While the ultimate goal remains a “smoke free world”, today there is a lot of discussion about the need to complement current public health policies with Tobacco Harm Reduction – THR for smokers who fail to quit. However, although there is a growing trend to adopt Harm Reduction strategies as a valuable complementary approach to smoking cessation and smoking prevention, there is still a need to tackle the misinformation about THR, and step up THR advocacy.
In this session, during the first day of the Summit, Professor Ignatios Ikonomidis & Dr Agathi-Rosa Vrettou moderated a discussion focused on the assessment of global regulation, legislation and existing scientific evidence for THR products.
In his speech, Mr Tim Phillips presented an assessment of global regulation for THR products, and the impact on market growth and consumer uptake based on research by TobaccoIntelligence / ECigIntelligence, a provider of global market and regulatory analysis on novel tobacco products. Starting with a quick overview of the development of THR sector globally, he pointed out that THR sector may be still small, but is growing fast, although there are many differences depending on the region, mainly because of the different concerns, regulations and bans around the world. For example, he said, European countries see disposable vapes as an important problem that needs to be addressed and, therefore, disposable vapes bans are discussed on the basis of environmental waste and youth usage. It is a fact that regulators have to deal with a variety of different issues, Mr Phillips said, and in order to conclude to the best decisions they need more data. Data are extremely important, he emphasized, since more data means greater understanding of the value of these alternatives to conventional smoking products. Of course, he concluded, data have to be communicated and the scientific community should be more active on presenting evidence-based findings to regulators, policy makers and the public. After all, besides the need for data-based policies, consumers’ confidence on THR is also an issue of high importance, Mr Phillips said.
Increasing awareness of consumers about the impact of smoking and the impact of novel lower-risk alternatives to combustible cigarettes is crucial, agreed Professor Solomon Rataemane, who spoke about the evolution of the relevant legislation in South Africa since the first Act in 1993 until today that a new Bill on tobacco legislation is going through Public Hearings. Public Hearings is a procedure that is very important in South Africa, he explained, since they reflect the public opinion. A main issue that is already being discussed and is expected to come up during this procedure is whether the new THR products should be addressed similarly with the combustible cigarettes, even though there is scientific evidence that switching from conventional cigarettes to the novel non-combustible products is improving smokers’ health. Nicotine is of course addictive, Professor Rataemane said, but nowadays it is scientifically proven that most of the damage is caused by other substances emitted during the combustion of cigarettes. Another important issue that will be discussed, he added, is how we can protect the minors from initiating smoking. In South Africa, he concluded, we need more data, we need more research to be done about the impact of smoking and THR, and we need to present all available data in order to build evidence-based policies. Public Hearings is an important procedure that helps in terms of stimulating research.
Professor Giuseppe Biondi Zoccai presented evidence from umbrella reviews on the health impact of e-cigarettes and discussed the main issues that need to be addressed in order to establish a balanced policy that will give to smokers who cannot quit the opportunity to improve their health, while protecting youth from adopting the use of nicotine. Globally as many as 8-10% of women and 12-14% of men use heated tobacco products or vaping cigarettes, Professor Biondi Zoccai said. Relapse is of course a huge issue of concern, he continued, since evidence shows that non-smokers who use e-cigarettes are consistently more likely to initiate combustible cigarette smoking and become current smokers, while former smokers using e-cigarettes have over twice the odds of relapse as non-e-cigarettes users. Although the wide variability in e-cigarette products makes it challenging to draw definitive conclusions about their overall health impact, and findings and conclusions of umbrella and systematic reviews can vary depending on scope of review, studies included, and methodologies used―professor Zoccai said―still, evidence from umbrella reviews show that e-cigarettes increase quit rates compared to nicotine replacement treatment (NRT), while evidence comparing nicotine e-cigs with usual care or no treatment also suggests benefit. However, we still need more high-quality studies in order to confirm the exact effect size, as well as long-term follow-up of completed trials. We also need comparative studies between different types of e-cigarettes, he concluded, and, finally, we need research to better define the optimal transition from combustible cigarettes to vaping cigarettes vs. heated-tobacco products and the other way around, towards eventual abstinence from all tobacco or smoking products.
