A new study by Queen Mary University of London, published in Addiction, shows that e-cigarettes are more effective in achieving long-term smoking reduction and cessation than nicotine-replacement therapies (NRT).
The study randomized 135 smokers who had been unable to stop smoking with conventional treatments into two groups—one received an eight-week supply of their choice of NRT and the other received an e-cigarette starter pack with instructions to purchase further e-liquids of their choice of strength and flavor. Products were accompanied by minimal behavioral support.
After six months, 27 percent of those in the e-cigarette group had reduced smoking by at least half compared to 6 percent in the NRT group. Of the participants in the e-cigarette group, 19 percent had stopped smoking altogether versus 3 percent in the NRT group.
“These results have important clinical implications for smokers who have previously been unable to stop smoking using conventional treatments,” said Katie Myers Smith, lead researcher and health psychologist, in Eurasia Review. “E-cigarettes should be recommended to smokers who have previously struggled to quit using other methods, particularly when there is limited behavioral support available.”
“This study shows e-cigarettes can be a very effective tool for people who want to stop smoking, including those who’ve tried to quit before,” said Michelle Mitchell, CEO of Cancer Research U.K., which funded the study. “And research so far shows that vaping is far less harmful than smoking. But e-cigarettes aren’t risk free, and we don’t yet know their long-term effects, so people who have never smoked shouldn’t use them.”
The message from the 30 speakers who spoke during the Global Forum on Nicotine (GFN) 2021 in person or online was clear. Policymakers in public health and tobacco control need to listen to both the science on tobacco harm reduction and the experiences of consumers who are benefiting from it every day. Ideology must be set aside to prioritize progress towards the common goal of ending smoking.
Credit: 1StunningART
Experts at the GFN were discussing an approach called tobacco harm reduction, in which people who cannot quit nicotine are encouraged to switch from dangerous combustible or oral products to safer nicotine products including vapes (e-cigarettes), pasteurized snus, non-tobacco nicotine pouches and heated tobacco products.
Compared to continued smoking, all are significantly less harmful to health. Gerry Stimson, Emeritus Professor at Imperial College London and a founder of the GFN, said during the conference that much of what she has seen and heard during the event was encouraging.
“It feels as though we’re on the right trajectory. Consumers all over the world are becoming aware of the opportunities offered by safer nicotine products, and innovations in the market will, I believe, lead to the eventual obsolescence of combustible cigarettes,” she said. “The question is how to speed up the process and scale up, so that tobacco harm reduction reaches all smokers, everywhere, as quickly as possible.”
Multiple panel discussions took in subjects ranging from safer nicotine product regulation, tobacco harm reduction in low-to-middle-income countries (LMICs), and orthodoxy and dissent in science. Speakers’ pre-recorded presentations for the panel sessions will remain available online at the conference website.
Three keynotes were delivered to honor the memory of professor Michael Russell, psychiatrist, research scientist and pioneer in the study of tobacco dependence and the development of treatments to help smokers quit. Russell’s observation in the British Medical Journal in 1976 that “people smoke for nicotine, but they die from the tar” remains highly influential within the field.
Fiona Patten MP and Leader of the Reason Party, Australia, opened proceedings with the first Michael Russell Keynote with her speech. Jon Fell, a founder of investment company Ash Park and Dr. Derek Yach, an anti-smoking advocate for more than 30 years, is the president of the Foundation for a Smoke-Free World, gave the other two keynote speeches. They all centered on harm reduction.
“In Australia, governments have consistently stated that drug use must be treated as a health issue not a criminal one. But when it comes to nicotine, they are actively making criminals out of users,” Patton said. “And not all nicotine users. Just those who are trying to end their deadly relationship with combustible tobacco. Most political parties refuse to accept donations from big tobacco – yet they still protect it. For decades they ignored the science about the dangers of smoking, but today they argue that there is not enough science to sanction alternative nicotine products.”
GFN does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products, including pharmaceutical, electronic cigarette and tobacco companies. However, the conference operates an open door policy. Consumers, policymakers, academics, scientists and public health experts participate alongside representatives from manufacturers and distributors of safer nicotine products. The event organizers believe that dialogue and strategic engagement of all stakeholders involved in tobacco and nicotine use, control and production is the only way to effect true, sustainable change – both to industry practices and the public health outcomes related to smoking.
MPs from the U.K.’s two main political parties agree that vaping holds the key to Britain achieving its ambitious target to be a “smoke free” nation by 2030, according to a report by the U.K. Vaping Industry Association (UKIVA).
