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Our Thoughts

//Milestones in Tobacco Harm Reduction

Posted 21/09/2020 12:00am


Next Generation Products (NGPs) decouple nicotine from harmful tobacco smoke. Although not completely risk-free, ongoing scientific research suggests their considerable harm reduction potential relative to smoking cigarettes.

By delivering satisfying levels of nicotine while replicating many of the sensorial and behavioural elements of the smoking ‘ritual’, NGPs offer an attractive option to conventional cigarettes for many adult smokers.

They are a viable alternative for the 1 billion-plus smokers worldwide, potentially facilitating the public health concept of Tobacco Harm Reduction (THR): so adult smokers uninterested or unwilling to quit cigarettes can consider transitioning from combustible tobacco to less harmful sources of nicotine.

However, not everybody believes in THR, or that NGPs can play a role in it. Some critics – citing the relative novelty of NGPs and the ensuing lack of long-term scientific data –  invoke the precautionary principle and play the waiting game.

This risks wasting time many adult smokers cannot afford.

It’s true even the most established NGP category – vaping – is still relatively nascent; heated tobacco and tobacco-free nicotine oral products even more so.

That said, there’s already a great deal of robust pre-clinical research to suggest these NGPs may be significantly less harmful than smoking.

Indications from short to medium term clinical and behavioural studies [1] are also promising, although we absolutely recognise more research is needed into NGPs and their long-term health effects.

We will continue to do this.

However, when it comes to regulating and facilitating NGP use, we also believe in making decisions based on the encouraging science available today.

Increasing numbers of key actors in public health regulation and policy agree. They’ve started to listen – and more importantly act on – the contemporary compelling evidence, acknowledging and endorsing the principle of THR and of NGPs as viable, scientifically-substantiated, potentially reduced harm alternatives to combustible tobacco.

In the UK, where vaping is both popular and widely endorsed by numerous public health groups – including Public Health England [2] – as a cessation tool, the smoking rate has plummeted. [3] Modelling suggests if other countries adopted this approach, the world would have 200 million fewer smokers. [4]

Now is the time to act. Public health bodies and regulators ignoring the evidence risk preventing millions of adult smokers worldwide from accessing potentially life-saving alternatives.

We urge policy advisers, media and regulators who believe in pragmatic and progressive public health policies to explore our dynamic THR timeline below and act on what the data tells us.

[1] E.g https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub3/abstract see “None of the studies found that smokers who used EC short‐ to mid‐term (for two years or less) had an increased health risk compared to smokers who did not use ECs. “

[2]Public Health England is an executive agency of the UK Department of Health and Social Care.

[3] https://ash.org.uk/media-and-news/press-releases-media-and-news/in-2019-around-half-as-many-britons-now-vape-as-smoke-and-the-majority-are-ex-smokers/

[4]https://www.betterretailing.com/products/vape-world-map/

Milestones in THR

2020
October 2020

In the UK

Action on Smoking and Health (ASH) data shows the number of UK vapers has fallen compared to last year. The charity warns “unfounded concerns about health risks from e-cigarettes may mean thousands of smokers who could benefit from switching completely are missing the chance.”

October 2020

A Cochrane review

An international review finds vapes could be between 25-130% more effective than nicotine replacement therapy in helping adult smokers transition away from smoking. The study used data from the UK, US, Canada, Italy and New Zealand.

September 2020

In the UK

The UK Committee on Toxicity (COT) releases a comprehensive report evaluating the  relative and absolute toxicological risks of vaping. When produced according to “appropriate manufacturing standards and used as recommended, as a replacement for [CC] smoking”, the report concludes, vapes are “likely to be associated with a reduction in overall risk of adverse health effects.”

September 2020

In New Zealand

In a new statement, the Ministry of Health reiterates its position that, based on the current evidence, vapes  “carry much less risk than smoking cigarettes” and “are attracting very few people who have never smoked into regular vaping, including young people”.

August 2020

In the UK

In a country where vaping remains extremely popular, it’s reported the smoking rate has again fallen to 14.1%.

July 2020
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In the US

The first ever heated tobacco product obtains a Modified Risk Tobacco Product (MRTP) order from the Food and Drug Administration (FDA), recognising scientific evidence which suggests it “reduces the body’s exposure to harmful or potentially harmful chemicals.”

