Tag: Knowledge-Action-Change

New Briefing Details THR Success for IQOS in Japan

Photo: wachiwit
Knowledge Action Change (KAC) has released a briefing paper on the rapid fall in cigarette sales in Japan following the introduction of heated-tobacco products (HTP).
Titled “Cigarette Sales Halved: Heated-Tobacco Products and the Japanese Experience,” the paper explores some of the social and cultural factors that have made Japan particularly suited to HTP and provides a case study showcasing the potential of tobacco harm reduction through the adoption of safer nicotine products.
As well as referencing a number of peer-reviewed science papers, the briefing paper, available in 12 languages, also includes some new Global State of Tobacco Harm Reduction research, which compares up-to-date sales figures that emphasize the changing nature of cigarette and HTP consumption.
According to KAC, the success of HTP in Japan offers significant hope of their potential to reduce cigarette sales in other similar countries.
“The speed and scale of the change in Japan shows just how quickly things can improve when those people already consuming nicotine are given access to a safer alternative,” said KAC Director David MacKintosh in a statement.
“This is not the result of a specific government policy or initiative, yet the benefits to individuals and society are significant. There are lessons to be learnt from Japan by all those who wish to see the use of combustible tobacco consigned to the history books. Harm reduction is about giving people the opportunity to improve their own health and the health of those around them. Given the chance, most people will do just that.”
May 15, 2024
Knowledge-Action-Change Briefing Explains COP 10

Gerry Stimson | Photo courtesy of GNF
Knowledge Action Change (KAC) has published a briefing to help policymakers, health officials and consumers better understand the Conference of the Parties (COP) to the World Health Organization Framework Convention on Tobacco Control (FCTC). The 10th edition of this event, which normally takes place every two years, is scheduled for November in Panama.
While decisions made at the conference are likely to significantly impact tobacco companies and their customers, industry representatives and organizations advocating for access to safer nicotine products have traditionally been barred from attending the event.
As a result, tobacco harm reduction has been getting short rift at COP meetings despite the fact that the concept is an integral part of the FCTC.
“Harm reduction is explicitly named as one of three tobacco control strategies in the opening lines of the Framework Convention on Tobacco Control, but at present, the indications are that COP10 is unlikely to result in any decisions that support consumer access to safer nicotine products,” said KAC Director Gerry Stimson in a statement.
“Parties to the FCTC must seize the opportunity in Panama to consider evidence from countries where tobacco harm reduction is saving lives, including the U.K., New Zealand, Sweden, Norway and Japan—and ask why the WHO and its influential philanthropic funders are refusing to do the same.
“With no media present, FCTC COP meetings are shrouded in a secrecy more akin to a U.N. Security Council meeting—and in direct contrast to other COP meetings, for example those on climate change. This briefing paper gives policymakers, health officials and consumers more insight into the processes of COP10 and the opportunity to engage more fully prior to and during the event in Panama,” said Stimson
May 15, 2023
Survey Reveals Scale of Advocacy for Safer Nicotine

Knowledge-Action-Change (KAC) has released a global survey investigating the role and activities of consumer organizations advocating for access to safer nicotine products (SNPs) and tobacco harm reduction.
Carried out by KAC’s Global State of Tobacco Harm Reduction project, the research was published in Public Health Challenges.
It reveals that there are 54 active consumer advocacy groups working around the world to raise awareness about, and promote the availability of and access to, SNPs, which include nicotine vaping products (e-cigarettes), Swedish-style snus, nicotine pouches and heated-tobacco products.
The authors of the survey found that the vast majority of organizations (42) were operated entirely by volunteers, most of whom had successfully quit smoking with the help of SNPs.
Only seven of the groups had any contracted or paid staff (13 people globally), and for the last full year, the total funding for all organizations surveyed amounted to $309,810. This is in stark contrast to the millions of dollars spent on campaigns by actors, such as Bloomberg Philanthropies, seeking to limit access to SNPs, such as nicotine vaping products. The paper also notes that none of the consumer advocacy organizations reported receiving funding from tobacco or pharmaceutical companies.