The All Party Parliamentary Group (APPG) on Smoking and Health presented its latest recommendations for a new Tobacco Control Plan (TCP) at Westminster yesterday.
Among its range of proposals to curb smoking prevalence in the U.K. were recommendations to expand the use of vaping based on the mounting “data and evidence” pointing to e-cigarettes’ efficacy in helping smokers to quit.
In a departure from most cross-party debates there was universal consensus that vaping should be a central part of any plan for the U.K. to meet its smoke free targets and save lives.
The first MP to bring vaping into the debate was Mary Glindon (Labour) who sits on the APPG on E-cigarettes.
She said “The forthcoming Tobacco Control Plan presents an enormous opportunity to cement the U.K. as the global leader in tobacco harm reduction.
“Having left the EU, the government must alongside the post implementation review of the Tobacco and Regulated Products Regulations (TRPR) set a clear direction for reducing smoking prevalence.
“To achieve its ambitions the forthcoming control plan must champion less harmful alternatives to smoking combustible tobacco, in particular the growing body of evidence showing vaping to be the most effective alternative for adult smokers looking to quit smoking.
“In its Blueprint for Better Regulation the U.K. Vaping Industry Association made recommendations to the Department for Health for consideration when reviewing TRPR, a process already under way.
“Those recommendations, many of which I support, could also be applied to the government’s TCP.
“One of those recommendations is effectively tackling increasing levels of misinformation and misperceptions about the relative harm of e-cigarettes versus tobacco.
“ASH data suggests millions of smokers could be dissuaded from switching to e-cigarettes because of incorrect views or confusion about vaping.
“To combat this the UKVIA recommends that the Department of Health launch an effective communications strategy including the introduction of approved health claims and switch messages displayed on vape devices and e-liquid packaging.
“It also recommends that medical professionals at local Stop Smoking services are supported with clinicians signposted to the latest clinical guidance and evidence about e-cigarettes.
“An evidence-based approach to smoking cessation must be adopted consistently by local services to support patients and their harm reduction journey—this is critical, considering the trials in NHS A&E departments.
“There should also be a review of regulations of nicotine in e-cigarettes to better understand the role nicotine plays in allowing e-cigarettes to be a satisfying alternative for adult smokers.
“For vaping to compete with combustible cigarettes and provide and alternative it must provide a comparably satisfying nicotine experience.
“It is the toxic by-products, not the nicotine, that are responsible for smoking-related deaths and diseases.
“Understanding alternatives and making clear distinctions between smoking and vaping are critical to our smoke free ambitions.
“The APPG on Vaping made several recommendations on vaping in the workplace and in public places, these are endorsed by the UKVIA and if implemented would support adult smokers in their transition to less harmful alternatives and give those who already made the switch the best chance of sticking with it.”
To achieve its ambitions the forthcoming control plan must champion less harmful alternatives to smoking combustible tobacco, in particular the growing body of evidence showing vaping to be the most effective alternative for adult smokers looking to quit smoking.
David Jones (Conservative), Honorary Life Governor at Cancer Research UK, said, “The key issue with smoking is, of course, the smoke. Any evidence-based policy to assist the U.K.’s 7 million smokers must put forward alternative products to combustible tobacco.
“Continuing to raise awareness of those products is also key. E-cigarettes and the use of other alternatives saves lives, and we should make sure that message reaches every smoker in Britain.
“E-cigarettes are hugely important in the fight against smoking, and I commend NHS England for promoting them to smokers. It’s based on evidence and has a proven positive effect on the health of the nation.”
Jones pointed out that, in 2017, more than 50,000 smokers who would have carried on stopped with the aid of a vaping product.
“The TCP should embrace new products and allow for more measures for companies to promote them,” he said. “And the plan should contemplate legislation for a robust regulatory framework for all the products we have on the market.”
Next to speak was Adam Afriyie (Conservative), also Chair of the Parliamentary Office of Science and Technology who sits on the APPG on Vaping.
“We’re in an era where we must be driven by data and evidence,” he said. “And it can’t be any clearer that, when it comes to vaping devices, electronic nicotine delivery devices and other technologies and ways nicotine can be used to help smokers to cease, that the data is only one way.
“It is so much safer to vape or use an electronic device than it is to smoke. Smoke is the killer. Tobacco is the killer.”
Afriyie urged the government to “not do what the EU has done and not do what the WHO seems to be doing by mangling the two issues (smoking and vaping) together.”
“Smoking is one thing,” he continued. “Smoking cessation devices that contain nicotine is a complete different thing. A completely different scale of harm and completely different scale of risk.
