The often controversial subject of tobacco was discussed during the virtual e-cigarette Summit which took place on December 3rd and 4th 2020. Many experts and scientists were part of the conversation around public health, regulations, policies and harm reduction.
Some challenging questions have arisen over the last few years about whether innovative tobacco products such as electronic cigarettes and heated tobacco are really efficient alternatives to combustible tobacco. During this conference, experts reflected on issues surrounding science and evidence on tobacco harm reduction and the reasons why, in spite of it, many still remain opposed to these alternatives.
Peter Hajek is Professor of Clinical Psychology and Director of the Tobacco Dependence Research Unit at the Wolfson Institute of Preventive Medicine, Queen Mary University of London. His research is concerned primarily with understanding health behaviors, and developing and evaluating both behavioral and pharmacological treatments for dependent smokers and for people with weight problems.
He first provided a review of some of the developments that are improving the competitiveness of less harmful alternatives against cigarettes:“To make cigarettes obsolete, alternatives need to first deliver nicotine in the way smokers want, and secondly provide « added value » to compensate for the likely enjoyment deficit and the effort of the switch as well as offer additional attractants such as flavours, lower cost, acknowledgement of lower risk, reduced stigma and regulatory advantages over smoking”.
He then presented an analysis of what motivates activists and regulators to prevent smokers from switching to less harmful options. Although innovative tobacco markets are succeeding in driving some products improvements in spearheading the adoption of different ways of nicotine delivery, Peter Hajek blames certain conditions such as “hostile regulations, bans, and misleading publicity” for the slowing down of product development and effectively sabotaging the “added value” elements” of new tobacco products.
He added that “efforts that prevent smokers from switching are obviously unethical, such as the influence of large industries whose profits are threatened such as organizations like Bloomberg Philanthropies.” Yet, scientific research led by independent experts and professors have shown through the years the great potential of less harmfulness of e-cigarettes.
Ray Niaura is Interim Chair of the Department of Epidemiology, Professor of Social & Behavioral Sciences School of Global Public Health, New York University. During the discussion, he insisted on the importance of having a strong scientific community that can address what he calls “myths” around e-cigarettes, by reasserting its scientific authority, and establishing a positive and common research agenda to move forward:
“The scientific agenda for research on reduced risk tobacco products remains splintered and counterproductive. This is because stakeholders have different goals in mind for what research ought to be able to demonstrate and which positions it should support. Tobacco and nicotine companies, naturally, hope to demonstrate that new, alternative products, compared to cigarettes or other combustibles, carry less individual health risks. Regulators more or less are open to harm reduction science, but have not been clear on defining what types of methods and evidence qualify. “
He added:
“Regulators are also wary of potential risks because no tobacco or nicotine product is, strictly speaking, risk free. Tobacco control activists’ agenda is to demonstrate irredeemable harms attached to any and all tobacco or nicotine consumer products, or at least to raise sufficient doubts about potential future harms vs benefits. This has resulted in an asymmetric research agenda focused on harms not benefits. This agenda is driven by beleifs that perversely attract scientists’ attention yet cannot be adequately addressed within the scope of current scientific methods (e.g., the “gateway” hypothesis, nicotine-caused brain damage, e-cigarettes don’t help smokers quit). This has led to wheel-spinning and little forward progress.”
One of the arguments used by those opposed to e-cigarettes such as the World Health Organization is the obligation to protect youth health. Steven Schroeder is a distinguished Professor of Health and Healthcare at the University of California San Francisco, where he directs the Smoking Cessation Leadership Center (SCLC).
For him, the youth argument is an excuse that prevents smokers from benefitting from a variety of alternatives:
“In their zeal to protect youth from the hazards of vaping, too many well-meaning researchers and advocates have gone beyond the evidence to overstate the dangers of harm reduction. In so doing, and at a time when authorities are suspected of disseminating “fake news,” we risk undermining our scientific and moral credibility, thereby damaging our prospects of further curbing the still devastating tobacco epidemic.”
According to the WHO, there are about 1.3 billion smokers worldwide. The Smoking incidence has risen 50% in Africa over 35 years and the number of smokers is expected to increase from 52 million people in 2000 to 84 million people in 2025 according to the WHO.
In Africa 13 million women use tobacco products, including chewing tobacco and snuff and 13% of young adolescent girls use tobacco products according to the organization.
The debate around e-cigarettes does not spare Africa where regulations and bans are tenacious. 80% of worldwide smokers live in low and middle-income countries where the load of tobacco-related diseases and deaths is the heaviest.