[Reporting from Warsaw — Taco Tuinstra, 2Firsts] The recent Global Forum on Nicotine (GFN) provided a platform to a wide variety of stakeholders. From June 19-21, health advocates, public policy analysts, lawmakers and others convened in Warsaw to advance tobacco harm reduction (THR). 2Firsts has been the official media partner of the Global Forum on Nicotine (GFN) for three consecutive years, delivering in-depth and timely coverage of the event to the global industry audience.
While each of the participants offered valuable insights, the success of safer nicotine products will depend largely on the actions of the world’s four largest tobacco companies, which between them account for nearly 70 percent of cigarette volume sales outside China.
Given their outsized influence, 2Firsts took special note of the GFN contributions from Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Brands. Boasting profound expertise and unmatched resources, the views of these companies are key in the transition from deadly cigarettes to less risky smoking alternatives.
Describing the scope of the challenge, BAT Global Medical Safety Officer Hugo Tan reminded listeners that there are 1.3 billion smokers worldwide, and that annually 8 million people die prematurely due to smoking-related health complications. By comparison, he noted that the Covid-19 crisis resulted in about 7 million deaths. “If Covid was a pandemic, if it was a public health crisis, then what about the 8 million deaths from smoking?” he asked.
To accelerate the progress toward less-risky alternatives, Tan called for better education of healthcare professionals. “Not too long ago, when I was in medical school, we were taught about the harmful effects of smoking, but we learned nothing about the science about alternative nicotine products,” Tann said. “How we teach medical students needs to change.”
Corroding Curiosity
In that context, big-company representatives at GFN worried about the growing hostility to THR by leading health bodies. While the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) lists THR as a fundamental pillar of tobacco control, the officials administrating the treaty increasingly dismiss the concept as an industry ploy to addict a new generation of nicotine users.
When the FCTC was drawn up, “the WHO recognized that progress and technology transformation would evolve to change and transform smokers' lives, and that harm reduction strategies would then become the third leg of their approach,” said Summer Hanna, head of scientific regulation at BAT.
“Unfortunately, over the last 20 years, we've seen that scientific mindset and curiosity erode. We now have leading jurisdictions of tobacco control—countries like the U.K. or New Zealand—with progressive regulatory frameworks and remarkable declines in the rate of cigarette smoking,” she said. “Meanwhile, the FCTC is still reporting, 20 years later, over 1 billion smokers. To me, that's a failure of creativity and scientific process.”
Hanna attributed the resistance to THR in part to the growing disconnect between policymakers and consumers. “I'm not confident how many of the people who are working in [the tobacco control] space actually know any smokers,” she said. “As smoking becomes less of a middle class or upper-class phenomenon, people who sit and learn at institutions do not ever interact with these people in their personal lives. They become an abstract entity. In the same way that the tobacco industry becomes a monolith, the smoker also becomes a monolith in this.”
This divide also makes it easier to vilify the other side. Noting that smoking is a consumer behavior rather than a communicable disease Thomas Nahde, global head of harm reduction and engagement at Imperial Brands, cautioned against framing tobacco control’s mission as a “war.”
“A narrative of war on a behavior is misapplied,” Nahde said. “I'm conscious that it's about urgency, but it demonizes smoking and stigmatizes people who smoke. It also substantially limits the options if you're using a narrative of eradication rather than control. We need way more focus on the consumer, to really understand the behavior of people who smoke.”
The Fight for Flavors
One behavior that has attracted widespread attention is consumers’ tendency to buy flavored products. In many jurisdictions, regulators have responded with bans and restrictions, often citing youth appeal as justification. At GFN, various experts reflected on the significance of flavors and the impact of restrictions.
Deborah Binks-Moore, chief corporate officer at Imperial Brands, cautioned against the unintended consequences of flavor bans. “In our sector, the big challenge faced by all of us, industry regulators and policy makers, is how do you provide choices that encourage adults to transition away from smoking, while banishing the rogue actors who undermine trust and encourage unintended or youth use,” she said.
“In one of our studies, 29% of smokers who switch from tobacco exclusively used fruit flavors, and where we see restrictions on flavors, either through regulatory inertia or legislative bans, we see a proliferation of the illegal, unregulated market. And once the market moves into the hands of criminals, there is a greater risk of unintended [use] or youth use and consumption of harmful products.”
She cited the case of Australia, where overregulation has shifted the business from legitimate suppliers to law-evading ones. “There are around 1 million vapers in Australia, and more than 90% of the vapes that those people consume are bought illegally, so a staggering number of law-abiding consumers who want to make a choice to improve their health have effectively become criminals through bad policy, and it's enriching criminal gangs,” said Binks-Moore. “It just is nonsensical.”
Piotr Kozarewicz, U.S. senior advisor, regulatory policy and director, U.S. post-market regulatory affairs at Philip Morris International, urged regulators to balance the desire to discourage underage uptake with the need to help adult smokers to move away from cigarettes.
“The reality is that the flavors that are liked by adults are almost identical to the flavors liked by youth,” Kozarewicz said. “So, there is a problem: tobacco harm reduction is all about successful transition from combustible cigarettes to better alternatives. We need flavors then to facilitate the switch, and we cannot base the policy on assumption that blueberry flavors are just a youth appealing flavor.” Kozarewicz called for more high-quality risk-assessments examining who is using a product and why. “With this, I believe we can have successful regulatory policies.”
Sharing Science
Keenly aware that credible research is vital to the success of THR, the GFN featured multiple “Science Labs,” providing participants with an opportunity to present their latest studies and discuss the results. Japan Tobacco International (JTI) shared new insights into the association between the use of heated tobacco products (HTPs) and the incidence of respiratory symptoms.
With the growing popularity of HTPs worldwide, and especially in Japan, interest has grown into the potential health effects of this relatively new product. However, because most HTP users are (former) smokers, it’s impossible to properly assess health impacts without considering users’ smoking history.
While JTI found a dose-response relationship between total incidence and amount of daily HTP use, its study results suggest that this relationship was largely due to users’ prior smoking history. The company’s research also revealed that the THR potential of HTPs is comparable across brands, suggesting that all heating products can help smokers reduce their risk.
2Firsts has been a media partner of the Global Forum on Nicotine (GFN) for three consecutive years.
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