Over the years, the conversation around reducing harm related to smoking cigarettes has been led by the World Health Organisation (WHO) as well as public health experts from various fields. This is largely due to the negative health effects that come as a result of smoking tobacco cigarettes.
According to World Health Organisation data, tobacco kills up to half of its users and also kills more than 8 million people each year. More than 7 million of those deaths are the result of direct tobacco use, while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
To curb the demand for tobacco, WHO proposed a raft of measures ranging from taxation and policy development to regulation and also encouraged quitting among others. Despite decades of international tobacco control activity spearheaded by WHO under the framework Convention on Tobacco Control (FCTC), one billion people continue to smoke, and seven million people die of smoking-related disease every year. In 2022, over 80 percent of the world's 1.3 billion tobacco users lived in low-and-middle-income countries.
Conventional smoking cessation policies and programs generally present smokers with two alternatives: quit, or die. There is clear evidence that smokers of any age can reap substantial health benefits by quitting. In fact, no other public health effort is likely to achieve a benefit comparable to large-scale smoking cessation. While quitting is regarded as the best solution to addressing the tobacco health burden, many who attempt to quit fail to do so.
As a result, a third approach to smoking cessation, known as Tobacco Harm Reduction (THR), which involves the use of less harmful alternative sources of nicotine, including modern smokeless tobacco products, has been championed over the years. At the 10th annual Global Forum on Nicotine (GFN23) in Warsaw, experts called on the World Health Organization to urgently reconsider its approach to the use of safer nicotine products for smoking cessation.
Dr. Moira Gilchrist, head global strategic and scientific communications for Philip Morris International (PMI) said for THR to be a reality, Tobacco Companies must have a stake in the Tobacco Harm Reduction process.
“The reason why industry should have a stake in Tobacco Harm Reduction is because I think we have an important role to play in Tobacco Harm Reduction. It really comes down to two main things. First of all, the will. The will comes in ensuring that we have a sustainable business for the long run and for Phillip Morris International (PMI), this sustainable business started 20 years ago. The vision was driven by the acknowledgment that smoking is harmful, it causes serious disease and premature death and we should do something about that,” said Dr Gilchrist.
“It took us a long time to do something about that. It took us a long time to develop the science that has ended up in the state in which we are today which is having a bright future I believe, in THR. But nevertheless, it’s a path that we set ourselves on 20 years ago and in 2016, we announced that this is the future. In fact the purpose of our company is to replace combustible cigarettes with non-combustible alternatives that are a better choice than continuing to smoke.”
She added that the investments that have been made in science and research around Tobacco Harm Reduction should earn companies a place at the table where THR interventions are discussed.
PMI has invested at least US$10.5 Billion since 2008 in their business which has since unlocked innovation and resulted in the company being able to design the products that meet the needs of adult consumers that deliver the aerosol that has a much different toxicological profile than cigarette smoke.
Fiona Patten, an Ex- member of the Victorian Parliament in Australia and also an avid harm reduction campaigner said smoking was mainly a class issue where the poor and vulnerable are largely exposed to harmful combustible tobacco products.
“The Tobacco Harm Reduction issue is both a justice and an equity issue because in Australia we are a relatively wealthy country and most Australians who are well off don’t smoke. Unfortunately, amongst our indigenous people there is about 40 percent smoking rate. If you are experiencing poverty, if you are disadvantaged or from vulnerable communities in my country, you are much more likely to smoke and that is going to have a significant effect on everything,” said Patten.
Addicted smokers from low-and-middle-income-countries feel that they do not have a stake in THR and at times they are presented with fewer safer options. Samrat Chowdhery, a consumer advocate from India said the system is designed against the tobacco consumer.
“The reality is that the space for the tobacco user is shrinking. The humane treatment of consumers is basically something you have to fight for. The problem is the people who are charged to protect us and our health, tobacco control, don’t see us as human beings. We will be pushed and punished in order to follow the decisions that they make. We should be allowed to choose to use safer alternatives instead of harmful products. It is our right. A drug user has more respect than someone who want to switch to safer nicotine products,” said Chowdhery.
He added that despite being a billion people, smokers don’t have genuine representation but rather the groups claiming to represent them are actually short-changing them.
“The genuine consumer is not allowed to engage and whenever we want to speak out. The system is designed against us, we cannot directly engage the industry, the people who make the products for us, to tell them what we would like. We are a vulnerable group because most of us are poor and we live in the developing world. There isn’t public healthcare to talk of. Tobacco Harm Reduction should be considered a really vital tool.”
Science and research have also been identified as key stakeholders in the Tobacco Harm Reduction process. Christopher Russell, a psychologist and Director of Russell Burnett Research said research studies around THR must have commonalities and be able to convince the regulator.
“The consequence of reducing safer nicotine options for adult smokers in all probability would be fewer adult smokers contemplating switching to a less harmful products and fewer adult smokers attempting to switch as well as fewer adults’ smokers succeeding in their attempt to switch. Behavioural science is a key stakeholder in Tobacco Harm Reduction as it leads to better and more consistent research study design that would offer a fair test of the benefits realised from different nicotine alternatives. We need to take a more uniform approach so that when we all conduct our studies and present evidence to the regulator, we are not speaking in 27 different languages,” said Russell.
