Category: Harm Reduction

Activists Lament EU Stance on THR

Photo: Andrzej
The European Commission’s approach to tobacco harm reduction is out of touch with EU citizens’ views, according to the World Vapers’ Alliance (WVA)
A recent public consultation on the EU Tobacco Products Directive (TPD), analyzed by Snusforumet, reveals a substantial consensus among citizens, NGOs and scientific institutions on the effectiveness of harm-reduction products in assisting smokers to quit.
A striking 77 percent of respondents recognize these products as helpful smoking cessation tools, while a mere 9 percent of EU citizens disagree. Furthermore, an overwhelming 82 percent of respondents refute the notion that new nicotine alternatives pose a risk to public health, with only 6 percent perceiving them as a threat.
“The EU Commission’s current stance on harm reduction is not just out of touch; it’s a blatant disregard for consumer opinions and scientific evidence,” said WVA Director Michael Landl in a statement. “It’s high time the Commission responds to the reality that harm-reduction products are not the enemy but a vital ally in the fight against smoking.”
According to the WVA, countries like Sweden serve as living proof of the success of a consumer-friendly harm reduction approach, significantly outpacing the EU in reducing smoking rates. The EU Commission’s reluctance to embrace this approach is not only perplexing but also detrimental to public health efforts, the organization says.
“Sweden’s success story is a testament to what can be achieved with a sensible harm reduction policy,” said Landl. “It’s baffling and frankly irresponsible for the EU Commission to continue its hostile approach towards these life-saving products. The Commission needs to align its policies with the clear evidence and public opinion, rather than clinging to outdated and ineffective methods.”
January 15, 2024
WHO Report ‘Unscientific”: Mata

Lorenzo Mata Jr. (Photo: Quit for Good)
A public health advocacy group based in the Philippines has criticized the latest report of the World Health Organization on the use of electronic cigarettes, saying the global body undermines the significant progress made in public health over the past two decades as smokers transitioned to smoke-free products.
Lorenzo Mata Jr., president of Quit for Good, said the WHO’s continued demonization of e-cigarettes disregards the wealth of scientific evidence demonstrating that smoke-free alternatives such as e-cigarettes, heated tobacco and snus have helped millions of smokers in countries like the United Kingdom, the United States, Japan and Sweden successfully quit smoking.
“The best available clinical and population studies consistently show that vaping has led to adult smoking cessation. While it is necessary to monitor youth vaping, a complete ban on e-cigarettes will only exacerbate the smoking epidemic and its associated serious health conditions,” Mata Jr. said in a statement.
As a Filipino physician, Mata said the WHO’s failure to differentiate between the risks of e-cigarettes and combustible tobacco is unscientific.
Last month, the WHO issued a statement calling for urgent action to safeguard children and prevent the adoption of e-cigarettes based on what Quit for Good insists is a misrepresented account of the scientific evidence to fit its predetermined conclusion to ban e-cigarettes or regulate them as strictly as far more dangerous cigarettes.
Additionally, the WHO provided data indicating that the global market for electronic cigarettes grew from $7.81 billion in 2015 to $22.35 million in 2022. Between 2018 and 2022, the disposable e-cigarette market expanded by 116 percent, encompassing over 550,000 different products.
Mata said the WHO’s diagnosis of the situation is flawed, as it fails to acknowledge the significant decline in harmful substance exposure resulting from smokers switching to e-cigarettes and other smoke-free alternatives, or the fact that smoke-free products work for many smokers better than traditional smoking cessation therapies.
“E-cigarettes do not threaten public health but provide smokers with an exit from smoking, which is the real problem. Labeling these innovative products an emerging threat to public health is worrisome because the WHO essentially tells smokers that continuing smoking is better than switching to e-cigarettes. This is patently wrong,” he said.
Quit for Good highlights that countries that banned e-cigarettes did not eradicate vaping but instead inadvertently created an unregulated underground market that poses risks to public health due to the absence of regulatory standards.
Mata said these bans only benefit unscrupulous criminal gangs that are happy to sell these products to anyone, including children, without any controls as to what’s in them or how they’re made.
According to independent public health experts, e-cigarettes and other smoke-free products offer an opportunity to combat smoking-related diseases such as cancer, heart disease and lung disease by transitioning to nicotine products with significantly reduced risk and no combustion.
Commenting on a similar WHO report published earlier, Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London, said: “Given the tremendous benefits this transition would bring to public health, it is paradoxical that the WHO has adopted such a strident anti-vaping stance that risks impeding this progress. This new report perpetuates this tradition, calling for a ban on less risky alternatives while freely allowing the sale of tobacco. The report misrepresents evidence and should come with a prominent health warning.”
John Britton, an emeritus professor of Epidemiology at the University of Nottingham, said the WHO still fails to differentiate between addiction to tobacco smoking, which leads to millions of deaths annually, and addiction to nicotine, which does not.
“The WHO appears content with the inconsistency of recommending medicinal nicotine products for treating smoking addiction while advocating the prohibition of consumer nicotine products that serve the same purpose, but more effectively. The WHO is correct in discouraging non-smokers, particularly children, from using any nicotine product. However, for over a billion tobacco smokers worldwide, electronic nicotine delivery systems are part of the solution, not the problem,” Britton said.
Mata said many countries, including the Philippines, have in fact chosen to embrace scientific evidence and regulate the use of innovative smoke-free products such as e-cigarettes to provide smokers with better options to quit.
January 15, 2024
Experts Concerned About Tobacco Control

