The central message of the report is enshrined in the title – if you want to consume nicotine, but don’t light up a cigarette, there is no smoke, and if there is no smoke, the release of potentially harmful toxins is reduced by several orders of magnitude. This is harm reduction in action.

On a personal note, I was honoured to be asked by Professor Gerry Stimson to write and edit this landmark report which came with the backing of an exemplary team of dedicated professionals working on data analysis, print and technological design and implementation. We were also able to call upon the expertise of key informants from around the world, some of whom we cannot name. They have families and they didn’t fancy going into an expert protection programme. Such is the dog-eat-dog world of international tobacco research.

GSTHR brings together all the available evidence and data detailing the history and development of safer nicotine products (SNP), information about consumers, and a comprehensive review of both the independent scientific and clinical evidence concerning SNP and the global landscape of regulation and control.

GSTHR takes its inspiration from the biennial drug harm reduction reports which Gerry Stimson inaugurated back in 2006 when he was Director of what is now called Harm Reduction International. What this means is that tobacco harm reduction does not exist in a public health vacuum. It is just the latest manifestation of a long and illustrious history of health-based community activism, beginning back in the 1980s with members of the gay community in the USA and drug users in the UK and Holland. Some of the most vilified and marginalised people in our communities, started movements which now have global reach, and fought for the right to health, enshrined in so many international treaties but conveniently ignored when it comes to protecting the health of people who are deemed to be living outside the pale.

And this applies no less to the community of smokers who, like their predecessors, took up the opportunities afforded by the early days of SNP, before any interest from the commercial world, and in the face of hostility from the international tobacco control community, which, if anything, has intensified as consumers have become increasingly empowered to seek solutions denied to them by many public health professionals.

This refusal to acknowledge the role of SNP is a public health and human rights disaster of epic proportions. By the WHO’s own estimates, one billion people could be dead by the end of the century because of smoking-related diseases. And given that population growth will give birth to more smokers especially in poor countries, one billion could be an underestimate. Yet the Mexican government has launched an unprecedented barrage of public misinformation about vaping and India with its massive state-run tobacco company and a million deaths a year from smoking has just advised a nationwide ban on e-cigarettes. These and many other countries take comfort from the World Health Organization who not only refuse to endorse SNP to stand alongside other tobacco control measures, but actively encourage FCTC signatories to treat these potentially life-saving products as cigarettes if not to ban them altogether.

Weak and flawed scare-mongering anti-harm reduction evidence is causing confusion among smokers and the general public, but crucially also among politicians, policy makers, public health officials and legislators, many of whom are being seduced into thinking against all the evidence that SNP developments are just a plot by Big Tobacco to renormalize smoking.  

The driving force behind the GSTHR and all the future work surrounding it is to help inform an alternative narrative to mainstream tobacco harm reduction.