Tag: tobacco harm reduction

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.”
Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

December 2, 2024
Research: THR Plan May Save 400,000 Nigerian Lives

Credit: Rawpixel
New research by leading international health experts has found that more than 400,000 Nigerian lives could be saved if policymakers adopt a progressive approach to tobacco harm reduction (THR).
The report, released on Nov. 19, outlines how integrating alternative nicotine products such as vapes and nicotine pouches into Nigeria’s tobacco control framework could dramatically reduce the nation’s smoking-related death toll.
According to the report, Saving 600,000 Lives in Nigeria and Kenya, 3.5 million Nigerians currently smoke, and each year 26,851 Nigerians die from smoking-related illnesses. While the World Health Organization (WHO) projects that smoking-related deaths will drop to 18,000 annually by 2060, experts argue that the number remains far too high.
By adopting THR strategies, the researchers estimate that the annual smoking-related death toll could be reduced to 7,600 by 2060, saving over 416,000 lives in the process.
Derek Yach
“We have a clear opportunity to reduce the burden of smoking-related diseases in Nigeria significantly,” said Derek Yach, one of the report’s authors and former leader of the Foundation for a Smoke Free World. “By embracing safer alternatives like vapes and nicotine pouches, Nigeria can drastically lower smoking-related deaths and help people who smoke quit more effectively. Tobacco harm reduction is the key to saving lives and improving public health in Nigeria.”
The use of THR products has already been proven to reduce smoking rates in countries such as the UK, Sweden, Japan and New Zealand. In these nations, the widespread adoption of e-cigarettes and other nicotine alternatives has led to a marked decline in cigarette consumption, the leading cause of smoking-related diseases, according to an emailed press release.
Delon Human
“The success stories from other countries are undeniable,” said Dr. Delon Human, co-author of the report and founder of the African Harm Reduction Alliance. “In nations where tobacco harm reduction is embraced, smoking rates are dropping, and lives are being saved. Nigeria can achieve similar results by adopting a more inclusive tobacco control policy incorporating standard measures and access to these life-saving alternatives.”
The report calls on Nigerian policymakers to take bold steps in reducing smoking-related harm by considering the introduction of safer nicotine products into the national health strategy. Nigeria could make significant progress toward its public health goals by offering people who smoke alternatives that are far less harmful than combustible cigarettes.
“As Nigeria’s leaders continue to refine tobacco control measures, they have a unique opportunity to reduce smoking-related harm while empowering people who smoke with the tools to quit,” Yach added. “With the right policy choices, Nigeria can not only improve the health of its citizens but also set an example for the rest of Africa.
November 22, 2024
A Broader Approach

