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  • Bonus Content: Stefan Bomhard

    Bonus Content: Stefan Bomhard

    Stefan Bomhard, CEO of Imperial Brands, highlighted how the industry has changed in the past couple years and how companies have dealt with these changes.

    “We’ve seen huge innovations and the growing diversity of products,” he said. “These have given adult consumers exciting, new and potentially healthier alternative choices.”

    Bomhard focused on the idea of challengers. He recalled his presentation at the 2021 GTNF, when he described Imperial, the smallest of the tobacco and nicotine companies, as the industry challenger. “Challengers drive increased consumer choice. They stimulate stronger competition, and they spur on innovation,” he said.

    The way to success for challengers, according to Bomhard, is by doing things differently—getting closer to consumers, being more agile and collaborating better with partners as well as recognizing limitations.

    Following his statement two years ago that Imperial could be the challenger in the industry, the company has made changes. “We haven’t always gotten it right,” he said. “That is the nature of business, of innovation, of trying new things.” Imperial has since created new capabilities in consumer insights, marketing and sales. The company has also invested in data and unifying dozens of legacy systems into a single solution. The company’s changes and investments have paid off, according to Bomhard. Imperial has stabilized its core combustible business and has credible offerings in all three of its next-generation product (NGP) categories. The company is starting to make meaningful contributions to reduce harm, he said.

    Circling back to his 2021 talk again, Bomhard reiterated that every consumer is different. Since then, Imperial has conducted the largest piece of consumer research in the category’s history, focusing on what is called “demand spaces.”

    The research breaks down the lives of consumers to individual moments when they enjoy tobacco and nicotine products, giving the industry a more nuanced understanding of how consumers are moving toward potentially healthier choices. The data showed that next-generation products are used more often when consumers are outside of the home and with other people while more traditional combustible products are more often used at home during periods of alone time.

    The research shows that “NGPs are no longer a niche category,” Bomhard said.

    “We still need to be humble,” he said. “The fact that there are large spaces in people’s lives where our new products have yet to find a firm footing means together, we still have much more work to do. We need to work harder together to create even better alternatives to the traditional cigarette.

    “Innovation, partnership and deepening the industry’s ecosystem are now more important than ever. And we need to provide reassurance to those consumers who are reluctant to consider alternatives to smoking. That means finding new ways of communicating the potential harm reduction benefits of NGPs.

    “Sadly, too many people still believe that vaping or heated tobacco is just as risky as smoking. And it means we need to use our collective experience to help policymakers build more orderly regulatory environments that inspire greater trust among adult consumers.

    “It is becoming clearer that in our industry, there will be no silver bullet, no single winner who takes it all. Consumers are not converging around a single product or category. Instead, they’re choosing different products for different occasions in their lives.”

    He went on to discuss how different countries are developing and cultivating their own distinctive nicotine cultures and how this makes it clear that there is “room for many players in this industry.”

    “The journey to the future typically never runs in a straight line,” he said, noting that the industry must continue navigating emerging challenges. “I am an optimist, and I believe that if, collectively, we continue to stay close to our consumers and continue to work openly and collaboratively, there’s a bright and healthier future ahead.”

  • Keynote: Kingsley Wheaton (given by Jonathan Atwood)

    Keynote: Kingsley Wheaton (given by Jonathan Atwood)

    During GTNF 2023, BAT’s global head of business communications, Jonathan Atwood, told attendees how BAT’s five-step plan for regulation could support achieving the right balance between harm reduction and the unintended consequences of access, including underage use.

    “As an industry, we stand at an important crossroads. There is much confusion as to the way forward. Consumers are slightly confused. Doctors are slightly confused. Regulators are slightly confused and are struggling to enforce the laws they have written,” said Atwood. “What’s too often missed is the opportunity that tobacco harm reduction presents. The opportunity for a more progressive environment where both tobacco harm reduction and the role of [vaping products] is far better understood.”

    Speaking on behalf of Kingsley Wheaton, BAT’s chief strategy and growth officer, Atwood said that reckless players in the market need to be penalized when they do not abide by the rules. He said the five suggestions are the areas that regulators should explore and then establish “smart regulation” that is right for their market.

    “When I talk about smarter regulation, I mean regulation that is evidence-based, concentrated by nature, and achieving its policy aims while also avoiding unintended consequences. Greater partnership is required to achieve this,” Atwood said. “We must join forces externally with regulators and policymakers to try and create catalysts for positive change if smoke-free ambitions are to be met. Sustained and lasting changes to consumer behavior are difficult. However, it is consumer choice that offers the greatest hope for making a cigarette obsolete.”

