Tag: Knowledge-Action-Change

Survey Details Advocacy for Safer Nicotine

Image: Andrii Yalanskyi | Adobe Stock
Knowledge-Action-Change (KAC) has released a global survey investigating the role and activities of consumer organizations advocating for access to safer nicotine products (SNPs) and tobacco harm reduction.
Carried out by KAC’s Global State of Tobacco Harm Reduction project, the research was published in Public Health Challenges.
It reveals that there are 54 active consumer advocacy groups working around the world to raise awareness about, and promote the availability of and access to, SNPs, which include nicotine vaping products (e-cigarettes), Swedish-style snus, nicotine pouches and heated-tobacco products.
The authors of the survey found that the vast majority of organizations (42) were operated entirely by volunteers, most of whom had successfully quit smoking with the help of SNPs.
Only seven of the groups had any contracted or paid staff (13 people globally), and for the last full year, the total funding for all organizations surveyed amounted to $309,810. This is in stark contrast to the millions of dollars spent on campaigns by actors, such as Bloomberg Philanthropies, seeking to limit access to SNPs, such as nicotine vaping products. The paper also notes that none of the consumer advocacy organizations reported receiving funding from tobacco or pharmaceutical companies.

This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate.
Gerry Stimson, director, KAC
Many of these organizations are members of four regional umbrella organizations covering Latin America (ARDT Iberoamerica), Africa (CASA), Europe (ETHRA) and Asia-Pacific (CAPHRA).
“This survey offered a unique opportunity to map these advocacy organizations for the first time and provide valuable insight into how they are operating all over the world,” said Tomasz Jerzynski, lead author and data scientist for the Global State of Tobacco Harm Reduction project. “The sustainability of these organizations is one of the main concerns that has come out of the data. All of these groups face challenges due to their small numbers of core workers and their dependence on volunteers.”
“This paper starkly demonstrates the major imbalance in resources available to consumer organizations advocating for access to safer nicotine products and those opposed to tobacco harm reduction, unfairly skewing the debate,” said Gerry Stimson, report author, director of KAC and emeritus professor at Imperial College London. “It also highlights why consumer groups must be recognized as legitimate stakeholders in the policy sphere.”
February 1, 2023
KAC: Seize Potential of Safer Nicotine

Photo: Sved Oliver
Knowledge-Action-Change (KAC) has published The Global State of Tobacco Harm Reduction 2022: The Right Side of History. The Global State of Tobacco Harm Reduction (GSTHR) publication charts the history of tobacco harm reduction and considers the future of a strategy that can hasten the end of smoking and drastically reduce smoking-related death and disease worldwide.
According to the report’s authors, the emergence of new safer nicotine products has caused substantial disruption to nicotine use, public health and tobacco control institutions and the traditional tobacco industry. However, mistrust and ideological opposition is hampering widespread adoption of a strategy that could help 1.1 billion adult smokers failed by existing tobacco control interventions.
“Technology helped smoking become one of the world’s biggest health problems,” said Harry Shapiro, author of The Right Side of History, in a statement. “Now, technological innovations from beyond both the tobacco industry and public health have combined to produce safer nicotine products, and millions of people who smoked have already chosen to switch. Yet progress is being hampered. Although disruption is not always comfortable, the genie is out of the bottle—these new technologies demand the development of new policies and new thinking.”

