October 22, 2021: 100 international specialists representing nicotine science, policy and practice have come together to call on 182 countries to the Framework Convention on Tobacco Control (FCTC) to take a more positive stance on tobacco harm reduction. In an open letter, the experts have countered WHO’s misguided and unscientific drive for prohibition, excessive regulation and taxation of vaping products, heated and smokeless tobacco products, and novel oral nicotine products.
Ahead the 9th meeting of the Conference of the Parties of the Framework Convention on Tobacco Control (COP-9), a global tobacco conference scheduled on 8-13 November 2021, the open letter includes representation from eminent international experts like David Abrams, PhD Professor of Social and Behavioral Sciences School of Global Public Health New York University United States, Clive D. Bates, MA, MSc Director, Counterfactual Consulting Former Director, Action on Smoking and Health London, United Kingdom, Peter Hajek, PhD Professor of Clinical Psychology Director, Queen Mary University of London United Kingdom, Aparajeet Kar, MD Consultant Pulmonology and Critical Care, Sir H.N Reliance Foundation Hospital, India, David Sweanor, JD Advisory Committee Chair, University of Ottawa Centre for Health Law, Policy and Ethics, Kenneth Warner, PhD Avedis Donabedian Dean Emeritus of Public Health University of Michigan United States amongst others.
Every year, over 8 million people die owing to deaths caused by tobacco accounting for economic burden of US$1.4 trillion spent on health care and lost productivity. Smoking accounts for 98% of the global burden of tobacco-related mortality. Over the years, the WHO has been spearheading varied global awareness campaigns and coupled with traditional nicotine replacement methodologies, yet the number of smokers has remained over a billion since 2000. Smoke-free nicotine products offer a promising route to reduce the harms arising from smoking and is backed by compelling evidence.
While the experts recognise the uncertainty of the benefits and risks associated with the evolving marketplace of non-combustible tobacco products over the longer term, there is a need to consider the substantial body of evidence instead of excessive caution to deny smokers promising alternatives.
Regrettably, WHO has been dismissive of the potential to transform the tobacco market from high-risk to low-risk products. WHO is rejecting a public health strategy that could avoid millions of smoking-related deaths. The letter raises key points relevant to FCTC parties and recommendations, urging the body to “modernise” its approach to tobacco policy.
Some of the arguments raised by public health experts include tobacco harm reduction presents significant public health opportunities. While evidence suggests that vaping is currently increasing smoking cessation, the impact could be much larger if the public health community paid serious attention to vaping’s potential to help adult smokers.
Infact, e-cigarettes are a driver of smoking cessation. Since COP8, evidence highlighted the role of e-cigarettes in reducing smoking, poised to work better than nicotine replacement therapy. Today there are significant regulatory assessments that support heated tobacco products.
US FDA’s extensive evaluation for HTPs concluded the product is “appropriate for the protection of public health” and disclosing to the public that it created significantly lower human exposures to toxicants is “appropriate for the promotion of public health”. The success of e-cigarettes has been across many countries which have embraced this opportunity. For example, in Japan there was a dramatic decline in smoking after the introduction of HTPs in 2015. Yet, these significant findings are not acknowledged by WHO in its recent paper for COP9 on novel and emerging tobacco products disregarding the clear public health potential.
Instead, WHO continues to advocate for prohibitions of low-risk alternatives to smoking and applauds countries that ban these products like in the case of India. However, policymakers must consider the impact of such bans on India’s 100 million smokers who are now denied safer alternatives. Would it mean young people take up smoking instead of ENDS use? Would it create significant illicit trade? Would it mainly serve the interests of India’s partially state-owned cigarette industry? This is not a call for an unregulated market but for carefully designed risk-proportionate regulation that is mindful of the risks of harmful unintended consequences.
Harm reduction is practiced in many areas of public health including illicit drugs, sexual health, HIV. Yet in the tobacco industry, everyday millions of people struggle to quit smoking, these products represent a significant additional pathway to escape from the deadliest ways to use nicotine.
Additionally, tobacco harm reduction can contribute to the Sustainable Development Goals. SDG target 3.4 aims to cut premature deaths from four key non-communicable diseases (NCDs) by one-third by 2030 compared to 2015. The only way for tobacco control to make a substantial difference over this period is rapid smoking cessation, switching from smoking to smoke-free products.
The experts urge parties to the FCTC take a more questioning and assertive approach to WHO’s advocacy on smoke-free alternative to smoking, while making negotiations more open to stakeholders with harm-reduction perspectives, including consumers, public health experts, and businesses with significant specialised knowledge not held within the traditional tobacco control community.
We believe that it is time for global tobacco policy to draw on the full potential of tobacco harm reduction. Through this letter, the public health science, policy, and practitioner communities will converge on a common purpose to meet the SDGs and to reduce the global burden of tobacco-related disease and premature mortality as quickly and deeply as possible.
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