Category: Harm Reduction

  • Smoke-Free World Foundation Urges Smokers to Quit/Switch

    Smoke-Free World Foundation Urges Smokers to Quit/Switch

    Photo: auremar

    Ahead of World No Tobacco Day (WNTD) on May 31, The Foundation for a Smoke-Free World (FSFW) is urging smokers to quit or switch to harm-reduction production

    The fact that more than 1 billion people still smoke and 8 million annual deaths are attributed to tobacco use proves that health policies and actions have been inadequate, according to the FSFW.

    “The challenges that smokers face when trying to quit have been largely ignored,” the foundation wrote in a press note. “The calls by the World Health Organization (WHO) for smokers to quit using fairly ineffective interventions suggest we need new approaches. Technology innovation, in the form of harm reduction, offers a new way forward for smokers that complements classic cessation efforts.”

    “Since my involvement in the first WNTD in 1988, we have focused narrowly on cessation often without engaging smokers in developing ways they feel work best. Too many efforts have failed because they have not addressed the fact that while many smokers want to quit, they are not being presented with options that appeal to them,” said Derek Yach, President of FSFW.

    “There is growing evidence that a range of harm-reduction products, including e-cigarettes (vapes), snus, nicotine pouches, and heated tobacco products, can help smokers quit or at least substantially reduce their harmful exposure to combustible cigarettes. The WHO, supported by heavily funded Bloomberg Philanthropies grantees, continues to blindly ignore scientific evidence, vilifying these products instead of promoting their use to save lives.”

    The FSFW cites a study published this week in The Lancet, in which the authors say the current level of tobacco control policy implementation is insufficient in many countries around the world and that evidence-based policies are needed to reduce smoking. According to the foundation, the study ignores the role for tobacco harm-reduction (THR) products as part of tobacco control policy.

    “This study was funded by Bloomberg Philanthropies, which does not support the use of THR products as cessation aides,” said Yach. “This is likely one reason why they were not included in the report. Denying the value and benefits of THR products is irresponsible and blatantly discounts the research showing they can help smokers quit.”

    There is growing evidence that a range of harm-reduction products, including e-cigarettes (vapes), snus, nicotine pouches, and heated tobacco products, can help smokers quit or at least substantially reduce their harmful exposure to combustible cigarettes.

    Derek Yach, president, FSFW

    By contrast, The U.K. Royal College of Physicians (RCP) believes THR products should play a prominent role in tobacco control. In a recently released report, “Smoking and health 2021: A coming age for tobacco control?” the RCP estimates that if the harm-reduction policies it advocated for in 1962 were adopted, smoking would have ended in the United Kingdom by now. The new report calls for doctors to play a more active role in helping their patients who smoke. “We argue that responsibility for treating smokers lies with the clinician who sees them, and that our NHS [the U.K. National Health Service] should be delivering default, opt-out, systematic interventions for all smokers at the point of service contact,” the report’s authors write. The RCP also recommends that the U.K. government invest in media campaigns to urge smokers to switch from tobacco to e-cigarettes, which are less harmful. Governments and doctors worldwide should heed their advice.

    A new report by BOTEC Analysis, a public policy research and consulting firm, finds that the availability of regulated alternative nicotine delivery systems (ANDS) like e-cigarettes and heated tobacco products (HTPs), combined with traditional tobacco control efforts such as tobacco taxes, smoke-free laws and cessation services, have helped to lower smoking rates in several countries. Titled, “Investigating the drivers of smoking cessation: A role of alternative nicotine delivery systems?” the report examines the policies in five countries that have long been considered international leaders in tobacco control: The United Kingdom, Canada, Australia, South Korea, and Japan.

    According to the FSFW, BOTEC’s key findings presented interesting results per country, including:

    • United Kingdom: A leader in tobacco control, the country has proactively helped smokers switch to e-cigarettes, which have been shown to be 95 percent safer. While the country has some of the highest tobacco prices in the world, the government has chosen not to tax e-cigarettes as tobacco products, making them less costly. Access to regulated e-cigarettes appears to also support smoking cessation services.
    • Canada: Following the introduction of e-cigarettes in 2018, there has been a significant decline in conventional tobacco sales. As stringent regulations and higher prices apply more to traditional cigarettes than e-cigarettes, smoking rates and tobacco purchases have collapsed, especially among young Canadians. Still, the country may be poised to reverse these successes with proposed regulations that would implement a new tax on e-cigarettes and cap the nicotine content of e-liquids.
    • Australia: The country succeeded in driving cessation with a combination of health warnings, tax increases, and effective publicity campaigns. The government has implemented de-facto bans on harm-reduction products, but many Australians continue to use smuggled and unregulated e-cigarettes, reporting a desire to quit or reduce smoking as a primary motivation.
    • South Korea: The country has more than 250 public health centers that provide comprehensive clinical services, including counseling, prescription medication, nicotine replacement therapy, and text/email follow-ups. Over six months, more than 800,000 adult male smokers used these clinics with an estimated 46.8 percent quit rate. Despite the South Korean government’s disapproving stance toward ANDS, both e-cigarettes and HTPs appear to be aiding cessation.
    • Japan: Although Japan has imposed an excise tax on cigarettes and banned e-cigarettes containing nicotine, HTPs are widely available and increasingly popular. Moreover, the uptake of HTPs appears to be causally associated with a reduction in demand for combustible cigarettes. However, a lack of regulatory distinction between HTPs and combustible cigarettes appears to limit the numbers of smokers who shift to exclusive HTP use, so their effect on cessation may be muted, thus reducing HTP’s potential to aid smoking cessation.

    BOTEC Analysis is one of several Foundation for a Smoke-Free World Foundation grantees who are spearheading research to uncover new solutions to combat this global health epidemic. The FSFW collaborates with other nonprofit, advocacy, and government organizations to advance smoking cessation and harm-reduction science. The FSFW also supports the development of alternative products and methods that may reduce a smoker’s health risks and help them to stop smoking entirely.