    Atwood said that the five areas were where smarter regulation could be applied to the vapor category to build a “more progressive environment” for tobacco harm reduction. He said the recommendations would need to be applied to the entire market and combined with greater enforcement. The five steps Atwood outlined included:

    • On-device technology and functionality: Vapor products should be accessible only to adults. Both underage prevention and restriction is crucial. On-device technology, when applied and enforced across entire markets, could help in this regard.
    • Flavors: More recognition is needed that flavors are an important driver of adoption for smokers seeking alternatives. However, flavors in vapor products should not particularly appeal to anyone underage.
    • Manufacturing and import level: ensuring that noncompliant products cannot reach the market in the first place.
    • Right to sell: Where no restrictions exist already, regulators may want to look at who should be able to sell vapor products and where. Reasonable safeguards at the point of sale would help ensure these products are sold only to adult consumers. Solutions such as retail licensing and facial recognition technologies should be seriously considered.
    • Enforcement and penalties: Governments must wield their power and ensure consumers are purchasing legitimate products. Such measures should be rigorously enforced, and those who fail to comply should face meaningful sanctions.

    Atwood said BAT was calling upon governments, regulators and industry peers to rally toward a sustainable and progressive environment in which vaping products are sold and marketed responsibly.

    “The time for boldness is now. The time to change the conversation is now. The time to change the outcome is now. The opportunity for change is here. It is not about relaxing regulations. It’s about recalibrating them to align with the evidence and aspirations of millions seeking a better alternative to smoking,” said Atwood. “We have the opportunity to redefine the future of public health, and it begins with smarter regulation that reflects the reality of smoking alternatives and provides smokers the freedom to choose less risky products.”

  • Panel: Talking Nicotine: Perception vs. Reality

    Panel: Talking Nicotine: Perception vs. Reality

    From a public health perspective, the misperceptions and misunderstandings surrounding nicotine are incredibly frustrating, according to David Sweanor, adjunct professor of law at the University of Ottawa, who moderated the GTNF panel on the public perception of nicotine. Science has proven that it is the delivery system [combustible cigarettes], not the nicotine itself, that causes the deadly diseases suffered by cigarette smokers.

    Sweanor said Sweden was an excellent example of a country where the use of different delivery systems, such as snus, led to massive decreases in the number of combustible cigarette smokers. Sweanor said it would be a major benefit to public health if the industry would or even could do more to educate consumers, public health groups and legislators about the facts. He emphasized that people can only make as good a decision as the information available to them allows.

    “We already knew from the work of Michael Russell that people smoked to get nicotine, but they died from the smoke. Nicotine wasn’t the problem. It was the delivery system that was the problem,” Sweanor explained. “We’ve known that for 50 years. And we’ve seen examples from places like Sweden where people can move to an alternative product and have disease rates that are massively lower than what you see elsewhere. In fact, looking at the long-term users of a product called snus, it is very hard to find anything to distinguish their disease risks from those people who don’t use any tobacco or nicotine product at all.”

    The first speaker on Sweanor’s panel was Carolyn Beaumont, a general practitioner, educator and founder of SmokerHealth Telehealth and Medical Nicotine Scripts who for the last three years has been prescribing vaping products to cigarette smokers in Australia. She said that there is an outpouring of need and frustration and even fear from the smokers that she works with. Australia’s vaping rules permit vaping products only through prescription and severely restrict the products that can be prescribed. Beaumont presented several quotes from former smokers showing how vaping had changed their lives for the better.

    “They really want their stories to be heard …. Smokers want to be heard—not judged—supported and advocated for. They’re also very fearful that if they can’t get their vape, they will return to smoking, and that seems true as well,” said Beaumont. “For those of you who are not sure how successful vaping is in [supporting] smoking cessation—it’s very effective.”

    The next speaker, Delon Human, president of Health Diplomats, said that misperceptions surrounding nicotine were causing people to die. “At the heart of nicotine misperception lies an issue that we are wasting unnecessary lives,” Human told attendees. “We are allowing the misperception of nicotine to lead to disease. And that is a time that we absolutely have to take hold of the stakeholders, who can change those perceptions.”

    He stated that the World Health Organization’s failure to differentiate between tobacco and nicotine, and between combustibles and noncombustibles, has caused the spread of misinformation among the government and nongovernment organizations it influences. “If you read WHO documentation … on the one hand, nicotine is part of the WHO list of essential medicines. Nicotine as part of nicotine-replacement therapy as prescribed by physicians and health professionals for smoking cessation,” said Human. “And on the other hand, there’s an all-out war on nicotine. What has happened over the years, over the last 50 years, is that the so-called war on tobacco has changed into the war on nicotine.”