“A failure to recognize and exploit the potential of tobacco harm reduction will mean millions more avoidable deaths each year.”
Gerry Stimson, project lead, GSTHR
“A failure to recognize and exploit the potential of tobacco harm reduction will mean millions more avoidable deaths each year and contribute to an ever-growing burden of disease that disproportionately affects the most vulnerable countries and communities,” said Gerry Stimson, GSTHR project lead and emeritus professor at Imperial College London.
“Tobacco control’s lack of evolution, despite its very limited gains, means that many aspirational targets to achieve smoke-free status by 2030 or within the next generation are no more likely to be met than former aspirations for a drug-free world. Tobacco harm reduction offers us an historic opportunity. We must not let it slip away.”
The Right Side of History is the third in the biennial series of GSTHR reports, following No Fire, No Smoke in 2018 and Burning Issues in 2020. A summary of the most recent report is here. The GSTHR project is produced with the help of a grant from the Foundation for a Smoke-Free World.
November 16, 2022
KAC Solicits Scholarship Applications
Knowledge-Action-Change (KAC), with the support of a grant from the Foundation for a Smoke-Free World, is looking for the sixth cohort of scholars for its Tobacco Harm Reduction Scholarship Program (THRSP).
The application period closes on Nov. 30. Successful candidates will receive a 12-month bespoke mentoring program to undertake a THR-related project of their own design plus $10,000 in financial support. On completion of the scholarship, graduates of the THRSP potentially have access to up to a further three years of funded support from KAC.
The THRSP was launched to increase research and practice capacity in tobacco harm reduction in target locations and populations where current activities and resources are limited. The THRSP has a particular focus on low-income and middle-income countries (LMICs), where the need for new approaches to tobacco-related harms are especially acute. It aims to introduce new thinkers, new ideas and new methods to tobacco harm reduction as well as increasing the use of social media and new technologies to disseminate accurate information about the potential for safer nicotine products to reduce the global number of smoking-related deaths, which currently total 8 million every year.
The THRSP achieves its goals in a number of ways. Applicants to the program must devise a project that will improve understanding of, or communication about, tobacco harm reduction appropriate for their country, region or personal area of expertise. Current and former scholars have published original research in peer-reviewed scientific journals, created national and international tobacco harm reduction networks, developed toolkits for smoking cessation or healthcare practitioners, and produced new media resources ranging from articles and films to radio shows and podcasts.
“The impact of the program to date has been immense,” said THRSP manager Jon Derricott. “It has helped to shape and challenge thinking, practice and policy in many areas of the world, particularly in LMICs. The biggest influence is yet to come to full fruition, but this will be a growing cohort of well-informed and highly capable THR professionals who will continue to speak up for the benefits of THR and robustly challenge misinformation wherever it occurs. This really matters because at the root of all this is people’s right to a healthy life, even if they continue to use nicotine. THR enables that goal to be an attainable reality.”
“Being part of the THRSP as a scholar, a mentor and then becoming the THR scholarship manager has been a life-changing journey,” said Chimwemwe Ngoma, a graduate of the program from Malawi. “The THRSP has opened new and exciting doors for me, and I am confident that many people have also benefited through what I have been able to offer. This has been the biggest opportunity for me to give back to the community and impact lives.”
For more information about the program, visit https://thrsp.net.
November 4, 2022
Sub-Saharan Africa Urged to Embrace THR

Photo: Pcess609
With more than 200,000 smoking-related deaths each year in sub-Saharan Africa, there is an urgent need for the region to embrace tobacco harm reduction, according to a new briefing paper published by Knowledge Action Change (KAC).
KAC argues that tobacco harm reduction could generate significant public health gains for the countries in sub-Saharan Africa and is particularly crucial at a time when the number of tobacco users across the continent as a whole is set to increase to 62 million by 2025.
“Many people either cannot or do not want to quit nicotine use, but smoking is deadly,” KAC wrote in a press note. “Tobacco harm reduction offers smokers the choice to switch from combustible cigarettes to safer nicotine products that pose fewer health risks, including nicotine vapes (e-cigarettes), tobacco-free nicotine pouches, Swedish-style snus (an oral tobacco) and heated-tobacco products.”
Authored by THR Malawi founder Chimwemwe Ngoma, Tobacco Harm Reduction in Sub-Saharan Africa investigates the current status of tobacco harm reduction in the 48 countries of sub-Saharan Africa.
As well as considering the economic role of tobacco in the region, the paper provides a country-by-country guide on the availability and legal status of safer nicotine products. It notes progress is being made with tobacco harm reduction across sub-Saharan Africa, highlighting the work of consumer advocacy groups offering tobacco users accurate information about combustible cigarettes and safer nicotine products.
However, the availability and accessibility of products such as nicotine vapes remains poor in many countries while appropriate regulation is needed for product safety. Many smokers cannot access smoking cessation support. Some governments are unable to meet basic requirements for a robust healthcare system, and there is a lack of funding to prevent the noncommunicable diseases linked to smoking.
There is also widespread and deliberate misinformation circulating about safer nicotine products, and many consumers, healthcare institutions and governments in sub-Saharan Africa remain unaware of tobacco harm reduction’s potential.
“To become smoke-free, sub-Saharan Africa needs safer nicotine products that are locally feasible, affordable, appropriate, accessible and culturally acceptable, supported by sensible product regulation,” says Chimwemwe. “For this to happen, governments in Africa should strive to remain independent, conduct their own social economic impact assessments and make science-based policies that embrace tobacco harm reduction.”
The new briefing paper is part of KAC’s Global State of Tobacco Harm Reduction project, funded by a grant from the Foundation for a Smoke-Free World.