    “In light of the billion smokers that remain, one may assume that the world has made little progress since the first WNTD three decades ago,” the FSFW concluded in its press note. “Yet, from a scientific and technological perspective, we have seen profound change. As a result of transformational research and development, we now have harm-reduction products that could end death and disease from tobacco. Still, innovation translates into saved lives only when smokers have access to the full range of cessation and harm-reduction options. Thus, in the same way that the Foundation calls on smokers to quit, it also calls on policymakers and physicians to embrace the tools that will help them do so.”

  • Consumers to Celebrate ‘Safer Choice’ on World Vape Day

    Consumers to Celebrate ‘Safer Choice’ on World Vape Day

    Photo: Aliaksandr Barouski

    Consumer advocacy groups in the Asia-Pacific region under the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) are joining the celebration of World Vape Day on May 30, with a call on the World Health Organization (WHO) and governments around the world to provide smokers with a better choice and spare them from almost 50 percent mortality rate linked to smoking.

    “The World Vape Day is a celebration of personal stories of smokers who have found a humane way out of smoking thanks to the advent of innovative smoke-free products such as e-cigarettes, heated-tobacco products and Swedish snus,” said Nancy Loucas, executive coordinator of the CAPHRA, in a statement.

    This year’s World Vape Day highlights smoke-free products as “the better choice” to combustible cigarettes, which are linked to more than 8 million premature deaths each year among 1.1 billion smokers globally.

    “We celebrate World Vape Day because it symbolizes hope for millions of smokers in Asia-Pacific and around the world who now have access to innovative nicotine products such as e-cigarettes and heated-tobacco products that were not available in the previous decades,” said Loucas.

    “Vaping is the safer choice based on our experience and on the numerous independent studies published in peer-reviewed scientific journals. Along with heated-tobacco products, e-cigarettes are considered a part of tobacco harm reduction—a public health strategy which aims to provide alternatives to reduce risks caused by smoking cigarettes,” she said.

    Loucas said these smoke-free nicotine products provide countries an opportunity to end the global problem of smoking. “We have an opportunity to save millions of lives by making the switch to better alternatives. It is also a reminder to governments and health authorities that smokers should be given the freedom of choice for their health and for their future,” she said.

    Asa Saligupta, representative of Ends Cigarette Smoke Thailand, said that while World Vape Day is being celebrated in many countries, some nations like Thailand still prohibit the use of e-cigarettes and heated-tobacco products (HTPs).

    “In several Asian countries, vapers continue to face imprisonment and fines for making the switch to e-cigarettes, which were found to be at least 95 percent less harmful than traditional cigarettes. It is a violation of consumer rights for safer alternative products and accurate information about e-cigarettes,” he said.

    I believe that vaping can achieve what existing tobacco control policies failed to accomplish in many years—end smoking.

    Peter Paul Dator, president, Vapers Philippines

    “But we remain hopeful that authorities will listen to science and give tobacco harm reduction a chance to make a difference in the lives of smokers who represent a fifth of the population in Thailand,” he said.

    Saligupta noted that Public Health England, in its 2018 independent evidence review, concluded that “e-cigarettes are around 95 percent safer than combustible cigarettes.”

    Peter Paul Dator, president of Vapers Philippines, said more than 50 million smokers around the world have already switched to vaping, which means they have significantly reduced their exposure to toxins and carcinogens found in tobacco smoke.

    “This is because unlike cigarettes, vapor products and HTPs do not burn organic matter at very high temperatures and therefore do not produce toxic fumes. I believe that vaping can achieve what existing tobacco control policies failed to accomplish in many years—end smoking,” Dator said.

    Dator pointed to the dismal smoking cessation rate of 4 percent in the Philippines, which he said reflects the ineffectiveness of existing smoking cessation strategies such as the “quit-or-die” approach. “Smoke-free products can help 16 million Filipino smokers quit smoking or switch to these less harmful alternatives,” he said.

    Mirza Abeer, the founder of the Association for Smoking Alternatives in Pakistan (ASAP), said he could attest to the effectiveness of vaping as a part of tobacco harm reduction.

    We advocate the adoption of scientifically substantiated smoking alternatives among adult consumers and policymakers.

    Mirza Abeer, founder, ASAP

    “Quitting smoking is a tough challenge to surmount, but e-cigarettes helped me and other smokers quit. Switching to vaping after smoking for 13 years resulted in my improved health. This also saved me from asthma attacks, and now I feel much better. I hope to share this personal experience to more than 15 million smokers in Pakistan so that they, too, will have a choice,” he said.

    “As head of ASAP, we advocate the adoption of scientifically substantiated smoking alternatives among adult consumers and policymakers to help significantly reduce smoking rates in Pakistan and positively impact public health as soon as possible,” said Abeer.

    World Vape Day is celebrated a day before World No Tobacco Day on May 31. CAPHRA said that with more than 50 million vapers worldwide and growing, the campaign is expected to gain ground in more countries in the coming years.

  • WHO Reiterates its Opposition to Harm Reduction

    WHO Reiterates its Opposition to Harm Reduction

    Photo: Olrat

    In the runup to World No Tobacco day on May 31, the World Health Organization (WHO) has reasserted its abstinence-only approach to nicotine.

    In a May 19 press release titled “Quit tobacco to be a winner,” the WHO said that the tobacco industry has “promoted e-cigarettes as cessation aids under the guises of contributing to global tobacco control” while employing “strategic marketing tactics to hook children on this same portfolio of products, making them available in over 15,000 attractive flavors.”

    The agency also insisted that the scientific evidence on e-cigarettes as cessation aids was inconclusive, and that “switching from conventional tobacco products to e-cigarettes is not quitting.”

    “We must be guided by science and evidence, not the marketing campaigns of the tobacco industry—the same industry that has engaged in decades of lies and deceit to sell products that have killed hundreds of millions of people,” said WHO Director-General Tedros Adhanom Ghebreyesus. “E-cigarettes generate toxic chemicals, which have been linked to harmful health effects such as cardiovascular disease and lung disorders.”

    We must be guided by science and evidence, not the marketing campaigns of the tobacco industry.

    Tedros Adhanom Ghebreyesus, director-general, WHO

    The global health body also reiterated its commitment to excluding the tobacco industry from the debate through article 5.3 of the Framework Convention on Tobacco Control.

