Tag: THR

  • A Platform for Dialogue

    A Platform for Dialogue

    Photos: BAT

    With its Omni tool, BAT has released a dynamic, science-based guide to tobacco harm reduction.

    By Stefanie Rossel

    The concept of tobacco harm reduction (THR) dates back to at least 1976, when Michael Russell made his famous statement that people smoke for the nicotine but die from the tar and suggested that altering the ratio of tar to nicotine could be the way to safer smoking. Almost 50 years on, there is an extensive array of less hazardous alternatives to combustible cigarettes, but misconceptions about nicotine and reduced-risk products (RRPs) continue to be so pervasive that the R Street Institute last year even published a list with the 10 most common misperceptions, arguing that over the past decade, an overwhelming onslaught of misinformation from academics, media outlets and public health agencies had created confusion and significantly slowed THR activities.

    BAT has set out to overcome these misunderstandings with a new tool. At its first-ever Transformation Forum, which took place in London in September, the company introduced Omni, an evidence-based, accessible and dynamic knowledge resource that shows how science and innovation can converge to achieve a smokeless world.

    Under its “A Better Tomorrow” strategy, the company aims to migrate adult smokers who would otherwise continue to smoke from cigarettes to smokeless products and to ultimately consign cigarettes to the dustbin of history. On its transformation journey, however, the company has faced several challenges, including the rejection of THR by key regulatory bodies and nongovernmental organizations, markets that prevent the sale of RRPs, onerous regulatory frameworks that hinder innovation, skepticism toward industry research as well as the already-mentioned misperceptions about nicotine and the relative risks of combustion-free products.

    James Murphy

    Omni, BAT states on its website, is intended to be a compendium of information that underpins the company’s corporate and scientific strategy and offers insights into the work being done at BAT to achieve a world without cigarettes. “The world’s first-of-its-kind resource, Omni explains why THR should be a prominent component of the public health strategy on tobacco,” says James Murphy, director of research and science at BAT. “It draws from hundreds of independent scientific studies, BAT’s own research into its smokeless innovations, and examples of THR in action globally. Beyond that, Omni serves as a dynamic platform for thoughtful, constructive conversations with stakeholders rooted in evidence, where open dialogue around THR is not just welcomed but encouraged.”

    Omni differs from BAT’s Science website, which focuses on the innovations driving the company’s business, Murphy points out. The Science website “serves as a hub for publishing data and peer-reviewed research on our smokeless products such as Vuse, VELO and Glo. The website also provides insights into our global research and development network, which comprises 1,750 R&D specialists across eight different sites worldwide. The emphasis here is on showcasing the science behind our products rather than facilitating discussions on THR policy,” says Murphy.

    Engaging All Stakeholders

    Kingsley Wheaton

    Omni is targeted at scientists, public health authorities, regulators, policymakers and investors, and it aims to spur a dialogue across the wider scientific and regulatory ecosystem related to tobacco and nicotine products. Across nine chapters, it addresses the big questions that the company and the tobacco industry in general are confronted with, among them classics such as what exactly tobacco harm reduction means, whether smokeless products are a gateway to cigarette smoking or what the role of flavors in smokeless tobacco and THR is.

    “We believe that open and constructive dialogue with a broad range of stakeholders is crucial for accelerating the decline in global smoking rates,” says Kingsley Wheaton, BAT’s chief corporate officer. “It is incumbent on regulators, scientists and policymakers to review the scientific and real-world evidence on THR and engage in dialogue on how to encourage smokers to switch completely to smokeless alternatives with a reduced-risk profile. Unfortunately, there are few spaces where these groups can review such evidence and reach common ground on THR science to drive progress.”

    According to Wheaton, Omni demonstrates that the evidence in support of THR is growing daily. “Sweden, which is on the brink of becoming smoke-free, has the lowest adult smoking rates and lung cancer deaths in Europe, which has attributed to the availability, affordability and increased use of smokeless tobacco and nicotine products,” he says. “Yet there is still significant debate on whether THR strategies should be used to reach global smoke-free targets, and more countries are restricting the sale of smokeless alternatives. Our hope is that Omni becomes the platform to engage these stakeholders so that we can create whole-of-society solutions and build smarter regulation that allows THR to flourish.”

    BAT plans to make Omni, which is also available as a PDF download, a fully online, dynamic resource in the coming months. “With THR research rapidly evolving, we want Omni to reflect the latest evidence in support of THR,” says Wheaton. “A team of scientists will regularly update Omni by assessing and collating new academic research, including BAT’s latest peer-reviewed evidence. Omni will both push out information and pull in insights, but the ultimate goal is to create a platform for dialogue. That’s why we are inviting anyone who shares our belief that a smokeless world is possible—and even those who don’t agree with us—to interrogate the evidence and join us on our journey to ‘A Better Tomorrow.’”

