Category: Harm Reduction

WHO Advises Countries to Ban Open System Devices

Photo: Vaperesso
Vapor advocates have expressed concern about recent recommendations made by the World Health Organization (WHO) study group on Tobacco Product Regulations to prohibit electronic nicotine and non-nicotine delivery systems where the user can control device features and liquid ingredients. The WHO has also called for a ban on vaping systems that have a higher “abuse liability” than conventional cigarettes, for example by controlling the emission rate or flux of nicotine.
Clive Bates
Clive Bates, a tobacco harm expert and former director of Action on Smoking and Health (ASH), called the advice irresponsible and bizarre. “If governments take it seriously, they will be protecting the cigarette trade, encouraging smoking and adding to a huge toll of cancer, heart and lung disease,” he said.
The U.K. Vaping Industry Association (UKVIA) said the WHO is out of touch with growing evidence on the public health potential of vaping. “Certain WHO positions are now so out of date, and so thoroughly refuted by the experts, that they may as well be saying the earth is flat,” said John Dunne, director general at the UKVIA, in a statement. “They deviate dramatically from leading experts, including Public Health England and Action on Smoking and Health.”
Dunne cited the WHO’s assertion that there is “little evidence” for vaping’s role in helping people quit smoking. As early as 2019 clinical trials were finding vaping to be almost twice as effective as nicotine replacement therapy, he noted.
This month, Public Health England (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.
John Dunne
“For the WHO to hold such contrary views is either bad science or bad faith. Both risk it becoming an enemy of harm-reduction,” said Dunne.
“Vaping’s success as an industry, and its potential for public health improvements, is built on empowering personal choice,” he added. “Different systems, styles and flavors give consumers the options they need to leave combustible cigarettes behind. I would urge the WHO to engage with vapers, to hear their stories and discover the life-changing decisions they’ve made in their lives. Prohibition is simply not the answer.”
The WHO is scheduled to hold a summit on vaping, during the Conference of Parties to the WHO Framework Convention on Tobacco Control (COP9) in The Hague in November 2021. Following its exit from the European Union, the U.K. will send a national delegation the meeting. The UKVIA was among expert guests invited by the All-Party Parliamentary Group for Vaping to advise on the COP9 delegation’s approach.
“The UK 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.”
March 2, 2021
Public Supports Innovative THR Approach

Photo: PMI
A new international survey commissioned by Philip Morris International (PMI) and conducted by independent research firm Povaddo reveals a public appetite for a better approach to reducing the societal harm caused by cigarettes. Seven in 10 respondents (71 percent) believe that encouraging those adults who would otherwise continue to smoke to switch to smoke-free alternatives instead can complement other efforts to reduce harm.
Conducted in December 2020 among 22,500-plus adults in 20 countries and territories, the survey explores attitudes regarding the role of smoke-free alternatives in improving public health. The results reveal broad support for novel approaches to accelerating the decline of cigarette smoking. Specifically, the survey found that: 73 percent of adults agree that governments should consider the role alternative products can play in making their country smoke-free; 77 percent agree that adult smokers should have access to and accurate information about smoke-free alternatives that have been scientifically substantiated to be a better choice than continued smoking; and 67 percent of respondents say that if it is possible to end cigarette sales in their country within 10 to 15 years (through smokers quitting tobacco or switching to better, science-based alternatives), their government should dedicate time and resources to making that a reality.
Three in four respondents (76 percent) believe it is important for governments to dedicate time and resources to reducing smoking rates. However, a majority (58 percent) believe that more regulation and taxation of cigarettes will not be enough to achieve a smoke-free future.
Jacek Olczak
“Smoke-free products have already started to play an important role in lowering smoking rates,” said Jacek Olczak, chief operating officer at PMI, in a statement. “With the right regulatory encouragement, support from civil society and the full embrace of science, I believe it is possible for the public’s call to be answered and for cigarette sales to be a thing of the past in many countries within a decade to a decade and a half.”
Most adults surveyed want to see a shift in the societal approach to tobacco harm reduction, including more collaboration between governments and tobacco companies. Moreover, nearly seven in 10 respondents (68 percent) support tobacco companies working with governments, regulators and public health experts to ensure smokers have access to and accurate information about the better, smoke-free alternatives science has made available. Further, eight in 10 respondents believe both governments (88 percent) and businesses (81 percent) have a responsibility to embrace the latest scientific and technological developments.
March 2, 2021
UK Health Group: Vapor Works as Quit-Smoking Aid

