In the 4th Scientific Summit on Tobacco Harm Reduction: Novel products, Research & Policy experts agreed that tobacco harm reduction is the line of defense against the tobacco pandemic.

Read a summary of 4th Scientific Summit with direct links to the sessions and lectures videos.

◊◊◊ Smoking is well known that kills more than 8 million every year, almost twice the number of Covid-19 pandemic deaths to date and between 1999 and 2019 smoking tobacco use accounted for 20.2% of all-cause deaths among males and 5.8% among females[2]. At the session “Tobacco Control Policy: Prevention, Harm Reduction, Cessation” chaired by Dr. Karl Erik Lund and Professor Anastasia Barbouni Dr. Konstantinos Kesanopoulos presented data on smoking prevalence during the last three decades to underline that the tobacco epidemic remains a major global public health concern. Despite the progress in tobacco control there are currently 1.14 billion active smokers. As Professor Giuseppe Biondi-Zocai put it “… the smoking epidemic is here to stay unless we do something to prevent it and reduce its burden”. Over the last years many smokers around the world replace conventional smoking with Modified Risk Products, novel nicotine releasing products that bear less harm in comparison to combustible cigarettes. This is “harm reduction”. When you cannot eliminate the risk altogether you reduce it. Professor Ignatios Ikonomidis underlined that harm reduction strategy is a strong weapon that we need to learn to use effectively. Concerns include uptake by adolescents. As Professor Barbouni put it, “we need to set strict rules to avoid use of alternative tobacco products by adolescents and to find a way to control the tool (harm reduction)”. Dr. Lund said, we must find a way to balance the benefits for smokers with the risks for young people. [Read the session’s summary]

◊◊◊ In 2020, there were 2.7 million cancer incidences and 1.3 million deaths in the EU. In February 2020, the European Beating Cancer Plan was introduced, a political commitment to reduce cancer in response to the growing challenges and an initiative to further reduce the smoking prevalence. In the session “The Future of smoking in Europe” chaired by the President of SCOHRE Prof. Ignatios Ikonomidis with the participation of distinguished panelists, Europe’ s “Beat Cancer Plan” was discussed. As point out, the plan did not discuss the evidence that e-cigarettes and novel tobacco products (NTPs) appear to have lower risk of exposure to toxicants compared to conventional cigarettes. There is agreement that the exact level of risk reduction is inevitably uncertain but are promising harm reduction agents for smokers that fail or are unwilling to quit smoking. The Plan aims to prioritize’ protecting young people from conventional and e-cigarette smoking and proposes measures such as banning non-tobacco flavors for e-liquids and suggests regulatory protection for adolescent use making them strictly available for adults. Prof Ikonomidis concluded that, based upon global experience, “Beat Cancer Plan” should include harm reduction policies to improve the rates of smoking cessation and contribute to the reduction of smoking consequences. Harm reduction should be the third pillar for tobacco control together with smoking cessation and smoking prevention. There was consensus amongst experts on the significance of cessation and prevention approaches to target adolescents and that more data is needed on the long-term implications of e-cigarettes and novel tobacco products. [Read the session’s summary]

◊◊◊ Professor Kenneth Ε. Warner, a “guru” in the field of tobacco harm reduction and public policy in his lecture, also talked about the need for balancing considerations of the risks and benefits of e-cigarettes, and presented the findings of a recent paper published in the American Journal of Public Health in August 2021 that describes the situation in US, where governmental health agencies and non-governmental medical and health organisations focus heavily on risks to kids and not on the potential benefits for adult smokers. “We can increase smoking cessation through vaping”, Professor Warner concluded. Vaping’s ability to promote smoking cessation is important and deserves more attention, since helping adult smokers to quit is a matter of social justice. [Read a summary of the lecture]