This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate.
Gerry Stimson, director, KAC
Many of these organizations are members of four regional umbrella organizations covering Latin America (ARDT Iberoamerica), Africa (CASA), Europe (ETHRA) and Asia-Pacific (CAPHRA).
“This survey offered a unique opportunity to map these advocacy organizations for the first time and provide valuable insight into how they are operating all over the world,” said Tomasz Jerzynski, lead author and data scientist for the Global State of Tobacco Harm Reduction project. “The sustainability of these organizations is one of the main concerns that has come out of the data. All of these groups face challenges due to their small numbers of core workers and their dependence on volunteers.”
“This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate,” said Gerry Stimson, report author, director of KAC and emeritus professor at Imperial College London. “It also highlights why consumer groups must be recognized as legitimate stakeholders in the policy sphere.”
February 1, 2023
Solons Must Seize Potential of Safer Nicotine Products

Knowledge-Action-Change (KAC) has published The Global State of Tobacco Harm Reduction 2022: The Right Side of History. The Global State of Tobacco Harm Reduction (GSTHR) publication charts the history of tobacco harm reduction and considers the future of a strategy that can hasten the end of smoking and drastically reduce smoking-related death and disease worldwide.
According to the report’s authors, the emergence of new safer nicotine products has caused substantial disruption to nicotine use, public health and tobacco control institutions and the traditional tobacco industry. However, mistrust and ideological opposition is hampering widespread adoption of a strategy that could help 1.1 billion adult smokers failed by existing tobacco control interventions.
“Technology helped smoking become one of the world’s biggest health problems,” said Harry Shapiro, author of The Right Side of History, in a statement. “Now, technological innovations from beyond both the tobacco industry and public health have combined to produce safer nicotine products, and millions of people who smoked have already chosen to switch. Yet progress is being hampered. Although disruption is not always comfortable, the genie is out of the bottle—these new technologies demand the development of new policies and new thinking.”

“A failure to recognize and exploit the potential of tobacco harm reduction will mean millions more avoidable deaths each year.”
Gerry Stimson, project lead, GSTHR
“A failure to recognize and exploit the potential of tobacco harm reduction will mean millions more avoidable deaths each year and contribute to an ever-growing burden of disease that disproportionately affects the most vulnerable countries and communities,” said Gerry Stimson, GSTHR project lead and emeritus professor at Imperial College London.
“Tobacco control’s lack of evolution, despite its very limited gains, means that many aspirational targets to achieve smoke-free status by 2030 or within the next generation are no more likely to be met than former aspirations for a drug-free world. Tobacco harm reduction offers us an historic opportunity. We must not let it slip away.”
The Right Side of History is the third in the biennial series of GSTHR reports, following No Fire, No Smoke in 2018 and Burning Issues in 2020. The GSTHR project is produced with the help of a grant from the Foundation for a Smoke-Free World.
November 16, 2022
Study: Number of Global Vapers up by 20% From 2020

Illustration: GSTHR
The number of vapers worldwide increased by 20 percent from 2020 to 2021, according to the latest research by the Global State of Tobacco Harm Reduction (GSTHR), a project from Knowledge Action Change. The organization estimates that there are now 82 million vapers worldwide.
The updated calculation was made possible by the release of a range of new data, including the 2021 Eurobarometer 506 survey, and is revealed in a new GSTHR briefing paper. The figure is based on 49 countries that have produced viable survey results on vaping prevalence.
To address the problem of missing data, the GSTHR used an established method of estimating vaper numbers in countries that currently have no information by assuming a similarity with countries in the same region and economic condition for which data points were available.
This estimate considers three factors—sales regulation status, World Health Organization regions and World Bank income groups—along with the Euromonitor data on vaping product market size from 2015 to 2021.