Photo: Andrey Popov
The Italian publication Formiche recently published a report raising concerns about the WHO’s tobacco control policies and strategies in combating smoking related diseases.
Titled, “Framework Convention on Tobacco Control: Challenges and Prospects for WHO,” the report provides a comprehensive overview of the smoking crisis, the limitations of current tobacco control policies, and the role of harm reduction and non-combustion products. Additionally, it emphasizes the need for innovative strategies and a re-evaluation of the WHO’s approach to effectively combat the global smoking epidemic.
The report highlights how the FCTC has not considered harm reduction efforts which led to a deviation from the original stance of the WHO. Despite the FCTC’s efforts, the number of smokers have remained stable over the last 20 years, with the decrease in smoking rates being countered by the effects of population growth.
It further suggests technology innovations that eliminate combustion, represent significant steps toward harm reduction. However, the FCTC, whilst acknowledging the potential of these innovations, has not adopted them, and discounts the growing body of science evidencing their potential. Experts state that the parties to the treaty have abandoned the core principle of harm reduction and ignored scientific evidence leading to misinformation amongst consumers.
“With 80-90 percent of alternative tobacco products being less toxic in comparison to combustibles, there is clearly a solution to reducing tobacco risk, but the world seems to be completely blindfolded. It is essential for tobacco control policies to respect human rights and consider the integration of the principles of risk reduction by adopting alternatives,” said Riccardo Polosa, professor of internal medicine at the University of Catania, in a statement.

With 80-90 percent of alternative tobacco products being less toxic in comparison to combustibles, there is clearly a solution to reducing tobacco risk, but the world seems to be completely blindfolded.
Riccardo Polosa, professor of internal medicine, University of Catania
“At the moment the biggest issue concerns the misinformation,” said Expressing his concern, Peter Hajek, director of Tobacco Dependence Research Unit of the Wolfson Institute of Public Health at Queen Mary University in London. “The public believes that tobacco alternatives are as dangerous as traditional cigarettes when they are much less dangerous, and people should be encouraged to use those less risky alternatives.”
Outlining an alternative approach, the report highlights the best practices in markets where alternatives have helped to accelerate the decline in smoking. Research suggests that a majority of Italian smokers support state-promoted information campaigns and research on non-combustion tobacco alternatives, according to Formiche. “A notable shift from traditional smoking to alternatives has been observed, with many smokers ceasing the use of cigarettes,” the report notes. “This suggests a strong substitution effect of new alternatives for cigarettes.”
The authors also point out that scientific evidence on alternatives has been evaluated positively by numerous regulatory bodies. In the U.S., for example, the Food and Drug Administration, introduced the “Modified Risk Tobacco Products” category, recognizing products with reduced risks compared to traditional cigarettes.
Germany’s Federal Institute for Risk Assessment, the Dutch RIVM, France’s Pasteur Institute, Belgium’s Superior Health Council and other European institutions have acknowledged the reduction of emissions and toxic substances in heated tobacco alternatives, albeit with caution about their overall health impact. Sweden’s approach toward smokeless alternatives has significantly reduced its smoking rate, achieving early targets set by the EU’s European Beating Cancer Plan.
The report’s author also worry about the tobacco control policies pursued by many low- and middle-income countries, which are home to 18 percent of the world’s smokers and where policies either ban alternative nicotine solutions entirely, or treat them like cigarettes.
The effect of these approaches, according to the report, is that smokers who do not quit, are not supported in changing to options that could present less risk to them. “The hope is that the forthcoming Conference of the Parties can represent an opportunity for public health but also, in the spirit of the United Nations, a moment of confrontation to guide policy choices based on established scientific evidence”, the report states.
December 15, 2023
The Risk of an Own Goal

