Australia is lagging well behind many other countries in the Asia-Pacific region when it comes to successfully tackling smoking through vaping, says the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA).
The CAPHRA’s observation comes as Australia’s Department of Health seeks feedback on its Draft National Smoking Strategy 2022–2030, with public submissions closing on March 24.
“We encourage vapers and supporters of a progressive tobacco harm reduction (THR) approach to have their say. Australians desperate to quit smoking and those keen to stay off deadly cigarettes need all the help they can get,” says Nancy Loucas, executive coordinator of the CAPHRA.
On Oct. 1, 2021, Australia’s Therapeutic Goods Administration expanded its prescription-only model with customs clamping down at the border on personal imports of nicotine vaping liquids from overseas websites.
Not only does Australia’s draft strategy ignore the potential of safer nicotine products, it also lacks ambition, according to Loucas. The strategy aims for a smoking rate of 10 percent or less by 2025 while New Zealand is pursuing a 5 percent smoke-free goal and looks on target to achieve it. “Instead of banning vaping, New Zealand has regulated it, making it tough for minors to access but available to all adults keen to keep off the cancer sticks. New Zealand is seeing its overall smoking rate tumble, yet the Australian government fails to accept that the most effective smoking cessation tool available is staring it in the face,” says Loucas.
“Australia is well down the world rankings when it comes to adopting effective THR policies and is light-years behind the U.S. and U.K. Subsequently, Australia’s overall smoking rate has fallen very little over the past decade, and without reasonable access to vaping, Australia will struggle to even achieve its 10 percent smoking goal,” says Loucas.
The Asia Harm Reduction Forum 2021 attended by the leading experts in technology, public health policy and science met to discuss the tobacco harm reduction (THR) strategies deployed in various countries, according to a press release from the Canadian Vaping Association.
“We have known the risks from smoking for many decades. We have known that it is the smoke, not the nicotine, that is responsible. We also know that we can deliver nicotine in ways that have minimal risk,” said David Sweanor, chair of the Center for Health Law, Policy and Ethics and an adjunct professor of law at the University of Ottawa. “As a result, Sweden’s rates of tobacco-related illness and death are by far the lowest that you can see in the European Union. Their smoking rates are now low enough that many people would call it a smoke-free society. When Norway allowed snus products to be more widely available, cigarette smoking fell by half in just 10 years. When Iceland allowed both vaping products and snus into the market, smoking fell by about 40 percent in just three years.”
For decades, Canada has tried to curb smoking through education and taxation with limited success. Reductions in smoking prevalence had generally slowed, with modest annual declines prior to more mainstream adoption of vaping by smokers. Vaping experienced peak adoption in 2019, which lead to a 7.5 percent decline in cigarette sales.
“Harm reduction is one of the four pillars of Canada’s drug and substances policy. Policy that makes vaping less appealing to smokers, like flavor restrictions and taxation, is out of step with this policy. In effect, Canada has embraced harm reduction in name but not substance,” said Darryl Tempest, Government Relations Council to the Canadian Vaping Association.
A global collaboration of THR consumer groups, SCOPE includes Consumer Advocates for Smoke-Free Alternatives Association (CASAA) in the United States, Iberoamerica (ARDT) in Latin America and the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA).
SCOPE recently broadcast around the clock during the nineth Conference of Parties for the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
Alex Clark
“SCOPE’s five-day global livestream was a huge success, countering and shining much-needed sunlight on COP9. It shows just what can be achieved when international consumer organizations come together in their tireless work to humanize and promote the life-changing tobacco harm reduction movement,” says Alex Clark, CEO of CASAA.
Hours of SCOPE’s presentations by international THR experts and panel discussions featuring consumer advocates have now been uploaded into one online library, available at https://bit.ly/319zzkx
Nancy Loucas, executive coordinator of CAPHRA, says if more smokers’ lives are to be saved then the World Health Organization must not be allowed to continue to demonize safer nicotine alternatives like vaping. Instead, it must be mandated to follow the scientific evidence.
It’s critical, she says, over the next two years that the world’s THR organizations work more closely and effectively together.
“SCOPE provides consumers, the public and the media with an invaluable resource and platform going forward. Our focus now shifts to COP10 in 2023 where risk reduced products will be a key discussion topic for delegates. With over one billion smokers’ lives at stake, consumers need one clear voice and SCOPE now provides that,” says Loucas.
