Phillip Morris International's (PMI) flagship heated tobacco product, IQOS could be a game changer in the public health sector, amidst growing scientific evidence showing that the product greatly reduces exposure to harmful chemicals during the nicotine delivery process.
While some governments are still sceptical about switching to nicotine products as safer Tobacco Harm Reduction (THR) alternatives, several government bodies have conducted literature reviews or performed research on heated tobacco products, finding that they expose users to significantly lower levels of harmful chemicals.
Speaking during a panel session on the Science-driven approach to Tobacco Harm Reduction at the just-ended Technovation Summit in Switzerland, Gizelle Baker, PMI’s Vice President of Global Scientific Engagement said the response and feedback from governments was reassuring.
“What is impressive now is that there is a lot of independent research that is looking at heated tobacco products. Looking at our tobacco heating systems, and IQOS specifically,” said Baker.
“We now have over 11 different governments who have written at least one report where they have either taken our product, tested it, and confirmed the scientific research that we conducted or have done literature reviews and come to the same conclusions about these products.”
In 2020, the American Food and Drug Administration (FDA) issued decisions on Modified Risk Tobacco Product (MRTP) applications for IQOS and three HeatSticks variants ("the IQOS tobacco heating system") submitted by Philip Morris International (PMI) in December 2016.
“In the US, the FDA authorised the sale of IQOS to smokers in the United States by determining it was appropriate for the protection of public health. They thought that there would likely be a substantial reduction in morbidity and mortality in subsequent studies and that by allowing us to market the products in the US, it would benefit the health of the smoking population and the whole population of the US.”
This decision by the FDA follows a review of the extensive scientific evidence package PMI submitted to the FDA in December 2016 to support its MRTP applications.
Other governments that have conducted independent public health studies on the IQOS include the Dutch National Institute for Public Health and the Environment (RIVM) which published the findings of its research on “A Method for Comparing the Impact on Carcinogenicity of Tobacco Products: A Case Study on Heated Tobacco Versus Cigarettes.” In their publication, they assessed eight carcinogens to understand the likely health impact on individuals who switch to IQOS, compared to those who continue smoking. In their conclusions they state that—while IQOS is not risk-free—it is associated with 10 to 25 times lower exposure to these carcinogens, and that this could translate into a substantially improved risk profile.
In April 2020, the Superior Health Council of Belgium (“SHC”) also published the results of its inquiry into heat-not-burn products. The SHC concluded that heat-not-burn products, while not safe, have a more favourable toxicity profile than cigarettes. However, in light of the uncertainty of such products’ short and long-term impacts, the toxic effects of the dual use with cigarettes, and the existence of approved smoking cessation tools, the SHC recommended that current regulations for cigarettes should apply to heat-not-burn products.
The United Kingdom Committee of Toxicity also conducted a review of available evidence on two heated tobacco products, one of which is IQOS, and concluded that there is a “likely reduction in risk for smokers switching to heat-not-burn tobacco products.” The Dutch National Institute for Public Health and the Environment (RIVM) published a fact sheet on novel tobacco products that are heated and an English-language summary. They concluded that "The use of Heatsticks with the IQOS is harmful to health, but probably less harmful than smoking tobacco cigarettes," based on their aerosol chemistry measurements, which are "of the same order of magnitude as in the data of Philip Morris."
The German Federal Institute for Risk Assessment (BfR), published laboratory studies in Archives of toxicology, finding that reductions in selected toxicants measured by the institute “are likely to reduce toxicant exposure.”
Sweden has gone a step further and implemented extensive Tobacco Harm reduction efforts. Due to the Tobacco Harm Reduction efforts, Sweden now has one of the lowest cancer death rates in the world and will very soon be declared smoke-free by the WHO criteria. Sweden has 44 percent fewer tobacco-related deaths, 41 percent lower lung cancer rates, and 38 percent fewer cancer deaths.
Patrik Hildingsson, the Vice President of Communication and Public Affairs at Swedish Match said, “The reason why Sweden has reached the World Health Organisation (WHO) target of 5% smokers 15 years ahead of target is because we have an alternative.”
“We have over time not chosen not to produce combustion. You would think we pioneered tobacco regulation because we have adapted quickly. No, that is not the case. Sweden has not yet reached the approved level of tobacco control scores. However, we have achieved what many other countries wish to achieve with minimal restrictions and laws.”
He added that at the current smoking prevalence reduction rate in the EU, where smoking prevalence has not been declining much over the past 15 years, it would take the block half a century to reach the WHO goal of 5% smokers.
Meanwhile, New Zealand embraces harm reduction and adopts two principles to help reach the target of a smoke-free country by 2025 defined as 5% or less of adult daily smoking. They are implementing strict regulations for smoked tobacco products to reduce their appeal and availability, such as reducing the number of retail outlets, lowering nicotine content, and introducing a smoke-free generation policy, amongst others.