Image: anekoho
Making e-cigarettes available only on prescription may be a net negative for public health, writes Neil McKeganey.
By Neil McKeganey
In response to the rising level of vaping there have been discussions in the U.K. and elsewhere about making e-cigarettes available on prescription only. Within the U.K. Wes Streeting, shadow secretary for health and social care, recently announced that an in-coming Labour government would consider such a restriction as a way of reducing youth vaping.
There is now clear evidence that e-cigarettes are both popular among smokers and that they can help smokers to quit. Alongside such positive evidence there is also the downside of rising numbers of young people using these devices irrespective of whether they are smoking.
Whilst making e-cigarettes available on prescription may seem like an effective way of reducing youth use of these devices, the reality could prove very different. The fact that young people—including some below the legal age of purchase—are vaping underlines the reality that there are more routes to obtaining these devices than legal sale.
It is entirely possible that even in a situation where e-cigarettes were available on prescription only that some young people would still source these devices through illicit routes. Whatever the impact on youth vaping, making e-cigarettes available only through prescription would reduce adult smokers access to these devices. In the event that such a policy were implemented, some adults would certainly go to their doctor seeking a prescription for these devices. Others, however, would be less inclined to go to their doctor. Some of those might source their e-cigarettes through illicit supply whilst others would simply continue to smoke.
There is a further reason why making e-cigarettes available on prescription only may have a downside. Research has shown that using e-cigarettes can increase the likelihood of smoking cessation even when the individual had no prior intention of quitting. Analyzing data from the widely respected Population Assessment of Tobacco and Health study in the United States, Professor Karin Kasza and colleagues from the Roswell Park Comprehensive Cancer Center found that adult smokers who had no prior interest in quitting smoking still stopped smoking in impressive numbers following their use of an e-cigarette. Such “accidental quitting” has been found in other studies, with Professor Riccardo Polosa and colleagues in Catania, amongst others, showing that simply providing smokers with access to e-cigarettes helps many to quit even where they have expressed no prior interest in quitting.
As is so often the case when it comes to regulating e-cigarettes, the question is one of how to balance the needs of young people, who ought not to be using these devices, with the needs of adult smokers who may benefit from their use. Whilst making e-cigarettes available on prescription only may reduce some young peoples’ use of these devices, regrettably it may have the same if not greater effect on adult smokers.
The public health goal of reducing smoking is too important to implement a policy that may be less effective than one might hope in reducing youth vaping whilst actually reducing adult smokers access to these devices. The challenge facing manufacturers, regulators and health educators is one of finding a way to reduce youth access to these devices whilst at the same time ensuring that any adult smoker wishing to use an e-cigarette can do so with the least possible difficulty. Requiring adult smokers to seek an appointment with their doctor before they can legally access an e-cigarette device is to place a huge barrier in the way of wider e-cigarette use by smokers and wider intended and accidental quitting on the part of those adult smokers. This is a restrictive regulation that needs to be given serious consideration before being implemented.
Neil McKeganey is the director of the Center for Substance Use Research in Glasgow, Scotland.