Ignacio Leiva Benitez
Chilean consumer advocate Ignacio Leiva Benitez, general secretary of ARDT Iberoamerica, says Latin America is delighted to be part of SCOPE. His organization, he says, is now working more closely with allies from all around the world.
“SCOPE is all about showing the world’s decisionmakers what has worked for us individuals and changed our lives for the better,” says Benitez. “I started vaping 12 years ago, after smoking two packets of cigarettes a day. For years I tried different ways to quit but was unsuccessful until I discovered nicotine vaping. SCOPE will enable us to fight more successfully on behalf of adult smokers, in every country, to gain better access to safer alternatives.”
One hundred tobacco harm reduction (THR) experts have published a joint letter challenging the World Health Organization’s (WHO) approach to tobacco science and policy. The group is urging members of the Ninth Session of the Conference of the Parties (COP-9) of the Framework Convention on Tobacco Control (FCTC), a global intergovernmental treaty in which the WHO plays a major role, to encourage the WHO to support and promote the inclusion of tobacco harm reduction into its regulatory advisements.
Credit: Igor Golovnev.
“Smoke-free nicotine products offer a promising route to reducing the harms arising from smoking. There is compelling evidence that smoke-free products are much less harmful than cigarettes and that they can displace smoking for individuals and at the population level,” the letter states. “Regrettably, [the] WHO has been dismissive of the potential to transform the tobacco market from high-risk to low-risk products. [The] WHO is rejecting a public health strategy that could avoid millions of smoking-related deaths.”
The letter was published on Oct. 18 and will be sent to COP-9 delegates. In a joint statement, Ruth Bonita, former director of WHO Department of NCD Surveillance, and Robert Beaglehole, former director of the WHO Department of Chronic Disease Prevention and Health Promotion, stated that they were “extremely disappointed by WHO’s illogical and perverse approach” to reduced-harm nicotine delivery products, such as vaping.
“A key challenge in global tobacco control is to assist cigarette smokers to transition from burnt tobacco products to much less harmful options that provide the nicotine without the toxic smoke,” the statement reads. “[The] WHO’s continuing disregard of the wealth of evidence on the value of these products is condemning millions of smokers to preventable disease and premature death.”
The letter goes on to make seven points about the current vaping regulatory environment, such as the value of vaping in THR and the unintended consequences of poor regulatory policies. The authors then go on to make six suggestions for the WHO to consider:
Make tobacco harm reduction a component of the global strategy to meet the Sustainable Development Goals for health, notably SDG 3.4 on non-communicable diseases.
Insist that any WHO policy analysis makes a proper assessment of benefits to smokers or would-be smokers, including adolescents, as well as risks to users and non-users of these products.
Require any policy proposals, particularly prohibitions, to reflect the risks of unintended consequences, including potential increases in smoking and other adverse responses.
Properly apply Article 5.3 of the FCTC to address genuine tobacco industry malpractice, but not to create a counterproductive barrier to reduced-risk products that have public health benefits or to prevent critical assessment of industry data strictly on its scientific merits.
Make the FCTC negotiations more open to stakeholders with harm-reduction perspectives, including consumers, public health experts, and some businesses with significant specialised knowledge not held within the traditional tobacco control community.
Initiate an independent review of WHO and the FCTC approach to tobacco policy in the context of the SDGs. Such a review could address the interpretation and use of science, the quality of policy advice, stakeholder engagement, and accountability and governance. The Independent Panel for Pandemic Preparedness and Response (IPPPR), initiated to evaluate the response to the COVID-19 pandemic, offers such a model.
Another signatory, David Sweanor, adjunct professor of law, chair of the Advisory Board of the Centre for Health Law, Policy and Ethics University of Ottawa, Canada, in a separate statement, said that effective public health efforts need to be based on science, reason and humanism. Instead, the WHO is aligning itself against all three when dealing with nicotine.
“The result is that one of the greatest opportunities to improve global health, separating nicotine use from smoke inhalation, is being squandered. Global trust in health authorities, and the WHO in particular, has never been so important,” the statement reads. “Yet the WHO is abandoning science, rationality and humanism on nicotine and instead apparently pursuing the moralistic abstinence-only agenda of external funders. This is a public health tragedy that extends well beyond the unnecessary sickening of the billion-plus people who smoke cigarettes.”
An international consumer group released a position paper today that claims blanket bans on vaping and heated tobacco products (HTPs) are a detriment to low- and middle-income countries (LMICs). The International Network of Nicotine Consumer Organisations (INNCO), a global advocate for sensible tobacco harm reduction (THR) says bans on electronic nicotine delivery systems (ENDS) are an overly simple solution that make the problems that come with combustible cigarette use far worse.
