On December 8th, 2022, a media panel discussion was held in London on tobacco harm reduction and smoke-free products with a focus on the United Kingdom Office of Health Improvement and Disparities (OHID) latest report (published in September 2022) and in particular, the update provided on harm perceptions in the United Kingdom (UK).
This event was organized by Philip Morris International (PMI), the leading tobacco company in the world, which aims to become a majority smoke-free business by 2025.
Four panelists held the discussion:
– Martin Cullip: Consumer Advocate, International Fellow of the Taxpayers Protection Alliance’s Consumer Center, UK.
– Daniel Pryor: Head of Research, Adam Smith Institute, UK
– Karl Fagerstrom: Professor Emeritus. President, Fagerstrom Consulting. Independent Researcher, Sweden.
– Gizelle Baker: VP, Global Scientific Engagement, PMI.
Smoke-free products (also called new nicotine products) such as e-cigarettes, heated tobacco and nicotine pouches are rapidly growing in popularity. These are at the core of tobacco harm reduction strategies which stated objectives are to reduce the damage caused by combustible cigarettes.
The panelists discussed how perceptions of new nicotine products may impact switching to smoke-free alternatives. In fact, in its report titled: “ Nicotine Vaping in England: an evidence update including health risks and perceptions ”, the OHID stated that “Among 11 to 18 year olds (ASH-Y) in 2021, 44.7% said they thought that vaping products were less harmful than smoking, indicating that most youth (55.3%) did not know the correct answer” also adding that “The proportion who inaccurately thought that vaping and smoking were equally harmful seemed to decline with age, going from 40.5% of 18 to 24 year olds to 23.1% of smokers aged 65 and over”.
In its report, the OHID also brought more precision on its previous and infamous statement that smokeless products are 95% less harmful than conventional cigarettes:
“We have previously stated, in our 2015 report, vaping poses only a small fraction of the risk of smoking and is at least 95% less harmful than smoking (that is, smoking is at least 20 times more harmful to users than vaping). This was to help the public and health professionals make sense of the difference in the magnitude of risk between vaping and smoking. We are aware that summarising the relative risks of vaping versus smoking across a range of different products and behaviours and assessed across multiple biomarkers can be simplistic and lend to misinterpretation. Based on the reviewed evidence, we believe that the “at least 95% less harmful” estimate remains broadly accurate, at least over short term and medium-term periods.”
The short and medium-term periods specified above are a major part of the controversy regarding scientific evidence and potential harm of these products. For Gizelle Baker, VP, Global Scientific Engagement, at PMI, short-term scientific evidence is fundamental even though it is “just” short-term.
She deplored some dissenters who put things in the wrong order when demanding long-term evidence before nicotine products could even be used, arguing that there are risks involved in not knowing the long-term effects.
“When you start talking about what are the long-term effects when a product has been around for 5 years the conclusion is going to be fairly obvious that data doesn’t exist today so when we are looking at these products from an epidemiological timeframe expecting to have evidence before the products exist long enough to generate the evidence, never mind having enough people using the products to generate evidence in the first place, it is kind of putting the cart before the horse. We need to look at what we can demonstrate, and what kind of evidence can we generate in the short term to give people the confidence to make these products available as well as what monitoring and surveillance can we put in place to make sure what we expect to happen does happen.”
As much as UK is considered top of the class in tobacco harm reduction, Sweden is often stated as well as an example to follow. In fact, the country has long endorsed a tobacco harm reduction model with “snus”, a smokeless tobacco product which has been used in the country for over 200 years:
“Evidence from Sweden, Norway, Japan, New Zealand and the UK shows that public health policies that allow or encourage consumers to switch to less harmful products can change public health outcomes.” declared Swedish researcher Karl Fagerstrom.
The use of new nicotine products has been low, to date, in Low and Middle-Income countries where 80% of all smokers live. According to the few scientific studies available for Africa this is mostly due to the regulatory landscape which makes it difficult for new nicotine products to enter markets. Many smokers in Africa perceive new nicotine products as being just as harmful as combustible cigarettes.