◊◊◊ Caitlin Notley, Professor in Addiction Sciences, UK, analysed the UK approach to smoking control and the consequences of social and cultural influences on behavioural and health long term outcomes. She cited the definition on THR according to the Royal College of Physicians, that “harm reduction is a strategy used in medicine and social policy to minimise harm to individuals and/or wider society from hazardous behaviours or practices that cannot be completely avoided or prevented” and commented that this strategy is additional and complementary to tobacco control measures. The concept of “nicotine addiction” has been medicalised and eventually accepted, the speaker said, and now is part of treatment strategies in the UK. Also, Royal College of Physicians moved away from abstinence to harm reduction. So, today, there is a consensus among stakeholders in the UK that the main tobacco control goal is to reduce the death and disease caused by tobacco use and there is less concern to reduce addiction to nicotine and about eliminating the tobacco industry. However, more needs to be done, the speaker emphasised. Another challenge is public’s (mis)perceptions of harm that need to be tackled. Around a third of young people think that e cigarettes are as harmful as smoking tobacco, while adults also have inaccurate perceptions. She concluded, divides in the field of THR that question the evidence are unhelpful and feed uncertainty to the public about whether e-cigarettes are a safer option than smoking. [Read a summary of the lecture]

◊◊◊ In the session entitled “To what extent scientific data drive political decisions?” chaired by Dr Dimitri Richter, Eva Kaili, MEP and Chair of EU Committee STOA, said that policy makers are given options so they can decide based on scientific data and not just on the news or non-verified sources. In the European Parliament there are many committees that do a lot of preparatory work before any legislation is put forward, she explained. it is true that the transition to less harmful tobacco products is a difficult discussion for politicians, Ms. Kaili noted, the target is to have tobacco-free societies and we need scientific data and to participate more in discussions with scientists, be open-minded, listen and understand that we cannot ignore the fact that we have 25% of tobacco users. So, we must be able to explore all the solutions, she concluded. [Read the discussion’s summary]

◊◊◊ Professor Konstantinos Farsalinos who is involved in laboratory, clinical and epidemiological research on smoking, tobacco harm reduction (THR) and e-cigarettes in the panel discussion entitled “Independent verification in industry data for novel products and interventions” stressed the importance of independent verification of data as a vital tool to understand THR products and how study replication is key for transparency, restricting prejudice, avoiding future mistakes of novel products and for research quality enhancement. Giovanni Li Volti added that study replication is the continued progress of science to further evaluate and understand hypothesis as well as conclusions providing solid scientific data. Massimo Caruso stressed there is a need for harmonization in methodological approaches and global documentation of the most recent and appropriate methods used in laboratories to analyse THR products. [Read the session’s summary]

◊◊◊ Clive Bates led a panel discussion on the “Transformation of the tobacco industry: strategy, competition, and tactics” with representatives from research and development units of Tobacco Industry. All panellists agreed that consumer needs are the driver and science is the compass. Dr Gizelle Baker, PMI, said “Harms are caused by smoking and combustible cigarettes; smoking-related diseases is where the journey of tobacco industry’s transformation started from. Novel products have the potential to have a huge impact to public health, moving people to less harmful alternatives and reducing the burden of smoking-related diseases”. Mrs. Sharon Goodall, BAT, underlined “Innovation is driven by consumers’ needs, human needs. Consumers’ needs, regulations and of course innovation are also evolving. The harm reduction purpose drives and accelerates the need for transformation. Dr. Ian Jones, JTI, said that the transformation of science is the cornerstone in the transformation of the tobacco industry. He added though that it is really worrying, that although industry in our days provides excellent scientific data, there is a lot of suspicion about industry science. The most important aspect of transformation is the consumer, Mr. Joe Murillo, JUUL Labs, pointed out. Consumers, smokers, are demanding different products, and are driving the innovation, the competition, and the transformation of the tobacco industry, he explained. A common conclusion is that industry, regulators, and public health should work all together to have the best possible outcomes. [Read the discussion’s summary]