“The hundreds of millions of people who smoke in these countries should have the ability to make decisions about safer nicotine products, particularly when their own health is on the line,” said Samrat Chowdhery, president of INNCO’s governing board. “Overly simplistic policy solutions, such as proposed bans on all ENDS and THR products by the Bloomberg Philanthropies-funded The Union, are being offered as a blunt and impractical tool for a situation that requires pragmatism and nuance, making meaningful and sustainable change more difficult.”
Samrat Chowdhery
The report, “10 Reasons Why Blanket Bans of E-Cigarettes and HTPs in low- and middle-income Countries (LMICs) Are Not Fit for Purpose,” sends a strong warning to organizations and governments that limiting options to reduce harm will only increase the number of people smoking tobacco, inevitably leading to illicit markets and increases in crime. The paper lists the Top 10 reasons the bans don’t work as the following:
Bans are an overly simplistic solution to a complex issue and will not work.
Prioritizing the banning of reduced harm alternatives over cigarettes is illogical.
Reduction and substitution are valid goals for smokers in LMICs.
People who smoke have the right to choose to reduce their own risk of harm.
Reduced harm alternatives can significantly contribute to the aims of global tobacco control.
Lack of research in LMICs is not a valid reason to ban reduced harm alternatives.
The prohibitionist approach in LMICs is outdated, unrealistic and condescending.
Bans will lead to illicit markets with increases in crime and no tax revenue.
Banning reduced harm alternatives leads people back to smoking and greater harm.
• Blanket bans in LMICs are a form of “philanthropic colonialism.”
INNCO estimates that that there are scores of LMICs in jeopardy of increasing the number of people who smoke cigarettes in their countries unless pragmatic approaches to tobacco harm control are adopted, including the availability of a wide selection of safer nicotine products. Leveraging the paper’s findings, INNCO states that it will work with its global membership to inform policy makers in developing nations to help achieve risk-relative regulations and access to safer THR products, according to a press release.
“Africa is home to some of the highest-ranked smoker countries on the planet,” said Joseph Magero, chairman of Campaign for Safer Alternatives, a pan-African non-governmental member organization dedicated to achieving 100 percent smoke-free environments in Africa. “While improving overall public health has made great strides in these regions, efforts to directly address smoking cessation and harm reduction strategies have lagged due to limited or no access to safer, non-combustion nicotine products. By denying smokers access to much safer alternatives while leaving cigarettes on the market, policymakers would leave only two options on the table – quit or die.”
Several other THR groups also agree with the paper’s position. Nancy Loucas of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates, a grassroots alliance of THR advocacy organizations, said a blanket ban in LMICs is a form of philanthropic colonialism, suggesting that these countries and their citizens cannot be trusted with any level of self-determination. “Inhabitants are treated as second-class citizens, which is offensive,” she said. “There is no benefit in limiting choice of safer nicotine products, but only the potential for increasing harm.”
Francisco Ordóñez of the Asociación por la Reducción de daños del Tabaquismo Iberoamérica, a network of consumer organizations in Latin America, says that very few low- and middle-income countries have adopted even the most basic prevention measures suggested by the World Health Organization (WHO).
“Policymakers should embrace harm reduction as a valid goal, particularly in LMICs where access to cessation programs is extremely limited,” said Ordóñez. “Replacing combustible tobacco with alternative nicotine products can significantly reduce the risk of harm by at least 95 percent. It works in industrialized nations and can do the same in LMICs.”
While tobacco harm reduction products have an important role to play, quitting ‘cold turkey’ remains a legitimate strategy in pursuit of better health.
By George Gay
According to a joke included at the end of a London Review of Books piece by Jerry Fodor, a keynote speaker opens his remarks at a philosophical conference by saying that, in principle, there are 12 philosophical positions, only to be interrupted by a heckler shouting, “13!” The keynote speaker continues: “As I was saying, there are 12 philosophical positions …” but again the heckler shouts, “13!” The speaker then says that he will describe briefly the 12 philosophical positions. The first, he says, is Naive Realism, according to which things are more or less the way they seem to be. At that point, the heckler shouts, “Oh no, 14!”
You don’t have to be a philosopher to get the message that there is a danger that complexity can suffocate simplicity and the common-sense benefits that the latter has to offer. This isn’t to say there is no need for complexity—just that there is also a need, at times, for simplicity. As I believe Einstein once put it: Things should be made as simple as possible but no simpler.
