According to the World Health Organisation tobacco Fact Sheet, tobacco kills up to half of its users who don’t quit. Tobacco also kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke. Around 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries.
However, in countries that have adopted alternative non-combustible nicotine products, tobacco-related deaths and morbidities have greatly reduced. In New Zealand, smoking prevalence has declined from 27% in 1992 to 18.4% in 2011-12 and then to 10.9% in 2020-21, one of the lowest in the world.
Despite these scientific facts, tobacco Harm Reduction experts believe Legislation regarding novel nicotine products and tobacco harm reduction is bent on maintaining the status quo and creating a situation whereby millions of smokers who had quit could go back to their old bad habits.
In the United Kingdom (UK), politicians from both the Labour and Conservative parties are considering reviving the UK Tobacco and Vapes Bill post-election period. The government also intends to introduce a steep new vape tax in addition to the 20% VAT currently being levied. In the European Union (EU), bureaucrats are moving to impose a tax on quitting smoking. In South Africa, the Parliamentary Portfolio Committee on Health is still holding consultation meetings to get feedback on the proposed Tobacco Products and Electronic Delivery Systems Control Bill.
Speaking during a panel on Legislation and regulation - health and economic consequences at the Global Nicotine Forum (GNF) in Poland, Clive Bates, Director of Counterfactual Consulting said the UK government was concerned about regulating non-combustible nicotine products more than they should focus on reducing the high morbidity and mortality associated with smoking combustible cigarettes.
“There are 18 times as many adults using nicotine products as there are young people in the UK, but all of the political focus is on the small number of young people who are vaping,” said Bates
“The needs of those adults are served by a legal supply chain, responsibly and proportionately regulated with acceptable risk. That should constrain the prohibition instinct, which has seen the rise of a big illegal and unauthorised market in Australia and the United States.”
He added that regulation and legislation around Tobacco Harm Reduction must be informed by science, not emotions.
“You can't assume or you shouldn't assume the regulation is inherently justified. It limits what people can do. It limits everything. Regulation has to be justified on its own merits. And those are sometimes simply illusions. Children are used to create emotive campaigns, to create a sort of moral panic and to justify things that would not be justifiable if they were done to adults.”
He added that the current regulation was doing more harm than good to the health of smokers as they are being forced to get their nicotine from combustible cigarettes instead of safer nicotine options.
David Sweanor, a Canadian lawyer who has worked in global public health efforts on tobacco believes regulation is not something that should be used to control behaviour.
“There’s a limit to how much you can move a market, you can facilitate things. People can only make as good a decision as the information and the options available to them allow. It has to be a consumer offer that makes sense to them. The bottom line is you have to at least start with that and see how far you get,” said Bates.
Sweanor added that regulation and legislation should empower individuals to make decisions that would be better for them.
“There are over a billion cigarette smokers, and that should be seen as a public health emergency. We should be looking at whatever we can do to move people as rapidly as possible to non-combustible products. I think it says a lot about the sociology of the field that all the end-game strategies are coercive. We want to force people to change in ways that they don’t want to. What if we told them the truth? What if we gave them better products?” added Sweanor.
Meanwhile, evidence points to the fact that countries that have ratified the WHO Framework Convention on Tobacco Control (FCTC) and implemented nationwide bans on tobacco sales are currently experiencing numerous tobacco-related challenges.
Nevena Crljenko, Vice President of Public Affairs at Philipp Morris International said regulation should not take away options from consumers, but rather facilitate and ensure people switch from more harmful combustible products to less harmful non-combustible ones.
“Nicotine use is here to stay. It’s been with us as humanity for a very long time. Over the last ten years, there has been a proliferation of new non-combustible products that are better alternatives to smoking. People are switching to them. The question is how to facilitate that process because it’s for the benefit of both the consumers and the government,” said Crljenko.
She added that the industry has a role to play in the regulation and legislation-making process and is best placed to transform the industry.
Meanwhile, Dr. Konstantinos Farsalinos a cardiologist at the Department of Pharmacy Universities of Patras and West Attica, Greece said there is a need for the industry to spell out its goals and what regulation aims to achieve.
“Before discussing how to regulate things, it is important to set the goal for the regulation. So why do we want to regulate it? In my opinion, in the case of harm reduction, the reason and the goal of the regulation is to help consumers make informed decisions. Do we have a nicotine-free society? 0% use among youth?” said Farsalinos.
Vaping in young people was also a big discussion topic at the Global Nicotine Forum with public health raising concern over the rising prevalence of young people who vape.
Joe Thompson, Imperial Brands said, “Protecting youth is important. “There are ways to prevent them from doing what they shouldn’t be doing, like drinking and driving. Yet, with tobacco products or vaping, regulation is not working, therefore, we need address the root cause.”
He added that declines in smoking rates have been witnessed in countries that have implemented and embraced tobacco harm reduction interventions.
“That's how I'd like to see regulation develop - through a framework that actually enables consumer choice, but informed choice, and I do think that the state has a bigger role to play in actually informing consumers.”