September 16, 2022
New Papers On Tobacco Harm Reduction

Gerry Stimson (Photo: KAC)
Knowledge Action Change (KAC) has launched the latest in a series of briefing papers as part of its Global State of Tobacco Harm Reduction project. Titled What is Tobacco Harm Reduction?, the publication provides a detailed introduction to the principles, history and evidence for this vital public health strategy.
For the 1.1 billion people across the world who smoke combustible cigarettes, tobacco harm reduction is a potentially life-saving approach. Like other forms of harm reduction, it recognizes that simply quitting isn’t possible for all smokers. People smoke for the nicotine, but nicotine itself does not cause smoking-related death and disease—it’s the chemicals inhaled in tobacco smoke. Removing combustion reduces the risk. For those people who can’t or don’t want to quit nicotine, tobacco harm reduction offers a chance to switch to safer nicotine products including nicotine vapes, tobacco-free nicotine pouches, Swedish-style snus, many U.S. smokeless tobaccos and heated tobacco products.
Many of these products have only been developed in the past 10-15 years, but they are proving increasingly popular. Research published in March by the GSTHR estimates there were 82 million vapers worldwide in 2021. This represents a 20 percent increase on the figure for 2020 (68 million), meaning safer nicotine products are now being used by 112 million people worldwide. A striking example of tobacco harm reduction’s potential can be found in Scandinavia. Sweden now has the lowest rate of tobacco-related disease in Europe, thanks to Swedish men switching from smoking to snus, and in Norway, 12 percent of women aged 16-24 use snus daily while only 1 percent smoke.
In England, tobacco harm reduction can play a key role in the government’s bold ambition to make the country smoke-free (defined as a prevalence rate of under 5 percent of the population) by 2030, according to KAC. The uptake of vaping has been accompanied by a rapid decline in smoking. Vapes are the most popular way to stop smoking, with 3.6 million people vaping in Great Britain, of whom 2.4 million have completely quit combustible cigarettes. But tobacco is still the single largest cause of preventable mortality in England with nearly 75,000 smokers dying from smoking in 2019 and figures show nearly one in 10 pregnant women are smoking at the time of delivery.

An end to smoking is possible—but the widest range of harm reduction products, from nicotine vapes and heated tobacco products to non-tobacco nicotine pouches and Swedish-style snus, should be available, accessible, appropriate and affordable to all.
Gerry Stimson, director, KAC
Continuing to drive down smoking rates is crucial if the U.K. government is to tackle the health disparities caused by smoking that currently see a disproportionate burden falling on the most disadvantaged families and communities. Smoking rates vary significantly across the country—for example in Blackpool about one in five people smoke (19.8 percent), compared to about one in 20 in Richmond upon Thames (6 percent). Rates are also very high among people who experience drug and alcohol problems (56 percent of those entering treatment smoke), people who are homeless (of whom 77 percent in England smoke) and people who live with mental health problems (of whom 26.8 percent in England smoke).
But adopting tobacco harm reduction will not just help the U.K. counter the impacts of smoking, according to KAC. It has huge potential as a global public health solution. Smoking is responsible for 7.7 million deaths a year and current tobacco control measures are failing to reduce the death and disease caused by smoking fast enough.
Translated into Spanish, Russian, Mandarin, French, Portuguese, Indonesian, Swahili, Japanese, German, Polish, Hindi and Arabic, this GSTHR briefing paper is intended to start conversations in countries across the world where harm reduction has yet to be recognized.
“An end to smoking is possible—but the widest range of harm reduction products, from nicotine vapes and heated tobacco products to non-tobacco nicotine pouches and Swedish-style snus, should be available, accessible, appropriate and affordable to all,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London.
“Strong government support is also needed to ensure access for marginal and vulnerable groups. The gains will be evident in the lives saved and the communities protected. Crucially, tobacco harm reduction is an extremely low cost yet effective strategy—a rare example of a health intervention that doesn’t require significant government expenditure, as consumers bear the cost. An end to smoking is possible—and tobacco harm reduction is the key.”
May 27, 2022
KAC: Number of Vapers up Significantly

Illustration: GSTHR
The number of vapers worldwide increased by 20 percent from 2020 to 2021, according to the latest research by the Global State of Tobacco Harm Reduction (GSTHR), a project from Knowledge Action Change. The organization estimates that there are now 82 million vapers worldwide.
The updated calculation was made possible by the release of a range of new data, including the 2021 Eurobarometer 506 survey, and is revealed in a new GSTHR briefing paper. The figure is based on 49 countries that have produced viable survey results on vaping prevalence.
To address the problem of missing data, the GSTHR used an established method of estimating vaper numbers in countries that currently have no information by assuming a similarity with countries in the same region and economic condition for which data points were available.
This estimate considers three factors—sales regulation status, World Health Organization regions and World Bank income groups—along with the Euromonitor data on vaping product market size from 2015 to 2021.

