The Goal for Tobacco Harm Reduction: ‘World No Cigarette Day’

The goal for Tobacco Harm Reduction: ‘World No Cigarette Day’

 

The title ‘World No Tobacco Day’ reveals an outdated approach to Tobacco that was relevant around 20 years ago but no longer holds true. In short, World No Tobacco Day suggests that all forms of tobacco should be removed from the world, even though certain smokeless tobacco and nicotine products present harm reduction opportunities.

Another way to look at this initiative would be to rename it ‘World No Cigarette Day’, as this is the ambition for Tobacco Harm Reduction: switching smokers who would otherwise continue to smoke to reduced-risk alternatives. Today, through innovation and technology, a range of smokeless tobacco and nicotine products exists that pose a potentially lower risk to adult smokers than continued cigarette smoking.

Long-term studies have shown us that it is the long-term exposure to the harmful chemicals present in cigarette smoke that increases the risk of smoking-related diseases. The cause of this is combustion, exposing tobacco to temperatures over 950 °C. This process is the root cause of the vast majority of disease-related issues with tobacco products.

The World Health Organisation’s Framework Convention on Tobacco Control (FCTC) was first ratified in 2005 when I started working for BAT as a graduate management trainee. I joined BAT because I wanted the opportunity to help the company reduce the health impact of its business.

At that time, BAT focused a tremendous amount of time and resources on methods to make cigarettes less harmful. However, despite decades of effort, BAT’s research failed to produce a product that reduced exposure to harmful chemicals.  This research led us to a key conclusion: we had to remove combustion from our products to create alternative products with a reduced risk profile.

Fast-forward twenty years, and technology and innovation have transformed the landscape. Today, there are two classes of smokeless products that contain tobacco: oral tobacco products like snus and heated tobacco products. Furthermore, smokeless products that operate at temperatures much below those of combustion and do not even contain tobacco, like vapour products and nicotine pouches, are also available now.

Isolating combustion as the primary causal issue in terms of smoking-related disease risk permits a new light to be shone on nicotine. For decades, the risk profile of nicotine was conflated with the risks of cigarettes, and it is no surprise today that many people across the spectrum of public health, regulations, academia, media and lay people have misperceptions on the risk profile of nicotine.

We need to be clear here: nicotine is not carcinogenic, and the leading global public authorities have widely accepted that it is the harmful chemicals generated from the combustion of tobacco and not nicotine that are the primary cause of smoking-related diseases.

Alternative smokeless products do not burn tobacco and produce a fraction of the toxicants present in cigarette smoke.  Countries adopting these products, such as Japan, New Zealand, Sweden, the United Kingdom, and the United States, have seen a greater decline in smoking prevalence, with Sweden and New Zealand on the cusp of becoming smoke-free as deemed by the World Health Organization.

Sweden, where long-term data is available, demonstrates that Tobacco Harm Reduction is effective. Over the last 30 years, many people in Sweden have switched from smoking to using snus—a traditional oral tobacco product. More recently, other smokeless products have become available in Sweden, and these are more affordable than cigarettes because they are taxed based on their lower risk profiles.

Although tobacco use per capita among Swedes is similar to the EU average, the country reports the lowest smoking prevalence in the EU at 5.4%. It also has the lowest health outcomes for lung, trachea, bronchus, and oral cavity cancers in the EU. Scientists have modelled that 3.5 million lives could be saved across the EU over the next 10 years, if the EU achieved the same tobacco-related health outcomes as Sweden.

If a behaviour is risky and is not avoided entirely, then modifying the behaviour so that it involves potentially less risk can improve outcomes at a population level. In my view, the Public Health strategy on Tobacco should have two streams. The first stream should focus on the access and availability of smokeless products for adult smokers in each country globally. The second stream should focus on unintended consequences, especially preventing underage access and usage of smokeless products.

We recently published BAT’s commitment to responsible vaping products – a series of new industry-leading ambitions for our vapour devices, supported by evidence-based solutions, designed to tackle some of the most pressing societal concerns.

One of our key ambitions is to prevent underage access, appeal, and accidental use by adopting age-verification technologies and continuing to ensure that devices, flavours, packaging, and marketing are designed for adults.

Banning or restricting products to the point of a de facto ban does not prevent adult consumers from accessing and using them. It creates a black market and a proliferation of non-compliant products. We estimate that up to 80 per cent of vapes across several markets are non-compliant or illicit.

Based on scientific evidence and the realities of our markets, I believe Tobacco Harm Reduction represents one of the most significant public health opportunities available to society today. If implemented with well-thought-out regulation, tobacco control and harm reduction measures can work together to reduce the projected health impacts associated with cigarette smoking.

Smokeless tobacco and nicotine products should be regulated based on their lower risk profile to differentiate them from cigarettes. Adult smokers should have access to smokeless products and accurate information regarding their risks compared to smoking so that those who would not otherwise quit can make an informed choice about switching. Importantly, measures are also required to ensure high product standards and prevent underage access, with robust enforcement and sanctions for those breaking the rules.

I appreciate that different views exist on the best approach for the public health strategy on tobacco. One thing is clear: it is in everyone’s interest to reduce the health impacts associated with smoking cigarettes. And addressing such a significant societal issue can only be achieved through open dialogue, sharing scientific research, and collaboration.

Dr James Murphy, Director of Research & Science, BAT