Summing up, the third edition of the Global State of Tobacco Harm Reduction outlines a clear framework on electronic nicotine delivery systems scenario: although there are now over 100 million people using these products worldwide, tobacco-related deaths still exceed 8 million a year and the strenuous opposition from governments and several public health authorities appears to be charting an uphill battle for smokers who can’t quit.
Historical opportunity or a different side of the same coin? According to the Right Side of History: Global State of Tobacco Harm Reduction the answer has never been clearer and is confirmed by over 100 million consumers of alternative nicotine delivery systems, from e-cigarettes to snus , who have now decided to quit combustible cigarettes for good.
Unfortunately, the forecast of the report, although they are confirmed by the undeniable mass of data obtained by scientific research, do not outline a short-term openness by public health authorities and politics.
The report gives a clear picture of harm reduction approaches in the field of tobacco consumption, starting form the most representatives among the alternative nicotine delivery systems, the electronic cigarette, up to the liberal choices of governments, such as UK.
“The rise of vaping products, which began life in small start-up companies, often in China, caused disruption, concern and confusion amongst the major tobacco industry players” explains in the introduction Gerry Stimson, director of Knowledge•Action•Change “Huge companies producing billions of cigarettes per year were wrong-footed. This new technology didn’t emerge from their research and development facilities, nor could it be claimed by public health.
But the evidence matters – and there is a growing mountain of it relating to the greatly reduced risk associated with safer nicotine products. Fortunately, a number of countries could see the benefits of enabling their smoking population to switch from the dangers of smoking cigarettes to much safer products”.
Although the numbers of harm reduction supporters are growing, there are still too many smokers attracted to cigarettes: with over 1.1 billion smokers worldwide and more than 8 million smoke-related deaths each year, the smoking emergency is still a long way off from being in check.
Yet, the potential of smokeless products is undeniable and represents one of the most valid alternatives we have to definitively change the world of tobacco addiction: a clear example is what happened in Japan, where cigarette sales fell 47% between the first quarter of 2016 and the same quarter in 2022 in the face of competition from heated tobacco products (HTP).
In addition, vaping products need to face the economic popularity of conventional cigarettes: sales of cigarettes account for over 90% of global tobacco revenues.
As we read in the report: “The advent of SNP also poses a threat to the profits of the pharmaceutical industry and a $50 billion dollar market in nicotine replacement products and medicines.9 For many years, the pharmaceutical industry has sponsored international tobacco control activities and related health events. In December 2020, the world’s largest healthcare company Johnson & Johnson and Cipla, a major Indian multinational pharmaceutical company, were both named as “partners” and “private sector companies that have offered support” for the WHO’s ‘Commit to Quit’ campaign.”
Furthermore, tobacco sales represents a huge profits for governments: in 18 countries, the government itself has a significant or even monopoly stake in the domestic tobacco industry. Major source of concern is the threat to the livelihoods of thousands of people working in tobacco-growing countries, especially those working in the regionalised, small-scale industries that produce traditional oral as well as combustible tobacco products in Africa, India, and other parts of Asia.
So, what is the future of alternative nicotine delivery systems?
Over the past 40 years, smoking rates have fallen mainly in high-income countries thanks to a mix of restrictions, high taxes and prevention campaigns. But the decreases have slowed. In recent years smoking rates have remained stable, also due to population growth. Rates then remain high especially in low- and middle-income countries and among the most disadvantaged sections of the population.
It is expected that by 2100 we will reach 1 billion smoking-related deaths: It took 60 years from the invention of the cigarette rolling machine for the links between smoking and cancer to be confirmed in the early 1950s. This timeframe is used as an excuse not to endorse SNP because we do not know everything.
But the evidence exists and above all we know how much smoking costs in terms of human lives and health. The conclusion of the Global State of THR leaves no room for doubt: “One thing is certain: we cannot wait another 60 years for tobacco harm reduction to be integrated into global public health.”