May 2020

In Australia

Recognising evidence that vaping is “considered to be less harmful” than smoking, the Western Australian Parliament’s Select Committee releases a report urging the government to lift the ban on vaping, replacing it with risk-proportionate regulation.

May 2020

In Japan

It’s found that heated tobacco’s popularity has caused cigarette sales to plummet 5 times faster than before the NGP was available.

March 2020

In the UK

On its blog, Public Health England (PHE) clears up some of the most commonly misunderstood topics on vaping – including EVALI (e-cigarette, or vaping, product use associated lung injury), youth-use and nicotine. It also refutes the findings of a controversial study, published – and latterly withdrawn – the previous year, which misreported data to suggest vapers had the same risk of heart disease as smokers.

March 2020

In the UK

Public Health England (PHE) issues guidance to National Health Service (NHS) mental health organisations, recommending “patients have access to vaping products” and that practitioners should consider “provid[ing] them proactively to patients who smoke.”

March 2020

In the UK

Public Health England’s annual report affirms that vaping regulated nicotine products has “a small fraction of the risk of smoking” and recommends “smokers should be encouraged to try regulated nicotine vaping products, along with smoking cessation medications.”

February 2020

In the UK

The Office for Product Safety & Standards launch a campaign on battery safety advice for vapes.

January 2020

In Australia

For the first time, the Royal Australian College of General Practitioners states in smoking cessation guidelines that vaping “may be a reasonable intervention to recommend” if first discussed with health practitioner and use of nicotine replacement therapies or other methods have failed.

2019
November 2019

In Norway

Vapes containing nicotine are legalised when the country notifies the EU it’s implementing the EUTPD. In line with these regulations, vapes in Norway must first make an application to the Norwegian Directorate of Health, which reportedly evaluates “whether the product will contribute to tobacco harm reduction”

November 2019

In the UK

A survey of Directors of Public Health finds they support the use of vaping as an aid to move away from smoking, with 75% of respondents advocating vape use in smoking cessation services.

October 2019
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In the US

The British Medical Journal reports the US’s declining in smoking rate mirrors a rise in vaping, “suggesting that the two may be linked”.

October 2019

In New Zealand

Evidence “indicates that low-risk, non-combustible nicotine technologies (referencing various NGP categories) can successfully displace smoking and provide a significant dividend for public health”, ASH New Zealand and End Smoking state in their Smoke-Free 2025 report

October 2019

In the UK

Responding to reports of THC vaping associated lung illnesses (EVALI), Public Health England (PHE) says “we are as certain as ever that e-cigarettes are far less harmful than smoking‘ and the outbreak ‘is not a problem linked to long-term use of regulated nicotine vaping products.”

October 2019
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In the US

The Food and Drug Administration (FDA) authorises the first-ever Modified Risk Tobacco Product order, meaning some specific Swedish snus products can claim that they are less harmful than smoking.

September 2019

In Germany

The Federal Government Commissioner for Drug Issues releases the latest Drug and Addiction Report. The review finds some studies exist which show vapes may be less harmful compared to cigarette smoke due the significant reduction of toxicants in the aerosol.

July 2019

In the UK

Public Health England (PHE) says vaping is contributing to a falling smoking rate. In England, 14.4% of adults now smoke, down from 19.3% in 2011.

June 2019

In New Zealand

Ministry of Health launches a factual vaping website which says “vaping can help smokers quit. That’s a good thing.”

May 2019

In the UK

The Royal College of Midwives recognise the significant harm reduction potential of vaping. They also state that if a “pregnant woman who has been smoking chooses to use an e-cigarette [(vaping)] and it helps her to quit smoking and stay smokefree, she should be supported to do so.”

March 2019

In Saudi Arabia

The Ministry of Commerce lifts the ban on vaping products. In the same piece of regulation, it also officially legalises heated tobacco products.

February 2019

In the UK

Public Health England’s (PHE) vaping report says that whilst experimentation has increased, regular use of vapes by young people who have never smoked (11-18) remains very low.

January 2019

In France

The Economic, Social and Environmental Council states vapes “with or without nicotine” can be useful helping smokers move away from smoking and should be placed “among the other smoking-cessation tools.”