    Major Milestone

    BAT will be introducing new tools and technology-enabled platforms to facilitate the interrogation of the latest science and real-world experience of tobacco harm reduction, Wheaton says. “For example, it gives us the opportunity to develop a tech-driven Omni tool to give stakeholders in the THR policy debate more access to our evidence-based answers to the big questions facing our sector and society.”

    “Omni is not a broadcast channel for BAT to talk about tobacco harm reduction,” he stresses. “Our ambition is for Omni to be a platform for a necessary conversation with stakeholders rooted in evidence—a manifesto for change and a call to action, backed by high-quality science and real-world evidence.”

    Omni, Murphy explains, is the result of a major scientific effort, involving over 60 contributors and writers. “It covers products that involve around 9,800 global patents and cites more than 600 pieces of external evidence. This comprehensive compendium reflects over a decade of research—both our own and independent studies—into THR, and we have included the very best of published industry science for assessing the risk profile of smokeless products. We’re incredibly proud of this achievement, and as we’ve said, this is just the beginning.”

    “The launch of Omni marks a major milestone in our transformation toward a smokeless world, and we’re excited about the progress it represents for both us and the industry. By 2030, we aim to have 50 million adult consumers of our smokeless products, and by 2035, for smokeless products to make up at least 50 percent of our global revenue,” says Wheaton. “The ultimate goal we are working toward is a fully smokeless business, hopefully in a fully smokeless world. We believe Omni will be instrumental in achieving this vision, and we’re eager for the next chapter.”

  • EU Urged to Embrace THR

    EU Urged to Embrace THR

    Photo: Teo

    Ahead of this year’s EU State of the Union address on Sept. 13 in Strasbourg, France, the World Vapers’ Alliance (WVA) urged President Ursula von der Leyen to tackle the devastating impact of smoking-related diseases in the European Union. The association proposes the EU Commission’s president embrace a coherent EU-wide harm reduction strategy that includes evidence-based approaches to vaping and nicotine pouches, which have been shown to significantly reduce harm compared to smoking.

    “We implore Ursula von der Leyen to finally address the far-reaching impacts of smoking,” said WVA Director Michael Landl in a statement. “Smoking is a public health problem requiring immediate attention, causing more than 700,000 deaths in the EU annually. Evidence is clear that alternative nicotine products, such as vaping and nicotine pouches, can be a game changer in the battle against smoking. The time for brave leadership is now.”

    According to the World Vapers’ Alliance, Sweden has become a bright example that a coherent harm reduction strategy is the key to successfully addressing smoking-related illnesses. Not only is Sweden the first country in the world to reach the smoke-free goal (17 years ahead of the EU targets), but it keeps its commitment to favor harm reduction. Last week, the Swedish government announced its plan to reduce the tax on snus, a smokeless tobacco product similar to modern nicotine pouches, by 20 percent while increasing the tax on cigarettes and smoking tobacco by 9 percent.

    Vaping is still a recommended means of quitting for smokers in France, the United Kingdom, Canada and New Zealand, according to the WVA. This April, the U.K. government launched a “Swap-to-Stop” program aimed to incentivize smokers to quit by exchanging their cigarettes for free vape devices. Following Sweden’s recent move to reduce the tax rate on snus based on a risk-based regulatory approach and the U.K.’s full endorsement of vaping as a tool for smoking cessation, the WVA calls on the European Union to follow their lead in adopting a coherent harm reduction strategy.

    “In Sweden and the U.K., we’ve seen the incredible impact that a harm reduction approach can have on reducing smoking rates and improving public health. These countries lead by example, using a balanced risk-based strategy that includes vaping and nicotine pouches as safer alternatives to smoking. It’s time for the European Union to follow their lead. President von der Leyen has an unparalleled opportunity to set a new course for the EU in her State of the Union speech—one that embraces innovative, evidence-based solutions to tackle the smoking crisis,” added Landl.

  • A Good News Story

    A Good News Story

    Photo: Teo

    Tobacco harm reduction has made more progress than is often assumed.

    By Patrick Basham

    The good news about tobacco harm reduction is the bad news is wrong. The tobacco harm reduction experience is actually a positive story.