    Human also noted that there is a serious amount of misperception surrounding nicotine among physicians and consumers. He mentioned a recent study from the Foundation for a Smoke-Free World that found that on average, nearly 77 percent of doctors mistakenly believe nicotine causes lung cancer, and 78 percent believe it causes atherosclerosis. While on average 87 percent of doctors at least moderately agree that helping patients quit smoking is a priority, lack of training and nicotine knowledge adversely impacts quitting and harm reduction advice, according to the study.

    “It found that 58 percent of those respondents thought that [nicotine] caused cardiovascular or heart disease, which again shows you that the level of misconception is not only dangerous—it’s sick …. It’s 2023 and so simple of a situation, but suddenly physicians have a complete misconception of what nicotine is,” he said. “In our own study in five countries, we [found that among] GPs [general practitioners], there was a persistent belief that nicotine is the most awful aspect of smoking. Nicotine causes cancer, and nicotine causes heart and lung disease.”

    Human pointed out the positive outcomes of correcting misconceptions about nicotine, including improved health for smokers and lower smoking rates. He proposed that medical professionals should receive new training on the effects of nicotine and the advantages of tobacco harm reduction. Human said that companies should also refrain from marketing to youth and keep up with the research and development of new reduced-harm products.

    “In terms of physicians, what can they do for misperceptions to be corrected? No. 1, training needs to be updated to the 21st century. Doctors need to know that nicotine does not cause cancer. It’s a crime for doctors to think that nicotine causes cancer or heart disease or lung disease in a way that they perceive it now, so correct the training,” he said. “No. 2, make sure that doctors understand what harm reduction is. Harm reduction is really part of everyday medical life. That’s what we do in medical practice. You’re trying to reduce the harm.”

    Hiroya Kumamaru, a cardiovascular surgeon and vice director of AOI International Hospital in Japan, said that in his country, there is also a wide misperception among physicians that nicotine is harmful. He argued that the industry needs to think about how best to educate regulators on understanding the effects of nicotine and the risks of different delivery systems. “Many, many … GPs are thinking that nicotine is quite harmful itself [in Japan], and we have to educate them somehow. Thinking about how we can [address] this issue, I tried to have a small meeting in the Swedish embassy about four years ago to educate not only physicians but also media and governmental officers to understand the concept of harm reduction in tobacco, in smoking,” explained Kumamaru. “But it was still difficult because some of the physicians, even [ones that] were working in a university hospital or working in the Ministry of Health, were saying that smoking is a sin …. They didn’t care about the difference [between] vapor and cigarette smoking. Because they say nicotine drug dependency is a very bad agent. We have to think once more to educate these people to understand.”

    Kumamaru said Japan has seen a historic decline in the number of combustible smokers because of the rise of heated-tobacco products. He said more than half of the combustible market has disappeared in just a few years. He also agreed that the industry could accomplish more if more were done to battle misinformation.

    “We’re still stuck with this problem of it. People and regulators can only make as good a decision as the information available to them allows us. And people believe that using nicotine is about sin rather than about health. If people don’t understand that [combustible cigarettes, not] nicotine causes cancer, what can you do? …. Millions of Americans who are able to move between the [various harm reduction] products never had the information that one product is very likely to kill you and [that] the alternative product is massively less hazardous.”

    Mohamadi Sarkar, a fellow of scientific strategy and analysis and regulatory affairs at Altria Client Services, told attendees that the science on nicotine is not new. He said that even though many mistakenly believe that vaping is just as dangerous or even more so than smoking combustible cigarettes, there is a plethora of evidence to show that vaping contains fewer harmful chemicals than cigarette smoke.

    “We often hear that ‘Well, these products have not been on the market long enough, so there is no long-term epidemiology.’ We don’t need it. What we do know is that cigarettes have 70,000 chemicals. Seventy of them are carcinogens and linear, cardiovascular and respiratory toxins,” he explained. “On the other hand, smoke-free products like e-vapor or [heated-tobacco products] are nicotine-positive and have far fewer chemicals.”

    In the end, all the speakers agreed that the industry could do more to battle the misinformation surrounding reduced-risk products. The vaping industry needs a unified voice. “We need unified goals for all the stakeholders to communicate …. We know that education works. Education has changed perceptions,” said Sarkar. “We need immediate action.”

  • Keynote: Hiroya Kumamaru,

    Keynote: Hiroya Kumamaru,

    Hiroya Kumamaru, vice director at Japan’s AOI Universal Hospital, gave a 15-minute overview of the current status of harm reduction in Japan.

    Quoting 2019 figures, Kumamaru said that, as in many other countries, smoking is the biggest cause of death in Japan, though high blood pressure is not far behind and is catching up, probably because of the aging of Japanese society.