    “The tobacco industry is the single greatest barrier to reducing deaths caused by tobacco use,” the WHO wrote. “Their interests are irreconcilably opposed to promoting public health and point to a critical need to keep them out of global tobacco control efforts.”

    The organization also cited the United Nations Global Compact, which banned the tobacco industry from participation in 2017. “In line with Article 5.3, industry has been entirely excluded from the UN system and its agencies have been urged to devise strategies to prevent industry interference,” the WHO wrote.

  • New Zealand Group Wants Vape ‘Starter Packs’ Like UK

    New Zealand Group Wants Vape ‘Starter Packs’ Like UK

    In the UK, the National Health Services (NHS) is trialing a program that will provide some smokers who are admitted to emergency departments free vaping starter kits and instruction on how to use them. This is in combination with ongoing quit-smoking support. Now, a group of vapor advocates in New Zealand wants its country’s Budget 2021 to supercharge already established smoking cessation programs by adopting the UK plan.

    “Our Government is now determined to get Smokefree 2025 back on track. Budget Day on 20 May is the first opportunity to put its money where its mouth is. Our District Health Boards and Maori health organizations have had huge success with switching smokers into vapers. It’s time for the Government to back them more,” says Nancy Loucas, co-director of Aotearoa Vapers Community Advocacy (AVCA), in a recent statement.

    Credit: Gustavo Frazeo

    Public Health England has repeatedly endorsed vaping and has never wavered from its scientific conclusion that it’s 95 percent less harmful than smoking. Recently, a new Cochrane review reinforces the effective role vaping plays in reducing smoking rates across the globe. Based in the UK, Cochrane is an independent network, involving 130 countries, health professionals, and researchers. With the strategic goal of putting Cochrane evidence at the heart of health decision-making all over the world, it represents the gold standard for high quality, trusted health information, according to a statement.

    Titled “Electronic cigarettes for smoking cessation (Review),” the Cochrane Library researchers reviewed 56 international studies, involving 12,804 adults who smoked. The study concluded that e-cigarettes could increase the number of people who stop smoking compared to other forms of nicotine replacement therapy, such as chewing gum and patches.

    It comes as a Georgetown University-led study published in the journal Population Health Metrics concludes that nicotine vaping in the US could help prevent 1.8 million premature deaths and see 38.9 million life-years gained in a span of 47 years. “Health officials in the UK believe tens of thousands of Brits stop smoking every year after switching to vaping. In fact, latest PHE estimates show that around 2.7 million adults now vape in England alone, compared to nearly seven million who smoke tobacco,” says Loucas. “What has happened over in the UK over the past decade is an impressive story. It’s one our Government needs to investigate if it is serious about rebooting New Zealand’s 2011 ambition of being smoke-free by 2025.”

    The AVCA is encouraging Kiwis to review and submit on the government’s discussion document before 5.00pm on Monday, 31 May 2021.

  • The Voice of Reason

    The Voice of Reason

    The UKVIA does a commendable job of promoting sensible vapor regulations. Will health authorities listen?

    By George Gay

    In March, I received a press note entitled, “The U.K. Vaping Industry Association [UKVIA] blasts World Health Organization [WHO] and says it risks becoming an ‘enemy of harm reduction.’”

    The UKVIA cannot be described as a militant organization. It has firm ideas, but it prefers to work quietly and closely with the U.K. government, health authorities and anybody else willing to listen to its tale of running businesses that promote tobacco harm reduction while trying to turn a profit. So, the tone of the heading made me sit up.

    What the UKVIA objected to in the first instance was what it described as “[r]ecent recommendations made by the WHO study group on Tobacco Product Regulations that would prohibit electronic nicotine[-delivery] and nonnicotine-delivery systems where the user can control device features and liquid ingredients.”

    On the face of it, I can certainly understand the UKVIA’s concern. Banning such products would be like banning automobiles with accelerator pedals because they could be used to make a vehicle travel at beyond the speed limit or banning glasses because they could be used to mix mind-altering drugs with lemonade.

    It has been said—rightly in my view—that newspapers are organizations that cannot tell the difference between a bicycle accident and a world war. By the same token, it would seem the WHO has become an organization that cannot tell the difference between a pandemic and everyday life—admittedly, life in all its messiness.

    The UKVIA said the WHO had called also for a ban on vaping systems that have a higher “abuse liability” than conventional cigarettes have; systems that, for example, allow the user to control the emission rate of nicotine. In this case, I’m so underwhelmed by the sound of the problem that I can assume only that I have misunderstood what is being said here. Isn’t it the case that nicotine uptake is controlled by the inhaler at a subconscious level?

    In any case, I cannot see what business this is of the WHO. Does it want to micromanage every aspect of the lives of everybody on the planet? Is it going to start looking into the “abuse liability” of high-performance cars, over-proof alcohol and sickly candy bars? Of course, if it wants to make itself useful and if it is happy working at a national rather than a world level, it could end no amount of inflicted harm by helping to do something about the abuse liability and abuse reality of the many and increasing dictatorial regimes around the world.

    Empowered personal choice

    The director general of the UKVIA, John Dunne, believes the WHO poses a threat to smoking cessation and harm reduction in the U.K. “While the WHO is scheduled to hold a crucial summit on vaping in November 2021, known as COP9 [the Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC)], it continues to find itself at odds with health and industry advocates,” he was quoted in the press note as saying.

    “Certain WHO positions are now so out of date, and so thoroughly refuted by the experts, that they may as well be saying the earth is flat. They deviate dramatically from leading experts, including Public Health England (PHE) and Action on Smoking and Health …

    John Dunne

    “Take for example vaping helping people to quit smoking, which the WHO says there is ‘little evidence’ of. As early as 2019, clinical trials were finding vaping to be almost twice as effective as nicotine-replacement therapy …

    “Just this month, … PHE … found in its Vaping Evidence Review 2021 that smoking quit rates involving a vaping product were higher than with any other method in every single English region. For the WHO to hold such contrary views is either bad science or bad faith. Both risk it becoming an enemy of harm reduction.”