December 12, 2023
Briefing Explores THR for the Homeless

Image: jaceksphotos
A new briefing paper from the Global State of Tobacco Harm Reduction (GSTHR), a project from U.K.-based public health agency Knowledge Action Change (KAC), examines the significant potential of the approach to help people experiencing homelessness.
Surveys consistently estimate that between 76 and 85 percent of U.K. homeless people smoke—six or seven times the smoking prevalence seen in the general population, which is now at an historic low of 12.9 percent. On average, U.K. homeless men die at 44 years of age, compared to 76 in the general population and homeless women at 42 years, compared to 81 in the overall population.
Tobacco harm reduction helps people quit smoking by giving them the choice to switch to safer nicotine products. A 2019 study found that at least two thirds of rough sleepers who smoked would be willing to switch to vaping if a device was freely available, and would take up smoking cessation support offered at their homelessness service.
Tobacco harm reduction initiatives developed in London, Manchester and Edinburgh included the provision of free vape starter kits to homeless people. As well as the longer term health improvements offered by switching, the leaders of those projects also noticed more immediate benefits; Covid-19 infection risks associated with sharing or smoking discarded cigarettes were reduced, along with the risk of eviction by breaking no smoking policies, and the risk of breaking lockdown to go out and purchase—or look for discarded—cigarettes.
“Homeless populations have long been disproportionately impacted by smoking, and therefore stand to gain enormously from effective and pragmatic harm reduction routes to quitting tobacco,” said KAC Director David MacKintosh in a statement.
“The sustainability of this type of intervention must be approached carefully, but there is real potential here and it should be explored. On average, homeless people in the U.K. live half a life compared to the general population. Reducing their high rates of smoking is one way to start addressing this tragedy.”
December 11, 2023
Thailand Asked to Embrace Alternatives
Asa Saligupta
The director of ENDS Cigarette Smoke Thailand (ECST) has asked the Thai government to pass legislation that encourages smokers to switch to less-harmful methods of nicotine consumption, reports The Inquirer.
Asa Saligupta believes that Thailand’s current restrictions on smoking alternatives are pushing these products underground, resulting in an unregulated market that deprives the government of revenues and forces consumers to keep smoking.
Thailand banned on vapes and other electronic nicotine delivery systems in 2014, resulting in the arrest of local vapers and foreign tourists. Saligupta says the measure has discouraged smokers from switching to potentially less harmful innovative products.
According to Saligupta, Thailand should follow the lead of the Philippines, which passed a law that recognizes tobacco harm reduction as a legitimate tool in the campaign against smoking.
Republic Act 11900, or the Vaporized Nicotine and Non-Nicotine Products Regulation Act, became law in 2022. The Vape Law regulates the importation, sale, packaging, distribution, use and communication of vaporized nicotine and non-nicotine products and novel tobacco products such as electronic cigarettes and heated tobacco products.
Thailand’s vaping regulations are among the strictest in Asia.
November 20, 2023
The Core of the Confusion