    On top of this, he put forward the economic argument for reducing smoking, which, he said, while having a positive annual impact on the economy of ¥2.8 trillion ($18.76 billion), mainly through taxation, had a negative impact of ¥4.3 trillion mainly due to loss of labor because of smoking-related diseases, the medical costs associated with smokers and passive smokers, cleanups and fire-related expenses.

    Kumamaru told how, about 15 years ago, he had started working in a small clinic in the center of Tokyo, where he became involved in a national smoking cessation program that was based on a three-month-long series of five visits by smokers to doctors. Although a lot of effort was put into the program, and nearly 60 percent of the participants at his clinic went on to complete the five outpatient visits, nine months after the end of the program, nearly half of those who had appeared to have quit started smoking again, a result he described as “disappointing.”

    He then compared this with what had happened after the start of sales of heated-tobacco products (HTPs) from 2016. By 2019, almost one-third of male and one quarter of female tobacco consumers were using HTPs, a result that he described as “amazing.” As a result, total cigarette and HTP consumption was heading down while HTP consumption was increasing.

    In part, his amazement sprang from the fact that while this was happening in Japan, it appeared not to be happening at the same level elsewhere, and he didn’t know why this was the case. For example, Japan’s smoking rate was decreasing at a faster rate than that of Australia, which had introduced very strict smoking restrictions but banned the sales of HTPs.

    Notwithstanding Japan’s success with lowering smoking rates, many people in Japan remained skeptical about HTPs and raised issues about the unintended use of these products: dual usage, initiation, relapse and what is called in Japan the gateway effect of youth initiation. But these turned out not to be significant issues. Kumamaru said about 20 percent of smokers use HTPs and cigarettes, which is not that many. And initiation or re-initiation has been at a very low level, with two years of surveys recording a 2 percent factor in the first year and 1.3 percent in the second. In particular, youth initiation is low, and there has been no increase in initiation among younger people due to the launch of HTPs.

    Kumamaru said that interesting data from Italy, Korea and Japan pointed to the fact that consumers of HTPs have better outcomes than smokers in respect of chronic obstructive pulmonary disease and cardiovascular disease while the exposure to carcinogens associated with HTP use is just 3 percent of that of smoking.

    He ended his presentation by saying that Japan could look forward to a better future because of HTPs, though it is necessary to keep carrying out surveys and probably starting a long-term clinical study.  

  • Fireside Chat: Robert Pye, Luis Sanches and Chris Greer

    Fireside Chat: Robert Pye, Luis Sanches and Chris Greer

    The Fireside Chat with Robert Pye, CEO of Filtrona, Luis Sanches, chief strategy officer at Greenbutts, and Chris Greer, president and CEO of TMA, offered insights into the environmental, social and governance (ESG) framework.

    The chat started with a discussion of each company and what it does within the larger industry—Filtrona and Greenbutts are both in the filters aspect of the industry in different manners. Filtrona is a traditional and specialty filter supplier while Greenbutts is a material science company that has been working to introduce a more sustainable alternative to traditional cellulose acetate filters. While Filtrona has been in the industry for 80 years, Greenbutts is relatively new at 13—“a startup of sorts,” in the words of Greer.

    Greer noted that Filtrona has many locations in Asia, with the headquarters being in Singapore, and brought up the idea of the 21st century being “the Asian century.”

    “What attracted you to Singapore, first, and for your part of the industry, what are some key takeaways that you can give us about Asia and the marketplace and where that fits in, in the change and transformation part of things?” Greer asked Pye.

    “I think Asia is, as you mentioned, a very dynamic place,” Pye said. “Our global head office is based in Singapore. We’re happily ensconced there because, I think if you think about our 2,000 employees, probably in Asia, we have maybe 1,500 of those 2,000 employees based in Asia. So it just makes sense to be in Singapore. And also our largest part of revenue and profits are based in Asia as well.

    “So it just made sense for us to really base ourselves in Asia and really base our footprint around Asia. And the reason for being based around Asia is really that we see this being the most dynamic part of the industry for our industry as well. We see a lot of companies coming to Asia. Indonesia has had probably a lot of expansion over the last few years. That market’s still very interesting. Of course, I mentioned the China market, but India’s still interesting. And then you’ve got all the Southeast Asian countries, and they’re all very different, right? Whether they’re regulations or whether they’re cultural aspects or even tobacco-related industries within that country.”

    Pye also expressed that Asia is willing to advance “whether it’s technology or whether it’s a market or whether it’s embracing something new.” He said countries “probably less developed than some other Western countries usually tend to leapfrog in a lot of areas of technology.”

