A future without smoke is within reach for the EU, but achieving it requires a pragmatic and collaborative approach that understands the changing ways that smokers access other nicotine products, such as vapes, pouches, or heated tobacco.
That was the key message to emerge from the GFN, a yearly conference organized by a UK-based collective of harm reduction experts, called Knowledge Action Change (KAC). KAC is also behind the Global State of Tobacco Harm Reduction reports.
The three-day GFN in Warsaw assembled scientists and consumer advocates, together with small and large companies producing new nicotine products. As innovations seem to have the power to disrupt the previously known tobacco landscape, and break the connection between smoking and the consumption of nicotine, the emerging consensus was that Europe now has the opportunity to drive positive change.
The mood in the GFN is not one of unguarded optimism, as the opinion is that organisations such as the WHO and the Commission – among others – seem reluctant to adjust their rhetoric and actions to the scientific evidence supporting risk reduction as an additional pillar of tobacco control. For such a change to take effect, the consensus in the GFN is that this will require a pragmatic, science-based approach and a regulatory framework flexible enough to respond to changing evidence on harm reduction. Experts said that unless the EU harnesses the potential that lower-harm products are presenting, then it could miss out on improving the health of millions.
Clive Bates is the former Director of Action and Smoking and Health in the UK and now leads The Counterfactual, a public health consulting and advocacy practice. He is frustrated that although new tools that can deliver a radical reduction in smoking harm are now available, they are currently not being embraced quickly or widely enough.
“There is always going to be demand for nicotine but for the first time we have an opportunity to break the link between nicotine and the harm caused by smoking,” he says. “Otherwise, we adopt a war on drugs model of prohibition – and that model simply does not work.”
For Bates, the breaking of that link could provide a springboard for the next phase of European smoking reduction. Despite decades of robust intervention and regulation the EU still has 100 million smokers. Finding new strategies to reduce harm for that cohort is, Bates argues, essential.
“Even with a massive policy onslaught, people are still choosing to use nicotine,” he says. “That demand is not going to just disappear. What we need to do is transform the market to make it easier for people to take nicotine with an acceptably low risk.”
It is a view shared by Professor Dr Andrzej Fal, Head of the Department of Allergy, Lung Diseases, and Internal Diseases at the National Institute of Medicine in Warsaw.
Faj told the event that he would like to see excise duty on cigarettes radically but progressively increased to reflect their status as the most harmful product for smokers and those around them. At the same time, he is convinced that the use of lower-harm products should be incentivised as a less damaging option for consumers.
“We do not question harm reduction in hard drugs so why should we question harm reduction here?” he says. “Politicians need to look more carefully at what is happening, and to be a little more flexible and willing to understand and cooperate.”
That plea for politicians to recognise the way that the landscape has been disrupted by reduced-harm products was a common message from speakers across the Forum. And there is now a chance for policymakers and legislators to take action and make a real difference to the lives of millions.
The EU executive is currently conducting a comprehensive evaluation of the EU legislative framework on tobacco control, comprising both the Tobacco Excise Directive (TED) and the Tobacco Products Directive (TPD). The TED seems to have been politically bumped down after Sweden voiced their opposition to the Commission’s attempt at banning Snus via tax. When it comes to the Commission’s plans for the TPD, experts at the GFN seem concerned, as the results of last year’s TPD Open Public Consultation have not been published.
Tommaso Di Giovanni, VP of International Communications at Philip Morris International, is hopeful that the revised TPD will acknowledge major changes that have taken place within his own industry. He believes that in the past there has been a sometimes combative relationship between the industry and regulators. However, he believes the increasing focus on developing and providing lower-harm products is opening up new opportunities for collaboration and impact.
“Debating about the past would not take us far but we can look at the future with new eyes,” Di Giovanni says. “This isn’t about ideology. It is about finding pragmatic solutions to today’s problems. We can find those solutions together, exactly like it is happening in other industries.”
Di Giovanni points out that the evidence for differentiation in the regulatory framework is too strong to be ignored. He says that countries that have in one way or another created conditions for the shift to smoke-free products are now starting to see positive health impacts. In Sweden, for instance, where many smokers have switched to snus over decades, smoking has reduced three or four times faster than in the rest of the EU, and the level of smoking related diseases is less than half. It is a similar story in Japan, where smoking rates have dropped dramatically, in coincidence with the availability and widespread use of alternative nicotine products, such as heated tobacco.
However, Clive Bates cautions that unless the EU recognises the science and adopts a pragmatic stance then those benefits may not be realised. He makes a plea for a modernised approach to policy interventions that understands the increased choices that consumers have.
“Some people think we are heading for a nicotine-free future but the reality is that nicotine, like other recreational drugs, will be around for a very long time,” he says. “The real question is how we allow people to use it more safely?”
Industry investment in driving innovation has resulted in the expansion of products that are already helping millions move away from cigarettes. Whilst the tobacco industry has traditionally been seen as part of the problem, there is an increasing recognition that industry changes now make it an essential part of the solution.
“Today there is a huge opportunity to improve society and more policymakers should embrace that challenge and work with the industry to reduce harm,” Di Giovanni says. “Together, we can provide alternatives to those who continue smoking and put a smoke-free future within our grasp."
This article is supported by Phillip Morris International