHO study group on tobacco product regulation’”. He quoted leading THR advocate Clive Bates who, commenting on the WHO report, wrote, “Though there is much to disagree with, there is also a reasonable attempt to recognize harm reduction concepts and not treat them like witchcraft…”

According to Prof. Pang, ATPs were discussed at the meetings of the WHO Governing Bodies and the Framework Convention on Tobacco Control (FCTC) Conference of Parties. “I believe there’s a little bit of an opening here. Countries, especially in the developing world, do look to the WHO for guidance on policies. Although overall the WHO position on ATPs is still fairly negative and unsupportive, I want to be optimistic. We’re beginning to see light at the end of the tunnel.”

He highlighted the significance of the U.S. FDA decision in July 2020 to authorize the marketing of the heated tobacco product IQOS in the U.S. as modified risk tobacco products (MRTPs), an authorization that the agency designated as “appropriate for the promotion of public health”.

The US FDA decision marks the first time that the agency has granted MRTP marketing orders for an innovative electronic alternative to cigarettes. “This is another step forward. Many developing countries look to the U.S. FDA for guidance not just in ATPs but in medicines and vaccines,” said Prof. Pangestu.

More smokers switching 

The smoking prevalence in Japan has gone down by 30% in three years since heated tobacco products (HTPs) became available in the country, with HTP penetration among Japanese smokers currently at 25%, according to Dr. Hiroya Kumamaru, a cardiovascular surgeon and vice director of AOI International Hospital in Kanagawa, Japan.

“Overall tobacco sales volume covering cigarettes plus HTPs is still decreasing, while HTP sales are increasing. This indicates that switching from cigarettes to HTPs is happening very quickly,” Dr. Kumamaru explained. He noted that HTPs are so far not causing the gateway effect on younger Japanese

Aside from Japan, dramatic and historic drops in cigarette sales following the introduction of ATPs have also been seen in the U.K., U.S., and Korea, according to Prof. Pangestu.

“There is a growing evidence base on the value of ATPs in smoking cessation. Evidence from the U.K., U.S., and Europe shows that the gateway effect of ATPs is limited and negligible. Public Health England notes the increasing trend in vaping is happening against a backdrop of decreasing smoking rates.”

Launched in Rio de Janeiro in 2008, the annual GTNF has become the global exchange for views and ideas among public health experts, government representatives, investors and members of the tobacco/nicotine industries.

The 2020 GTNF was held from September 21-24, 2020. Due to the Covid-19 pandemic, this year marks the first time the global forum was held online.