    It is true that the preponderance of influential and well-funded public health institutions and stakeholders are rabidly anti-tobacco harm reduction (THR). The World Health Organization is the most clear-cut example, with billionaire philanthropists funding global campaigns that, in concert with the WHO, incentivize national governments and their public health agencies either to ignore or to disparage THR’s demonstrated ability to improve public health.

    It is also true that most politicians who talk about THR-related reduced-risk products (RRPs) are critical of the technology and its marketing and are subsequently prohibitionist with regard to e-cigarettes, heated-tobacco products (HTPs), oral smokeless tobacco, etc. It is also true that the tone and substance of the vast majority of media coverage is highly negative.

    Such a choreographed chorus of naysaying has most everyone with even a passing interest in THR assuming that the political, institutional and media criticism is, first, representative of a global consensus among stakeholders that THR is a bad idea and second, that THR policies fail whenever and wherever they are introduced. Consequently, when surveyed, the public is at best ambivalent about RRPs’ comparative benefits vis-a-vis combustible cigarettes.

    All of the above may be true, but it is not the entire truth about tobacco harm reduction and reduced-risk products.

    The Other Side of the Coin

    My recent THR report pushes back against the criticisms—and against the broader skepticism they engender. The report does not attempt to catalogue THR’s critics and their mostly ill-informed critiques. The case against THR is readily available, easily accessible and delivered ad nauseam. Instead, this report seeks only to inform the reader that there is actually another, distinctive and very positive side to the THR coin.

    To that end, my report addresses overlooked and underappreciated elements of this policy conundrum. The report discusses the public opinion hurdle that must be surmounted by THR proponents in order for their political representatives to adopt more progressive and enlightened positions on this crucial aspect of public health policymaking. A summary is also provided of RRPs’ successful, yet largely unknown and therefore unappreciated, track records since their adoption in many parts of the world.

    There is an accounting of the many pro-THR governments who have adopted sophisticated strategies and policy prescriptions; there is also recognition of influential public health stakeholder endorsements since THR products became a commercial reality more than a decade ago. The report concludes by drawing lessons from the THR story so far, so that open-minded political and regulatory decision-makers may be better guided on their policymaking journey.

    Consumers worldwide are, on average, either uninformed or ill-informed about the concept of tobacco harm reduction and the specific reduced-risk products central to its implementation. Such ignorance is understandable as the THR paradigm is a comparatively new concept beyond public health circles and RRPs are innovative new technologies that only recently delivered commercially viable options for consumers.

    Such ignorance is nonetheless frustrating because respective prohibitionist politicians, philanthropists, regulators, public health organizations, academics and consumer groups have consciously erected the central barriers to better consumer understanding of, and appreciation for, THR and RRPs.

    The aforementioned anti-THR actors are seemingly dedicated to the proposition that tobacco and nicotine products scientifically proven to be less harmful than combustible cigarettes should not be readily available for use either by current smokers seeking less (often far less) toxic sources of tobacco and nicotine or even by smokers seeking to quit smoking altogether.

    Layered upon the anti-THR and anti-RRP campaigns are unhidden, viscerally anti-industry agendas that reflexively oppose any innovative technology or business model that may preserve, let alone enhance, the profitability of the tobacco and nicotine industries.

    A great many countries, international institutions and public health organizations are employing, and advocating for, THR policies and strategies to reduce cigarette consumption. To date, nearly 70 countries have adopted regulatory frameworks on reduced-risk products.

    An enormous number and variety of electronic nicotine-delivery products are in the marketplace, with nearly 16,000 flavors available and global sales rising to $15 billion in 2019. HTPs were also available in over 50 markets worldwide in 2020. Only one Western democracy (Australia) still requires its citizens to acquire a nicotine prescription in order to vape.

    Snus can be legally bought in 81 countries. RRPs are already being used by 112 million people worldwide, with approximately 82 million using nicotine vaping devices, 20 million using heated-tobacco products and 10 million using smokeless tobacco.

    Contributing to Cessation

    The evidence in favor of THR as a complementary intervention to help drive down death and disease from smoking is robust. For example, we now have evidence of the impact vaping has had on smoking. Vaping is today widely considered to be the world’s most effective smoking cessation tool.

    Extensive international evidence supports the conclusion that vaping plays a major role in smoking cessation. All of the nearly 70 countries that have adopted regulatory frameworks on safer nicotine products subsequently report a decline, often a dramatic one, in smoking prevalence. Countries that embrace vaping have witnessed a decrease in smoking rates that is twice as fast as the global average.

    Snus’ extensive contribution to improvements in Swedish public health is well documented. When Norway allowed snus products to be more widely available, cigarette smoking fell by half in just 10 years.