Is there not a danger that in pursuing tobacco harm reduction (THR) we are losing sight of the simple? I know it’s unfashionable to ask, but what is wrong with smokers going cold turkey if they want to quit their habit? There was a time when all smokers who wanted to quit went cold turkey because that was the only route out of tobacco. And millions did it. I was one of them.
What a lot of readers will be thinking, however, is that there’s nothing stopping smokers from going cold turkey, so what’s the problem? Well it’s not quite true that there’s nothing stopping them doing so. I can think of at least two things that would be holding them back. One is the fact that various people and organizations have taken a lot of trouble to convince smokers that quitting cold turkey is incredibly difficult, if not impossible. They have tried and largely succeeded in convincing many smokers that they are victims who cannot control their own destiny. Their ability to make decisions about smoking and health has been taken from them by tobacco manufacturers. This, of course, is nonsense, but it is a useful narrative for some people to spread and, regrettably, for others not to counter.
The other reason is that smokers are given too little help to quit cold turkey. Why couldn’t a large part of THR comprise tobacco tax-funded public announcements encouraging smokers to quit? Of course, there would be a need firstly to sound a very loud warning bell. Such announcements should not descend into the type of propaganda beloved of certain governments and organizations where smokers are depicted as being victims of the tobacco industry, patients of the medical profession and the scourge of society. And such announcements should not feed smokers a bunch of lies and half-truths, try to frighten the pants off them and generally treat them as though they were children without the ability to make rational decisions.
Better still, smokers should be provided with positive rather than negative information. They should be told how quickly, post-quitting, their risk of contracting certain diseases and conditions falls to that of, or near to that of, nonsmokers. And they should be told how, in quitting smoking, and especially in quitting cold turkey, they will be saving money while making a positive contribution to helping prevent pollution and the further degradation of the environment.
One of the problems is that THR has become monetized—become part of the destructive system under which the worth of everything is judged by its performance on the “market.” We have been fooled into believing that what matters is that smoking is replaced by something that can be sold, preferably for the same sorts of profits that are currently enjoyed in selling cigarettes. That is, cigarettes have to be replaced by less risky tobacco and nicotine products, including nicotine-replacement therapy products manufactured by the pharmaceutical industry.
And it is true that there would be something to be said for such a way of looking at smoking cessation if it weren’t for the fact that less-risky products seem to be struggling—entangled in endless debates based on science and pseudo-science, conspiracy theories, political shenanigans and great dollops of bureaucracy. These debates are all very interesting and take up hours of conference time, but they remain largely unresolved, like Fodor’s philosophical positions two through 12, and they simply leave smokers up a creek without a paddle. The interests of the smoker seem to have been pushed into the background as the various sides in the THR debate defend their own positions and brief against each other.
That something is seriously wrong with efforts being made to promote smoking cessation is clear from Burning Issues: Global State of Tobacco Harm Reduction 2020, the second (the first appeared in 2018) such report written by Harry Shapiro and published by Knowledge-Action-Change. This 162-page report makes the point that after more than a decade of product availability, there are only nine users of “safer nicotine products” (SNP—vapor devices and heated-tobacco devices, Swedish style snus and some other safer forms of smokeless tobacco) for every 100 smokers.
This should sound alarm bells, and it does, but those bells are peeling out the wrong message as far as I can hear. They are calling for more of the same. How does it go? Having lost sight of our objectives, we redoubled our efforts.
I should add, however, that this is an excellent report with masses of information about where we are with THR and the SNPs that underpin it and how we got here. The way forward is less clear because it is difficult to navigate a path in the face of the guerrilla activities employed by those opposed to the THR approach—activities that have so far proved fatally successful in casting doubts in the minds of smokers and vapers. Nevertheless, the report contains 15 recommendations (as well as 20 conclusions) that map out a route to the future. Though, in the light of the short history of THR, some of those recommendations might better be described as wishful thinking.
One of the things that becomes clear in the report is how little success had been achieved in pushing the quit-smoking agenda before the incorporation of the sorts of harm reduction principles that had already been well established in respect of other health challenges. And little wonder given that pre-THR, the approach had been to bully smokers into quitting. THR takes an altogether more humane approach, as the report spells out: “Harm reduction refers to a range of pragmatic policies, regulations and actions, which either reduce health risks by providing safer forms of products or substances, or encourage less risky behaviors. Harm reduction does not focus primarily on the eradication of products or behaviors.”