    Turning to Sanches, Greer said, “You’re in material science, you’re blazing your trail. What’s the biggest change that you’ve had to make in your thinking?” Sanches joined Greenbutts from BAT, a large company with lots of resources.

    “It’s an interesting consideration,” Sanches said. “Because I think for a gearbox perspective, every company, regardless of its size, it needs the core to be properly functioned. For instance, you need to define your goals. … And regardless if you’re in startup, the organization needs to have this very well defined. Then you set up a strategy, and the strategy has to be the way you want to deliver those goals. And then you move to metrics, and then you move to engagement, primarily to whom you need to partner with and which organizations you need to be very close [with], the shareholders you need to bring to your organization, the stakeholders that get affected or being affected by you.

    “So I think, in a sense, we share the same values. I think we share the same structure. … I think the biggest differences will be the size of the pocket for sure. Being part of a startup, funds and resources are not always there. So it’s more limited in terms of resources and talent footprint that Robert just mentioned. I think the other aspect is big organizations; they have very good governances. They sometimes, and most of them, they’re very bureaucratic. And the politics inside organizations drive you crazy and slow you down in every decision you need to make,” Sanches said. He noted that a big advantage to being a startup is flexibility.

    Greer noted that ESG sometimes gets a “bad rap” as a buzzword and, in the spirit of changing the conversation, asked Pye and Sanches to talk about the real work behind ESG. “We see it in our business as being very important,” said Pye. “We want to be part of the solution. We see it makes great business sense, and we also see it makes great moral sense. You have a morality to it that you can flag and engage with your employees and your customers.”

    “We are the largest producer of sustainable filters globally,” Pye continued. “I can sit on the stage and say that quite confidently. We work with all of the major suppliers in that area. We work with all the latest think tanks in that area, such as Greenbutts. But we also work with all the large customers and some small customers as well.

    “We are a zero waste to landfill business. Any waste we generate, we use it to generate steam for our products.” Pye also noted that one of Filtrona’s sites has zero emissions and that the company uses solar panels on many of its sites as well.

    Sanches added to that, noting that he made it clear in his early days with Greenbutts that the company could not “be seen as disruptors because disruption implies chaos” and the tobacco industry is a very efficient machine, so the company should focus on helping the industry transform itself without disrupting it.

    “When we establish this as a premise in our ways of working, we say we need to ensure that the entire value chain is covered. We’re going to do the pre-work, ensure that we have all the sources of the material that you utilize well set up in a proper geography. The converters which convert fibers into substrate are well set up as well in a global scale. … Therefore, when the tobacco industry decides to adopt this or the biodegradable filters as their future solution today, we are all set up. So, not chaotic, not disruptive, but in a very gentle and very smooth way that we can introduce this.”

    According to Sanches, Greenbutts aims to have the value chain covered so that companies can focus on other aspects. “We can help them in delivering their ESG targets,” he said.

    The fireside chat highlighted what ESG looks like with tangible products and outcomes and pivoted the conversation away from targets toward real results.  

     

     

  • Panel: Putting Consumers First

    Panel: Putting Consumers First

    Toward the end of the Putting Consumers First panel held during September’s Global Tobacco and Nicotine Forum in Seoul, South Korea, Matt Drodge, research director at Walnut Unlimited, made the point that while nicotine consumers were all different, they all wanted to be able to make informed decisions about whether to continue smoking combustible cigarettes or when and how to make the transition to new nicotine products.

    Of course, nicotine users can make such transitions only in countries where regulations allow them to do so, and the moderator of the panel, Nancy Loucas, public health policy expert and executive coordinator of the Coalition of Asia Pacific Harm Reduction Advocates (CAPHRA), made the point that the panelists represented countries forming a continuum of nicotine regulation.

    Panelist Samrat Chowdhery, former president of the International Network of Nicotine Consumer Organisations, told participants that he felt unhappy about representing India, a country that had put consumers last by effectively banning vapes. Chowdhery said this is a pity because India does not have a strong or widely used public health network, so prevention, including through the use of safer alternatives, is vital, as it is in other parts of the developing world where 80 percent of tobacco users live.

    Fiona Patten, leader of the Reason Party and former member of the Legislative Council of Victoria, who was unable to attend the GTNF in person and instead recorded a video message, apologized for representing Australia, a country that she said is leading the way on what not to do around tobacco harm reduction. Patten said that Australia’s “so-called medical model” of regulation is so onerous that 99 percent of Australians who are looking for a safer way to consume nicotine are being forced onto the black market.