◊◊◊ The subject of “Economic dimensions of smoking control and harm reduction” was also discussed. Professor Andrzej Fal chair of the session stressed that the newest tool to improve the quitting efficacy, limiting health loss and financial burden is Tobacco Harm Reduction. The available financial tools, prices, differential taxation based upon potential harm, were extensively discussed. The financial burden of smoking is enormous. If we manage to reduce smoking by 1% in Europe, we will save 40 billion euros that could be invested in other areas said Tomas Drucker former Minister of Health, Minister of Interior of the Slovak Republic. Numbers are indicative of the significance! We need to employ all available tools to decrease smoking. Differential taxation of innovative products potentially less harmful was the suggestion of the panel. [Read the session’s summary] This point was also put forward by Professor Michael Pesko in his lecture. Prof. Pesko concluded that from an economic perspective, products should be taxed according to their externality and internalities, according to the cost and benefit they bear. Alternative policies are necessary other than e-cigarette taxes that would help keep e-cigarettes away from the youth, which is a major concern. [Read a summary of the lecture]

◊◊◊ David T. Sweanor J.D., led the panel discussion on “Ethics & people’s rights”, and stressed that it is really disturbing to deny rights to consumers. He also underlined that people do not receive adequate information or even receive inaccurate information; therefore, we should not blame the people, people are to be held responsible only for the information given to them. with renowned panellists, Professor of Community Health and Health Behavior Lynn T. Kozlowski made the distinction between the right for a tobacco-free world and the right for a tobacco-smoke-free world. There is no need to establish that there are nicotine-containing products that are much less harmful than tobacco cigarettes. The data presented showed that smokeless tobacco is dramatically less dangerous than smoking cigarettes. [Read the discussion’s summary]

◊◊◊ The relation of tobacco use with risk of Covid-19, and the association between smoking and the severity of disease were discussed in a session by Professor Konstantinos Farsalinos and Dr Michael G. Toumbis. [Read the session’s summary]

◊◊◊ In three unique sessions dedicated to Asia, Africa and Latin America respectively, experts from different countries shared their country policies and experience in implementing Tobacco Harm Reduction as well as relevant ethics and people’s rights issues. The experts’ panel for Asia was led by Sharifa Ezat Wan Puteh [Read a summary of the discussion], the Africa experts panel by Fares Mili & Solomon Rataemane [Read a summary here], and the Latin America panel by Monica Gorgulho [Read a summary here]. All four chairpersons are founding members of SCOHRE.

◊◊◊ Dr Joe Kosterich in his keynote lecture entitled “Two different approaches towards THR – Contrasting the cases of New Zealand & Australia”, successfully demonstrated the superiority of New Zealand’s tobacco control policies, which included THR in decreasing smoking prevalence vis a vis Australia’s strategy and underlined that there is a lot of work still to be done to achieve uniformity in global strategies. [Read a summary of the lecture]

◊◊◊ More than 300 participants from 42 countries[1] including 62 speakers from 31 countries from around the globe participated in the 4th Summit organised by SCOHRE, the newly founded International Association on Smoking Control & Harm Reduction, that seeks a new broader approach to smoking control policies that do not neglect smokers. A 360^o approach was adopted and covered all aspects with the participation of Tobacco Harm reduction advocates from diverse research fields to debate issues from basic science to ethics, human rights, health policies and health economics.

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[1] Albania, Argentina, Australia, Austria, Bosnia, Brazil, Bulgaria, Costa Rica, Canada, Czech Republic, Colombia, Croatia, Cyprus, Equador, Estonia, France, Finland, Greece, Hong Kong, Hungary, India, Indonesia, Ireland, Italy, Jordan, Kenya, Latvia, Lebanon, Lithuania, Malaysia, Moldova, Morocco, Mexico, North Macedonia, Netherlands, Niger, Norway, Pakistan, Poland, Portugal, Romania, Russia, Serbia, Singapore, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Thailand, Tunisia, Turkey, United Kingdom, USA, Zimbabwe.

[2] www.thelancet.com Vol 397 June 19, 2021

Executive Summary PDF