    Dunne made the point that vaping’s success as an industry, and its potential for public health improvements, were built on empowering personal choice. “Different systems, styles and flavors give consumers the options they need to leave combustible cigarettes behind,” he said. “I would urge the WHO to engage with vapers, to hear their stories and discover the life-changing decisions they’ve made… Prohibition is simply not the answer.”

    The press note also said that the U.K. was due to send a delegation to the COP9 summit later this year, the first time it would be attending such a summit since leaving the EU, and it was to be hoped that this would provide an opportunity for it to promote harm-reduction. In addition, it said the UKVIA had been among expert guests invited by the All-Party Parliamentary Group for Vaping to advise on the COP9 delegation’s approach.

    “The U.K. has a genuine opportunity to promote harm reduction as a valid, progressive strategy for public health on the world stage,” said Dunne. “We must not allow misinformation to undermine this potential, irrespective of the source.”

    It is indeed to be hoped that the U.K. delegation to COP9 can bring a little reason to the table, assuming it gets to the table. From what we of the outer dark can ascertain, however, the FCTC does not brook dissent and, as part of its strategy to avoid it, tends to block the attendance at meetings of those not of the true faith. It will be interesting to observe what it will make of a delegation that has been in direct or indirect contact with a vaping body, assuming the delegation does not cave in and join the happy-clappies.

    Return to sender

    Meanwhile, the UKVIA has a further problem. In another press note in March, it said it was deeply concerned by news that U.K. businesses were being impacted by the U.S.’ “vape mail” ban, part of a congressional spending bill passed under former President Trump. By April 27 [after this report was written], leading carriers, such as UPS, FedEx, DHL and the U.S. Postal Service, were due to be off-limits for vaping shipments.

    FedEx had cited “cigarettes, cigars, loose tobacco, smokeless tobacco, hookah or shisha, vaporizers (and) e-cigarettes” as “tobacco products,” which would no longer be accepted. The UPS said it would prohibit “any and all noncombustible liquid or gel, regardless of the presence of nicotine, capable of being used with or for the consumption of nicotine” as well as “all related vape devices, products and accessories …”

    Again, we find ourselves in a bizarre world. I take it these bans are somebody’s idea of a health and safety policy, but, with more “premature deaths” worldwide attributed to outdoor pollution than to tobacco consumption, logically, the carriers should ban deliveries of everything—they should remove themselves from the roads, the air and the sea. Or there should at least be an acceptance that both tobacco smoke and vehicle pollution are health hazards and that whereas carriers might be trying to lessen the pollution they create by switching to cleaner vehicles, craft and vessels, the tobacco industry is trying to lessen the amount of tobacco smoke by getting consumers to switch to vaping, a task not made any easier by carrier bans. Of course, there is little the carriers can do to reverse this nonsense, but they could at least have a word with any politician ready to listen.

    “The vaping supply chain is a global one, bringing together resources and expertise from around the world,” said Dunne. “It is bitterly disappointing to see these American restrictions having a negative impact in the U.K., but the nature of the supply chain makes it inevitable. In the EU, too, we are hearing of vaping businesses being turned away from major carriers.

    “The potential impact on public health is grave as so many people are relying on shipped goods as a lifeline during the pandemic. Without proper access to harm reduction products, we know people can revert to smoking cigarettes, today in the U.S. but perhaps tomorrow in the U.K. With businesses already struggling through lockdown, and our health services under great strain, supply chain issues really are the last thing we need.

    “I call on the distribution industry, many of whom have been partners of the vaping industry for many years, to do all they can to support their U.K. customers and to avoid the blanket implementation of U.S. restrictions worldwide.

    “Furthermore, I call on the U.K. government to ensure that carriers in this country are free to continue to deliver vaping products to retailers and direct to consumers and to resist any urge to follow the U.S. down this regressive route.”

    I take it that the “vape mail” ban is largely about keeping vaping products out of the hands of young people. It’s a strange thing that the activities of adults, which have always been restricted by the need to guard against criminal activities, are now increasingly becoming restricted by perceived threats to young people—often inappropriately referred to as “children” when it becomes necessary to ramp up the emotional blackmail.

    Credit: Haiberliu

    Such restrictive measures would be acceptable in my view if they were applied across the board, but they are not. Young people are seen by many people in authority as having to be protected against the minuscule threat posed by vaping products while many youngsters are allowed to go hungry, threatening their development and negatively affecting their whole lives.

    It would seem that young people are granted protections when those protections do not inconvenience the majority of voters. See how far you would get trying to introduce a 20-mph speed limit in cities so as to cut the number of deaths and injuries suffered by young people in collisions with cars.

    The Conservative Party, which has been in government in the U.K. for more than 10 years, has a poor record on child poverty, which has shot up under its governance, and on child hunger, in the face of which it twice provided relief for the neediest children during lockdowns only after being shamed into doing so by a campaigning footballer.

    But, on the other hand, it has had a good record in respect of supporting the tobacco harm reduction potential of vaping, and the UKVIA is hoping the situation in the U.K. can be improved further following the country’s exit from the EU.

    On March 15, the UKVIA launched its Blueprint for Better Regulation in response to the U.K. government’s consultation on the Tobacco and Related Products Regulations (TRPR) (and the Standardized Packaging of Tobacco Products Regulations), in which it was seeking until March 19 feedback on the effectiveness of the legislation in achieving its objectives and any unintended consequences that may have occurred.

    In a foreword to the blueprint, Dunne said the review of the regulations represented a defining moment in the history of the vaping industry, one of the leading market disruptors in the 21st century responsible for a significant decline in smoking across the U.K. It also presented the biggest opportunity yet for the government to create fair and proportionate vaping regulation that supported its 2030 smoke-free target and ensured the sector could make a bigger contribution to the nation’s public health and economy in the future.

    To achieve such a goal, the UKVIA needs the help of the government to counter the misinformation currently providing an increasingly powerful drag on efforts to encourage people to switch from smoking to vaping. It needs the government’s help in mounting promotional campaigns aimed at such switching, and its permission to mount its own agreed consumer communication campaigns, including with those buying online. And it needs the freedom in which its members can develop vaping products capable of competing with conventional cigarettes on a nicotine-satisfaction basis.

