The seventh annual Global Forum on Nicotine (GFN) held from June 11 to 12, 2020h and was organised by “Knowledge Action Change Limited (KAC)”, headed by Professor Gerry Stimson, a public health social scientist from the United Kingdom.
Usually held in Warsaw, Poland, this year’s event took place virtually due to Covid-19. Under the theme “Science, ethics and human rights”, over 30 experts/scientists from the public health sector, tobacco industry, tobacco control sector, and consumers discussed various topics including the relevance of science versus ideology, the importance of a patient centred approach, the potential of vaping in low-income countries, and prohibited scientific alternatives to conventional tobacco.
For years now, numerous scientific studies have revealed that alternatives to traditional tobacco do less harm than conventional cigarettes. Despite those studies, several policy makers at national and international level, notably the World Health Organisation (WHO), promote extremely strict regulatory measures that don’t take evidence of risk reduction potential in non-combustible products.
Clive Bates is Director of The Counterfactual, a consulting and advocacy practice focused on a pragmatic approach to sustainability and public health in the United Kingdom. For him, these regulations are “punitive measures, coercion, restrictions, stigma, denormalisation. There has been a failure in doing what good policy makers should do which is to do proper impacts assessments and scrutinise. There is a massive failure of policy making, at all levels, governments, legislature, and international organizations like the World Health Organisation”.
For the experts who participated in the conference, safer nicotine products have a role to play in reducing smoking related diseases. They blame the institutional obstacles that have been set up for years which, according to them, benefit the status quo and do more harm than good:
“Everybody who looks at the history of innovation and industry of science and technology sees that. There are a lot of people interested in the status quo. Cigarette companies make a tremendous amount of money out of the status quo. And there is also a tremendous amount of funding of this status quo. Sweden, Iceland, Norway have the lowest smoking rates in the world.
“And now Japan, where a third of the cigarette market disappeared in a short period of time because they got access to alternatives. Consumers move to alternatives when they get an option,” said David Sweanor, Chair of the Advisory Board of the Centre for Health Law in Canada.
Mark Tyndall, professor and infectious disease specialist from Canada, is, as well, very firm on the topic of scientifically proven alternatives to traditional tobacco, saying: “I’ve always considered that smoking cigarettes was a form of harm reduction for people who use drugs. However, in the same time, it was painfully obvious that cigarettes were killing people more than HIV, more than hepatitis C, and even more than the catastrophic overdose epidemic that has been devastating North America. Death from cigarettes is slow and insidious.
“Until vaping appeared in 2012, there were not so much to offer. Most professionals encouraged people to stop smoking. At the best, we offered people nicotine patch or some gum, and told them it may help them to stop. Eight years later, who would have thought that throwing a lifeline to cigarettes smokers would be so contentious. It should have been a slam dunk. By now, leading public health authorities around the world should have launched global campaigns to rid the world of cigarettes through vaping.”
Moreover, many experts underscored that consumers and patients are at the core of health systems and that, they should know about alternatives and feel free to choose which one is better for them.
Clarisse Virgino, a vape consumer from the Philippines, is pushing for the fair regulation of electronic cigarettes in her country. She said: “It is the consumer, in the end, that will suffer if prohibitionist policies are put in place as these will deprive people who smoke to do the switch. It is basic human rights. Prohibition will also affect those who have already made the switch. It will force them to return to smoke regular combustible cigarette. Which is, quite frankly, very counterproductive.
“The alternative products are able to curb, if not eradicate smoking. These are less harmful products which can help people quit a bad habit that do not only affects smokers but also people around them. It is unfair and wrong at so many levels. As one says, there is nothing about us without us.”
The tobacco industry was also invited to the conference. Moira Gilchrist Vice-president for strategic and scientific communications at Philip Morris International, spoke at the conference.
According to her, “In an ideal world, we would be having an open, evidence based conversation to figure out how to replicate these results – alluding to cases of countries such as Japan – as quickly as possible in as many countries as possible. Astonishingly, back in the real world, we are far from this. Many public health advocates and public health organisations seem unwilling to objectively assess the opportunity that smoke-free products present. Why? Because these solutions come from the industry.”
Policy makers argue that there is irreconcilable conflict between the tobacco industry and public health. For Moira Gilchrist, it is “pure and simple scientific censorship”. For her, science and evidence are the most relevant:
“I cannot talk for the whole industry, but at Philip Morris International we are committed to replacing cigarettes with better alternatives as rapidly as possible. I cannot really understand why this change is met with skepticism. Today our Research and Development expenditures are mostly dedicated to a smoke-free portfolio.
“Our goal is a smoke-free future. The impact of these products is already being seen. A study made by researchers working for the American Cancer Society concluded that the rapid decline of cigarettes seen recently in Japan is most likely due to the introduction of Iqos, the electronic nicotine device designed by Philip Morris International.”
How about low-income countries and more specifically Africa?
In low-income countries, Electronic Nicotine Devices Systems (ENDS) are increasingly used. However, the legislation is often against these alternatives. For example, India has recently stopped the sale of e-cigarettes and other electronic devices citing health risks. Samrat Chowdhery is Director at Council for Harm Reduced Alternatives in India. He blamed what he called “an obvious conflict of interest”:
“China and India are at the forefront of keeping corporations’ proceedings secret which lost public scrutiny of their actions and globally harms tobacco control efforts by making them less transparent, and denying the rights of people who are most affected by their policies,” he added.
In Africa, several countries use heavy taxes to prevent electronic nicotine devices to disrupt the market. They, as well, cite health reasons for these strong regulations. For Chimwemwe Ngoma, social scientist from Malawi, education is the key to inform properly the population about what is really at stake.
“Government, farmers, civil society organisations and nicotine consumers should understand that tobacco is not the real problem, but smoking is. We need to demonstrate that safer nicotine products can be produced from the same tobacco,” Ngoma stated.
Clarisse Virgino from the Philippines goes beyond saying that these measures are highly detrimental: “There are countries which cannot afford to provide proper healthcare to their people. I think it is high time to embrace tobacco harm reduction. There is a ton of data, research, evidence that can support it. Policies go against the very essence of tobacco harm reduction.
“Consumers should not be the ones to take the blow for policies which are arbitrary and not based on facts. Policies should be protective of the people and not destructive, so consumers do not serve as collateral damage.”
Despite what seems to be a complex struggle, many experts such as David Sweanor, are hopeful that transformation will eventually come: “We can also see the opportunity that we have to fundamentally change the course of public health,” he said.
By Marie Camara