On December 9th, 2022, the 10th E-Cigarette Summit took place in London, United Kingdom (UK). Scientists, practitioners, regulators, public health sector and industry gathered during this one-day meeting point. Experts shared their scientific views on a major - yet controversial - public health topic. In fact, e-cigarettes and other alternatives to conventional cigarettes have been the object of frequent disagreements and scandals over the last years.
Philip Morris International (PMI) and other historical tobacco companies are at the center of the critics as they have re-designed their structure and heavily communicated on their transformation toward a “smokeless world” as a new vision - while spending billions of dollars on research and development of those new nicotine products marketed as safer than combustible cigarettes.
The world leading tobacco company claims that it has ambitions to become a majority smoke-free business by 2025 implying “the biggest shift” in the history of the company.
PMI’s smoke-free products were available in 30 Low and Middle-Income country (LMIC) markets at the end of 2021, mostly in Asia and Latin America. Nevertheless, it seems more challenging for them to make their way into the African market in which they plead for more flexible regulation:
“Traditionally our presence in Africa is less important than in other regions so we have less of a distribution network. There are regions where we are already stronger where the regulatory environment is more open to commercializing those products. Of course, we are moving more rapidly in these regions like the European Union. In others, like in Africa the situation is more complex but it is just a matter of time before we commercialize smoke-free products everywhere”, declared Tommaso Di Giovanni, VP Communications, PMI - in parallel to the meeting.
He added that “the resistance more than anything else stems from slowness in adapting regulations that were designed in the 80s, 90s when these products didn’t exist. The regulations were designed for traditional cigarettes and therefore do not really allow you to commercialize novel products successfully…I think it is the biggest obstacle in most countries.”
For many, the “prevention or cessation system” (some call it “quit or die” approach) has been unsuccessful – and to realize better results, a third approach with in-between solutions, supported by new nicotine products, must be available for smokers who would like to quit, but can’t.
Africa is undeniably experiencing an increasing rate of tobacco use according to the World Health Organization (WHO) which consider that “prevention is the most cost-effective measure” to block the tobacco epidemic. Yet, a growing number of voices, such as Joseph Magero, an African expert on tobacco harm reduction, and chair of the Campaign for Safer Alternatives (CASA) (a regional organization that advocates for the adoption of tobacco harm reduction in Africa), express their concern about the lack of options for smokers to make informed choices with full knowledge of the facts:
“Lawmakers (in Kenya), and Africa as a whole, take their cue from the WHO in regulating and taxing e-cigarettes and nicotine pouches. Pouches, which would appear to be a pertinent solution for our continent, where there is a tradition of using oral stimulants, were even suspended from sale in Kenya… Innovative products such as e-cigarettes and nicotine pouches are giving desperate smokers the chance to quit and save their own lives” he recently wrote.
On the other hand, some researchers question the “positive” communication around these intermediary solutions as safer choices for smokers:
“I have a problem with how vaping is being marketed as more healthy than smoking cigarettes. In my opinion, we are just not at the point where we can really say that. E-cigarette aerosols contain other completely uncharacterized chemicals that might have health risks that we don't yet know about. People just need to know that they are inhaling a very complex mixture of chemicals when they vape. And for a lot of these compounds we have no idea what they actually are," declared Carsten Prasse, co-author of a study on e-cigarettes liquids and aerosols and assistant professor of environmental health and engineering, at Johns Hopkins University, USA.
Besides access, affordability represents another key obstacle in LMICs, and more specifically in Africa. To address this question in regions where the average income is much less substantial than in other parts of the world, PMI has recently commercialized - in Philippines as a pilot market - a more affordable tobacco heating system named BONDS by IQOS:
“One other obstacle that we found very often is the perceived initial price of the technology. We are also working at solutions, for instance increasing the range of products, so we can have a range of prices. We are also working at finding innovative solutions that will enable people to gain access to the products.” stated Tommaso Di Giovanni.
The critics are accusing the company of “cynicism” and show concerns about them trying to “gain a mask of respectability” but that doesn’t stop the group which has recently bought three pharma entities. They additionally aspire to have at least 50% of their markets that sell smoke-free products, to be LMIC markets by 2025.