    Japanese tobacco harm reduction is the story of HTP-driven success.

    Japan’s policies have led to a remarkable drop in cigarette smoking. In October 2020, in the world’s largest heated-tobacco market, the smoking rate dropped to a record low of 16.7 percent, down 1.1 percent on the previous year. Between 2016 and 2021, domestic combustible cigarette sales declined 43 percent.

    This decline is directly attributable to the availability of noncombustible RRPs, mainly HTPs. HTP popularity caused cigarette sales to plummet five times faster than before HTPs were available.

    Tobacco harm reduction is a refreshingly good news story, as detailed in the preceding sections. That is the reason governments around the world are increasingly placing THR at the heart of their tobacco control strategies.

    Pro-THR policymakers are legalizing RRPs for widespread consumer use as regulators in these countries construct regulatory frameworks that harness the products’ potential to reduce tobacco-related harm while restricting their availability to adult consumers exclusively.

    That said, certain governments and regulatory agencies have disproportionate influence on the global stage. The governments of many smaller and medium-sized nations, in particular, look to the likes of the U.S. Food and Drug Administration, the European Union and the Chinese government for case studies, regulatory models, bureaucratic signals and political cover regarding THR’s innate veracity, as well as the applicability and suitability of specific RRPs to public health in general and the consumer marketplace specifically.

    Some of the steps taken by governments and public health bodies with outsized influence have empowered THR while other steps have retarded its progress. My report’s accounting and cataloging of THR successes and adoptions provides these institutional actors, and those influenced by them, with numerous lessons concerning the best way forward should public health be the overriding concern.

    Ten policymaking lessons stand out:

    • Tobacco harm reduction should be the principal driving force behind a nation’s tobacco control strategy.
    • Legalize the import, export, sale, possession and use of reduced-risk products. These products should be as widely available as tobacco products and available without a prescription.
    • The debate is not legalization versus prohibition. The latter approach is empirically unsound, unenforceable and counterproductive. Hence, it is crucial that specific regulations and tax policies are THR-friendly, too.
    • Employ the “weighting principle,” that is, employ concepts such as absolute risk, relative risk, and usage patterns in order to calculate the net public health effect of RRPs, and utilize that data to guide the adopted regulation.
    • RRPs are most suitably regulated as consumer products rather than as medicines or tobacco products.
    • Apply the “continuum of risk” approach across tobacco and nicotine products. Regulation should reflect the lower toxicity levels of RRPs and, therefore, regulations and taxes should correspond to the level of harm caused by a given product, hence the need for the differential taxation of RRPs.
    • Lower rates of taxation for RRPs than for cigarettes help to ensure the affordability of RRPs for low-income consumers, who smoke disproportionately, and incentivize smokers to switch from combustible products.
    • Smokers have the right to accurate information on RRPs; therefore, governments should underwrite health education messages about the comparative risks of RRPs. A pragmatic regulatory approach furthermore recognizes the utility in fewer restrictions on RRP advertising than on cigarettes, hence reduced-risk claims for RRPs should be permitted in advertising.
    • Providing a choice of flavors to adult consumers encourages them to switch from combustibles to less harmful products.
    • Traditional cessation approaches are not the only tools available to help people transition away from smoking cigarettes. Vaping is the world’s most effective smoking cessation tool.

    The greater the number of governments that learn and apply these lessons, the greater will be the public health benefit that the world experiences from tobacco harm reduction’s focus upon the reduced-risk potential of innovative tobacco and nicotine products.

  • Differential Progress

    Differential Progress

    Photo: Nopphon

    Will the valuable insights revealed in the Tobacco Transformation Index accelerate tobacco harm reduction?

    By George Gay

    The second biennial report on the Tobacco Transformation Index (TTI), which details the findings of two further years of research into the efforts made by the world’s 15 largest tobacco companies to reduce the harm caused by the consumption of their products, was launched at the recently staged GTNF. The 140-page 2022 report evaluates tobacco companies’ actions across six business functions, designated “categories” and 35 underlying indicators that are said to cover “measures indicative of harm reduction ….”

    Of the 15 tobacco companies examined, three are state controlled, nine are publicly traded (including Egypt’s Eastern Co., in which the government owns a majority stake), and three are privately held. Together, they are said to account for about 90 percent of global tobacco product volume sales. The geographical sweep of the index takes in 36 countries spread across the globe and accounting for about 85 percent of the global population of adult smokers.

