New report to map the journey of tobacco harm reduction

Yes, it has been a while since the last blog, but the main reason is the need to push on with the next Global State of Tobacco Harm Reduction report due out in November. This report will be a status report, analysing just how far we have come trying to embed tobacco harm reduction in the international health discourse alongside drug and HIV harm reduction. We maintain that access to safer nicotine products (SNP) to protect health is a basic human right derived from the original WHO declaration on the universal right to health. And from a standing start in 2004, progress along the THR journey has been encouraging.

With apologies to Lennon & McCartney, it was just two decades ago this year that the first commercially viable vapes became available in China thanks to the pioneering work of Hon Lik trying to find a way to stop smoking himself and in light of his father’s death from lung cancer.

Since then, the global consumer population has grown to over 120 million users. It is likely, with the possible exception of North Korea, that at least one SNP is to be found in every country in the world. Unfortunately, the generally hostile regulatory environment in which SNP operate means much of that product will be illegal. That illegality might derive from outright bans, illegal smuggling to avoid import taxes or simply unsafe products. This of course is the result of banning a much in demand product.

Product development has happened at pace, much of it derived from consumer demands. Indeed, in the very early days, a handful of consumers were designing products of their own to compensate for the unsatisfactory nature of the original cig-a-likes. Many of those ideas were taken up by the burgeoning vape industry.

The science too has built up beyond a critical mass of evidence showing unequivocally that relative to traditional tobacco products, all SNP be they vapes, heated tobacco products or safer oral products such as snus and nicotine patches are significantly safer and do offer an exit ramp from smoking.

Despite a constant stream of value-laden pronouncements from the WHO and others for countries just to implement outright bans on SNP, there are still only a handful of countries who have heeded this call. Some countries have reversed previous prohibitionist policies and others are considering similar. It is no coincidence that Norway, Japan and Sweden, countries with proportionate SNP regulations are also those countries projected to be the first countries to reach the smoke-free target of adult smoking prevalence down to 5% or less. At this years’ meeting of the Conference of the Parties (COP) to the Framework Convention on Tobacco Control, for the first time, some Parties challenged the WHO’s persistent refusal to engage in debate about harm reduction, let alone began to integrate THR into tobacco control policies.

But as I say this latest GSTHR is a status report on THR and huge challenges remain towards achieving the promise of millions of lives potentially improved and saved by a universally pragmatic response to SNP. The challenges are multi-faceted. Many governments rely on income from growing and exporting tobacco and/or from various domestic taxes levied on smoking. Some countries have a long tradition of ‘cottage industry’ production of local tobacco products which sustain poor communities. Politicians, legislators, health professionals, smokers and wider society are constantly bombarded in the media by flawed or even fake science from academic and medical institutions and anti-THR NGOs who often have financial and professional vested interests in denying the essential health benefits of SNP. The perverse irony here is that these bodies are quick to condemn THR advocates over spurious conflicts of interest without revealing their own deep collusion with anti-THR funders.

Among those regularly attacked are consumer activists campaigning for the right to health from bases across the world and formed into national and international associations. Those lobbying for the right to access a consumer product simply on health grounds might be unique in the general history of consumer activism which more often is focused on demanding redress from commercial companies.

There are concerns about teen vaping and the environmental impact of disposable vapes. As we show in our report. much of the loud hailer politics around teen vaping does not stand up to much statistical scrutiny. The issue of preventing young people accessing vapes and addressing irresponsible device disposal are matters for enforcement and trading standards authorities. Simply trying to ban your way out of problems is never going to work as we see with the growth in the illicit vape market. Nor should either issue become a smoke screen to hide behind what are essentially moral objections to the consumption of nicotine. Such arguments become even more exposed for what they are when SNP allow nicotine to be decoupled from cigarettes.

Compared to the global value of the cigarette market at around $800 bn USD, the market value of SNP at around $30 bn USD is still tiny by comparison. But all the market analyses indicates that the SNP market will continue to grow. Progress might be slower than desirable for the benefit of public health, but it is inexorable.