Photo: Westock
The likely origins of the prevailing misperceptions about nicotine—and how that impacts tobacco harm reduction
By Sudhanshu Patwardhan
A widely prevalent misperception prevailing in society is that nicotine in tobacco products causes cancer. This myth and its widespread acceptance even among healthcare practitioners worldwide was recently highlighted by a survey among 15,000 doctors from 11 countries. Nicotine misperception may be the key reason preventing the world from becoming free from risky forms of smoked and smokeless tobacco products. The origins of this misperception may have something to do with south Asia and the nasty oral tobacco products sold there.
The Basis of Tobacco Addiction
To achieve a world free of risky tobacco product use, understanding nicotine’s role in tobacco addiction is crucial. Tobacco addiction—in lay terms, the harmful habit of consumers of risky forms of tobacco to continue consuming despite knowing the harms to themselves and society—is primarily driven by the psychoactive effects of nicotine. The hand-to-mouth action, the action of nicotine on brain receptors, the activation of reward pathways in the brain, the release of neurotransmitters during product use and their eventual depletion, the expectation of the kick of the drug on longer term use, the craving and withdrawal effects that are mitigated by further consumption (or dosing) of nicotine, the social and cultural cues—all these point to a complex interplay. Nicotine is central to this addiction. An addiction that kills over 8 million people worldwide every year, affecting millions more in bereaved friends and families, and sees another 1.3 billion people in the world struggling to quit.
It Is the Smoke, Stupid … or Is It Just?
Over nearly five decades of tobacco control, thought leaders in the West have been enamored by—and have generously quoted—Michael Russell’s statement, “People smoke for nicotine, but they die from the tar” (Russell, British Medical Journal, 1976). He was right in the context of smoked tobacco. Indeed, this insight underpinned the enlightening among some tobacco control researchers in the U.K. and across the Atlantic. That in turn manifested in ground-breaking publications, e.g., the 2001 National Academy of Sciences’ Clearing the Smoke report, the 2007 U.K. Royal College of Physicians’ report Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit and the 2014 U.K. Royal College of Physicians’ report Nicotine Without Smoke: Tobacco Harm Reduction.”
Indeed, the U.K. medicines agency’s authorization of an additional harm reduction indication for nicotine-replacement therapy (NRT) products from 2010 onward established the world’s first class of licensed tobacco harm reduction products. This is often forgotten by tobacco harm reduction advocates as well as tobacco control enthusiasts around the world, with even lesser understanding of how and why the U.K. arrived at this fork on its journey in addressing tobacco-related harms (Patwardhan, Drug Testing and Analysis, 2022).
Metaphorically separating nicotine from its toxic delivery system that burned tobacco allowed Russell and the subsequent generations of public health thought leaders to pave the way for nicotine in cleaner forms to be formulated in various delivery systems, starting with medically licensed nicotine gums, patches and lozenges and culminating in Hon Lik’s invention of the e-cigarette. Heated-tobacco products launched by large tobacco multinationals also entered the market, with companies keen to “unsmoke” the world and phase out combusted tobacco, just like electric batteries in place of combustion engines in automobiles. Or Coke Zero and Pepsi Max instead of Coke and Pepsi. Right? Wrong! This narrative ignores oral tobacco consumption by nearly 300 million tobacco users, living mostly in Asia and Africa, and the attending oral and pharyngeal cancer-related morbidity and mortality.
Smokeless Tobacco’s Harms: A Collective Blind Spot
One estimate suggests that nearly 10 percent of doctors in the U.K. are of Indian or Pakistani origin and a sizeable number from Africa and the rest of Asia as well. There is even a higher proportion of healthcare professionals from these continents in mental health settings. Training in south and southeast Asia or Africa inevitably exposes doctors to patients presenting with the harms of oral tobacco.
Current medical curricula in these countries (or in fact anywhere else in the world) do not go into any level of detail when it comes to treating smoked or smokeless tobacco addiction. During medical education, it is quite common to simply identify the myriad diseases that tobacco is responsible for and to require trainee doctors to advise patients to quit. Which nicotine-replacement therapy to prescribe, why, how to provide behavioral counselling for tobacco de-addiction, the need for follow-up and relapse prevention, the impact of smoking on specific drugs’ metabolism and reduced efficacy are skills and knowledge that are not imparted at any stage of clinical training to doctors, dentists or nurses anywhere in the world.
There are millions of healthcare professionals in Asia and Africa and hundreds of thousands of expatriate doctors and nurses from these continents in Europe, America and the Middle East who have seen oral cancer patients, most likely resulting from oral tobacco use. They have seen firsthand the harms from oral tobacco products.
Unsurprisingly, telling them that tobacco harm reduction can be achieved by going smoke-free or by switching to “smokeless tobacco products” or giving “safer” nicotine alternatives will be perceived as fake news at best, disingenuous and dishonest at worst. Even licensed NRTs are not spared in this misperception, with many clinicians worried about nicotine causing cancer and NRT addiction with longer term use. This may result in inadequate NRT being prescribed for not long enough, thus making relapse more likely.