    Erik Bloomquist

    The report contains a huge amount of information, clearly presented and backed with a statistical methodology that aims for transparency and, despite its robust nature, is open to review. The global nicotine and tobacco investment analyst and consultant Erik Bloomquist, who is chairman of the TTI’s technical committee, said during the GTNF investor panel, which he chaired, that everybody should be visiting the TTI website because it contained a “fantastic” amount of “incredibly valuable” information.

    Meanwhile, a press note issued on Sept. 28 by the TTI, which is a Foundation for a Smoke-Free World* initiative and whose research partner is Euromonitor International, said research had demonstrated “differential progress toward harm reduction across the 15 largest tobacco companies,” and highlighted:

    • That high-risk products made up about 95 percent of retail sales volume across the 15 largest tobacco companies during 2021, with reduced-risk products (RRPs) making up 5 percent;
    • That tobacco harm reduction (THR) momentum was developing across a subset of the 15 companies, albeit to varying degrees; and
    • That with companies having been analyzed across the six categories and 35 indicators on their actions to reduce the harm caused by tobacco use, Swedish Match was found to have been making the most relative progress.

    The press note went on to list the following takeaways from the 2022 index findings:

    • “Only Swedish Match sells a greater volume of RRPs than substantially more harmful combustibles, due in most part to the popularity of its snus in Sweden and nontobacco nicotine pouches in the U.S. …
    • “Four index companies directed the majority of capital and R&D investments toward RRPs. In addition, five index companies, including three state-owned entities, made incremental investments or early indications of movement toward future production of RRPs during the review period.
    • “However, tobacco companies are … failing to invest in harm reduction in low-[income] and middle-income countries, with the vast majority of sales for their RRPs concentrated in markets with the highest disposable income. Notably, RRPs are banned in a number of countries around the world.”

    For those who like lists, the 2022 index’s overall scores set the companies’ relative rankings as follows, with their 2020 relative rankings in parenthesis: Swedish Match 1 (1), Philip Morris International 2 (2), Altria Group 3 (4), BAT 4 (3), Imperial Brands 5 (5), Japan Tobacco Group 6 (6), KT&G Corp. 7 (7), Swisher 8 (8), ITC 9 (9), China National Tobacco Corp. 10 (10), Vietnam National Tobacco Corp. 11 (12), Tobacco Authority of Thailand 12 (11), Eastern Co. 13 (13), Gudang Garam 14 (14) and Djarum 15 (15).

    As can be seen, there was little shifting of positions, but the devil is in the details, and there was more relative movement in each of the six categories that were researched: strategy and management, product offer, product sales, marketing policy and compliance, capital allocation and expenditure, and lobbying and advocacy. And this differentiation is seen as important, though, in fairness, it has to be set against any number of factors, some of which, such as portfolios, companies have control over, and in respect of some of which, such as regulations, they are largely at the mercy of outside forces, especially those companies operating mainly in countries that ban RRPs. And there are some factors that might be seen as sitting in between. Increases in sales of higher risk products, for instance, are seen as negatives.

    Sense of Proportion

    The report clearly has some important information, which is likely to become even more valuable in the future if, as seems likely, more of the 15 companies engage with the TTI. Six companies, mainly the multinationals, provided feedback in respect of the 2022 report.

    Nevertheless, I have reservations about what is going on here. Glancing through the minutiae of the huge report and the 84-page methodology that defines the way the report’s data is arrived at, I couldn’t help wondering whether we weren’t in danger of losing our sense of proportion, even losing track of our objectives. To a large extent, tobacco transformation is pushing at an open door because consumers undoubtedly want the choices that new-generation products offer, and the business case is compelling.

    David Janazzo

    But what truly concerned me as somebody living in a country whose economy is being systematically tanked by the last remaining devotees of trickle-down economics was that the TTI seemed to be embracing trickle-down THR. For instance, the TTI was described in the Sept. 28 press note as having been created “to accelerate the reduction of harm caused by tobacco use by ranking the world’s 15 largest tobacco companies on their relative progress or the lack thereof.” From ranking tobacco companies in this way to accelerating THR sounds to me like a bit of a stretch. Certainly, it seems to beat something of an indirect path toward THR.

    In fairness, though, I should say that the TTI program officer, David Janazzo, in his insights introduction to the 2022 report, added that part of the purpose of the index was “to inform the public about the activities of the tobacco industry that influence achieving a smoke-free world.” Such an undertaking, if it could be achieved, would certainly have a more direct influence. But I don’t see that happening. The report talks of “stakeholders,” but that term is not defined, and whereas, as far as I have been told, it potentially includes everybody, such a claim to inclusivity falls a little flat if you try to imagine smokers around the world engaging with a 140-page report and an 84-page methodology. Unsurprisingly, currently, stakeholders are largely confined to tobacco/nicotine companies, researchers and investors.