This [increase in vapers] is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”
Gerry Stimson, director, KAC
“As well as the substantial growth in the number of vapers globally, our research shows there has been rapid uptake of nicotine vaping products in some countries in Europe and in North America,” said Tomasz Jerzynski, data scientist at GSTHR. “This increase is particularly significant, because in most markets, these products have been available for only a decade.”
Indeed, the rise in the number of global vapers comes despite the GSTHR’s database showing nicotine vaping products are banned in 36 countries, including India, Japan, Egypt, Brazil and Turkey.
The new data also shows the U.S. is the largest market for vaping at $10.3 billion, followed by Western Europe ($6.6 billion), Asia-Pacific ($4.4 billion) and Eastern Europe ($1.6 billion).
“As this updated data from the Global State of Tobacco Harm Reduction shows, consumers find nicotine vaping products attractive and are switching to use them in increasing numbers worldwide,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London. “This is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”

March 9, 2022
Call for Harm Reduction Scholarship Applications
Photo: zimmytws
Knowledge Action Change (KAC) is looking for people to propose projects exploring their professional or personal interest in tobacco harm reduction (THR) for the next cohort of its Tobacco Harm Reduction Scholarship program (THRSP). Applications for the fifth year of the program close on Nov. 30, 2021, and successful applicants will receive a 12-month bespoke mentoring program and up to $10,000 in financial support.
According to Paddy Costall, a director at KAC, the THRSP is a crucial part of global efforts to communicate the benefits of safer nicotine products, helping to raise awareness about vaping, heated tobacco products, snus and nicotine pouches.
“The Tobacco Harm Reduction Scholarship program is the jewel in the crown for KAC,” he says. “When we were setting out on this journey, we wanted to attract a passionate and diverse group of new advocates into the tobacco harm reduction field from across the globe. We wanted to inspire them to take the movement into the future. We wanted to find the researchers of tomorrow, and with the THRSP that is exactly what we are doing.”
To further enhance the program’s status, KAC recently appointed Ethan Nadelmann, the founder of the Drug Policy Alliance, as the THRSP’s new patron. Nadelmann will be providing support to the recipients of these scholarships.
Launched in 2018, the program has supported 75 Scholars on six continents. Projects completed by THRSP participants include:
A short documentary film exploring attitudes on smoking and THR in Malawi
Novel scientific research in Romania showing that switching completely from combustible cigarettes to heated tobacco products can boost the oral health of smokers
The creation of a smoking and recovery toolkit in the U.S. to combat the high rates of smoking among people in recovery or seeking treatment for dependency on alcohol or other drugs
A study assessing the THR knowledge base of healthcare staff in Lithuania
A pair of studies that demonstrated the potential for safer nicotine products, such as vaping and Swedish-style snus, to help India’s smokers and smokeless tobacco users
The creation of THR Uganda, an organization set up to share accurate information on tobacco smoking and nicotine with its own dedicated website
A study on the effects of providing vapes to homeless smokers in Ireland
To find out more about the program, visit the Tobacco Harm Reduction Scholarship program website.
November 23, 2021
WHO Urged to Embrace Tobacco Harm Reduction
The ninth Conference of the Parties (COP9) to the World Health Organization Framework Convention on Tobacco Control (FCTC) will operate under conditions of secrecy comparable to those of the U.N. Security Council, according to a new report by the Global State of Tobacco Harm Reduction (GSTHR) titled, Fighting the Last War: The WHO and International Tobacco Control.
The public and media are banned from attending all but one largely ceremonial opening plenary, yet millions will be affected by the decisions taken at COP9, which is scheduled to take place virtually Nov. 8–13.
The report contends that current implementation of the FCTC is a global public health failure. In force since 2005, when there were 1.1 billion smokers around the world, the FCTC set out the principles of global tobacco control—to reduce the death and disease caused by smoking. In 2021, however, there are still 1.1 billion smokers worldwide and 8 million smoking-related deaths each year. What’s more, the number of smokers is predicted to rise, and the number of smoking-related deaths is set to top 1 billion this century.
Change is urgently needed, and harm reduction for tobacco offers the opportunity for that change, according to the GSTHR.