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Nicotine vaping products were the most popular quit-smoking aids (27.2 percent) in England in 2020, according to Public Health England’s (PHE) seventh independent report on vaping, carried out by researchers at King’s College London. Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates—between 59.7 percent and 74 percent in 2019 and 2020. An estimated 50,000 smokers stopped smoking with the aid of a vaping product in 2017.
Despite these trends, 38 percent of smokers in 2020 believed that vaping is as harmful as smoking; with 15 percent believing that vaping is more harmful
The coronavirus pandemic is likely to have had an impact on smoking and vaping behaviors in both adults and young people. However, it is still too early to assess the full effect of the pandemic, with much of the data examined in this report being pre-pandemic.
Vaping has plateaued in adults and young people since the last PHE report in March 2020. Around 4.8 percent of young people (aged 11 to 18 years) reported vaping at least once a month—the same as last year—and most of these were either current or former smokers (only 0.8 percent of young people who had never smoked currently vape). Smoking prevalence among young people, including those who smoked sometimes or more than once a week, was 6.7 percent in March 2020, similar to March 2019, at 6.3 percent.
Similar to last year, around 6 percent of adults are current vapers, equating to about 2.7 million adult vapers in England. Smoking prevalence continues to fall and is between 13.8 percent and 16 percent depending on the survey. Vaping prevalence was between 17.5 percent and 20.1 percent among current smokers, around 11 percent among former smokers and between 0.3 percent and 0.6 percent among those who have never smoked. The proportion of vapers who also smoke, or “dual users,” has declined since 2012.
“Our report draws together findings from randomized controlled trials, stop-smoking services and population studies and concludes that nicotine vaping products are an effective way of successfully quitting smoking,” said Ann McNeill, professor of tobacco addiction at King’s College London.
“What is concerning is that smokers, particularly those from disadvantaged groups, incorrectly and increasingly believe that vaping is as harmful as smoking. This is not true and means fewer smokers try vaping.
“The goal for 2030 is to be smokefree in England. The development of a new Tobacco Control Plan and this year’s review of the Tobacco and Related Products Regulations 2016 is an opportunity to ensure that the regulations around vaping are appropriate. The regulations are also hoped to help smokers to quit, while not attracting people who have never smoked.”
February 25, 2021
Vapor Advocates Welcome PHE Evidence Review

Photo: Chris Dorney – Dreamstime.com
Public Health England’s (PHE) latest evidence review reinforces vaping’s role in smoking cessation as well as the low rate of use among underage never-smokers.
As the U.K. prepares to reevaluate its Tobacco & Related Products Regulations following Brexit, the report shows great successes in harm reduction and smoking cessation linked to vaping products.
In every region of the country, quit rates among adult smokers were found to be higher with the use of vaping than with other products, ranging from 49 percent success in the South West to 78 percent in Yorkshire and the Humber.
PHE states that the use of nicotine-replacement therapies (NRT) among long-term former smokers is declining while the use of vaping products is increasing. Citing data from Action on Smoking and Health, the review highlights that the most common reasons given for vaping were to quit combustible cigarettes (29.7 percent), stay off cigarettes after quitting (19.4 percent) and to reduce tobacco consumption (11.2 percent).
Flavors remain an important driver for those using vaping products, with 31.6 percent of vapers reporting fruit flavors to be their preference.
Uptake among “never-smoker” youth remains very low, between 0.8 percent and 1.3 percent, with PHE confirming that this rate has not increased in recent years.
John Dunne
“This a defining moment for the vaping sector and truly shows the considerable progress it has made against a backdrop of significant misinformation around the industry, with Public Health England once again stating that perceptions of the harm caused by vaping compared with smoking are increasingly out of line with the evidence,” said John Dunne, director general of the U.K. Vaping Industry Association (UKVIA).
“This latest data, which the review is based upon, provides incontrovertible evidence as to the importance of vaping to successful smoking cessation and the nation’s public health.”
Dunne also pointed to challenges that need addressing by the industry and policy makers.
“Despite the many positives in this report, a great deal remains to be done,” he said. “Action on Smoking and Health, for example, has found that just 11 percent of local authority stop-smoking services are offering vaping products to some or all of those trying to quit smoking. With the clear efficacy of vaping evidenced in this report, we must ensure this figure grows.
“As an industry, we also share PHE’s views on stronger enforcement in preventing underage sales. In our response to the government’s TRPR consultation, which we will be publishing shortly, we call for fully funded regional and national test purchasing schemes to better understand compliance and to help educate retailers on their legal requirements. The UKVIA has already published the first ever Preventing Underage Sales Guide for vape shops and online retailers, which has been supported by Trading Standards.
“The review’s finding that more than 50 percent of people believe vaping to be as harmful or more harmful than the use of combustible cigarettes means we need to keep educating smokers about the fact that vaping is a fraction of the harm of smoking, has literally changed the lives of former smokers for the better and is acknowledged as one of the best ways to quit conventional cigarettes.”
February 23, 2021
Vapor Advocates Attend U.K. Parliament Group Meeting