Contrast this with the methods employed before THR and that are still pushed by many governments, organizations and individuals—methods that are based on discouragement or punishment. Such methods include the degradation of the products that smokers enjoy through pointless controls on nicotine levels, the banning of harmless flavors and the despoiling of packaging. They include the inexcusable use of smoker “denormalization” or officially sanctioned discrimination. And they include the imposition of grossly unfair levels of taxation.
Credit : Omni Matryx
Meanwhile, there are issues brought up in the report that I believe could usefully be subjected to further analysis in any forthcoming edition of Burning Issues. The report mentions that the World Health Organization (WHO) has “not revised downwards its estimate that one billion lives could be lost to smoking-related disease by the end of the century.”
Despite the fact that many of us are highly critical of the WHO’s attempts at encouraging smoking cessation, we tend to accept its figures unquestioningly. But whereas, for instance, a figure of one billion is convenient to throw about, when you think about it, it is ludicrously rounded. And given that this is a worldwide figure, you have to ask yourself how the data are gathered in many countries, especially in those where, perhaps because of wars, there are no fully functioning administrations.
And it would be good to see some of the methodologies used in compiling such figures. Since, I guess, some people die of “tobacco-related diseases” that might also be seen as “pollution-related diseases,” how are these deaths divided up? I suspect that the default setting is to put such deaths into the tobacco-related deaths column, in which case the WHO’s tobacco-related deaths figures are likely to be inflated.
This is not an attempt to get tobacco partly off the hook but to make sure that we are taking action where action is required and not just where some people would like to see it applied. There is no point in developing vapor devices if the disease problem is down to the pollution caused by air travel, etc.
But what I would like to see, especially, is detailed information on how “tobacco-related” diseases and deaths have fallen with the reduction in smoking in those countries where such smoking reductions have occurred. In countries such as the U.K., smoking has been falling long enough for the related diseases to be also showing declines, and there should be a recognizable correspondence between the two.
Credit: Kjerstin Michaela Haraldsen
The problem with accepting blind what the WHO has to say is that one can end up being mesmerized by huge figures and drawing some questionable conclusions. The report states, for instance, that the one billion tobacco-related deaths “[are] equivalent to the combined populations of Indonesia, Brazil, Nigeria, Bangladesh and the Philippines dying from Covid-19.” I know that it is considered rather trite to say so, but shit happens, people die, and it is necessary to keep a sense of proportion.
If you look at a long enough time frame, you could probably say that the equivalent of the population of Belgium will die from having pieces of toffee stuck in their windpipes. And I think the reference to Covid-19 doesn’t stack up.
There is a world of difference between smoking and Covid-19. A lot of people won’t agree with me here, but people have a choice about whether or not they smoke. But the ordinary person in the street has next to no control over the rise and spread of viruses. That is why, to my way of thinking, viruses are a valid area of interest for the WHO whereas smoking is not. I’m not saying that we should row back from THR products, but, at the same time as we are improving these products and making them available, we should be putting our foot down harder on the cold turkey pedal just in case those opposed to THR win the day. It’s not just me being pessimistic. This is from the report.
As the environment for THR has grown ever more toxic since our last report, we have turned our attention this time to the mechanisms of the well-orchestrated and well-funded global campaigning driving an increasingly prohibitionist response to SNP. Despite the above, it is claimed in the report that SNPs have been “disruptive” and that they have provided one of the most startling public health success stories of modern times, claims that, given the slow conversion rate from smoking to using SNPs, seem not to be supported by the evidence. Or perhaps I’m looking at things from the wrong direction. This, too, is from the report:
“Globally, the value of the vaping market has continued to grow since our 2018 report and is projected to grow further. The chart from Statista43 shows the value of the e-cigarette market at around $19 billion and its steady projected growth from 2012 through to 2023.” I see. So it is about monetization, is it? OK, we have to be practical. We have to allow companies to make money, but there’s clearly a problem here. Declines in smoking predated the arrival of SNPs in many of the countries where these sorts of products are affordable, basically the West, but smoking is still on the increase in many low-income and middle-income countries where they are less affordable. If we are not careful, THR will become a system that helps to underpin health inequalities. If you’re rich, you can afford the products to keep you healthy; if you are not … well, too bad.
By all means, let’s redouble our efforts, but let’s make sure we’re still focused on the goal of encouraging people to stop smoking. We might need to look for new ways of doing this or even old ways, such as cold turkey.