Fighting the Last War notes that while tobacco control policy has remained frozen in time, innovative noncombustible nicotine technology and supporting evidence have moved forward. Vaping devices, snus, nicotine pouches and heated-tobacco products are significantly safer than cigarettes as they deliver nicotine without combustion, according to the report’s authors. This, they argue, enables people who cannot or do not want to stop using nicotine to quit deadly smoking and switch to less risky products.
“Just as delegates at COP26 will be discussing the world’s urgent need to stop fossil fuel combustion, the technology is now in place to ensure the end of the age of combustion for tobacco as well,” the GSTHR wrote in a press note. “A number of Parties to the FCTC, such as the United Kingdom and New Zealand, have successfully introduced tobacco harm reduction policies alongside their tobacco control regimes and have seen marked decreases in smoking rates.”
When given accurate information about comparative risk, many smokers switch, the organization notes. Worldwide, the GSTHR estimated in 2020 that 98 million people worldwide were using safer nicotine products.
The authors also point out that the concept of harm reduction is embedded in the WHO response to drug use and HIV/AIDS. It is explicitly named as the third pillar of tobacco control alongside demand and supply reduction in the FCTC. Yet the WHO has remained implacably opposed to harm reduction for tobacco and is increasingly viewed as having overseen a “mission creep,” which now sees international tobacco control setting its sights on prohibition for nicotine in all its forms.
“There are concerning signs in published agenda and briefing papers that the FCTC secretariat and leadership continue to urge Parties against increasing access to, or even to prohibit, safer nicotine products,” the GSTHR wrote.
Fighting the Last War considers the motivations—ideological, financial and historical—that have led to many global tobacco control practitioners becoming so hostile to what others see as the greatest potential public health advance in decades.
The report argues that Parties to the FCTC need to seize back control of the COP meetings from the FCTC secretariat, which it says has become overly influential with little oversight. FCTC Parties should press for more evidence-based discussions, calling upon the widest breadth of scientific, clinical and epidemiological expertise on safer nicotine products and tobacco harm reduction, according to the authors. “This should include evidence from Parties that have implemented harm reduction policies, those involved in manufacturing safer nicotine products and the lived experience of consumers,” they wrote. “The establishment of a working group on tobacco harm reduction would offer a pragmatic route to move the FCTC toward a tobacco control regime fit for purpose in the 21st century.”

“As global leaders prepare to make important pledges on climate change under the glare of the media spotlight at COP26, we urge them to demand more from their delegations inside the closed and unscrutinized rooms of COP9,” says Gerry Stimson, director of Knowledge-Action-Change and emeritus professor at Imperial College London. “Every day, more than one billion smokers are being failed by the international tobacco control regime. The age of combustion—for tobacco as for fossil fuels—must end.
“Tobacco harm reduction offers new routes out for adult smokers. GSTHR estimates suggest that 98 million of them have already switched. At COP9, government delegations must seize back control and prevent the slide into outright nicotine prohibition that would see many return to smoking and many millions more never succeed in quitting.”
“The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment,” said report author Harry Shapiro. “Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
“If those who dominate the global tobacco control discourse were truly committed to public health imperatives, harm reduction principles and policies would be front and center,” said Ethan Nadelmann, founder of the Drug Policy Alliance. “This valuable report exposes the ways in which international institutions have turned their backs on scientific evidence and the human and political rights of hundreds of millions of people whose lives might be saved by safer nicotine products.”
“Fighting the Last War provides an insight into the dark arts of the WHO that many would find breathtaking and incomprehensible,” said Jeannie Cameron from JCIC Consulting. “It shows a concerning difference between the world’s preparations for COP26 on climate change and COP9 on tobacco. Governments need to stand up at COP9 to support tobacco harm reduction against the outdated views of the WHO.”