This [increase in vapers] is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”
Gerry Stimson, director, KAC
“As well as the substantial growth in the number of vapers globally, our research shows there has been rapid uptake of nicotine vaping products in some countries in Europe and in North America,” said Tomasz Jerzynski, data scientist at GSTHR. “This increase is particularly significant, because in most markets, these products have been available for only a decade.”
Indeed, the rise in the number of global vapers comes despite the GSTHR’s database showing nicotine vaping products are banned in 36 countries, including India, Japan, Egypt, Brazil and Turkey.
The new data also shows the U.S. is the largest market for vaping at $10.3 billion, followed by Western Europe ($6.6 billion), Asia-Pacific ($4.4 billion) and Eastern Europe ($1.6 billion).
“As this updated data from the Global State of Tobacco Harm Reduction shows, consumers find nicotine vaping products attractive and are switching to use them in increasing numbers worldwide,” said Gerry Stimson, director of KAC and emeritus professor at Imperial College London. “This is in spite of prohibitive policies in many countries who follow the World Health Organization’s anti-scientific stance against tobacco harm reduction, thanks to Michael Bloomberg’s billions and his personal zeal for a war on nicotine.”

March 9, 2022
Fighting the Last War
A new report by Knowledge-Action-Change urges the World Health Organization to embrace safer nicotine products.
By George Gay
On the face of it, it seems odd that a case has to be made for the promotion of safer nicotine products (SNPs) as part of a global tobacco harm reduction (THR) strategy. But making this case, in large part, is the aim of a report published by the U.K.-based public health agency Knowledge-Action-Change (KAC) and launched at a hybrid event on Oct. 27 in London. And it has to be said that the case needs to be made, as becomes clear toward the end of the report, in a section looking toward the future, where it is stated that it is a “moral imperative” that the World Health Organization and its allies retrench from their current “intransigent and obstructive position of not only refusing to accept any positive health benefits from SNPs but actively campaigning against their use.”
I would agree wholeheartedly with the general sentiment being expressed here, but invoking morality is problematic, I believe. The idea of an overarching morality is not universally accepted because a lot of people believe “morality” resides in the preferences individuals or groups of people have. And, in fact, Harry Shapiro, the author of the report Fighting the Last War: The WHO and International Tobacco Control, seemed to acknowledge this point when, speaking at the launch, he said everybody working in tobacco control was aiming to reduce smoking but that tobacco control split into two broad camps: one comprising those who supported SNPs and THR and the other comprising those who didn’t. This was a good concession to make because having the word “war” in the title of the report seemed to be pointing us back down a road we surely don’t want to travel.
Misguided and Irrational
Having said that, this is a good report aimed at challenging the direction of travel of tobacco control under the auspices of the WHO’s Framework Convention on Tobacco Control (FCTC) ahead of the Conference of the Parties to the FCTC, COP9, which was due to take place virtually on Nov. 8–13 (after this report was written). In doing so, the report seeks to address what must surely be one of the most unsound and unreasoned strategies ever to have arisen within the international health community. Put briefly, it is about the WHO and its allies being not immoral but, more worryingly, misguided and irrational.
According to the WHO, an epidemic of cigarette smoking is currently causing the deaths of 8 million people a year, usually referred to as “premature deaths,” a phrase up there with “pre-ordering” in the list of linguistic curiosities. But while a number of SNP products have been developed that can wean people off tobacco smoking, the most powerful international body charged with protecting the health of people around the world has decided it would be best not to use these products but to apply the old “quit-or-die” patch to the gaping wound. After all, quit-or-die has a long track record whereas the products being offered up are—mention it only in hushed tones—new or newish. The fact that the long track record of quit-or-die is, like the art of bleeding patients, one largely comprising failure seems not to enter the thinking of the WHO and its allies.
But perhaps this isn’t fair. The report makes the point that the number of smokers worldwide has remained at 1.1 billion for the past 20 years, during which time, I understand, the world’s population rose from 6.11 billion to 7.75 billion, so it could be argued that the number of smokers would, without intervention and with all other things having remained equal, have risen to 1.38 billion. So what has occurred might not be failure, I guess, but it is hardly a galloping success.
Of course, it might be said correctly that individuals and states are not bound to follow the WHO’s advice, but it is often the case that they do, perhaps because of the peculiar tendency of humans to create or invent institutions or belief systems and then slavishly accept the advice purportedly coming out of them, no matter how daft, rather than go back and question whether there was a fault in the original idea that gave rise to the institution or belief system.
But I would not recommend going back to question the setting up of the WHO itself, which, to my mind, should be a powerful force in the global fight against transmissible diseases, but to question the WHO’s FCTC, whose provisions are used to steer the direction of travel of the international tobacco control movement.
A Matter of Interpretation
Harry Shapiro
The report does an excellent job of explaining the roles of the WHO, the FCTC, the Conference of the Parties to the FCTC and the FCTC secretariat, the relationship between them and the decision-making processes they employ. This section of the report doesn’t make encouraging reading, however, though it largely defends the FCTC’s provisions and blames the way they are interpreted for the failure to embrace SNPs and THR. It is said that the provisions of the FCTC are no bar to the consideration of scientific advances, new technologies, economic circumstances and the concept of THR. But this is surely no reason to keep heading down the same road hoping things are miraculously going to get better, especially given that the seemingly unaccountable FCTC secretariat is making much of the running, and nation states tend to go with the flow, unlike when they discuss other global issues such as trade. There have been eight FCTC-based COP meetings since the COP first met in 2006, and I cannot help thinking that, given the lack of progress it has made in 15 years of working with the FCTC, the decent thing to do would be to put the COP and the FCTC out of their misery.
One of the problems identified in respect of COP meetings is that they are almost totally exclusive, owing to a particular interpretation of an FCTC provision. And a comparison is made in the report, and was repeated by others at the report launch, of the FCTC COP meetings and those associated with the Framework Convention on Climate Change (FCCC). The tobacco COPs were said to be shrouded in a level of secrecy comparable to U.N. Security Council meetings whereas to be an observer at the FCCC COP, it was necessary only to demonstrate representation of a national or international body and relevant experience. The inference was that if more people were allowed to observe and even take part in the tobacco COP, things would be better.
I hate to spoil the party here, but the comparison is a little out of proportion, to my way of thinking. Tobacco COPs look at consumer choices involving various tobacco and nicotine products whereas the FCCC COPs are about trying to prevent the whole of humankind going belly up. The comparison seems also to gloss over the evidence. As I write this, the FCCC COP, COP26, is about to start and is widely expected to end largely in a PR-burnished failure, with the result that the world will be plunged deeper into the existential crisis it is already in and from which it is unlikely to be able to row back. Having more participants doesn’t seem to guarantee success, at least not on its own, even where the fate of the earth hangs in the balance.