    There is, of course, much more in the UKVIA’s blueprint. No such presentation would be complete without a discussion of the important role flavors play in encouraging people to switch. The blueprint looks at packaging and labeling, descriptors and product quality and safety. It supports age restrictions on the purchase of vaping products and the need to work with trading standards officers in ensuring such restrictions are enforced. And it wants the government to act in relation to vaping in public places.

    What are the chances? Well, Dunne appears to be confident, and, as is mentioned above, the government has in the past been supportive of the tobacco harm reduction argument made in respect of vaping; so it could be willing to work with at least some the UKVIA’s ideas, perhaps all of them. But caution must be advised.

    Two skills the U.K. government is known for are its shape-shifting and U-turns. And one concern must be the government’s likely reaction if it found that conversions to vaping picked up so fast that tax revenues from tobacco fell dramatically. It’s addicted to such revenue, especially since the promised Brexit dividend, not even mentioned in March’s budget, seems to have melted away.

  • Consumer’s Choice

    Consumer’s Choice

    INNCO works with consumer advocacy groups to promote tobacco harm reduction around the globe.

    By Timothy S. Donahue

    Most of the world’s cigarettes are consumed in low-income to middle-income countries (LMICs). From Armenia to Zambia, these countries can also have high rates of adolescent smoking, particularly among males. Rates in some countries can reach as high as 46 percent, according to the U.S. National Institutes of Health. Research suggests that 80 percent of the world’s combustible cigarette users are in LMICs.

    While numerous studies have shown otherwise, the World Health Organization (WHO) has long insisted that less risky nicotine products, including vapor products and e-cigarettes, are as harmful and dangerous as combustible tobacco products and should be banned or heavily regulated. The International Union Against Tuberculosis and Lung Disease (The Union), a Bloomberg partner for The Initiative to Reduce Tobacco Use, published its fourth position statement on e-cigarettes last year. It called for a blanket ban on all electronic nicotine-delivery systems (ENDS) and heated-tobacco products (HTPs) in all LMICs. These organizations, typically through groups funded by Michael Bloomberg, the billionaire anti-smoking advocate, will often donate millions of dollars to poor or struggling countries if governments agree to ban or heavily restrict access to less risky products.

    As a result of policies based on false information from organizations such as The Union and the WHO, nicotine consumers in LMICs often have no delivery system available other than combustible products. Experts say that the lure of massive amounts of funding is just too great for such countries to resist.

    The International Network of Nicotine Consumer Organisations (INNCO), a global advocate for sensible tobacco harm reduction (THR), states in a recent position paper that bans on ENDS are overly simple solutions that make the problems that come with combustible cigarette use worse. It also states that reduction and substitution are valid goals for smokers in LMICs as replacing combustible tobacco with alternative nicotine products can reduce risk of harm by at least 95 percent.

    “The hundreds of millions of people who smoke in these countries should have the ability to make decisions about safer nicotine products, particularly when their own health is on the line,” said Samrat Chowdhery, president of INNCO’s governing board. “Overly simplistic policy solutions, such as proposed bans on all ENDS and THR products by the Bloomberg Philanthropies-funded The Union, are being offered as a blunt and impractical tool for a situation that requires pragmatism and nuance.”

    The need for INNCO

    INNCO was founded in 2016 to build cooperation between the growing number of global associations that advocate for THR. An organization can join INNCO if they are nonprofit, consumer-controlled and focused on tobacco harm reduction. The organization has 40 members in 35 countries, including the U.S.-based Consumer Advocates for Smoke-free Alternatives Association, a well-established advocacy group that raises awareness and protects the rights of consumers to access reduced harm products. INNCO also has members from Canada, Denmark and Greece to the Philippines, Brazil and Kenya.

    The organization continues to grow. “We are enlisting new members in several countries,” Chowdhery told Vapor Voice after the release of the position paper in March. “We are helping consumers form organizations where there are none. Africa came on board, where we have four, five members from that region this year, and since 80 percent of smokers do live in LMICs, it’s an additional focus that we have developed. It is something that, with this paper, we want to really say, ‘OK. We want to participate in discussions on these issues in LMICs.’”

    Samrat Chowdhery

    When The Union released its position paper calling for outright bans, Chowdhery says the recommendations were discriminatory. It was centered on the idea that if LMICs would not be able to enforce regulations, the only other option was a total ban on reduced-risk products.

    “They were not very mindful of the situation where if you could not regulate, it’s likely that you will also not be able to enforce a ban either. We know this because it’s what has happened in Mexico, Brazil and Thailand, where there have been bans, but products are very easily available,” explains Chowdhery. “If they would have instead implemented some sort of a regulatory control, you could ensure that there are product standards, they’re not sold to minors … but only having them available on the black market, those controls are not there, and you end up increasing the level of population harms to health.”

    Typically, when organizations like the WHO or United Nations develop policy, the organizations involve the industry stakeholders. After all, these are the people and businesses that the policies impact, says Chowdhery. Tobacco is the only industry that consumers and stakeholders do not have a say in policymaking.

    “The media should be taking this up. There is some trickery here,” he says. “The way the debate has been developed and the way Article 5.3 is getting misused all the time—it is a tough fight, but we’re up for it … we have our lives in the balance.” Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC) states that when setting and implementing their public health policies with respect to tobacco control, “Parties shall act to protect these policies from commercial and other vested interests” of the tobacco industry. Many anti-tobacco organizations have interpreted this as a ban on all interactions with the industry.