Mark Pawsey MP and Chairman of the APPG for Vaping
Prominent tobacco harm reduction advocates Gerry Stimson (Knowledge-Action-Change), Clive Bates (The Counterfactual), John Dunne (U.K. Vaping Industry Association) and Daniel Pryor (Adam Smith Institute) attended a virtual meeting organized by the U.K. All-Party Parliamentary Group (APPG) for Vaping, a collection of MPs and Peers focused on e-cigarettes.
The tobacco harm-reduction advocates’ input will be used to advise the U.K. delegation to the Conference of the Parties (COP9) to the World Health Organization’s Framework Convention on Tobacco Control, which is scheduled to take place in the Netherlands this November.
Chaired by Mark Pawsey, the APPG is keen for the U.K. to defend its vaping position internationally, and to promote the successes of British vaping. The expert witnesses highlighted the considerable public health benefits of harm reduction tools, and the potential benefit they could provide around the world.
Tuesday’s evidence session came as the U.K. government continues its own review of tobacco regulations, meaning a busy time for advocates hoping to protect the public potential of vaping.
“I was happy to accept the invitation from the APPG, because the UKVIA believe we have an incredible opportunity to spread the word—that innovative, appropriately-regulated vaping industries save lives,” said Dunne in a statement. “Post-Brexit Britain is newly independent in forums like COP9, and it means we can drive this positive message home like never before.”
February 10, 2021
E-Commerce Leader Asks FDA to Prioritize Harm Reduction