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The Way Forward
So, how could things be arranged to ensure a more beneficial outcome to the problem of tobacco smoking? Well, through the employment of THR, where harm reduction is defined in the report as “a range of pragmatic policies, regulations and actions that either reduce health risks by providing safer forms of products or substances or encourage less risky behaviors with an important role in championing social justice and human rights for people who are often among the most marginalized in society.” One of the most frustrating aspects of the refusal of the WHO and parties to the FCTC to embrace THR is that the WHO employs harm reduction in respect of other health issues. Such an inconsistent stance is difficult to understand, but then perhaps there is a visceral satisfaction in bleeding the patient, either actually or metaphorically, through taxation, the main weapon in the quit-or-die armory. Increasing tobacco taxation is held up as a quit-or-die success story, but, in fact, it is a strategy that further impoverishes the often less well-off while providing a boost for black marketers.
Under a section titled “What can be done? New thinking for the 21st century,” it is said that parties to the FCTC should press for more evidence-based discussions on THR and SNP. This is a nice thought, but given the history laid out in the report, I wonder if it can lead anywhere helpful. I’m sure COP participants believe they are making evidence-based decisions already, but my guess is, to get back to my original point, they are viewing only the evidence that is able to squeeze through their locked-in “moral” filters. The more alcohol they quaff together, the more they come together in the belief that nicotine is evil and shouldn’t be enjoyed. Evidence is no guarantor of success. The EU’s deadly ban on snus, a ban that defies all reason, has been upheld in the courts.
Under the same section, it is said also that a pragmatic route forward could be the establishment of a working group on THR to take the FCTC forward into the 21st century in a world where SNPs are now available. This, too, is a good thought, but again, given the history laid out in the report, one that might be difficult to pull off. Still, nothing ventured, nothing gained, and the report describes five ways in which such a working group might be able to move things forward.
One of the key starting points is said to be disaggregating combustible and more dangerous oral tobacco products from safer noncombustible products. But is this likely when, in a world where we hang onto the belief that the U.S. Food and Drug Administration is the paragon of scientific reason, that agency feels it right, and has the right, to “deem” electronic cigarettes to be tobacco products?
It is easy to become gloomy about the situation, especially when it is considered that even if a smoker is saved from a tobacco-related death through switching to an SNP, she is anyway more likely now to die of a pollution-related disease (for which there is no COP), or, slightly further into the future, the effects of a climate change event.
But, looking on the bright side, there is a powerful and growing force in support of THR, and it was on display at an event in London on the day following the launch of the Fighting the Last War report. The THR scholarship program, which is described as the jewel in the crown of the KAC, was the subject of a separate report, Tobacco Harm Reduction Scholarship Program: The First Three Years 2018–2021, which describes how the program has built an extensive network of advocates raising awareness of THR around the world.
The report is worth reading. Although I was aware of the program, I had no idea how extensive it had become. Since its launch, the program has attracted 260 applications and has taken on 75 scholars from 33 countries, 18 of whom have gone on to enhanced scholarships. But perhaps the most significant figures are those describing how 95 percent of the scholars are still working in THR, 27 percent full-time, 50 percent part-time and 18 percent on a voluntary basis.
The Oct. 28 event was an opportunity also to celebrate the life of Kevin Molloy (1957–2021), who, from 2018 until earlier this year, was head of the scholarship program.
The Fighting the Last War report, which is part of a series of Global State of Tobacco Harm Reduction reports from KAC, and the scholarship program are funded by grants from the Foundation for a Smoke-Free World, a U.S. nonprofit organization that had no role in the planning or execution of either project.
George Gay is Tobacco Reporter’s European editor, but his territory spans the globe. Based in London, George has covered the tobacco industry since 1982, initially for a U.K.-based publication and since 2004 for Tobacco Reporter. George’s understanding of industry issues, combined with his keen sense of observation and dry wit, have earned him a loyal following among Tobacco Reporter’s readers.