    Words of reason

    In the paper, INNCO claims that blanket bans on vaping and HTPs are a detriment to LMICs. The report, “10 Reasons Why Blanket Bans of E-Cigarettes and HTPs in low-[income] and middle-income Countries (LMICs) Are Not Fit for Purpose,” warns policymakers that limiting nicotine consumption options to reduce harm will only increase the number of people smoking combustible tobacco. The paper lists the following reasons:

    • Bans are an overly simplistic solution to a complex issue and will not work.
    • Prioritizing the banning of reduced harm alternatives over cigarettes is illogical.
    • Reduction and substitution are valid goals for smokers in LMICs.
    • People who smoke have the right to choose to reduce their own risk of harm.
    • Reduced harm alternatives can significantly contribute to the aims of global tobacco control.
    • Lack of research in LMICs is not a valid reason to ban reduced harm alternatives.
    • The prohibitionist approach in LMICs is outdated, unrealistic and condescending.
    • Bans will lead to illicit markets with increases in crime and no tax revenue.
    • Banning reduced harm alternatives leads people back to smoking and greater harm.
    • Blanket bans in LMICs are a form of “philanthropic colonialism.”

    INNCO says many LMICs risk an increase in smokers as a result of their policies. Leveraging the paper’s findings, INNCO states that it will work with its global membership to inform policymakers in developing nations to help achieve risk-relative regulations and access to THR products

    “Africa is home to some of the highest-ranked smoker countries on the planet,” said Joseph Magero, chairman of the Campaign for Safer Alternatives, a pan-African nongovernmental member organization dedicated to achieving 100 percent smoke-free environments in Africa. “While improving overall public health has made great strides in these regions, efforts to directly address smoking cessation and harm reduction strategies have lagged due to limited or no access to safer, noncombusti[ble] nicotine products. By denying smokers access to much safer alternatives while leaving cigarettes on the market, policymakers would leave only two options on the table—quit or die.”

    Nancy Loucas of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), a grassroots alliance of THR advocacy organizations and an INNCO member, said a blanket ban in LMICs is a form of philanthropic colonialism, suggesting that these countries and their citizens cannot be trusted with any level of self-determination. “Inhabitants are treated as second-class citizens, which is offensive,” she said. “There is no benefit in limiting choice of safer nicotine products but only the potential for increasing harm.”

    Samsul Arrifin, president of the Malaysian Organisation of Vape Entities (MOVE) and an INCCO member, concurred with the INNCO assessment, saying that “any move to deprive smokers and consumers of better alternatives to cigarettes, such as vapes, would only contribute [to] the problem that [it] seeks to address.”

    Francisco Ordonez of the Asociacion por la Reduccion de danos del Tabaquismo Iberoamerica, a network of consumer organizations in Latin America and an INNCO member, says that few LMICs have adopted even the most basic prevention measures suggested by the WHO. “Policymakers should embrace harm reduction as a valid goal, particularly in LMICs where access to cessation programs is extremely limited,” said Ordonez. “Replacing combustible tobacco with alternative nicotine products can significantly reduce the risk of harm by at least 95 percent. It works in industrialized nations and can do the same in LMICs.”

    The Bloomberg conundrum

    Much of the ire of the THR community is reserved for Bloomberg Philanthropies (BP). In September 2019, Bloomberg and Matthew Myers, president of the nonprofit Campaign for Tobacco-Free Kids, launched a $160 million three-year campaign to end what they described as an epidemic of e-cigarette use among kids. The campaign is supported by several large nonprofits, like the Truth Initiative, American Cancer Society, American Heart Association and American Lung Association. Together, the organizations are pushing for a national ban on flavored ENDS products in the U.S.

    Chowdhery says that Bloomberg is using philanthropy in an unprecedented manner. “I’ve not seen anyone do this. This is so insidious. You have Bloomberg-funded attack groups,” says Chowdhery. “They were anti-smoking for a long time until these new [reduced-risk] products came on the market. Then they expanded their focus to become anti-nicotine … they are becoming more and more radicalized, proposing more and more extreme ideas as we go along. You have groups that their only stopping-tobacco tactic is just attacking people. That’s their job. That’s all they do.”

    Bloomberg, both as an individual and through his foundation, has committed nearly $1 billion to combating tobacco use worldwide, most of it focused on LMICs, according to BP. “These policies are what we call philanthropic colonialism because they’re just pushing an idea they have, an idea a New York billionaire has, on countries, which may not be suited for this,” explains Chowdhery. “He’s not proposing those policies [total bans] in the U.S.”

    Chowdhery says Bloomberg and his charities spread lies and disinformation without any regard for the negative impact on public health. During an appearance on CBS News, Bloomberg suggested vaping lowers IQ, even though there is no evidence about a relationship between nicotine use and intelligence.

    Chowdhery hopes the INNCO position paper will be read by the policymakers working with Bloomberg. “That was the main objective of the paper: to reach out to policymakers, reach out to media and professionals and let them know … what is being proposed has another side to it,” said Chowdhery. “See, this is a David and Goliath problem. What they have are well-funded organizations to push this narrative. And what they also have is credibility because a lot of this is coming from [well-known nonprofit groups]. Even if they publish a paper with lots of misinformation and have a disclaimer: ‘We received a million dollars from Bloomberg but that did not influence our work.’ That is a big problem.”

    The push forward

    The pandemic hit INNCO hard. Chowdhery, a former journalist, founder of the Council for Harm Reduced Alternatives and the director of the Association of Vapers India, was approached to head INNCO in July 2020. He said the organization had a lot of plans for the year, including regional meetings and setting up networks, projects that required a lot of on-ground activities. Then everything needed to be scaled back. The year 2020 became about recalibrating INNCO’s efforts. “The year was full of uncertainty and adapting and doing things differently. We did a lot of online meetings and a lot of internal objectives online,” said Chowdhery. “We enrolled more members. When we put out a call for a CEO, we got 400 resumes.”

    Chowdhery says that the main goal for INNCO now is to have a say in policymaking and be recognized as a legitimate stakeholder in this tobacco control intervention. It won’t be easy. Already, groups funded by Bloomberg are trying to discredit INNCO. “Our strength is our membership base. They are organizations that might be poor but [are] passionate, and they are volunteering their time and effort[s]. That is the real strength, and we need to leverage that and get everyone on the same platform so that we speak with common messaging,” says Chowdhery. “This is the first year that we actually have a budget to do our work. Unfortunately, we’ve not started because of Covid-19. We’re getting a new CEO, who should be with us soon. Things are looking really good.”