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The U.S. Food and Drug Administration should encourage harm reduction products and help smokers give up cigarettes, according to Markus Lindblad, head of external affairs at the Haypp Group, the parent company of NicoKick, which describes itself as the world’s largest American e-commerce company in the smokeless industry.
In a letter to Acting Food and Drug Administration (FDA) Commissioner Janet Woodcock, Lindblad encouraged her to prioritize the goal she helped set at the FDA in previous years to enable greater use of healthier harm reduction products and help smokers quit combustible products.
“Our mission at NicoKick is to drive real change in the industry and encourage alternative nicotine enjoyment for adults seeking products other than inhalants,” Linblad wrote.
“We recognize that your focus is understandably on addressing the coronavirus pandemic, but we hope as you lead the Food and Drug Administration that you continue to prioritize tobacco harm reduction products that will produce better health outcomes for millions of American smokers. We can all agree any effort to transition from traditional tobacco products to those that reduce harm to the consumer should be supported and would be an important win for public health.”
February 1, 2021
Public Health Expert: Harm Reduction is Future of Nicotine
Nicotine is addictive. Most people who have smoked 60 cigarettes are going to be daily smokers. According to Jonathan Foulds, professor of public health sciences and psychiatry and co-director of Penn State Center for Research on Tobacco and Health, the average middle-aged smoker has made about 20 serious attempts to quit.
Jonathan Foulds, Penn State Cancer Institute
After deciding to try to quit, the average smoker has a 95 percent chance of still smoking a year later. Even with counselling and using a U.S. Food and Drug Administration (FDA)-approved cessation medicine, there is still an 80 percent chance they will be smoking again in a year.
Speaking during the Global Tobacco & Nicotine Forum (GTNF), Foulds said that people smoke for the psychological effects of nicotine, but they suffer the health effects created by inhaling combustible tobacco. To lessen the harms of nicotine consumption, regulators should focus on ways to get cigarette smokers to switch to less-risky forms of nicotine intake.
“If it were not for the nicotine in tobacco smoke, people would be little more inclined to smoke than they are to blow bubbles,” he said. “Blowing bubbles is fun, but no one wants to do it 20 times a day for the rest of their life. It’s the nicotine that’s key to [people smoking].”
Despite the addictiveness of nicotine, cigarette consumption in the United States has been falling consistently over the past 20 years. Cigarette consumption has fallen more than 50 percent since 1997. That is equal to approximately 200 billion fewer cigarettes being sold per year since 1997, and there are now many more people in the U.S. Foulds said there is also evidence that the decline has been accelerating over the past few years [alongside the growing popularity of vapor products].
Meanwhile, youth smoking rates have declined dramatically. In the 1970s, an average of 30 percent of high school seniors smoked cigarettes. In 1995, that number dropped to 25 percent. Today, less than 2 percent of high school seniors smoke cigarettes.
“The massive cigarette sales that the industry has been used to—clearly, that is coming to an end. I mean, the end is in sight from the cigarette industry,” Foulds told the GTNF audience. “What I’m trying to get across here to many of you—who are from the industry—is that we may be coming to a tipping point where it would be much better, rather than to just fight [regulators], it may actually be a wiser strategy to accept that this is happening sooner or later in terms of cigarettes and get ahead of it and embrace it.”
For cigarette manufacturers to survive, Foulds said they must promote less-risky forms of nicotine intake. Lower nicotine cigarettes are one example of how manufacturers can help push people to other products, such as e-cigarettes. He was unconcerned about consumers compensating for lower amounts of nicotine by smoking more cigarettes. “There’s now a bunch of studies—almost a dozen studies and they’re fairly consistent—showing that compensatory smoking really isn’t a thing that happens with these kinds of cigarettes,” he said. “The smokers learn pretty quickly that they can puff as much as they like, and they’re not going to get any satisfying amount of nicotine out of them.”
Another concern is that if only lower nicotine cigarettes are available, this would push smokers to the black market for higher nicotine cigarettes. Foulds says several studies have shown that that is not true. Smokers would be more likely to move to products such as e-cigarettes and heat-not-burn systems to get the nicotine they crave.
E-cigarettes are not without health risks, according to Foulds. “They are likely to be far less harmful than combustible tobacco cigarettes,” he clarified. “E-cigarettes contain fewer numbers and lower levels of toxicant substances than conventional cigarettes. There’s been more and more evidence that e-cigarettes deliver far, far lower levels of harmful toxicants than cigarettes. It’s become very, very consistent … e-cigarettes can help people quit.”
If regulators allow high-nicotine, reduced-harm products, like e-cigarettes, to remain in the market, Foulds says that it is highly likely that many current smokers will reduce their smoking, quit or switch to reduced toxic-exposure products, resulting in a substantial improvement in overall public health. “It is time for major cigarette manufacturers to support nicotine reduction in combustibles as perhaps their best chance of still being in business in 2030,” he said.
January 1, 2021
Health Expert Wants Malaysia to Focus on Harm Reduction

