Atthe height of COVID-19, the general assumption by the scientific world was that COVID-19 would fill the gap between scientific data and policymaking, and probably lead to fact-based regulation. However, developments on the ground show that this has not happened and may not happen in the mid-term with regards to designing health policies, and later on, Tobacco Harm Reduction (THR).
Despite data showing that the novel nicotine products industry is growing at a faster rate than expected and the global novel nicotine market value is estimated to be above US$50 Billion with more than 100 million users, the nicotine sector has experienced a barrage of attacks in the form of regulation, taxation, and bans amongst a host of other challenges.
At the heart of the heavy-handed approach to novel nicotine products' regulation is misinformation, which has been described by the American Psychological Association as false or inaccurate information or simply getting the facts wrong. Although the term is at times used interchangeably with disinformation, experts believe that disinformation is false information that is deliberately intended to mislead—intentionally misstating the facts.
Speaking during a session on "Information & Misinformation About THR" at the 6th Summit on Tobacco Harm Reduction in Athens, Greece, Mr Tim Phillips, Managing Director of Tamarind Intelligence, UKsaid that there was a need for data-driven and scientifically-backed regulation.
"Data is extremely important in this sector. The more data we get, the more these products will be understood.As an organization, we have been tracking this sector for about 10 years now and this sector is worth over US$50 Billion now. By the sector, I am referring to e-cigarettes, nicotine patches, and heated tobacco with more than 100 million users. It's still a very small sector but it is growing fast.
"The main issue with the industry is how different regions in the world have accepted these products. Some of this is due to the regulations that exist in the market and some is due to the way the products are adopted by the consumer," said Phillips.
According to Mr. Phillips, regions like Latin America have very little activity regarding the consumption of novel nicotine products and have very little market value. This is largely to do with the restrictive regulatory situation in that region as there are many bans in place and consumers can't get access to the products. However, in markets such as the United States, Japan, and South Korea, the nicotine products' market value has grown exponentially.
Mr. Phillips further said that regulators must deal with a variety of different issues, and in order to conclude the best decisions they need more data. Also, data must be communicated and the scientific community should be more active in presenting evidence-based findings to regulators, policymakers, and the public. Besides the need for data-based policies, consumers' confidence in THR is also an issue of high importance.
"The reason why we have these varying market values is because of different regulations in place in different countries. Another point to make is that the regulation around these products is changing very fast. Harm reduction has not been adopted as a policy generally across the world. There are significant policy problems and regulators are trying to deal with a lot of these problems."
The discussion during the "Information & Misinformation About THR" focused on the assessment of global regulation, legislation, and existing scientific evidence for THR products.
Solomon Rataemane, Professor & Head Of Department, Psychiatry Department at Sefako Makgatho Health Sciences University, South Africa, said while tobacco legislation has gone through various stages in South Africa, the current bill that is set to regulate the tobacco sector has received widespread criticism from various sectors.
"At the moment in South Africa, there is a Bill that is going through public hearings. It's a new bill on tobacco legislation in South Africa. There has been an evolutionary process in terms of legislation in South Africa. The proposed legislation in South Africa has faced opposition from Tobacco Control because going along with this process is looking at whether combustible cigarettes should be taxed as novel nicotine products.
"The private companies have argued that introducing a substance reduces harm, for example when people switch from combustible cigarettes to vaping, heat-not-burn products etc, their lung function tended to improve. Should we be therefore taxing these products similarly," said Professor Rataemane.
He further said there is a need to educate the governments and public sufficiently regarding Tobacco Harm Reduction as most people were not aware of the health benefits associated with new nicotine products such as e-cigarettes.
Professor Giuseppe Biondi Zoccai, Associate Professor in Cardiology at Sapienza University of Rome, Italy said while scientific evidence is pointing to numerous health benefits that come with taking up novel nicotine products, the evidence base was not strong enough to convince policymakers to make the right decision.
"I really believe harm reduction can work and it has worked on me. Not using any tobacco products or using any nicotine is probably the best option for your health. While the evidence is very limited, it is clear that vaping or heated tobacco products may improve cessation rates and they may be leveraged on at a level with drug therapies and similar interventions," said Professor Zoccai.
He further stated that although the wide variability in e-cigarette products makes it challenging to draw definitive conclusions about their overall health impact, and findings and conclusions of umbrella and systematic reviews can vary depending on the scope of review, studies included, and methodologies used, still, evidence from umbrella reviews show that e-cigarettes increase quit rates compared to nicotine replacement therapy (NRT), while evidence comparing nicotine e-cigarettes with usual care or no treatment also suggests benefit.
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Meanwhile, in a separate panel session that sought to answer the question, "What is needed to showcase the benefits of harm reduction?" David Sweanor said, "People are buying cigarettes every day, every day we have a chance to intervene by offering a product that is massively less hazardous, doesn't harm the people around you, and is less addictive; and we can make sure that it is available more widely than cigarettes, at a lower price than cigarettes, with more accurate information about relative risk."
Mrs. Marewa Glover referring to the case of New Zealand, which is generally considered successful, said that their policy should not be copied as the best example anymore. She stressed that education is number 1, not taxes. In New Zealand taxes are so high relative to income, that the main group of the population who smoke, of the lowest socio-economic status, can often no longer afford to buy legal cigarettes, so other problems arise; people turn to the black market, or they cut money from their budget for food. Many policies have negative consequences, especially for the lowest socio-economic groups, but good policies should take into account these consequences. ENDS