    In a recent essay in the journal Science, “Evidence, Alarm and the Debate Over E-Cigarettes,” five experts in public health state that it is a mistake to restrict access to vaping products while leaving deadly cigarettes on the market. The authors include Cheryl Healton, the former chief executive of the Truth Initiative, who is dean of the New York University school of public health, as well as the deans of the schools of public health at Ohio State and Emory universities. The essay concludes: “Careful analysis of all the data in context indicates that the net benefits of vaped nicotine products outweigh the feared harm to youth.”

    Chowdhery says that 15 years ago, there were no groups championing tobacco consumer rights. It’s now, when safer means of consuming nicotine are available, that consumers want to have access to them. “We consider that a right. This campaign of misinformation and regulatory overreach is a disaster waiting to happen,” says Chowdhery. “People in tobacco control, they’re earning paychecks to develop a policy which they then get passed through Parliament somewhere and they believe their work is done and they go home. The problem is, did legislation stop the use of that product that day? No, it just went underground. It became riskier. Now, it’s costing people their lives.”

  • Stroud: UK Could Lead World in Tobacco Harm Reduction

    Stroud: UK Could Lead World in Tobacco Harm Reduction

    If a nation’s public health policy succeeded in making its citizens healthier, wouldn’t you expect intergovernmental health organizations to examine that policy, embrace it, perhaps see if it could be applied to other countries?

    Common sense, right?

    Unfortunately, the taxpayer-funded World Health Organization (WHO) is doing the opposite when it comes to tobacco harm reduction products, states Lindsey Stroud, an analyst for the Taxpayer’s Protection Alliance (TPA), in an editorial for Inside Sources.

    The United Kingdom is a world leader in e-cigarette use among current and former adult smokers. In 2015, Public Health England (PHE) released a landmark report that found e-cigarettes 95 percent safer than smoking. In 2018, the agency would reiterate this finding in an additional examination of the evidence.

    Moreover, UK public health agencies actively campaign for the use of e-cigarettes as a substitute for smoking. PHE’s “Stoptober” campaign (launched in 2012) endorsed e-cigarettes and has advocated for “the use of e-cigarettes to help quit smoking.” The strategy appears to be working. In 2019, there were more than 4 million ex-smokers in the UK that had tried vapor products, with 2.2 million of them no longer smoking.

    Now that the UK is no longer a member of the European Union, members of parliament have sought to redefine the country’s relationship with WHO. In particular, parliament is reviewing the provisions set forth in the organization’s Framework Convention on Tobacco Control (FCTC), of which the UK is a signatory member. Under the FCTC, members must adhere to a plethora of adopted guidelines including price and taxing measures to control – and ideally reduce – demand for tobacco products, as well as other policies to help protect public health and reduce cigarette consumption.

    Unfortunately, the FCTC (and WHO) ignore the vast evidence regarding tobacco harm reduction products. Instead, they are steadfast in refusing to allow tobacco companies to provide safer alternatives to smoking.

    Regularly, the members of the FCTC meet at a Convention of Parties (COP) to “review the implementation of the Convention and any other legal instruments that the COP adopts.” Since 2008, the organization has consistently pushed its members to “prohibit or restrict” smoking alternatives like vaping.

    Lindsey Stroud
    Lindsey Stroud

    By 2019, any hope that the FCTC would even acknowledge the role of tobacco harm reduction products (including e-cigarettes, heated tobacco products, smokeless and snus) as a way for smokers to quit, was essentially snuffed out. In September 2019, Head Convention Secretariat Dr. Vera Luiza da Costa e Silva blasted e-cigarettes, calling vaping “a treacherous and flavored camouflage of a health disaster.”

    But the UK may be preparing to push back. In a March 2021 report by the All-Party Parliamentary Group (APPG) for Vaping, the group reported that at the upcoming FCTC/COP9, the UK is in a unique position to “champion its … domestic policies on tobacco harm reduction.” In prior COPs, the UK delegation was “obligated to adhere to the consensus view within the European Union, post-Brexit.” At FCTC/COP9, the delegation is permitted to defend their own domestic regulation of e-cigarettes and tobacco harm reduction products, but also emerge “on the world stage as a leader pragmatic and effective health regulation.”

    The APPG for Vaping has denounced WHO’s position on tobacco harm reduction products. Their report notes two papers leaked from WHO’s Eastern Mediterranean Regional Office, which “suggest that the WHO is exploring whether to advocate that reduced-risk products are treated in the same manner as cigarettes or to ban them outright.” As a result, the APPG report recommends the UK delegation to COP9 should oppose “any decision proposed … that would equate vaping products with combustible cigarettes.”

    It’s an utter shame the UK must still defend its tobacco control policies, as it was one of the very first countries to examine cigarette use and cancer incidence. In 1962, the Royal College of Physicians (RCP) published its landmark report on “Smoking and health” which “made a strong epidemiological case for the harm done by smoking,” and urged the government to introduce public health measures to reduce smoking.

    By comparison, it would take two additional years for the United States to publish the 1964 Surgeon General’s report on smoking.

    The RCP has also endorsed the use of e-cigarettes as a method to quit smoking, reporting in 2016 that the use of vapor products is “unlikely to exceed 5 percent of the risk of harm from smoking tobacco.”

    The UK should not have to defend its tobacco harm reduction products to WHO, a taxpayer-funded organization that purports to protect global health, but staunchly disregards novel tobacco products. At the publication of the APPG for Vaping report, MP Mark Pawsey – and chair of the APPG Vaping group – declared that with “WHO taking an increasingly hostile stance on vaping, it is more important than ever that the UK be guided by the science.”

  • Think Tank: Relax the Rules on Alternative Products

    Think Tank: Relax the Rules on Alternative Products

    Photo: lezinav

    The U.K. Vaping Industry Association (UKVIA) has welcomed the Adam Smith Institute’s report published today. “The Golden Opportunity—How Global Britain can lead on tobacco harm reduction and save millions of lives,” warns the U.K. is on course to miss its “smoke free by 2030” target unless regulations around alternative products are relaxed.