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The Malaysian government wants to reduce the number of smokers in the country by 15 percent by 2025. They are hoping to accomplish the goal through regulation and taxation, however, not by exploring less-risky nicotine products.
According to an article in The Sun Daily, previous measures such as raising taxes and the price of tobacco in a bid to reduce consumption had not only been ineffective, but also catapulted the growth of the illegal cigarette market.
During the third virtual Scientific Summit on Tobacco Harm Reduction 2020 in September, public health expert professor Sharifa Ezat Wan Puteh, was quoted saying that the tobacco harm reduction strategy could be used as an alternative solution. However, it would face many hurdles as it was still not well-received by Malaysians in general.
She said there were still concerns over the efficacy of non-tobacco nicotine products on top of the notion that e-cigarettes could increase smoking gateways among youths, adding that there was also the issue of no proper monitoring of tobacco alternative products, electronic nicotine delivery systems (ENDS) and heat-not-burn (HnB) products, such as IQOS.
At the moment, rules and regulations only cover the selling of nicotine products and are categorised under the Poison Act 1952. This clearly states that the supply and sale of any preparation containing nicotine is only allowed by licensed pharmacists and registered doctors for the purpose of treatment.
Sharifa was speaking as a panellist during the summit’s discussion titled “Tobacco Harm Reduction in low- and middle-income countries”, where she told the panel the government was taking a harder stand with its plan to introduce the standalone Tobacco Control Act to replace the Control of Tobacco Products Regulations 2004, which seeks to tighten control on all types of tobacco products.
Speaking on the sidelines, she told the newspaper the new act will deem nicotine products, including vapes and HNB devices, as tobacco products and will be enforced as such and likely to be totally banned. “This means only vape with non-nicotine e-juices will be allowed in the market,” she said. “This would only lead to less ‘safer choices’ for hard core smokers to transition to safer practices and options.”
She added that combustible cigarettes have been known to be more hazardous not only to the smoker themselves but also to those around them as opposed to the alternatives like vapes and HnB due to the lack of tobacco combustion. This, she said, was compounded with the large availability of contraband and illicit cigarettes that are abundant in the market at a low cost.
Sharifa also acknowledged there has been a visible dip in smoking prevalence in the country following its rigorous anti-smoking strategy nationwide. However, she said it could not be taken wholeheartedly since the authorities were unable to determine whether former users had switched to contraband cigarettes, vapes, HnB or that they had truly quit smoking.
“No proper study has been concisely implemented to look at the nature, but nicotine replacement therapy (NRT) is very common in Malaysia. However, implementation wise, it does have its concerns of access, lack of availability, and standardisation across urban and rural areas, and lack of trained health personnel in rural settings,” she said. “Many studies have shown that all types of nicotine products such as vapes, ENDS and NRT rate is curtailing persistent smokers are almost similar.”
December 14, 2020
Philippine Health Expert Wants Vapor Warnings to Match Risk
The health warnings for e-cigarettes and other vapor products should be different from warnings on combustible cigarettes, according to a health expert. Indonesian professor and medical expert Tikki Pangestu sought a distinction on the health warnings during the second Philippine Harm Reduction Online Forum held by Harm Reduction Alliance of the Philippines recently.
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“Health warnings on combustible cigarette packs should not be the same as those on the packaging of e-cigarettes and HTPs (heated tobacco products). This is because e-cigarettes and HTPs have been shown to be 90- to 95-percent less harmful than combustible cigarettes,” said Pangestu, visiting professor at the Yong Loo Lin School of Medicine at the National University of Singapore and former director for research policy and cooperation of the World Health Organization, according to an article in The Manila Times.
The implementing rules and regulations of Republic Acts 11346 and 11467 mandate the Department of Health to issue health warning templates for HTPs and vapor products. Pangestu said the health warnings should be “proportionate to the risk of smoke-free products.”
He suggested that health warnings could state that HTPs or vapes, while not free from harm, are “significantly less harmful” than combustible cigarettes.
“The health warnings could also indicate that smoke-free products are for adults only and should not be used by the youth,” Pangestu said. “There are many factors to be considered in developing regulations but in my view, such regulations must be based on the science and evidence around smoke-free products.”
December 13, 2020
Study: U.S. Youth Smoking Down, Vapor Rising

Photo: Tobacco Reporter archive
Cigarette and smokeless tobacco prevalence among U.S. adolescents declined more rapidly between 2012 and 2019 than in previous periods, according to a new study.
An analysis by the University of Michigan (UM) and Georgetown University shows that past 30-day and daily use of both cigarettes and smokeless tobacco fell more rapidly since 2012, even as e-cigarette use began to increase—leading to historical low levels of both cigarette use and smokeless tobacco among teens in the United States.
“While the increases in e-cigarettes are indeed concerning and is something we need to address and reverse, the decreases in other tobacco products, in particular, cigarettes—the most concerning form of tobacco use—are accelerating,” said lead researcher Rafael Meza, associate professor of epidemiology and global health at UM’s School of Public Health, in an article on the UM’s website.
Utilizing data from the nationally representative Monitoring the Future survey at the UM from 1991 to 2019, Meza and his colleagues examined the use prevalence of tobacco products in the last 30 days among key sociodemographic groups.
They found that daily smoking prevalence among 12th grade boys increased 4.9 percent annually 1991 to 1998 but saw annual declines of 8 percent between 1998 and 2006 and 1.6 percent from 2006 to 2012. However, from 2012 to 2019, prevalence declined at a 17 percent annual rate. Overall, daily smoking prevalence among 12th graders fell to about 2 percent by 2019.
David Levy
“This is an astoundingly low rate, and our goal from a public health perspective should be to keep smoking at this rate or lower,” said researcher David Levy, of Georgetown University’s Lombardi Comprehensive Cancer Center.
Meza said the results are important because while e-cigarettes are concerning on their own, there have been concerns that the increase in vaping could result in an uptick in the use of other tobacco products that could potentially upend the declines seen over the past decades.
“But in contrast, what we found is that the decline in smoking has accelerated,” he said.
December 3, 2020