The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment. Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
Harry Shapiro, author, ‘Fighting the Last War’
“The challenge for lower and middle-income countries while fighting the last war and promoting real tobacco control is about two major issues,” said Nataliia Toropova from Healthy Initiatives. “Firstly, the current provisions of the WHO FCTC have not been properly implemented due to stretched government resources. Thus, smoking cessation programs are nonexistent, and adult smokers feel hopelessly stuck while making their numerous unsuccessful attempts to quit with no medical help or guidance provided. Secondly, the lack of a comprehensive harm reduction strategy is aggravated by a massive misinformation campaign about harm reduction products and a declared war on nicotine. Unless these two issues get tackled, unless the powerful voice of doctors becomes loud and gets heard, unless education and awareness building campaigns take place, no changes will occur, and this last war will be lost.”
October 27, 2021
Experts Challenge WHO Position on Safer Nicotine

Photo: Tom
The Global State of Tobacco Harm Reduction (GSTHR), a Knowledge·Action·Change (KAC) project, launches a new series of briefing papers ahead of the publication of its latest report, Fighting The Last War: The WHO and International Tobacco Control on 27 October.
The suite of new GSTHR publications aim to draw attention to, and challenge the direction of travel of, the Framework Convention on Tobacco Control (FCTC) Conference of the Parties 9 (COP9), a major global meeting on tackling smoking. The meeting is being held virtually in early November. According to the GSTHR, the FCTC agenda and briefing papers indicate the FCTC Secretariat and leadership are continuing to urge parties against the adoption of tobacco harm reduction approaches that could help save millions of lives.
The GSTHR briefing papers offer analyses, commentaries or explainers on topics related to tobacco harm reduction and its role in combating the death and disease caused by smoking.
The first paper provides a brief overview of both the FCTC and the Conference of the Parties biennial meetings, explaining their role in global tobacco and nicotine policy, as well as highlighting some of the problematic elements of their current operation. A deeper analysis of these issues will be revealed when Fighting The Last War is published later in the month.
The second GSTHR briefing paper focuses on the U.K.’s potential leadership role at COP9. According to the GSTHR, the U.K. has successfully implemented important aspects of a domestic tobacco harm reduction policy, while retaining a strong tobacco control record. Currently, the FCTC project does not reflect the U.K. approach–yet the U.K. is one of the most consistent and generous financial backers of both the FCTC and the WHO. At COP9, the paper argues, the U.K. must be prepared to take a strong line and advocate for policies it has enacted that are demonstrably increasing the numbers of people successfully quitting smoking.
These issues and more will be explored in depth in the GSTHR’s forthcoming report, to be published on Oct. 27 at a hybrid launch event, free to attend online. In Fighting The Last War: The WHO and International Tobacco Control the report’s author, Harry Shapiro, takes a close look at the history, development and often secretive processes of the FCTC COP, its early battles with the tobacco industry – and the range of influences shaping international tobacco control’s response to safer nicotine products in 2021.
The report launch will be broadcast on Oct. 27 from the Kia Oval in London. Two roundtable sessions will be livestreamed from 11 am British Summer Time, with time allowed for questions from those watching in the room and from afar. Will Godfrey of Filter will host the first session, “The FCTC: past, present and future,” which features Harry Shapiro, KAC, report author; Derek Yach, Foundation for a Smoke-Free World, former WHO cabinet director and executive director for noncommunicable diseases and mental health; and Tom Gleeson of the New Nicotine Alliance Ireland.
The second session will be hosted by Jeannie Cameron of JCIC Consulting and will be centered on the “Challenges to making the FCTC an inclusive international framework convention.” Audience members will hear from Ethan Nadelmann, founder, Drug Policy Alliance; Nataliia Toropova, Healthy Initiatives and Professor Gerry Stimson, director, KAC.

Parties to the FCTC must seize the opportunity to consider evidence from countries where tobacco harm reduction is succeeding, including the U.K., New Zealand, Sweden, Norway and Japan.
Gerry Stimson, director, KAC
“We’re gravely concerned by the WHO’s continued rejection of tobacco harm reduction,” said Stimson. “It already accepts harm reduction as a valid, evidence-based public health intervention for drug use and HIV/AIDS. Harm reduction is explicitly named as one of three tobacco control strategies in the opening lines of the Framework Convention on Tobacco Control. Adoption could hasten the end of the public health crisis caused by smoking.
“Instead the WHO rejects and, worse, repeatedly misinforms the public about safer nicotine products, demonstrating a disregard both for the lives of over one billion adult smokers and the eight million deaths each year due to smoking. Parties to the FCTC must seize the opportunity at COP9 to consider evidence from countries where tobacco harm reduction is succeeding, including the U.K., New Zealand, Sweden, Norway and Japan—and ask why the WHO and its influential financial backers are refusing to do the same.”
October 15, 2021
Harm Reduction Proponents Lambast ‘War on Nicotine’