The use and harm profile of south Asian and African smokeless tobacco products is often not mentioned when championing snus (and therefore smokeless tobacco) as harm reduction. This can only add to the distrust of the industry and tobacco harm reduction advocates by the public health community.
Nicotine Misperception: The Likely Origin Story
There is an unprocessed wrong belief that most health experts and lay people have come to harbor: tobacco = nicotine = cancer. Toxicants, including carcinogens, are delivered during consumption of most tobacco products: from the smoke due to combustion of tobacco in the case of cigarettes/cigars/cigarillos and bidis, or added/formed in the manufacturing and storage of Asian and African oral tobacco products, e.g., chemicals, slaked lime, areca nut-specific nitrosamines and tobacco-specific nitrosamines (TSNAs).
The exception to these is Swedish-style pouched smokeless tobacco (snus). Through decades of evolving manufacturing standards and innovation, concentrations of carcinogens such as TSNAs and other toxicants in Swedish-style snus have been engineered to be minimal. The population level effects of the “Swedish experience” with snus in enabling a transition to a smokefree nation with the attending lowest male lung cancer rates in the EU, are the darling of tobacco harm reduction advocates. However, the use and harm profile of south Asian and African smokeless tobacco products is often not mentioned when championing snus (and therefore smokeless tobacco) as harm reduction. This can only add to the distrust of the industry and tobacco harm reduction advocates by the public health community.
In the absence of a curriculum that does not specifically distinguish nicotine’s psychoactive properties and dependence-causing potential from the toxicants formed or present in smoked or most smokeless tobacco products, healthcare professionals may easily conflate the tobacco products’ harms with nicotine.
Furthermore, their experience with patients from south Asia and Africa makes it logical for them to unconsciously do so. There are already lazy parallels with other widely prevalent addictions afflicting the world: e.g., alcohol. The nuance, however, is lost, that unlike nicotine, ethanol is the psychoactive component as well as the chemical that harms the liver and brain cells.
Lay media add to the confusion. Globally, tobacco control slogans and campaigns have run for decades now, most often using simple one-liner messages against nicotine. There was no need or place for nuance for those wanting to rid the world of the indirect harms of nicotine. It could even be justifiable for some to do so to achieve their utopian prize of a tobacco-free society (not to be confused with a society free from the harms of tobacco, a worthy goal).
The problem arises when nicotine, the very chemical that is vilified in the prevalent anti-tobacco narrative, when delivered in clean systems is recognized as a key solution for the 1.3 billion users of risky smoked and smokeless tobacco products. E.g., the World Health Organization has NRT on its model essential medicines list for treating tobacco dependence.
Nicotine: An Orphan Drug
Eighty percent of the world’s users of risky tobacco products, nearly 900 million people, live in low-income and middle-income countries (LMICs). Most of them do not have access to affordable and appealing safer forms of nicotine-replacement products, including NRT. A majority of healthcare professionals in those countries wrongly believe that nicotine in tobacco products causes cancer. In these countries, tobacco cessation treatments are either unavailable or delivered by healthcare professionals who are not trained in the art and science of nicotine replacement and behavioral interventions.
For too long, pharma and tobacco companies have shied away from owning nicotine, with pharma perhaps worried about the optics of selling a psychoactive substance with such global harms, albeit due to the dirty delivery system it is currently sold in. Tobacco companies care about their own brand and product and may prioritize brand building over broader product-agnostic market conditioning about nicotine. The result is that a large swathe of countries that lack the sophistication or the academic rigor and experience of the U.K.’s tobacco control community or the U.S.’ Food and Drug Administration find themselves accepting hand-me-down anti-tobacco-harm-reduction rhetoric.
Light at the End of the Tunnel?
A rush to launch new nicotine products globally without adequate disentanglement between tobacco and nicotine education will only lead to more knee-jerk reactions and bans. That shall slow down any ambition to make the world smoke-free, or to be more precise, free from risky tobacco products. Achieving nicotine literacy through education and practice may be the much-needed game changer. In theory, most countries, including LMICs, have NRT on their national essential medicines list.
That does not necessarily translate into actual availability and affordability for cessation. Anyone truly invested in tobacco harm reduction should recognize that much groundwork needs to be laid first to get the new generation of healthcare students and future practitioners to be nicotine confident—starting with NRT. Tobacco cessation, underpinned by tobacco harm reduction principles, should be taught, practiced and experienced in LMICs through well-regulated healthcare ventures and partnerships.
Consumers, healthcare practitioners and governments first need to see the success with cessation using conventional NRTs but also recognize the need for a wider choice of safer nicotine alternatives to wean off the 1.3 billion current tobacco users. Only then will the conditions be ripe for companies to responsibly market their nicotine innovations to adult tobacco users in such markets.
Sudhanshu Patwardhan is a medical doctor, nicotine expert and health tech entrepreneur from India, based in the U.K. He works on projects around the world to reduce harm from tobacco, especially among the most disadvantaged tobacco user populations.

November 13, 2023
Consumer Groups Critical to THR: Paper

Image: mtsaride
Consumer advocacy organizations play a critical role in ensuring safer nicotine products are available as alternatives for those who use high-risk tobacco products, according to a new briefing paper by the Global State of Tobacco Harm Reduction (GSTHR).
The absence of consumer perspectives from 10^th Conference of the Parties to the Framework Convention on Tobacco Control–which was scheduled to be held in November but has been postponed due to social unrest in the host nation, Panama—will hamper collective efforts to bring an end to the smoking epidemic, according to the GSTHR.
Consumer advocacy groups are also overstretched and under-resourced, according to the report. During the 12 months prior to the study, the total funding for all of the groups surveyed was only $309,810. None of this money came from tobacco or pharmaceutical companies, despite oft-repeated allegations from opponents of tobacco harm reduction. By contrast, the Campaign for Tobacco Free Kids received $160 million from Bloomberg Philanthropies in 2019 to oppose flavors in nicotine vapes.