“Nobody really wants to smoke. It’s a good idea to remind people on an annual basis that there are alternatives, and not just nicotine patches but certainly to be looking at vaping devices.
“There is still ambiguity about whether or not vaping is a smoking cessation device or just another way of inhaling nicotine. The truth is, and this is clear from the evidence, it’s a smoking cessation device that woks and is twice as effective—if not higher than that—at helping smokers to cease smoking relative to the other treatments available.”
He concluded: “We are the first in the world at genomics, first in the world for the vaccine rollout, first in the world for fintech and financial services—let’s make this another one: let’s be the first in the world to implement a TCP that clearly takes on board the wonderful innovations of vaping, e-cigarettes and all the other technologies and not mangle it together in a smoking directive.”
We are the first in the world at genomics, first in the world for the vaccine rollout, first in the world for fintech and financial services—let’s make this another one: let’s be the first in the world to implement a TCP that clearly takes on board the wonderful innovations of vaping, e-cigarettes and all the other technologies and not mangle it together in a smoking directive.”
Labour MP Virendra Sharma told the committee that he came from “a family of nonsmokers” and that he himself does not smoke.
“I cannot see the appeal,” he said. “But clearly, people are addicted, and addiction needs treatment not moralizing. There are 3 million people who vape in Britain and nearly all are former smokers. That’s 3 million who choose a less harmful option. This is good news, but BAME communities and those with manual jobs and without university degrees are 2.5 times more likely to smoke than white, office working university educated colleagues. This has to be addressed.
“In the Asian community we need to offer alternatives to tobacco. There are terrible statistics about rates of oral cancers and anything we can do to reduce these rates will save lives.”
Another Labour MP, Alex Norris, spoke next and emphasized the consensus nature of the debate.
“We are all here in the spirit of cross party cooperation,” he said.
“E-cigarettes and vaping must be a feature of the TCP. I hope the minister and government generally via its role in the WHO push harder for stronger messages and clearer messages around the data and evidence at WHO level.
“I looked at the WHO website myself and could not fathom what it was trying to tell me. That makes it really hard for people thinking about alternatives to know what they’re supposed to do or not.
“Personally, I always rely on the Public Health England position from 2018, that vaping represents a 95 percent reduction in harm.
“The APPG’s report says that in 2017 vaping helped 50,000 people to stop smoking, and that concerns around children starting have not materialized.”
Bringing the debate to an end Jo Churchill (Conservative), who is also Parliamentary Under-Secretary of State for Prevention, Public Health and Primary Care at the Department of Health and Social Care, said: “Within our plan we will re-commit to the role of e-cigarette products. They certainly have a place in supporting smokers to quit and we will ensure they remain accessible while protecting nonsmokers and young people.”
Speaking after the session John Dunne, director general of the UK Vaping Industry Association, said:
“It was a very proud moment for the UKVIA to be quoted so extensively during this important debate and at such a crucial moment in the U.K.’s journey towards harm reduction.
“It’s not often that you witness different political parties reaching a consensus in this way but, it appears, the urgent need to reduce smoking rates in Britain and the vital role vaping can play in achieving smoke free 2030 are the issues where tribalism is put aside, and common sense prevails.”
The concept of tobacco harm reduction is gaining momentum in Europe, according to a new report by The European Tobacco Harm Reduction Advocates (ETHRA). On July 8, ETHRA published the results of its 2020 EU Nicotine Users Survey.
Launched online by ETHRA in the last quarter of 2020, the questionnaire addressed consumer use of nicotine products. Topics included smoking and the desire to quit, use of safer nicotine products and barriers to switching caused by European and national regulations. More than 37,000 people, including more than 35,000 EU residents, participated in the ETHRA survey.
According to ETHRA, more than 27,000 of the survey participants had completely quit smoking. Vapes, snus and nicotine pouches are the main harm reduction products used to quit. Among the respondents who had ever smoked, 83.5 percent of vapers and 73.7 percent of snus users had successfully stopped smoking.
Over 93 percent of vapers and 75 percent of snus users cited harm reduction and improvements to health as their reasons for adopting these products. The report shows that the reduced cost compared to smoking, the availability of flavors, the availability of products and the ability to adjust vaping products are other major factors for consumers when switching to harm reduction products.
The lack of availability of low-risk nicotine products presents a major obstacle to consumers wishing to quit smoking.
However, smoking remains the predominant way of consuming nicotine in Europe. More than 67 percent of the current smokers who responded to our survey want to quit, but the ETHRA report shows they face barriers in their desire to be smoke-free.
