On November 4th, 2020, the United-Kingdom based Public Health Organization Knowledge Action Change, which aimed at promoting health through the concept of harm reduction issued a report entitled: Burning Issues: The Global State of Tobacco Harm Reduction and also organized two discussions about the state of Tobacco Harm Reduction in the world.
The organization that focuses on harm reduction as a key public health strategy brought to attention the fact that 1.1billion people smoke worldwide according to the World Health Organization (WHO). Experts reminded participants that this figure has remained unchanged for two decades and that it was urgent to scale up tobacco harm reduction to save lives.
Experts also revealed updated figures regarding the consumption of smokeless tobacco such as e-cigarettes, heated tobacco and pasteurized tobacco. Globally, there are only 9% of smokers who use these alternatives, mainly in high income countries when most of smokers are located in low and middle-income countries (LMICs).
The topic of the first session of the conference was: The context and importance of tobacco harm reduction for global health. They key Guest speaker UK Professor and neuro-psycho-pharmacologist David Nutt made a strong point about the importance of data and science:
“My work leading a multicriteria decision analysis on the harms of different nicotine products back in 2013 contributed to the understanding that e-cigarettes are around 95 per cent less harmful than traditional cigarettes. Yet many so-called ‘experts’ rebuff scientific evidence on vaping or snus safety and deny relative harm data, while insulting and libeling scientists like myself. To reject the opportunity of Tobacco Harm Reduction is, perhaps, the worst example of scientific denial since the Catholic
Church banned the works of Copernicus in 1616.”
Professor David Nutt pointed out the responsibility of WHO for public health and criticized the fact that they do not differentiate between smokeless tobacco and traditional cigarettes: “I think the credibility of the WHO is at stake if it fails to accept a clear change or development of an evidence base.”
It was his assertion that the UN agency is steadfastly holding on to its outdated position even in the face of contrary scientific proof. According to WHO official communication: “Currently there is insufficient evidence to conclude that HTPs are less harmful than conventional cigarettes. In fact, there are concerns that while they may expose users to lower levels of some toxicants than conventional cigarettes, they also expose users to higher levels of other toxicants.”
Moreover, all the countries that have ratified the Framework Convention of Tobacco Control (FCTC) of the WHO must « prohibit all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any means that are false, misleading or deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions »
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What is the current situation in Low and Middle -Income Countries (LMIC)
A large number of scientific reports have mentioned that these alternatives to conventional tobacco are potentially less harmful and that using these devices may improve health and reduce death thanks to the absence of the combustible smoke and the carcinogens it produces that actually cause disease. 80% of tobacco users are located in LMICs. Yet, regulations and policies are drastically against innovative tobacco systems. In most of those countries, products are either banned completely, heavily taxed, or no specific laws exist to regulate it and so it is treated in the same way as traditional cigarettes.
For the Malawian social scientist and Tobacco Harm Reduction advocate Chimwemwe Ngoma, it is a denial of human rights: “The concept of harm reduction is not new in Africa and millions of people should not be denied access to products that can help them avoid poor quality of life, disease, and premature death. Preventing access to these products through bad policies robs people of their right to health. Policy should encompass issues to do with access to credible information/science and making Tobacco Harm Reduction products available”.
According to the Burning Issues report, 98 million people are estimated to use safer nicotine products worldwide. 68 million of those are vapers, with the largest vaping populations in the United States, China, Russia the UK, France, Japan, Germany and Mexico. 20 million are heated tobacco products users; with most users in Japan; and 10 million are smokeless or “snus” (pasteurized product) users.