December 1, 2021
Call for THR Scholarship Applications
Photo: zimmytws
Knowledge Action Change (KAC) is looking for people to propose projects exploring their professional or personal interest in tobacco harm reduction (THR) for the next cohort of its Tobacco Harm Reduction Scholarship program (THRSP). Applications for the fifth year of the program close on Nov. 30, 2021, and successful applicants will receive a 12-month bespoke mentoring program and up to $10,000 in financial support.
According to Paddy Costall, a director at KAC, the THRSP is a crucial part of global efforts to communicate the benefits of safer nicotine products, helping to raise awareness about vaping, heated tobacco products, snus and nicotine pouches.
“The Tobacco Harm Reduction Scholarship program is the jewel in the crown for KAC,” he says. “When we were setting out on this journey, we wanted to attract a passionate and diverse group of new advocates into the tobacco harm reduction field from across the globe. We wanted to inspire them to take the movement into the future. We wanted to find the researchers of tomorrow, and with the THRSP that is exactly what we are doing.”
To further enhance the program’s status, KAC recently appointed Ethan Nadelmann, the founder of the Drug Policy Alliance, as the THRSP’s new patron. Nadelmann will be providing support to the recipients of these scholarships.
Launched in 2018, the program has supported 75 Scholars on six continents. Projects completed by THRSP participants include:
A short documentary film exploring attitudes on smoking and THR in Malawi
Novel scientific research in Romania showing that switching completely from combustible cigarettes to heated tobacco products can boost the oral health of smokers
The creation of a smoking and recovery toolkit in the U.S. to combat the high rates of smoking among people in recovery or seeking treatment for dependency on alcohol or other drugs
A study assessing the THR knowledge base of healthcare staff in Lithuania
A pair of studies that demonstrated the potential for safer nicotine products, such as vaping and Swedish-style snus, to help India’s smokers and smokeless tobacco users
The creation of THR Uganda, an organization set up to share accurate information on tobacco smoking and nicotine with its own dedicated website
A study on the effects of providing vapes to homeless smokers in Ireland
To find out more about the program, visit the Tobacco Harm Reduction Scholarship program website.
November 23, 2021
Critics: WHO Tobacco Trends Report ‘Celebrating Failure’
Photo: Syda Productions
The World Health Organization’s fourth WHO global tobacco trends report, which was released today, shows that there are 1.3 billion tobacco users globally compared to 1.32 billion in 2015. This number is expected to drop to 1.27 billion by 2025.
Sixty countries are now on track to achieving the voluntary global target of a 30 percent reduction in tobacco use between 2010 and 2025; two years ago, only 32 countries were on track.
According to the WHO, millions of lives have been saved by effective and comprehensive tobacco control policies under the Framework Convention on Tobacco Control and by measures taken under the global health body’s MPOWER initiatives (Monitoring tobacco use, Protecting people from tobacco smoke, Quitting tobacco, Warning about the dangers of tobacco, Enforcing tobacco advertising, promotion and sponsorship bans and Raising taxes on tobacco).
“It is very encouraging to see fewer people using tobacco each year and more countries on track to meet global targets,” said WHO Director-General Tedros Adhanom Ghebreyesus in a statement. “We still have a long way to go, and tobacco companies will continue to use every trick in the book to defend the gigantic profits they make from peddling their deadly wares. We encourage all countries to make better use of the many effective tools available for helping people to quit and saving lives.”