    Relative Rankings

    The TTI throws up a number of oddities, not the least of which has to do with the understandable decision to compare the 15 largest tobacco companies. Gudang Garam against BAT seems to be a total mismatch, and, given that the index is aimed at informing, in large part, potential investors, the presence of companies that are not publicly traded, though understandable from a nudge theory standpoint, nevertheless looks strange. PMI was said in the press note to be ranked second in the 2022 index and Djarum last, and while I understand that this is how the index’s methodology sees the tobacco world, I have to ask, is this a fair reflection of tobacco harm? If you constructed an index that ranked companies on the number of people worldwide who currently were harmed by consuming those companies’ products, I would guess that Djarum would move up the rankings.

    It was disappointing, in my view, that the 2022 report did not cover the environmental credentials of the RRPs on offer, either relative to each other or relative to the higher risk combustible cigarettes they are supposed to replace, though I understand such matters might be covered in the third iteration of the report, which is due out in 2024. RRPs are supposed to comprise a disruptive technology and, if disruptive means anything, it surely means speedy. Is it wise to wait so long for such information to trickle down? We have on the one hand a problem with the diseases caused to individual smokers, which are tragic on an individual basis but contained, and, on the other hand, an existential environmental crisis enveloping everybody, and we seemingly choose to try to fix the first problem and not the second.

    Timing is important, and one of the main weaknesses of the TTI seems to be its two-year time frame. The 2022 report took in research through the end of 2021 while the next report is due out in 2024, so this suggests that, unless interim updated TTI reports are issued, the publication schedule is going to provide a three-year drag on the incorporation of anything of significance that occurred in early 2022.

    To my way of thinking, the commitment to THR is driven and will be driven by regulations and taxes, and one benefit of the index is that it might influence governments in these areas. And this is important. Taxes are currently set in some jurisdictions so that some RRPs attract revenues much greater than those of combustible cigarettes, and investors are clearly going to put pressure on companies to transform their portfolios while the profits generated by the sale of RRPs are higher than those from the sale of combustible cigarettes. Of course, you would have to be terribly naive to imagine that those same investors would keep up the pressure if the profit advantage were wiped out. There is nothing wrong with this if you believe that the market should be the ultimate arbiter of what is good, though one has to accept, too, that things might head in the other direction.

    Finally, I would be concerned that the cynics will have a field day because while the TTI is listed as an initiative of the foundation, in my view, it is not spelled out prominently enough where the foundation’s money comes from: PMI. Despite the fact that the foundation is independent, those cynics will see that the number two company on the list is PMI, which is possibly about to acquire the number one company and move into the number one spot. All above board, I’m sure, but these things have to be seen from the point of view of those with different agendas.

    My argument is not that the application of trickle-down THR would be socially destructive in the way that trickle-down economics has been but that it would be slow and there would be more efficacious ways of approaching THR. Why spend the foundation’s money carrying out research that is going to benefit mostly analysts, banks and pension funds that have the resources to carry out such research on their own behalf? Surely, the money should be spent on projects that will more directly help smokers. Even helicopter THR might be preferable to trickle-down THR.

    *The Foundation for a Smoke-Free World is an independent nonprofit organization created in 2017 with the mission to end smoking within this generation.

  • Moving Backward

    Moving Backward

    If enacted, Spain’s proposed regulations on vaping products will hamper tobacco harm reduction.

    By Stefanie Rossel

    In mid-May, a shockwave hit Spain’s vaping industry: The government presented a bill that would end the independent domestic vaping sector. The proposal calls for limiting vapor product sales to state-owned tobacconist shops within five years. Specialized vape shops can stay in business only if they transition into licensed tobacconists—a step that would oblige them to sell combustible products as well. The bill would also ban online sales of vape products.

    At a recent conference, Angeles Muntadas-Prim Lafita, chair of the Spanish Association Supporting Vapers (ANESVAP) explained that the proposed legislation means the government wants to monopolize the nicotine market. “A country that is a member state of the European common market wants to monopolize a free and independent market. That’s like going back to a time when Spain wasn’t even a democracy—or even to the Spanish Inquisition,” she said.

