Africa: Tobacco - Can Smoke-Free Products Contribute to Improved Public Health?

Harmful. Despite the existence of the Anti-smoking Law, many people continue smoking cigarettes in public (file photo).
24 February 2021

Paris — On February 17th, 2021, Philip Morris International (PMI) held an online event entitled " Can scientifically substantiated smoke-free products contribute to public health outcomes?".

This event was the third of its « Open Science Conference series » aimed at discussing and sharing the latest scientific data around tobacco and smoke-free products, and also fundamental principles behind their research "in an open and transparent manner" as the host, Gizelle Baker, said. She is the VP, Global Scientific Engagement at PMI. Baker is an epidemiologist and biostatistician by training and has worked on clinical research for 20 years. She specifically works on harm reduction and the science behind smoke-free products. For her, science, and only science, should prevail over any other field.

Her assertion was as follows: " It is our responsibility to transparently share our research and data with governments, authorities, organizations, and the public to encourage dialogue and debate on tobacco harm reduction that is rooted in science. Because It is important that science is at the center of any discussion on health and policy decisions. Smokers and society more generally are expecting that scientists, regulators, public health and industry are working together to find solutions that can help reduce smoking and more precisely, smoking-related death and disease."

In fact, PMI has designed a smoke-free inhaled nicotine aerosol, under the brand name IQOS. This tobacco heating system (THS) heats tobacco rather than burning it. It is currently sold in 64 markets around the world. Recent studies and the Food and Drug Administration (FDA) recently declared IQOS as potentially less harmful than conventional cigarettes:

" The toxicological assessment also found that, compared with cigarette smoke, IQOS aerosols contain considerably lower levels of potential carcinogens and toxic chemicals that can harm the respiratory or reproductive systems…Data submitted by the company shows that marketing these particular products with the authorized information could help addicted adult smokers transition away from combusted cigarettes and reduce their exposure to harmful chemicals, but only if they completely switch ," said the FDA in July 2020.

Moreover, according to recent data given by Gizelle Baker , there are more than 17 million IQOS users globally and 12.7 million have completely stop ped smoking cigarettes. This means that 72% of IQOS users no longer smoke cigarettes. Baker states that she has no doubt that smoke-free products like IQOS can contribute to public health.

Mikael Franzon also contributed to this event. He is a psychologist by training with a Ph.D. in Neuroscience. He worked for the pharmaceutical industry before starting to collaborate with PMI 5 years ago. It is his opinion that smoke-free alternatives are essential to public health:

" Studies have shown over the years that combustion and exposure to toxicants are responsible for smoke-related diseases and death…In other words, we could supplement existing tobacco control strategies for smokers who would otherwise continue to smoke by promoting switching to less harmful alternatives. If you don't quit, change." He pleads for pragmatism to improve individual and public health. He stated that " By definition, the best thing a smoker can do to reduce this risk of developing a smoking-related disease, is to quit tobacco and nicotine altogether. But we all know that many won't."

Dr. Andrea Costantini is Head of Regional Scientific Engagement Latin America & Canada. She is a medical doctor specialized in clinical pharmacology. She presented a recent study led by PMI at the event. In this study ( charts available in this presentation – at 5 minutes  ), experts divided adult smokers into three groups to observe over 90 days: Those in the first group continued to smoke for the period, those in the second one quit smoking during the study, and those in the last group switched to heated tobacco systems.   Over a period of 90 days, they measured participant's exposure to 15 selected harmful chemicals such as carbon monoxide, acrolein, and nitrosamines, among others.

Andrea Costantini presented the conclusion of this study: "This study shows that switching completely to our heated tobacco system achieves almost 95% of the reduction in exposure that is achieved by smoking abstinence.”

According to Dr. Constantini, several internationally recognized experts support PMI’s findings such as the U.S. Food and Drug Administration, the German Federal Institute for Risk Assessment, Public Health England among others. "The totality of the available evidence today strongly indicates that switching to our heated tobacco system, although it is not risk-free, is a much better alternative than continuing to smoke for those adult smokers who otherwise would keep smoking" stated Dr Constantini.

SteveRoulet, who leads the development and execution of PMI's consumer research studies on smoke-free products, corroborated the arguments through a specific case. He, in fact, used the example of Japan, which is the country with the highest prevalence of heated tobacco products in the world. It is also the country where IQOS was first introduced in 2014. Also, Japan is one of the few countries, where the public health authorities have recently started measuring the prevalence of cigarette smoking separately from the use of heated tobacco products:

" The data from the government's National Health and Nutrition Survey show that while the trend in the overall prevalence of tobacco use in Japan remains unchanged, the introduction of heated tobacco products in the Japanese market in 2014 – which were measured for the first time in the national survey separately from cigarettes in 2018 – appears to have contributed to the accelerated decline in combustible cigarette smoking. In fact, Japan's smoking rate is now among the lowest in the developed world." according to Roulet.

He concluded that " the THS has the potential to transition many adult smokers away from combustible cigarette use, which is the most harmful use of tobacco. These transition patterns are starting to emerge at a population level in Japan, the country with the highest prevalence of heated tobacco product use to date".

In Africa, the only tobacco heating system available to date is IQOS. It is sold in only one market - South Africa. On the continent, there are no studies available yet on the potential connection between public health and those heating systems as alternatives to cigarettes.

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