    The UKVIA has consistently called for the U.K. to make the most of the opportunities presented by leaving the European Union, which are now available to the vaping sector. This includes removing unnecessary regulations which the association believes are often a barrier to harm reduction and tackling misinformation about e-cigarettes. The UKVIA included these matters in its recent submission to the government’s consultation on the Tobacco and Related Products Regulations (TRPR) published in March.

    The U.K. has taken a world-leading role in harm reduction in this area, and it should continue to do so, according to the UKVIA. To achieve smokefree status, however, more work still needs to be done. The report points out that despite huge take up in smoking cessation products in recent years, there are still 7 million smokers in the U.K., which equates to 14.1 percent of adults. There is a concern within the sector that current low rates for smoking could be reversed by an increase in social smoking because of recent Covid-19 lockdowns.

    The Adam Smith Institute report, written by its head of programs, Daniel Pryor, also calls for “ineffectual warnings” on some vaping products to be replaced and argues that the U.K. should “robustly defend its approach to tobacco harm reduction” at the global Framework Convention on Tobacco Control’s COP9 and related WHO meetings later this year.

    This report is welcome as it shows the opportunities which are now available for the U.K. vaping sector in terms of increasing smoking cessation and promoting harm reduction.

    John Dunne, director, gereral, UKVIA

    Following the recent announcement of a trial of e-cigarette products taking place in five hospital A&E departments later this year, the sector anticipates an additional boost to the numbers of people switching to e-cigarettes and awaits the results of the trial with interest.

    “This report is welcome as it shows the opportunities which are now available for the U.K. vaping sector in terms of increasing smoking cessation and promoting harm reduction, which is why the UKVIA called for vape retail outlets to be classified as ‘essential retail’ throughout the recent lockdowns,” said UKVIA Director General John Dunne.

    “The Adam Smith Institute’s report builds on our own proposals which we submitted to the government’s TRPR Consultation. We support the report’s proposals on opposing ‘counterproductive regulations’ which can harm efforts to get smokers to switch to safer alternatives.”

    “The UKVIA is already working with international partners ahead of the crucial COP9 summit later this year. We will continue to represent the sector as a whole and highlight the consensus opinions of U.K. public health bodies on the safety and efficacy of e-cigarettes to policymakers. We will continue to encourage the government to allow ‘Global Britain’ to use its newly independent position to encourage the World Health Organization to adopt a more reasonable approach with regards to reduced-risk products.”

  • U.K. Health Service to Offer Free Vaping Devices

    U.K. Health Service to Offer Free Vaping Devices

    Photo: UAV4

    As part of a trial being led by the University of East Anglia, the U.K. National Health Service (NHS) will provide vaping devices and e-liquids to smokers coming to the emergency departments of five hospitals across the U.K. to help them quit.

    Patients attending emergency departments in five hospitals in Norfolk, London, Leicester and Edinburgh will be offered a device, enough e-liquid supplies for a week and referral to local smoking-cessation services, alongside medical advice.

    This will be followed up at one, three and six month intervals over a 30 month period, to monitor success rates for those introduced to vaping, compared to those only offered leaflets with details of local smoking-cessation services in the same trial.

    “I welcome this trial being launched and the additional research, which will hopefully make it easier for people to quit smoking in the future.,” said Norman Lamb, former health minister and former chair of the House of Commons science and technology committee.

    I welcome this trial being launched and the additional research, which will hopefully make it easier for people to quit smoking in the future

    Norman Lamb, former health minister

    “I am particularly keen to ensure that vaping is made available to people with mental ill health given continuing high smoking rates. It is very positive to have such a prominent trial funded by the National Institute for Health Research (NIHR) including clinical trials. I await the results with interest.”

    The U.K. Vaping Industry Association (UKVIA) heralded the NHS’ decision as a landmark moment. “This is a hugely significant moment in the history of vaping and harm reduction,” said John Dunne, director general of the UKVIA.

    “For the first time, following years of research and campaigning, we are finally at the point where the NHS looks to be fully embracing vaping and acknowledging its important role as the number one quit method.”

    Dunne renewed his call to government to give vaping more opportunity to promote itself as a harm reduction alternative to smoking when it is due to review the Tobacco Related Products Regulations in May.

    “We have put forward the idea of using government-approved, expert health claims on vaping products to encourage the remaining six to seven million smokers in the U.K. to switch, as well as making sure that there are greater opportunities for the vaping industry to engage with smokers through marketing and advertising means, as current restrictions deter those who may have otherwise made the changeover,” he said.

    “It is extremely important that hospital staff have the knowledge to advise smokers about vaping, including which devices to use, nicotine levels and flavors to opt for in order to support a successful quit.”

  • SHEER Opinion on Novel Products Due Friday

    SHEER Opinion on Novel Products Due Friday

    Photo: andriano_cz

    The European Commission’s Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) is due to present its opinion on novel tobacco products Friday.

    The opinion is part of an assessment of the EU Tobacco Product Directive (TPD), which will determine whether e-cigarettes will be treated the same way as traditional cigarettes.

    SHEER’s preliminary opinion published in September 2020 drew strong criticism of several stakeholders who accused the EU of being selective in its findings when it comes to their health implications.

    “Research in recent years, after the adoption of TDP in 2014, has become increasingly positive about e-cigarettes, always as a substitute for smoking,” Konstantinos Farsalinos of the University of Patras told Eurarchiv. “Compared to 2014, one would expect a more positive attitude. On the contrary, EU policymakers remain scientifically unsubstantiated with the risk of sabotaging the efforts to replace smoking with e-cigarettes,” he said.

    Pietro Fiocchi, a member of the European Parliament from the European Conservatives and Reformists Group, expressed concern about increased smoking if the EU Commission decides to equate novel tobacco products with traditional ones.

    “My impression is that the Commission is against a differentiation between traditional tobacco and reduced-risk products, and it will plan to apply the same limitations, through heavy regulations and fiscal impositions,” he said.

    “We all agree that not smoking at all is the best solution, but it would be detrimental if SCHEER will ignore plenty of scientific studies that show much smaller health impact of reduced-risk products is versus traditional tobacco,” said Fiocchi.