Photo: Aleksey Novikov
Knowledge Action Change (KAC) condemned the recently released WHO Report on The Global Tobacco Epidemic, 2021, which describes e-cigarettes as harmful.
“The World Health Organization and its single most significant funder for anti-smoking efforts, U.S. billionaire Michael Bloomberg, have today sought to distract from years of failure under the WHO’s MPOWER tobacco control strategy by focusing instead on what U.K.-based public health agency Knowledge Action Change and other observers are calling a new ‘war on nicotine,’” KAC wrote in a press release.
“On publication of the WHO’s ‘eighth annual report on the global tobacco epidemic,’ the organization is continuing its misguided insistence that vapes (e-cigarettes), snus, nicotine pouches and heated tobacco devices, collectively known as safer nicotine products, are a threat,” KAC wrote. “This ignores the growing international, independent evidence that they offer millions of adult smokers the opportunity to quit deadly combustible tobacco.”
“The WHO’s self-congratulatory focus on strategy over outcomes indicates the lack of vision and ambition underpinning the international tobacco control establishment,” said Gerry Stimson, co-director of the Global State of Tobacco Harm Reduction (GSTHR) project and emeritus professor at Imperial College, London. “This report offers no surprises and no hope for the world’s 1.1 billion smokers, who need and deserve better.”
The GSTHR estimates that there are 68 million vapers worldwide, 20 million users of heated tobacco products and 10 million snus users. By comparison, there are 1.1 billion smokers.
July 30, 2021
New Report Urges Global Tobacco Harm Reduction
A new report urges regulators to scale up tobacco harm reduction (THR) around the world to help smokers make the switch. Burning Issues: The Global State of Tobacco Harm Reduction 2020 (GSTHR), the recently released second edition of a major biennial report produced by Knowledge-Action-Change, found that smoking-related death and disease disproportionately impact poor and marginalized groups, especially in low- and middle-income countries.
Credit: Kevin Phillips
Author Harry Shapiro, coins new terms in the report, calling e-cigarettes “safer nicotine products” (SNP) and EVALI (E-cigarette or Vaping Lung Injury) is now “Vitamin E-Related Lung Injury” (VITERLI).
The report found that there are only nine SNP users for every 100 smokers globally; most live in high-income countries. Overall, 98 million people are estimated to use SNP worldwide. Of those, 68 million are vapers, with the largest vaping populations in the US, China, the Russian Federation, the UK, France, Japan, Germany and Mexico and 20 million are heated tobacco product users—most of whom live in Japan, where cigarette sales have dropped by 32 percent since 2016.
Shapiro also criticizes bad science in the vaping industry, such as studies by discredited researcher Stanton Glantz. GSTHR examines two of his studies that were severely criticized by leading tobacco experts and one study that was retracted. It compares Glantz to Harry Anslinger, the former head of the Federal Bureau of Narcotics who used fear-mongering and moral panics to enact cannabis prohibition.
“SNP is one of the most startling public health success stories of modern times … THR offers a global opportunity for one of the most dramatic public health innovations ever to tackle a non-communicable disease,” Shapiro writes. “In a time of COVID-19 when global health and public finance systems are stretched to breaking point and may not recover for some time, the imperative to drive forward with THR has never been more urgent.”
The report makes several conclusions, including:

SNPs have the potential to substantially reduce the global toll of death and disease from smoking, and to effect a global public health revolution.

Many US and US-funded organizations have manufactured panics about young people and vaping, about flavors and the outbreak of lung disease, overshadowing the real public health challenge, which is to persuade adult smokers to switch.

The increasingly prohibitionist emphasis risks many consequences, including that current smokers may decide not to switch, current users of SNP may go back to smoking, and the growth of unregulated and potentially unsafe products.
December 3, 2020