The Global Forum on Nicotine took place in Warsaw, Poland from June 16th to 18th, 2022. The aim of this international conference was to focus on the role of nicotine products that are considered safer than combustible cigarettes (nicotine vapes or e-cigarettes, nicotine pouches, oral tobaccos such as Swedish- style snus and heated tobacco products).
The Forum claims to be the only global event that welcomes “all stakeholders involved with new and safer nicotine products”. Over 50 international public health experts on nicotine and tobacco, civil society, academics and researchers, the tobacco industry, policy makers… gathered at this ninth edition under the theme “Tobacco Harm Reduction – Here for good”.
There is a growing number of smoke-free products around the world. When Public Health England, the executive agency of the Department of Health, published in 2015 that e-cigarettes were 95% less harmful than traditional cigarettes and have the potential to help smokers quit smoking, other independent studies followed only to show that these (and other nicotine products) are potentially safer alternatives. Nevertheless, nearly half the population (44.8%) didn’t realize e-cigarettes are much less harmful than smoking, still according to the review. Latest studies say that there are now 70% of people holding this belief. Moreover, the misinformation on tobacco and nicotine is higher in Low and Middle-Income (LMICs) countries even if they constitute 80% of worldwide smokers:
“Over 80% of the users are in LMICs with meagre means to deal with tobacco-related consequences and are the largest vulnerable group on the planet by any measure. The focus turns out to be unwaveringly on harm reduction by allowing them to exercise the choice of avoiding death and disease by switching to affordable and accessible risk-reduced alternatives should they feel unwilling or unable to quit” said Samrat Chowdhery, President of the International Network of Nicotine Consumer organizations in Global State of Tobacco Harm Reduction (GSTHR) Burning Issues publication, 2020.
Professor Marewa Glover from New Zealand worked on smoking-related harm for 25 years among the Māori population. For her, those products should be made available and affordable everywhere, no exception. However, health professionals in LMICs don’t feel confident enough to recommend safer alternatives to patients who want to quit smoking due to misinformation. Also, due to limited resources, most countries including Africa go with the template of World Health Organization policies – which is a strong opponent to smoke free products:
“Heated tobacco products (HTPs) contain tobacco and expose users to toxic emissions, many of which cause cancer and are harmful to health. Electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), commonly known as e-cigarettes, do not contain tobacco and may or may not contain nicotine, but are harmful to health and undoubtedly unsafe”.
Therefore, those countries tend to have the least access to other alternatives to combustible cigarettes with regulation aligning with the WHO:
“Why would you encourage lower and middle-income countries (LMICs) to make the same mistakes that were made in West with smoking cessation. Why give them an old model that is flawed and defunct. If they use it, then nobody can expect the results to be any better. Many people are being trained in the stages of change model of overcoming addiction, which is outdated and flawed. The UK and New Zealand dumped that model 20 years ago. We don’t use it anymore, so why are LMICs being taught a defunct model? Do we want them to die?” urged Professor Glover.
The tobacco industry, while battling skepticism for trying to become a serious public health stakeholder, affirms that there are solutions to reduce smoking harm and that they can make it available to every smoker who can’t or don’t want to quit:
“At the core of our transformation is the change of our portfolio. The clear aim is to produce products that will reduce the health impact on consumers. People who would have continued to smoke would have the opportunity now for a viable alternative. By so doing, it reduces smoking and mortality rates. This is the core of the transformation. And the destination of our transformation” said Flora Okereke, Head of Global Regulatory Insights and Foresights at British American Tobacco (BAT), and Nigeria native.
Another tobacco industry giant, Philip Morris International (PMI) made a radical pivot and goes through a major transformation too with now more than 90% of its Research and Development dedicated to smoke-free products:
“… We have already progressed. Today, more than 20 million consumers use our heated tobacco product and 71% have stopped smoking cigarettes. Our smoke-free products are sold in more than 70 countries around the world, 99% of our investment in terms of research & development are dedicated to those products and 75% of our commercial expenses” said Tommaso Di Giovanni, PMI Vice-President International Communications
According to the WHO, tobacco kills up to half of its users and smoking is still the leading cause of preventable death with 8 million deaths worldwide. The organization also states that by 2025, there will be the same number of smokers, i.e. 1.3 billion, as today. They are 77 million in Africa.