The lack of availability of low-risk nicotine products presents a major obstacle to consumers wishing to quit smoking. The EU ban on the sale of snus (which exempts Sweden), illustrates this barrier, with 31 percent of current smokers indicating that they would be interested in trying snus if its sale were legalized in the EU.
A quarter (24.3 percent) of those who smoke but who want to quit cited the high price of safer alternatives as a barrier to quitting smoking. This number rises to 44.7 percent in countries with a high tax on vaping products, such as Estonia, Finland and Portugal.
The EU Tobacco Product Directive (TPD) restrictions of a maximum nicotine concentration of 20mg/ml and a maximum bottle volume of 10ml have driven vapers to very low nicotine e-liquids. More than 30 percent of people who vape and smoke (“dual users”) believed they could completely quit smoking if the EU nicotine limit were increased.
Meanwhile, harm reduction advocates are anxiously awaiting pending amendments to the TPD. If the EU bans flavors, 28 percent of vapers are likely to restart smoking, and 71 percent would consider using the black market or other alternative sources, according to the survey. In the 16 EU countries without a vape tax, only 1 percent of vapers are currently using alternative sources.
If the EU repealed the 10 ml bottle limit, 89 percent of vapers said they would buy larger bottles of e-liquid to reduce plastic waste. 83 percent of vapers are in favor of having access to an EU database on e-liquid ingredients.
Considering the results from the EU Nicotine Users Survey 2020, ETHRA recommends the lifting of the EU ban on the sale of snus, revising upwards the 10 ml refill bottle and 20 mg/ml nicotine concentration limits, and the publication of databases on vaping products.
The organization also urges a repeal of vaping taxes in 12 countries and the lifting of flavor bans in Estonia, Finland and Hungary to give European smokers the freedom to quit smoking using low-risk products.
The U.K. Vaping Industry Association (UKVIA) is asking members of parliament to champion the public health benefits of vaping as the Department of Health and Social Care looks to publish a new Tobacco Control Plan (TCP) later this year, to support the government’s Smokefree 2030 ambition
The U.K. House of Commons will debate the “Recommendations for the forthcoming Tobacco Control Plan” on June 10.
According to the UKVIA, the upcoming debate is a huge opportunity to refocus efforts in ensuring that England achieves its aim of becoming smokefree by 2030. The U.K. is estimated to have a smoking prevalence of 14.1 percent and the forthcoming Tobacco Control Plan is a chance to see this number decrease further, particularly in light of an uptake during the pandemic period, the association writes in template letter to local MPs.
The UKVIA letter urges MPs to make the following points during the debate:
The government must seize the opportunity presented by the U.K. having left the European Union. With the ongoing review of the Tobacco and Related Products Regulations (TRPR), and the forthcoming TCP, the government has the opportunity to diverge from EU law governing tobacco and nicotine policy to level up on health inequalities across the U.K. Independence allows for U.K. regulations to stay relevant, be easily adapted to changing consumer trends and any market and technological developments, with greater ease and less bureaucracy.
The government’s forthcoming TCP should be based on the significant and growing body of evidence showing vaping to be an effective alternative for smokers looking to quit and should cement the concept of harm reduction, placing the U.K. as the global leader in tobacco harm reduction. Vaping is twice as effective as other nicotine replacement therapies, such as gum and patches. Research from University College London has found that e-cigarettes, in one year alone, helped an additional 50,000-70,000 smokers in England quit. Despite the overwhelming and growing evidence in support of e-cigarettes, perceptions of harm from vaping among smokers are increasingly incorrect and out of line with the evidence. This is despite ONS data from Great Britain showing that over half of smokers want to quit.
Misinformation and misperceptions about the relative risk of e-cigarettes must be challenged at every opportunity. To do so, the government must work with industry leaders to develop a series of policies that can help the vaping industry communicate directly with existing adult smokers. It is suggested that approved health claims and switching messages, alongside nicotine health warnings, should be available to vape manufacturers and retailers, to communicate the facts about vaping. Such claims and messages could be used on both device and e-liquid packaging, as well as on posters and leaflets. Similar proposals have been made by the governments of New Zealand and Canada.
In light of the University of East Anglia’s study to trial e-cigarettes in NHS A&E departments, greater support is also needed for medical practitioners. The new TCP should support medical professionals by ensuring that clinicians are signposted to the latest clinical evidence on e-cigarettes and that local stop smoking clinics adopt a consistent approach to the advice given smokers looking to switch to less harmful alternatives and/or quit smoking combustible cigarettes.