    Alex Clark, CEO of the Consumer Advocates for Smoke-Free Alternatives Association, who also did not attend the event, but appeared via a live link, said the premarket tobacco product application (PMTA) system in the U.S. appears to consumers to be acting as a very tight bottleneck on the products they have access to; no flavored products have been authorized through the system, only variations of tobacco. Beyond the PMTA system, there was also concern that a methodical state-by-state, municipality-by-municipality effort to severely restrict the availability of lower risk products would continue. Clark said that while he hopes that in the future people will be able to find products they can trust, he questioned why there has to be a delay. What is needed now is to disseminate the idea that nicotine users are not just data on a spreadsheet and to get that message out, elevating it up the chain to the regulator.

    Clarisse Yvette Virgino, a Philippines-based member of the CAPHRA, had a more positive tale to tell because a “wild journey” that had seemingly been headed toward prohibition had ended with regulation. The regulations were somewhat burdensome, however. Retailers had a lot of rules to comply with, and there was a problem when it came to consumer choice because manufacturers had withdrawn certain products, such as juices, rather than go through the process of complying with what were stringent requirements.

  • Panel: Reinforcing Scientific Research

    Panel: Reinforcing Scientific Research

    During the Reinforcing Scientific Research panel held as part of September’s Global Tobacco and Nicotine Forum in Seoul, South Korea, New Zealand-based Marewa Glover, director of the Center of Research Excellence on Indigenous Sovereignty and Smoking, made the point that the forum had heard many times how there is a need for tobacco and nicotine policies to be grounded in science and, therefore, evidence-based. There is, in fact, no disagreement on this point between tobacco control officials and tobacco harm reduction (THR) advocates, she said. However, care needs to be exercised because a form of evidence has been appropriated by some opposed to THR, and they are driving a broad social change agenda aimed at instituting a utopia where, for instance, no one would ever use drugs. They used scientific platforms loaded with people who shared their views to spread their ideology. They redefined the meanings of words so that unproven assertions became facts and facts became lies. To combat such views, she added, it is necessary for THR advocates to produce demonstrably robust research as part of a project that includes a communication strategy identifying stakeholders and how the information is to be gotten to them.

    Glover had been asked three questions by moderator, Mark Littlewood, director general of the Institute of Economic Affairs: What needed to be done to reinforce scientific research into tobacco and nicotine?; who should form the audience for the research findings?; and how should the findings of junk science be challenged?—questions he also posed to the rest of the panel.

    Kai-Jen Chuang, professor in the Department of Public Health at Taipei Medical University, explained that THR is not taught as part of medical degrees in Taiwan and therefore is not a well-recognized term, even though harm reduction principles are engaged in other areas. In fact, vapes were banned in Taiwan on March 22 this year. What is taught is health promotion and, more latterly as part of social-work courses, disaster reduction. He pointed out, nevertheless, that health promotion, disaster reduction and THR have similar goals, so those from outside Taiwan wishing to engage at conferences with public health officials over THR principles should present their papers, translated into Chinese, as health promotion studies. Nevertheless, he warned that it would be difficult, because of their training, to convince public health people of all stripes of the efficacy of using new technology to reduce the harm caused by smoking. The starting point for getting across messages about THR, he added, should be scholars with open minds, and from there, the focus could move to journalists and politicians.

    Riccardo Polosa, professor of internal medicine at the University of Catania and founder of the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), said there is a need to reinforce quality science that has good repeatability. Repeatability, he added, is currently in crisis and not just in respect of tobacco control science, so the CoEHAR has established a comprehensive repeatability program pertaining to research into toxicity and biology in respect of combustion-free, nicotine-containing products. The program involves setting up and researching in seven laboratories with the same equipment and the same procedures to come up with super strong findings. Another thing that is needed, Polosa said, is to shift the focus from risk to harm. Relative risk has been studied for a decade now, and it is an easy win if combustible products are compared with combustible-free products. So now is the time to look at the absolute risk and show that it is low and that the level of harm is super low. This would provide a better position from which to convince governments, regulators and the public. Polosa had some good news on junk science, which he said is easy to debunk because it is junk, though this takes energy and time and requires a willingness to do it. A global network of scientists is actively rebutting junk science articles, though the challenge now is to speed up this process of rebuttal.