According to experts, established tobacco control measures may be insufficient to achieve the desired reductions in smoking and the associated burden on healthcare systems. | Photo: Taco Tuinstra
To lower the health and economic burden of smoking, lawmakers should incorporate tobacco harm reduction into their policies.
By Stefanie Rossel
The figures are staggering. Smoking cost the world economy an estimated $1.85 trillion, or about 1.8 percent of global gross domestic product (GDP), in 2012, according to a monograph published by the World Health Organization and the U.S. National Cancer Institute in 2016.
The authors distinguish between direct and indirect costs. Direct costs, which include both healthcare expenses, such as physician fees or medical supplies, and nonhealthcare costs, such as transportation, were approximately $467.3 billion, representing 6.5 percent of global health expenditures, or 0.5 percent of global GDP. Indirect costs, which include the value of productivity and lives lost due to tobacco-related diseases, were an estimated $446.3 billion for disability and $938.6 billion for mortality.
Low-income and middle-income countries (LMICs) account for almost 40 percent of the expenses incurred globally due to tobacco use, with direct costs representing up to 4 percent of total health spending in these countries. The total economic costs of smoking in LMICs ranged from 1.1 percent to 1.7 percent of GDP in the countries investigated in the report compared with an estimated 2.4 percent in the Americas and 2.5 percent in Europe.
Some of the data in the monograph dates back to the late 1990s, and it is likely that costs have increased since its publication. While some research released since the publication of the paper suggested that reductions in smoking prevalence would translate into lower healthcare costs quite quickly, these papers focused primarily on the healthcare systems of large, wealthy and technologically advanced societies rather than LMICs, where 80 percent of the world’s smokers live.
People in LMICs are significantly more likely to die from noncommunicable diseases (NCDs), which include cardiovascular and chronic respiratory diseases, cancer and diabetes, along with mental and neurological conditions. According to the WHO’s website, NCDs account for the deaths of 16 million people prematurely, i.e., before their 70th birthday, worldwide each year.
Tobacco use represents the leading risk factor for NCDs, ahead of other risk factors such as air pollution, excess sodium intake, alcohol abuse or sedentary lifestyles. According to WHO data, tobacco currently accounts for 8.2 million deaths per year, including the effects of exposure to secondhand smoke, a figure that is projected to increase over the coming years.
However, the WHO is far from achieving the U.N. Sustainable Development Goal of reducing premature deaths from NCDs by one-third by 2030. Depending on the source (and even the WHO’s numbers are inconsistent here), there are currently between 1.1 billion and 1.3 billion smokers in the world, and the figure is likely to rise, due in part to population growth.
One of the major weaknesses of prevention is that the benefits take a long time to materialize.
Focus on Prevention
“When governments and government agencies lie about the health costs of vaping relative to smoking, they are betraying the trust of the public.”
According to critics, the WHO’s established tobacco control measures are insufficient to achieve the desired reductions in smoking and the associated burden on healthcare systems. To accelerate progress, policymakers need to fundamentally change their approach, argues Andrzej M. Fal, president of the Polish Society for Public Health, who spoke at the Warsaw Global Forum on Nicotine in June.
“If we enforce policies that reduce the risk of smoking now, there will be a significant reduction in cancer in 15 [years] to 20 years,” Fal pointed out. Because chronic diseases account for 90 percent of premature deaths, he argued, investing in their prevention is more cost-effective than treatment. The WHO itself recommends prevention as a response to noncommunicable diseases. Fal cited calculations from the global health body showing that every dollar invested in smoking prevention saves $7.43 down the road.
Based on such considerations, Fal urges authorities to place greater emphasis on prevention and tobacco harm reduction. In 2023, the Polish Parliament analysis office asked Fal to prepare an analysis of the state of the tobacco “epidemic” in Poland. Fal and his co-authors concluded that the country lost 250,000 years of life as a result of tobacco consumption.
Education about health, Fal suggested, should begin in kindergarten. People who are already ill and refuse to quit smoking should be incentivized to minimalize their risk using less hazardous nicotine-delivery alternatives. “If someone is already seriously ill,” Fal explained, “they can still achieve a better quality of life, live longer, and cost the system less,” he said.
Fal proposed that each country launch at least one prevention clinic, which should be accessible without referral and would offer access to anti-smoking therapy, nicotine-replacement pharmacotherapy and harm reduction products. The clinics should also be responsible for regional health prevention programs and smoking information campaigns.
