Mistrust and ideological opposition hampering adoption of safer nicotine products: report

A new report has urged global policymakers to seize potential of safer nicotine products to reduce smoking-related death and disease, warning that failure to do so will cost many lives.

The Global State of Tobacco Harm Reduction 2022: The Right Side of History, the latest in a landmark report series from UK-based public health agency Knowledge Action Change (KAC) added that 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.

Noting that smoking-related diseases are not caused by nicotine, but by the thousands of chemicals released when tobacco burns, the report explores how the past two decades have witnessed substantial disruption to patterns of consumer nicotine use, public health narratives, the work of tobacco control institutions and traditional tobacco industry interests, due to the emergence of new products that independent evidence shows are substantially safer than cigarettes and can support smoking cessation. These products include nicotine vapes, tobacco-free nicotine pouches, Swedish-style snus and heated tobacco products.

“Technology helped smoking become one of the world’s biggest health problems. 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,” Harry Shapiro, author of The Right Side of History, said.

“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.”

Despite the billions spent to date on tobacco control by the World Health Organization (WHO) and governments around the world, international tobacco control measures have stalled, the report says, as the number of smokers has remained unchanged for two decades at 1.1 billion.

Large scale substitution of deadly combustible cigarettes with much safer nicotine products, known as tobacco harm reduction, can significantly reduce the death and disease caused by smoking, the report argues.

However, the late entrance of the traditional tobacco industry into the safer product market has seeded some mistrust in the category, and ideologically driven opposition to the approach, with public health and policymakers split over tobacco harm reduction’s role, has led to the spread of mis- and disinformation, it added.

The report calls for integrating effective harm reduction into the global public health response to tobacco, saying that it can help bring about substantial reductions in smoking-related death and disease at pace and at minimal cost to governments and health agencies.

GSTHR estimates show that in two decades, 112 million people have begun using safer nicotine products, but consumer uptake is currently concentrated in higher income countries.

While the WHO Framework Convention on Tobacco Control explicitly includes harm reduction, the report shows that the strategy has been ignored in implementation to date. In light of new developments in nicotine consumption, and in consideration of the fundamental human right to health, harm reduction now can and should be incorporated into international and national tobacco control efforts, it said

“A failure to recognise 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,” Professor Gerry Stimson, GSTHR Project Lead, Emeritus Professor, Imperial College London, said.

“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. Alongside the biennial reports, GSTHR Briefing Papers and other publications, the GSTHR also delivers a free-to-access global database enabling users to explore tobacco harm reduction and safer nicotine product use on a country-by-country basis.