    Picking up on an earlier comment about uncertainty, Konstantinos Farsalinos, research fellow at the Onassis Cardiac Surgery Center, made the point that uncertainty is inherent in science and essential to human progress. There is nothing wrong with uncertainty provided that it is not used to maintain the status quo, especially where the status quo has failed miserably. It is important, also, that uncertainties are not used as the basis for decision-making, which needs to be based on current knowledge. But one problem being faced today is that current knowledge is not being used to make decisions [about THR]; rather, decisions are being made on the back of the abuse of uncertainties [that the long-term use of THR strategies are unknowable at this stage]. Revisiting the 1986 Ottawa Charter for Health Promotion by the World Health Organization, Farsalinos said, it is obvious that it was basically talking about harm reduction in our everyday lives. Everything, even medicine itself, was a harm reduction science because it was not possible, probably, to cure any disease besides certain infections. We were treating diseases and reducing the adverse effects and consequences of diseases. This was all known. What is needed now is the reinforcement of the applicability of scientific data, of which there is a lot, on decision-making, something that has not happened in many parts of the world. Finally, Farsalinos said that he has had bad experiences in rebutting junk science even though he has been successful. Basically, he had run into a wall behind which people had decided what they believed and were casting around for the data to support their predetermined views. With science, you have to do the opposite of that, he said.

  • Keynote: Julian Cheung

    Keynote: Julian Cheung

    The 2023 GTNF conference theme of “Change the Conversation. Change the Outcome.” was reiterated by keynote speaker Julian Cheung, anti-illicit trade operations director for Japan Tobacco International’s Asia-Pacific region. Cheung spoke on changing the conversations about illegal trade.

    Before working with JTI, Cheung worked for the Independent Commission Against Corruption in Hong Kong, bringing much experience to the subject of anti-illicit trade.

    She noted that there are many aspects to anti-illicit trade operations, including investigations, collecting evidence and looking at the forensics of samples. JTI works closely with law enforcement agencies to stop illicit trade, according to Cheung.

    Behind the contraband, Cheung said, is often organized crime, which takes advantage of shifts in supply and demand and sees tobacco as a “high-profit, low-risk” market.

    The illicit tobacco trade “impacts us all,” she said. Many jurisdictions have attempted to limit tobacco product usage and illicit trade through increased excise taxes, which has only led to more illicit trade—back to supply and demand; the demand is high, and if organized crime can offer supply at lower prices, they will profit rather than the licit industry. Online commerce, too, has made it easier for illicit products to flood the market. Consumers do not have an easy way to determine whether the products they order online are illicit or legal, regulated products. Online sales increased during the Covid-19 pandemic as many “nonessential” businesses closed either temporarily or permanently.

    Cheung expressed a need for greater cooperation between governments, industry and law enforcement agencies at national and international levels to help combat illicit trade. The tobacco industry has a role to play, she said. Policies should be better balanced with deterrents that disrupt the financial gain of criminal networks.

    “Let’s switch the narrative on illegal trade and act together,” Cheung said. “Through innovative strategies, cooperations and a focus on disrupting the financial foundation of these criminal networks, we can curtail the illegal trade and safeguard our communities and economies.”

  • Keynote: Brian King

    Keynote: Brian King

    When Brian King speaks, people come to listen. The U.S. Food and Drug Administration’s Center for Tobacco Products (CTP) director’s keynote address was easily the best attended session of GTNF 2023. King’s speech served as an overview of the current state of the CTP and an outline of the center’s main priorities over the next few years.

    King said that the CTP has made considerable progress in reducing combustible cigarette smoking in the United States, which he contends as one of the most remarkable public health achievements of the past century. He hopes that those declines continue, given that “we do know” that combustible smoking is responsible for the overwhelming burden of death from using combustible tobacco.

    Tobacco use continues to cost the U.S. government a considerable amount of money—to the tune of $600 billion per year from both direct healthcare costs and lost productivity, according to King. He said there are important human health benefits as well as financial benefits for regulators to continue to focus on reducing combustible use in the United States. As a part of this focus, he said, the CTP is continuing to make inroads when it comes to premarket tobacco production application review.

    “We have a new director of our Office of Science who has jumped in headfirst to continue to fiercely lead our 550-plus scientists on application review …. We have processed 99 percent of those and continue to finalize the remaining 1 percent. I’m hopeful that in the coming months and years, we will get back to what was intended to be a premarket approval process,” said King. “In the meantime, we have authorized 23 e-cigarettes, all tobacco flavored. So, it is possible. We have had successful authorizations. But again, I can’t reinforce enough the importance of providing that sound and robust science to inform on potential authorization.

    “And it is possible, as you can see. There will be more authorizations in the future, but it’s important that we have that science to support those decisions. As I noted earlier, we also continue to fold in the nontobacco nicotine work into our broader portfolio around regulation. We did receive a million applications, which I don’t think anyone anticipated. I will say that we are making great numbers. We are 99.9 percent through with the review of those. I will say that 100 percent is very imminent.”

    King said that when it comes to products that are illegally on the market (having received a marketing authorization and are not currently under review by the CTP), the CTP is mindful of the importance in exercising all authorities that it has to ensure that people are complying with the law. He said that the FDA has given retailers the information they need to comply with the law through a list of authorized products (the 23 products that have been authorized for sale). The CTP also continues to ramp up efforts in terms of training, education and outreach across the supply chain, particularly to retailers.