“Whilst on one hand the current regulations and the existing TCP have allowed the vaping industry in the U.K. to flourish, on the other, they have hindered the ability of the vaping sector to promote vaping as an effective way of switching to a less harmful alternative, thereby preventing the government achieving the aims set out in the Tobacco Control Plan,” the UKVIA wrote. “Parliamentarians should therefore be advocating for fair and proportionate policies and regulations of e-cigarettes to help reduce inequalities and improve public health.
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.
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.”
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.
“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.
“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.
Anti-smoking groups and pharmaceuticals company Pfizer are urging the next Dutch government to extend smoking bans and restrict tobacco alternatives such as e-cigarettes, reports Dutch News.
The outgoing government has increased cigarette prices and limited sales outlets as steps towards a smoke free generation by 2040, and the number of smokers has gone down from 25 percent to 20 percent in the last five years.
However, even though there are fewer smokers, the total amount of tobacco being consumed has remained stable. “The remaining smokers are smoking more,” campaigner Wanda de Kanter told Financieele Dagblad.
De Kanter is skeptical about Philip Morris International’s attempts to market its IQOS tobacco-heating device as a less-risky alternative to smoking. The multinational is trying to persuade the Dutch government to relax rules around such products. Health institute RIVM has stated that heated tobacco still contains cancer causing substances and can damage lung cells.
I am concerned about these reports, especially in light of the global World Health Organization’s COP9 summit which takes place in the Netherlands in November 2021.
The U.K. Vaping Industry Association (UKVIA) warned that cracking down on smoking alternatives would be counterproductive.
“To further reduce smoking rates in the Netherlands, legislators should be embracing alternative tobacco products, such as vaping—not introducing stricter regulations which will only serve to facilitate tobacco consumption,” the group wrote in a press note. “Adopting an evidence-based approach, like that which has been successful in the United Kingdom, will help cement the concept of tobacco harm reduction.”
“I am concerned about these reports, especially in light of the global World Health Organization’s COP9 summit which takes place in the Netherlands in November 2021,” said UKVIA Director-General John Dunne.
“Smoking-related illness still kills many thousands of people each year in both the U.K. and the Netherlands. It is imperative on both governments to do all that they can to reduce this number of smoking related deaths. They should trust the science and the overwhelming evidence and embrace vaping products and e-cigarettes. They are the most popular and effective nicotine replacement products on the market.”
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
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.”
If Health Canada has its way, this year vaping will be dealt three knockout blows that will see, not just the end of the business as we know it, but an increase in smoking-related deaths nation-wide, says Ian Irvine, a professor of economics at Concordia University.
Ottawa is recalibrating the delicate equilibrium between harm reduction and youth use of nicotine. It plans to introduce a mandatory limit on nicotine concentration in e-cigarettes and to ban most flavours. Maximum permissible content is currently at 66 milligrams per millilitre; the new limit will be 20. Eventually, we will see strike three: excise taxes.
Ian Irvine, courtesy Concordia University
Harm reduction tries to induce smokers to switch to nicotine products with greatly reduced toxins, particularly if they are habituated or even addicted to nicotine. Public Health England has repeatedly stated that the toxins in e-cigs are at most five per cent of those in regular cigarettes. The toxins that cause cancer come from the burning of tobacco at 700 degrees Celsius. But vaping devices heat rather than burn. Nicotine is not the health demon. It does cause habituation. But it’s the burning that shortens lives.
In an article for the Regina Leader-Post, Irvin explains that e-cigarettes are not harmless. The health problem vaping poses is that between five and 10 per cent of teens are regular vapers and nicotine is bad for the developing brain. But while a pack-a-day smoker will on average lose 10 years of life, an equally indulgent vaper might lose just one. Most adults who drink moderately, gamble, like sugar too much, or exercise insufficiently might think one year off a normal lifespan a reasonable price to pay to indulge a passion or need.
As for adult smokers, people considering a transition from smoking to vaping require a product yielding enough nicotine to satisfy their craving. Many potential switchers will not make the transition — and will end up dying prematurely — if they cannot get a strong enough nicotine substitute for their cigarettes. Canada has about 40,000 smoking-related deaths per year, so if even a small percentage of smokers don’t transition because of insufficient nicotine, that will mean thousands more deaths annually.
If Health Canada succeeds in introducing both a nicotine cap and a flavour ban on vaping, smoking rates will continue to be higher than necessary and many thousands of unnecessary deaths will folllow.