To see numbers reduce from 1.32 billion to 1.30 billion tobacco users over five years cannot be argued as evidence of a successful strategy.
Gerry Stimson, emeritus professor at Imperial College London and project director for the Global State of Tobacco Harm Reduction
Critics, by contrast, said the WHO report showed tobacco control failing. “As the WHO publishes its latest global tobacco trends report, it trumpets falling tobacco use. But the global health institution is celebrating failure,” said Gerry Stimson, emeritus professor at Imperial College London and project director for the Global State of Tobacco Harm Reduction.
“To see numbers reduce from 1.32 billion to 1.30 billion tobacco users over five years cannot be argued as evidence of a successful strategy. Eight million lives are lost every year due to smoking-related disease. What we are seeing is evidence of a dereliction of public health duty.”
Stimson lambasted the WHO for failing to consider reduced-risk products in its strategy.
“With modern safer nicotine products, these technological disruptors such as vaping devices, nicotine pouches [and] heated-tobacco products, we have the means at our disposal to end smoking and to end it soon,” he said.
“Global State of Tobacco Harm Reduction estimates put the number of users of harm reduction products at 100 million worldwide. Many smokers are put off from switching, though, as a direct consequence of the distortion of public health messaging from the WHO and other tobacco control organizations funded by U.S. philanthropic interests that seem to care little for the health of current smokers.
“Harm reduction is the third pillar of the tobacco control strategy named in the FCTC along with supply and demand reduction. We urge the WHO to integrate harm reduction into its approach to tobacco control as it already does for drug use and HIV/AIDS prevention and to address current deficits in the WHO’s MPOWER strategy by enabling it to become EMPOWERED—adding ‘Engage with affected communities,’ ‘Encourage smokers to switch to safer nicotine products’ and ‘Deliver accurate information about safer alternatives.’”
Key findings of the WHO report include:
In 2020, 22.3 percent of the global population used tobacco, 36.7 percent of all men and 7.8 percent of the world’s women. Currently, 60 countries are on track to achieve the tobacco use reduction target by 2025.
The steepest decline in prevalence rates over time is seen in the Americas. The average rate of tobacco use there has gone from 21 percent in 2010 down to 16 percent in 2020.
The WHO’s African Region has the lowest average rate of tobacco use at 10 percent in 2020, down from 15 percent in 2010.
In Europe, 18 percent of women still use tobacco, substantially more than in any other region. Women in Europe are the slowest in the world to cut tobacco use. All other WHO regions are on track to reduce tobacco use rates among women by at least 30 percent by 2025.
Pakistan is the only country in the WHO’s Eastern Mediterranean region that’s on track to reach the tobacco reduction target. Four of the six countries in the world where tobacco use is increasing are in this region.
Southeast Asia currently has the highest rates of tobacco use, with around 432 million users, or 29 percent of its population. But this is also the region where tobacco use is declining fastest. The region is likely to reach tobacco use rates similar to the European region and the Western Pacific region by 2025.
The WHO Western Pacific region is projected to have the highest tobacco use rate among men (more than 45 percent) using tobacco in 2025.
November 16, 2021
WHO Urged to Embrace Harm Reduction
The ninth Conference of the Parties (COP9) to the World Health Organization Framework Convention on Tobacco Control (FCTC) will operate under conditions of secrecy comparable to those of the U.N. Security Council, according to a new report by the Global State of Tobacco Harm Reduction (GSTHR) titled, Fighting the Last War: The WHO and International Tobacco Control.
The public and media are banned from attending all but one largely ceremonial opening plenary, yet millions will be affected by the decisions taken at COP9, which is scheduled to take place virtually Nov. 8–13.
The report contends that current implementation of the FCTC is a global public health failure. In force since 2005, when there were 1.1 billion smokers around the world, the FCTC set out the principles of global tobacco control—to reduce the death and disease caused by smoking. In 2021, however, there are still 1.1 billion smokers worldwide and 8 million smoking-related deaths each year. What’s more, the number of smokers is predicted to rise, and the number of smoking-related deaths is set to top 1 billion this century.
Change is urgently needed, and harm reduction for tobacco offers the opportunity for that change, according to the GSTHR.