    “We also continue to do surveillance inspection investigations. This is something that occurs on a daily basis. We have arrangements with all 50 states and territories to continue to do investigations. We have issued many warning letters for flavored disposable e-cigarettes, which we know are particularly popular for youth,” said King. “There’s been a variety of blitzes that have occurred monthly throughout the summer. I will say there are more to come. We are going to continue to conduct those blitzes and making sure that we are routinely monitoring, particularly with a focus on those products that we know have high youth appeal.

    “On balance, we are also continuing to do work around issuing import alerts. I was a little tickled by all the attention that the import alert on Elf Bar got. That’s nothing new, folks. We’ve been doing that for many years. It was suggested it was something seismographic, but we’ve been doing import alerts for quite some time. And we do use those as, again, another tool in our toolkit to make sure that we are addressing not only the products that are already in the country but preventing illegal products from entering the country.”

    As of Sept. 31, the FDA has issued over 1,200 warning letters for online investigations. For manufacturers, the CTP has sent more than 800 warning letters, with more than 750 letters for e-cigarettes. Beginning earlier this year, the FDA also issued the first civil money penalties against manufacturers for violations for illegal e-cigarette sales. He said civil money penalties will remain a part of the CTP’s tools to combat illicit sales.

    “We also issued the first six injunctions in coordination with the Department of Justice. I got a lot of flak for that as well about enlisting the Department of Justice. And I will remind folks that the FDA doesn’t have an independent litigation authority. If folks do not comply with the law, we will escalate further, as has been evidenced by these actions, which again are going to be part of our broader portfolio moving forward,” said King. “Everyone is going to be held accountable across the supply chain. We do want to make sure that we address the bad actors in a meaningful way. We also continue to pursue no tobacco sale orders among retailers as well. This has traditionally been issued for underage sales. But again, we’re committed to using the full scope of our authorities granted through Congress.”

    King added that education is also a priority for the CTP. The center is ramping up efforts to address misinformation in the continuum of risk for nicotine products. He mentioned that he recently wrote a commentary where he highlighted the importance of opportunities and considerations for addressing misperceptions in nicotine. “There is science that exists in that there are misperceptions around the continuum of risk and also nicotine. And so, we do have opportunities that are present, but we have to follow the data-driven pandemic-based approach,” he explained. “That said, I’m putting my money where my mouth is …. We’re working with the National Institutes of Health for a funding opportunity to get more data on public health communication messaging about the continuum of risk.

    “And as noted in that funding announcement, we’re looking for data both for the target population, which is called smokers, but also unintended populations, particularly youth. This is several million dollars on an annual basis, and we look forward to that kickstarting and getting data to inform our work.”

    King said the CTP will also continue to gather input from the industry and the public. The CTP is creating a new office within the Office of the Center Director and is looking to hire a new director for Policy and Partnerships. “That posting is public,” he said. “And I’m looking forward to seeing those who have applied and getting someone in that seat to meaningfully oversee the product regulation portfolio across the center, particularly as we get that strategic plan in place.”

    During the closing of his address, King said that he continues to be big on communication and stakeholder engagement. He expects to provide the industry with more opportunities for communication with the CTP. “I know that you’ll see in the future an evolution of our messaging. Both through our press releases, our social media and our [overall] messaging to make sure that we are clearer, simpler and more digestible,” he said. “I’ve been a bureaucrat for many years, but that doesn’t mean that I can’t communicate effectively with the general public. I think we can do better. I know we can do better.”

  • Tradition and Technology: Indonesia

    Tradition and Technology: Indonesia

    Photo: Ink Drop

    In the tobacco industry, Indonesia is best known for its rich variety of leaf tobaccos, its characteristic clove cigarettes and its relative tolerance for smoking; the Southeast Asian nation is one of the few countries that has neither signed nor become a party to the Framework Convention on Tobacco Control.

    While those characteristics still hold true, they are increasingly only part of the story, as Indonesia now also manufactures some cutting-edge new nicotine products. Attracted by the country’s rapidly growing economy, young workforce and business-friendly policies, investors have been setting up shop here to supply not only the large domestic market but also other countries in the region.

    For example, in January 2023, Philip Morris International inaugurated a factory for the production of IQOS HEETS consumables in Karawang, West Java. Leading atomization companies such as Smoore, have built production facilities, as well. And in September 2023, KT&G announced the construction of a second factory in Indonesia, which in addition to traditional cigarettes is slated to produce heat-not-burn products.

    The combination of heritage and forward-thinking makes Indonesia a market to watch.

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