Governments, he suggested, should set tobacco tax rates based on the relative harm of each product category, following the principle of “less harm, less tax.” Taxes on cigarettes—the most harmful tools for tobacco consumption—should rise “radically but progressively,” said Fal, who also called for publicly funded and supervised studies assessing the efficacy, safety and harm reduction in cases where the existing evidence was insufficient.
One of the major weaknesses of prevention, however, is that the benefits take a long time to materialize. In a U.S. study analyzing the relationship between cigarette sales and lung cancer deaths, for example, it took 20 years for the first measures taken to curb tobacco consumption to show up in lower lung cancer death statistics. That time frame is too long for many lawmakers. “Politicians are not interested in investing in prevention as its benefits are seen long after they have left the government,” said Fal.
Progress is also obstructed by conflicts of interest. In 2018, he noted, Poland’s tobacco-related health expenditures plus productivity loss were between PLN7 billion ($1.71 billion) and PLZ8 billion in 2018, whereas excise and VAT income from cigarettes amounted to PLN23.5 billion.
Every dollar invested in smoking prevention saves $7.43 down the road.
Myopic MPs
Sinclair Davidson
All too often, politicians are uninterested in considering the potential unintended consequences of their decisions. For example, Australia’s rules requiring vapers to get a medical prescription and banning imports of disposable e-cigarettes have caused the illicit market to flourish. Ninety-two percent of Australian vapers currently source their vapes from the black market, exposing them to unrelated products. More than 70 tobacco shops have gone up in flames since Health Minister Mark Butler started his crackdown on vapes. Police suspect some of the attacks are carried out by criminal groups as retaliations against store owners who refuse to stock their black market products.
“Australia tends to pursue harm minimization policies in most areas—except in tobacco and nicotine consumption,” said Sinclair Davidson, professor of institutional economics at RMIT University, Melbourne. “Here, Australia pursues the most socially harmful policies that the so-called public health lobby can dream up. The costs this policy’s short-sightedness imposes on the economy are likely to be large but hidden or indirect. For example, when cigarettes are stolen from convenience stores, this results in insurance costs being increased on those stores and prices being increased for all consumers.
“Similarly, when criminal profits are increased, criminal behavior in the economy increases. When criminal behavior increases, police budgets increase, resulting in higher taxes for all citizens and higher levels of criminal behavior. We are all victims of crime and criminal behavior—except, of course, the public health lobby, who have built careers off their policy work, and politicians and law enforcement agencies who get expanded budgets and powers as a result of poor policy. It is a vicious cycle of ‘Baptists and bootleggers’ who benefit while the rest of society suffers.”
Meanwhile, the decline in tobacco tax revenue even as smoking rates have stabilized suggests that people are still smoking—they’re just not smoking legal cigarettes. “The challenges are twofold,” said Davidson. “Government itself has become addicted to tobacco excise revenue, and that source of revenue has become unreliable. The subsidy from smokers to the rest of the population has been captured by criminals. Criminality imposes huge costs on society. This occurs through the normalization of violence and the misallocation of resources from legal activity to illegal activity. Furthermore, criminality has a corrupting influence on law enforcement activities. Poor policy corrodes civil society by undermining public trust in public institutions. When governments and government agencies lie about the health costs of vaping relative to smoking, they are betraying the trust of the public and undermining their moral worth in society.”
By contrast, Sweden’s success in reducing smoking rates by accommodating snus is a public health success story, according to Davidson. Since 2008, Sweden has slashed its smoking rates from 15 percent to 5.6 percent, according to Smoke Free Sweden. The nation’s smoking prevalence is expected to dip below 5 percent this year, making it the first country to achieve “smoke-free” status as defined by the WHO.
Sweden’s incidence of cancer is 41 percent lower than in the rest of the EU, corresponding to a 38 percent lower level of total cancer deaths. The country has a 39.6 percent lower rate of death of all tobacco-related diseases compared to the EU average. “I don’t know to what extent Australian consumers are familiar with snus and what the uptake would be—but the principle remains. Low(er) risk products on the market result in consumers substituting away from the high(er) risk products,” said Davidson.
Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