Despite the lack of funding, tobacco harm reduction consumer advocacy organizations have achieved a lot. “From the very early days of simply sharing information on products with peers who hoped to quit smoking, through to the emergence of more organized advocacy efforts, consumers have been central to the development of tobacco harm reduction,” said Jessica Harding, director of external engagement at Knowledge Action Change, in a statement.
“Consumer advocacy groups play a vital role in maintaining access to safer nicotine products throughout the world and, despite the many obstacles they face, their achievements are impressive.”
“People who use safer nicotine products and people who smoke are significantly affected by policy responses to tobacco and nicotine, broadly described as ‘tobacco control,’” said Gerry Stimson on behalf of the GSTHR project.
“They are also the people who would most benefit from tobacco harm reduction. As in other comparable areas of public health, there must be a recognition of the contribution consumer advocacy groups can make to inform decisionmaking at meetings such as COP10. Their experiences are testament to the potential of harm reduction, and they should be heard.”
Tobacco Reporter’s Stefanie Rossel recently explored the role of consumer advocacy groups in her article “Persistence Pays.”
November 10, 2023
Alternatives Boost Cessation: Tholos
The Tholos Foundation, in partnership with Japan-based Pacific Alliance Institute and Sweden-based consulting firm Scantech Strategy Advisors, has released a policy paper, Safer Nicotine Works, on how Sweden and Japan have successfully reduced smoking rates by introducing safer alternative nicotine products.
Safer Nicotine Works investigates oral nicotine and heated tobacco’s effects on smoking rates in Sweden and Japan. It follows Vaping Works, which studied four countries’ vaping experiences. The latter found that nations adopting vaping, like the United Kingdom, France, Canada, and New Zealand, experienced smoking rate reductions at double the global average.
In Japan, the introduction of heated tobacco products has remarkably reduced male smoking rates below 30 percent for the first time, reversing previous stagnation.
Sweden, with a smoking rate of 5.6 percent ¹ is poised to be “smoke-free” within the year. The recent decline in smoking is attributed to the rise of nicotine pouches introduced in 2019.

Tholos Foundation’s research indicates consumers in both countries led the shift to safer alternatives. Policymakers’ key role was to ensure these alternatives were accessible and viable. Data confirms that safer nicotine significantly aids smoking cessation. With safer nicotine products like vaping, heated tobacco, nicotine pouches, and snus, smoking rates are dropping rapidly.
“Safer nicotine is, quite literally, saving lives around the world,” said Tholos Foundation Vice President Lorenzo Montanari in a statement. “The experience of Sweden and Japan, just as in the U.K., Canada, New Zealand and France, proves that when people have access to safer products, they choose them in huge numbers. We now have the tools we need to fight harmful high smoking rates: governments around the world must now support their citizens to make a better choice.”
According to the Tholos Foundation Sweden and Japan’s success in lowering smoking rates highlights the efficacy of comprehensive tobacco control strategies. “They have regulated alternative nicotine products, prioritizing public health,” the organization wrote in a press note. “Sweden and Japan’s experiences provide key lessons for nations aiming to decrease smoking and encourage smoke-free alternatives. By enabling access to safer alternative nicotine products and implementing appropriate regulations, countries significantly improve public health outcomes and address smoking.”

November 9, 2023
Vapers Cheer EU Recognition of E-cigs as Possible Quit Aid

Photo: Maren Winter
The EU’s Subcommittee on Public Health (SANT) has endorsed the potential role of vaping in supporting smoking cessation, according to the World Vapers’ Alliance (WVA).
Parliament’s report on non-communicable diseases acknowledges that vaping is a way for smokers to gradually quit.
“Parliament’s recognition that vaping can help smokers quit is a step in the right direction,” said WVA Director Michael Landl. “With the well-documented success of vaping as a smoking cessation aid, it’s crucial for the EU to fully embrace this tool within its strategy to reduce smoking-related illnesses. Vaping not only offers a way out for smokers but is instrumental in achieving public health goals.”
Despite this recognition, the WVA views the report’s proposal to extend smoking bans to vaping as problematic.
“Treating vaping the same as smoking in public spaces sends the wrong message to smokers who want to quit,” said Landl. “There is no evidence of harm from secondhand vaping. The Subcommittee must reconsider the broader impact, including the risk of former smokers relapsing. A more thoughtful regulatory approach based on common sense is imperative to ensure that vaping remains a viable option for those committed to quitting cigarettes.”
The WVA believes that for the EU to significantly lower smoking rates and effectively tackle NCDs, supportive measures for harm reduction strategies like vaping must be integrated into public health policies.
November 8, 2023