    Muntadas-Prim Lafita considered it unlikely that vape shop owners would sell combustibles. Established tobacconist shops, on the other hand, might or might not sell vaping products under the planned rules. “This would be harmful for consumers who would be forced to go to a tobacconist to get their vape products—or as many as they could find because it would be up to the tobacconist to decide what he is going to sell,” she said. “In addition, smokers who use vaping to quit more hazardous products might be tempted to purchase combustibles again. It’s like forcing an Alcoholics Anonymous meeting to be held in a liquor store.”

    If the bill, which is now in the stage of public consultation, passes, it would also mean the loss of 1,200 direct and 3,000 indirect jobs in times of emerging economic crisis, according to Muntadas-Prim Lafita. Vape shops would have only six months to notify the commission for the tobacco market that they wanted to transition to become tobacconists. “The result of this legislation would be black markets, disobedience and lots of people going back to smoking,” she predicted. “Tobacco control in Spain is one of the fiercest and most stalled in the European Union.”

    A Worrying Precedent

    Criticism also came from the Independent European Vape Alliance (IEVA), the trade representative of independent producers and retailers of vaping products in the EU.

    In a statement, the organization pointed out that the proposed legislation went against the main principles of EU competition law. “Considering the consequences of the proposed measures, the [draft bill] will set a worrying precedent in which legally established business can be unilaterally closed in an EU member state and handed over to a state-owned network of tobacco shops,” the IEVA wrote.

    The planned legislation also violates the freedom of movement of goods in the EU and would generate severe adverse economic impacts in Spain and the EU, according to the group. It would drastically cut the European distribution value chain and negatively impact the exports to Spain from other EU member states, as the sales of vaping products in tobacco shops are expected to be extremely limited compared to the ones in specialized shops. Tobacco shops, after all, aim to maximize sales of combustible cigarettes and will be disinclined to devote time to explaining electronic devices to smokers looking to switch to less harmful alternatives.

    An online sales ban for vape products would also drastically reduce the movement of goods in the EU as retailers in other countries would no longer be allowed to sell their products in Spain. Lastly, the IEVA said, the proposed law fails to distinguish between combustible tobacco products and noncombustible products as established in the EU’s 2014 Tobacco Products Directive (TPD).

    The association called on the Spanish government, medical authorities and other stakeholders that will provide comments on the draft bill to critically reconsider the measure and insisted authorities review the proposed legislation for competition issues.

    A Small Market

    Compared with markets such as the U.K., vaping in Spain is relatively rare. After pharmaceutical companies lobbied the government for tougher legislation on vape products, the number of vape shops dropped by 90 percent in 2014. Today, there are around 535,000 vapers, which represents an adult vaping prevalence of 1.33 percent, according to the Global State of Tobacco Harm Reduction. This compares to a smoking rate of 27.9 percent, or 11.1 million people.

    Vaping devices, like heated-tobacco products, are legal in Spain and can be sold to those aged 18 or older. E-liquids are currently untaxed. Statista estimates that the Spanish revenue service will collect the equivalent of $183.4 million in e-cigarette taxes in 2022. The market is expected to grow annually by 2.89 percent.

    The bill is part of a wider effort by the Spanish government to bring its regulatory framework for tobacco products in line with World Health Organization and TPD standards.

    The manufacture, advertising and sale of vape products in Spain is regulated under the Royal Decree 579/2017, implemented five years ago, which basically translates the TPD into Spanish national law. The rules ban smoking and vaping in all indoor state-owned public places, on public transport and in some outdoor places, such as parks. Advertising of vape products on TV is allowed, though there are regulations about the type of program and the times of day in which advertisements may be broadcast. Cross-border sales of e-cigarettes are prohibited.

    A Tough Stance

    In December 2021, the government published the draft of its “Comprehensive Plan for Smoking Prevention and Control 2021–25,” which aims to extend anti-smoking legislation from 2006 to include vaping products. During the consultation period, several Spanish medical societies took a hard stance on vaping, saying e-cigarettes are an ineffective tool for smoking cessation and asking the government to regulate them like combustible tobacco products.

    Among other things, the plan aims to make more places—including private vehicles—smoke-free and vape-free, ban all e-liquid flavors except tobacco and introduce plain packaging for combustible cigarettes, vape devices and e-liquids.

    Following a June 2021 report by the National Committee for the Prevention of Smoking, the plan also called for the taxation of vapor products. The report proposed a general e-liquid tax at the EU average rate of €0.15 ($0.15) per milliliter and an additional tax of €0.006 per milligram of nicotine. This would amount to an average tax rate of 35.6 percent, enabling the Spanish government to collect €35 million in taxes per year, according to the National Committee. With all measures combined, the government aims to reduce the percentage of the population that smokes to 10 percent by 2040.