July 1, 2024
Beyond Tobacco Harm Reduction

To see clearly into the decades ahead, we need to rethink nicotine.
By Clive Bates
There is no doubt that tobacco harm reduction is a powerful and effective public health strategy. It takes the widely understood public health concept of harm reduction (see drugs, alcohol, HIV and so on) and applies it to the enormous burden of harm created by smoking. We already have enough science and experience to know that this strategy works. Two conditions must be met: (1) The new noncombustible nicotine products must be much less risky than smoked products; (2) these low-risk products must displace the high-risk combustible products. Let us briefly consider these two questions.
Are the noncombustible products much less risky? We know from biomarker data and considerable additional supportive evidence that noncombustible nicotine products are, beyond reasonable doubt, much less dangerous than smoking. There should be no serious dispute about this. Though some activists stress long-term uncertainties in risk, those are as likely to turn out to be negligible as to turn up unwelcome surprises. The simpler and more controllable chemistry of the smoke-free products will allow for regulation and product modifications if risks do ultimately emerge. Though there are studies showing various effects on the body, there is little to suggest that these amount to material risks. The human body is not defenseless: World-famous epidemiology shows that regular smokers who quit before age 40 avoid nearly all the long-term mortality impacts. That is not intended as a recommendation to smoke for 25 years but to apply some perspective to the much lower exposure from noncombustible products.
Do the low-risk smoke-free products displace the high-risk combustible products? There is now a wealth of triangulating evidence from multiple sources showing that noncombustible products can and do displace combustibles. The most persuasive evidence is the experience of snus in Scandinavia. In Sweden and Norway, smoking has become marginalized on average and has dwindled to very low levels among younger age groups. Nicotine use, however, remains typical of other European countries. The Cochrane review assessed 78 studies, including 40 randomized controlled trials, and concluded in November 2022, “There is high‐certainty evidence that [e-cigarettes] with nicotine increase quit rates compared to NRT [nicotine-replacement therapy].” Population trend data shows an accelerated decline in smoking coinciding with the rise of vaping. Quasi-experimental studies compare the effects of price and regulatory differences to show that e-cigarettes function as economic substitutes for cigarettes.
In one sense, we are advancing well on tobacco harm reduction; we know it works, and there is potential to avoid millions of premature deaths. But we could be doing much better. The main barrier to deeper and faster worldwide progress is dogmatic resistance from misguided tobacco control activists, reflexive hostility from public health agencies and regulators, pervasive misinformation about risks and a blizzard of negative media coverage driving a moral panic about adolescent vaping. As I have argued, many tobacco control interests need tobacco or nicotine use to be harmful or they lose their purpose, prestige and money. If there is no harm to address or abusive corporations to thwart, there is little point in their work. Tobacco harm reduction directly threatens their interests, and they have responded accordingly.
So why do we need to move “beyond harm reduction,” as I suggest in the title above? Why do we need to “rethink nicotine”? The answer is that tobacco harm reduction is an unsatisfactory and incomplete framework for understanding the direction and destination of the consumer nicotine market. Without a rethink of nicotine, the rancorous arguments will continue.
Harm reduction implies that there must be harm to reduce. It suggests that reducing harm is the underlying justification for allowing the availability of reduced-risk nicotine products. That tends to focus attention on the benefits of the product-switching choices of existing smokers. But also, it classifies the uptake of nicotine products by current nonusers, whether adults or adolescents, as problematic and a basis for justifying restrictions or prohibitions designed to curtail use. The United States Tobacco Control Act embodies this idea through its public health standard: New nicotine products seeking premarket tobacco authorization must be evaluated as “appropriate for the protection of public health” (see Section 910(c)(4)).
Implicit in this view is that no one wants to use nicotine, and new smoke-free products should function as a souped-up smoking cessation aid for which there would be little justification without smoking.
But no one thinks of other common psychoactive substances in this way. At the launch of a new craft beer, does anyone ask, “is this appropriate for the protection of public health?” Of course they don’t—it’s beer! We do not agonize over routine and perhaps compulsive morning caffeine consumption because we are not concerned about dying from coffee-related diseases. Increasingly, legislators recognize that cannabinoids are widely used and that society would be better off if these were regulated and taxed rather than outlawed.
The critical concept in rethinking nicotine and going beyond tobacco harm reduction is the demand for nicotine. Is this demand really involuntary and just driven by addiction? Or do people experience real or perceived benefits that create the demand? Nicotine has been found to improve certain cognitive functions, including attention, memory and processing speed. It can temporarily increase alertness and focus, making users feel more mentally sharp. Nicotine stimulates the release of neurotransmitters, which can help regulate mood, helping users feel more relaxed, feel less anxious or experience an improved sense of well-being. Some evidence suggests that nicotine may have potential therapeutic benefits for conditions such as Parkinson’s disease, attention deficit hyperactivity disorder, schizophrenia and other conditions. For those seeking scientific citations, a fully sourced list is available via the Safer Nicotine Wiki, an outstanding living library curated by tireless citizen scientists.
How does our approach change if we accept that, at least for some people, nicotine provides functional benefits or even just a pleasurable sensation that they enjoy? If we look beyond the harm reduction approach to smoking, we must address the consumer demand for nicotine as a recreational stimulant. Once we recognize a demand for the product, we need to have a mature conversation about how this demand will be met in the future. The attempt to control demand by prohibiting supply has never been a conspicuous success. There are many reasons why lawful and regulated products are better for consumers and wider society than nurturing an informal or criminal supply chain via prohibitions.
The future of the nicotine market is becoming much clearer now: Consumer nicotine will be available through a range of noncombustible nicotine products, including vapes, oral nicotine and heated or smokeless tobacco. The regulatory challenge shifts from harm reduction to making nicotine products available that may have minor risks but fall within the normal societal tolerance for risk. Instead of asking, “is this appropriate for the protection of public health?,” in the future, we would ask, “are the risks associated with this product acceptable for recreational nicotine use?” Our approach to adolescent nicotine use would more closely resemble our approach to alcohol: measures to discourage use and restrict sales, but not a moral panic.
The evolving demand curve for nicotine is complicated by both the harms of smoking and the dependence-forming properties of nicotine. The great harms of smoking and the pressures of the policies, such as taxation, to reduce smoking have suppressed the demand for nicotine. That is changing. When nicotine can be used with minimal risk, then it is likely that latent demand will be released. People who would have otherwise been deterred from using nicotine by the harms and stigma of smoking may be inclined to try nicotine in much safer forms.
In formal definitions, such as the Addiction Ontology’s, a dependence becomes an addiction only when there is “serious net harm.” Addiction is defined as “A mental disposition toward repeated episodes of abnormally high levels of motivation to engage in a behavior, acquired as a result of engaging in the behavior, where the behavior results in risk or occurrence of serious net harm.”
The inclusion of serious net harm is to limit the definition to conditions “that merit a treatment and public health response.” But what if there is no serious net harm? It follows that there should be far less public health concern about nicotine use.
To move beyond harm reduction, we need to recognize that the demand for nicotine runs deeper than the demand for smoking and will outlive cigarettes. Then the challenge is to develop a regime that allows for nicotine products with acceptable risk and to be lawfully available to those who wish to use them. Despite the dogmatic rear-guard action of tobacco control activists, traditional tobacco control is being steadily overtaken by the strategy of tobacco harm reduction. But tobacco harm reduction is an interim stage in the evolution toward a full rethink of the place of nicotine in society. To see the pathway to the future of nicotine, it is essential to look out toward the destination.
Clive Bates is the director of Counterfactual Consulting and the former director of Action on Smoking and Health (U.K.).

April 1, 2023
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.
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.
November 1, 2022