Fighting the Last War notes that while tobacco control policy has remained frozen in time, innovative noncombustible nicotine technology and supporting evidence have moved forward. Vaping devices, snus, nicotine pouches and heated-tobacco products are significantly safer than cigarettes as they deliver nicotine without combustion, according to the report’s authors. This, they argue, enables people who cannot or do not want to stop using nicotine to quit deadly smoking and switch to less risky products.
“Just as delegates at COP26 will be discussing the world’s urgent need to stop fossil fuel combustion, the technology is now in place to ensure the end of the age of combustion for tobacco as well,” the GSTHR wrote in a press note. “A number of Parties to the FCTC, such as the United Kingdom and New Zealand, have successfully introduced tobacco harm reduction policies alongside their tobacco control regimes and have seen marked decreases in smoking rates.”
When given accurate information about comparative risk, many smokers switch, the organization notes. Worldwide, the GSTHR estimated in 2020 that 98 million people worldwide were using safer nicotine products.
The authors also point out that the concept of harm reduction is embedded in the WHO response to drug use and HIV/AIDS. It is explicitly named as the third pillar of tobacco control alongside demand and supply reduction in the FCTC. Yet the WHO has remained implacably opposed to harm reduction for tobacco and is increasingly viewed as having overseen a “mission creep,” which now sees international tobacco control setting its sights on prohibition for nicotine in all its forms.
“There are concerning signs in published agenda and briefing papers that the FCTC secretariat and leadership continue to urge Parties against increasing access to, or even to prohibit, safer nicotine products,” the GSTHR wrote.
Fighting the Last War considers the motivations—ideological, financial and historical—that have led to many global tobacco control practitioners becoming so hostile to what others see as the greatest potential public health advance in decades.
The report argues that Parties to the FCTC need to seize back control of the COP meetings from the FCTC secretariat, which it says has become overly influential with little oversight. FCTC Parties should press for more evidence-based discussions, calling upon the widest breadth of scientific, clinical and epidemiological expertise on safer nicotine products and tobacco harm reduction, according to the authors. “This should include evidence from Parties that have implemented harm reduction policies, those involved in manufacturing safer nicotine products and the lived experience of consumers,” they wrote. “The establishment of a working group on tobacco harm reduction would offer a pragmatic route to move the FCTC toward a tobacco control regime fit for purpose in the 21st century.”

“As global leaders prepare to make important pledges on climate change under the glare of the media spotlight at COP26, we urge them to demand more from their delegations inside the closed and unscrutinized rooms of COP9,” says Gerry Stimson, director of Knowledge-Action-Change and emeritus professor at Imperial College London. “Every day, more than one billion smokers are being failed by the international tobacco control regime. The age of combustion—for tobacco as for fossil fuels—must end.
“Tobacco harm reduction offers new routes out for adult smokers. GSTHR estimates suggest that 98 million of them have already switched. At COP9, government delegations must seize back control and prevent the slide into outright nicotine prohibition that would see many return to smoking and many millions more never succeed in quitting.”
“The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment,” said report author Harry Shapiro. “Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
“If those who dominate the global tobacco control discourse were truly committed to public health imperatives, harm reduction principles and policies would be front and center,” said Ethan Nadelmann, founder of the Drug Policy Alliance. “This valuable report exposes the ways in which international institutions have turned their backs on scientific evidence and the human and political rights of hundreds of millions of people whose lives might be saved by safer nicotine products.”
“Fighting the Last War provides an insight into the dark arts of the WHO that many would find breathtaking and incomprehensible,” said Jeannie Cameron from JCIC Consulting. “It shows a concerning difference between the world’s preparations for COP26 on climate change and COP9 on tobacco. Governments need to stand up at COP9 to support tobacco harm reduction against the outdated views of the WHO.”

The fight to reduce eight million smoking-related deaths a year is now being actively undermined by the WHO and the international tobacco control establishment. Together, they are fighting the last war against the tobacco industry—to direct attention away from the evidence that safer nicotine products can make a significant contribution to reducing that death toll.”
Harry Shapiro, author, ‘Fighting the Last War’
“The challenge for lower and middle-income countries while fighting the last war and promoting real tobacco control is about two major issues,” said Nataliia Toropova from Healthy Initiatives. “Firstly, the current provisions of the WHO FCTC have not been properly implemented due to stretched government resources. Thus, smoking cessation programs are nonexistent, and adult smokers feel hopelessly stuck while making their numerous unsuccessful attempts to quit with no medical help or guidance provided. Secondly, the lack of a comprehensive harm reduction strategy is aggravated by a massive misinformation campaign about harm reduction products and a declared war on nicotine. Unless these two issues get tackled, unless the powerful voice of doctors becomes loud and gets heard, unless education and awareness building campaigns take place, no changes will occur, and this last war will be lost.”
October 27, 2021