    Uncertain Outcome

    According to the World Vapers Alliance analysis, the draft plan is biased against vaping, selectively citing studies, many of which have already been refuted. However, it didn’t consider studies acknowledging the harm reduction potential of vape products, such as the findings of Public Health England that vaping is 95 percent less harmful than smoking and may serve as an important smoking cessation tool.

    “What this means is that the government wants to make it harder to vape than to smoke,” the organization stated. “Overall, the government draft shows the lack of knowledge politicians have on harm reduction tools, such as vaping, and the need for vapers to press them and tell their stories. Public health laws need to be based on evidence and not on stigma.”

    The ANESVAP has started collecting signatures for a petition urging Spain to keep vapor taxes low and e-cigarettes accessible for customers. It also calls on regulators to keep online sales legal, allow an appropriate range of flavors and differentiate between vapor products and combustible cigarettes in smoke-free places.

    The busy schedule of the Spanish government leading up to next year’s general election presently plays into the hands of the country’s vape community. Already more than a year behind schedule, the plan is now less likely to be brought before the Spanish Parliament soon, according to ECigIntelligence, which expects the bill to be discussed next year at the earliest.

  • Australia Urged to Include Vaping in Smoking Strategy

    Australia Urged to Include Vaping in Smoking Strategy

    Photo: Zerophoto | Adobe Stock

    Australia is lagging well behind many other countries in the Asia-Pacific region when it comes to successfully tackling smoking through vaping, says the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA).  

    The CAPHRA’s observation comes as Australia’s Department of Health seeks feedback on its Draft National Smoking Strategy 2022–2030, with public submissions closing on March 24.

    “We encourage vapers and supporters of a progressive tobacco harm reduction (THR) approach to have their say. Australians desperate to quit smoking and those keen to stay off deadly cigarettes need all the help they can get,” says Nancy Loucas, executive coordinator of the CAPHRA.

    On Oct. 1, 2021, Australia’s Therapeutic Goods Administration expanded its prescription-only model with customs clamping down at the border on personal imports of nicotine vaping liquids from overseas websites.

    Not only does Australia’s draft strategy ignore the potential of safer nicotine products, it also lacks ambition, according to Loucas. The strategy aims for a smoking rate of 10 percent or less by 2025 while New Zealand is pursuing a 5 percent smoke-free goal and looks on target to achieve it. “Instead of banning vaping, New Zealand has regulated it, making it tough for minors to access but available to all adults keen to keep off the cancer sticks. New Zealand is seeing its overall smoking rate tumble, yet the Australian government fails to accept that the most effective smoking cessation tool available is staring it in the face,” says Loucas.

    “Australia is well down the world rankings when it comes to adopting effective THR policies and is light-years behind the U.S. and U.K. Subsequently, Australia’s overall smoking rate has fallen very little over the past decade, and without reasonable access to vaping, Australia will struggle to even achieve its 10 percent smoking goal,” says Loucas. 

  • THR Strategies Have Reduced Smoking Rates

    THR Strategies Have Reduced Smoking Rates

    The Asia Harm Reduction Forum 2021 attended by the leading experts in technology, public health policy and science met to discuss the tobacco harm reduction (THR) strategies deployed in various countries, according to a press release from the Canadian Vaping Association.

    “We have known the risks from smoking for many decades. We have known that it is the smoke, not the nicotine, that is responsible. We also know that we can deliver nicotine in ways that have minimal risk,” said David Sweanor, chair of the Center for Health Law, Policy and Ethics and an adjunct professor of law at the University of Ottawa. “As a result, Sweden’s rates of tobacco-related illness and death are by far the lowest that you can see in the European Union. Their smoking rates are now low enough that many people would call it a smoke-free society. When Norway allowed snus products to be more widely available, cigarette smoking fell by half in just 10 years. When Iceland allowed both vaping products and snus into the market, smoking fell by about 40 percent in just three years.”

    For decades, Canada has tried to curb smoking through education and taxation with limited success. Reductions in smoking prevalence had generally slowed, with modest annual declines prior to more mainstream adoption of vaping by smokers. Vaping experienced peak adoption in 2019, which lead to a 7.5 percent decline in cigarette sales.

    “Harm reduction is one of the four pillars of Canada’s drug and substances policy. Policy that makes vaping less appealing to smokers, like flavor restrictions and taxation, is out of step with this policy. In effect, Canada has embraced harm reduction in name but not substance,” said Darryl Tempest, Government Relations Council to the Canadian Vaping Association.