The challenges of regulation and prohibition of new nicotine products was at the center of discussions during the ninth Global Forum on Nicotine, which took place in Warsaw, Poland, on June 16th to 18th, 2022.
Several studies have shown that new nicotine products are potentially safer alternatives to combustible cigarettes as they may deliver nicotine with dramatically reduced risk compared to combustible cigarettes. Other studies beg to differ when, in the same time, a growing number of countries have changed their regulation to help increase access to these products.
Among those countries, high income nations appear to be the ones moving relatively fast in terms of changing policies. In 2014, the European Union distinguished “Novel Tobacco Products” as a separate category from conventional tobacco products. Since then, countries such as Norway, Greece, Sweden and New Zealand have changed their regulation to approach smoke free nicotine products and combustible cigarettes differently.
In Japan, the number of smokers dramatically declined after the launch of smoke-free alternatives falling by 34.2 percent between 2015 (when Heated Tobacco Products – HTPs were introduced to the Japanese market) and 2019. The research was led by the International Journal of Environmental Research and Public Health and published in May 2020. The data used for this study came from the Tobacco Institute of Japan and Philip Morris International.
However, many countries’ regulations stand against these scientific studies and innovation on smoke-free tobacco products.
How about Low and Middle-Income Countries
In LMICs smoke free tobacco is, in most countries, not considered as a different category of product as combustible cigarettes, and is prohibited:
Tomás O’Gorman, Pro-Vapeo Mexico (Mexico)
“In low and middle-income countries, prohibition is like trying to stop a wave with an umbrella. E-cigarettes will be there. It is difficult, but [in Mexico] we are still able to get access to these products.”
In those countries, policy makers appear to be the most unwilling to embrace what some call “huge innovation”. For Federico N. Fernández, from the organization “Somos Innovación” (We Are Innovation) in Argentina, innovation is aimed at consumer service:
“Regulation always comes behind innovation and this is unfortunately something regulators sometimes forget. These regulations should always leave space for innovation. When we look at the history of vaping devices, they are not only an amazing innovation, they’re also an innovation that’s been pushed by the consumers, and that should be allowed. The starting point for this discussion should be that there are no grounds for these products to be illegal. Then we should talk about regulation, and we shouldn’t do it with a feeling of panic. Regulation is ok. I just want to make sure that a liquid has the ingredients it says it has and not something else.”
One of the main arguments to blocking these products’ availability in LMICs is the appeal to young people. LMICs constitute the largest number of young people in the world. Opponents to new nicotine products say that flavours may appeal to the young, and just like everywhere else in the world, they would try to experiment, as it is common in adolescence to want to experiment. Also, a number of organizations such as “Centers for Disease Control and Prevention” argue that “e-cigarettes can contain other harmful substances besides nicotine and that young people who use e-cigarettes may be more likely to smoke cigarettes in the future”.
In Africa more precisely, these arguments are often mentioned to justify regulation and bans.
But for Flora Okereke, every stakeholder should have a seat at the table:
“It should be a combined effort, a constructive effort between the industry doing what they can and also the regulators and public health organizations. We need to focus more on transition and making whatever measures that are available to launch people to move on. I see better efforts spent on that, than lining up stricter and stricter regulation or prohibition.”
The “quit or die” approach does not work according to the new nicotine products subscribers and there must be an intermediary solution for those who do not want to or can’t quit.
South Africa is the only country in Africa where these “solutions” are available on the market. According to the World Health Organization, between 2002 and 2030, tobacco-attributable deaths are projected to double in low and middle-income countries (LMICs), including in Africa.