2018
December 2018

In the UK

Public Health England (PHE) launches its ‘Health Harms’ campaign, encouraging adult smokers to consider vaping.

December 2018

In the UK

Following the Select Committee inquiry, the  Government says once it leaves the EU, it’s committed to exploring regulatory alternatives to ensure “the proportionate regulation of e-cigarettes”, specifically in areas such as the 20 mg/ml maximum nicotine limit and the block on advertising vaping’s relative harm-reduction potential. It also states it will continue to consider the evidence on heated tobacco, and will also consider reviewing the current ban on snus.

December 2018

In Canada

As vapes are officially legalised, the  government says “vaping is less harmful than smoking” and “switching …will reduce a person’s exposure to many toxic and cancer-causing chemicals”. It also confirms “nicotine is not known to cause cancer”.

November 2018
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In the US

The Center for Disease Control (CDC) confirms that in America – the world’s largest vape market – the adult smoking rate has fallen to its lowest level in recorded history.

November 2018
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In the US

The Food and Drug Administration (FDA) Commissioner states “we must recognise the potential for innovative, less harmful products that can efficiently deliver satisfying levels of nicotine to adults who want them” while preventing uptake by vulnerable populations.

September 2018

In New Zealand

The Ministry of Health affirms “the evidence on vaping products indicates they carry much less risk than smoking cigarettes but are not risk free‘ and says they believe vaping products ‘could disrupt inequities and contribute to Smokefree 2025.”

August 2018

In the UK

An Action in Smoking and Health (ASH) UK study finds youth use of vapes is “very low” and “experimentation does not turn into regular use”.

August 2018

In the UK

The Royal College of General Practitioners issue a statement encouraging GPs to recommend vaping. The position says vaping is “a far safer alternative” to smoking and that the “benefits of ECs [(vapes)] in assisting cessation should not be ignored.”

August 2018

In the UK

The Science and Technology Select Committee advocates for a ‘shift to a more risk-proportionate regulatory environment, where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarettes, heat-not-burn and tobacco products available.’

June 2018
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In the US

In a whitepaper,  the American Association of Public Health Physicians (AAPHP) argues “[no one] ever imagined that there could be a product that could satisfy the urge to smoke for many, if not most smokers, and would reduce risk by 95% or more, without addicting teen non-smokers – while being easier to quit than cigarettes. There is now solid evidence e-cigarettes and related vapour products, snus, the chewing tobaccos currently on the American market, and, more likely than not, the new Heat-not-Burn products are likely to meet these specifications.”

April 2018

In Switzerland

Based on the growing body of scientific evidence, vaping is legalised.

April 2018
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In the US

The Food and Drug Administration (FDA) Commissioner confirms the potential for “novel forms of nicotine-delivery to provide a potentially less harmful alternative for  currently addicted individual adult smokers who still want to get access to satisfying levels of nicotine, without many of the harmful effects that come with the combustion of tobacco.”

February 2018

In Iceland

The Directorate of Health recognises the use of vapes may be contributing to smoking’s decline.

January 2018

In Denmark

The Danish Cancer Society’s Cancer Control Project Manager for Tobacco Prevention says vapes “are undoubtedly less dangerous than cigarettes.”

January 2018
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In the US

The National Academies of Sciences, Engineering and Medicine says that while vapes “are not without health risks, they are likely to be far less harmful than conventional cigarettes.”

2017
December 2017

In the UK

The  Committee on Toxicity says “it is likely there is a reduction in risk, though not to zero, to health for smokers who switch completely to heat-not-burn tobacco products.”

November 2017

In France

The National Association for the Prevention of Alcoholism and Addiction (ANPPA) recognises vapes may provide a ‘substitution tool (for smoking cessation) among the other existing devices’.

October 2017

In the UK

For the first time Stoptober, the annual national cessation campaign led by Public Health England (PHE) and the National Health Service (NHS), endorses vape use.

September 2017

In Scotland

National Health Service (NHS) Scotland declares vaping is “definitely less harmful than smoking tobacco.”

September 2017

In Australia

The Drug and Alcohol Nurses Association  (DANA) recognise vaping is a “much safer alternative to smoking for those who are unable to quit with conventional therapies” and vapes “are not risk free, but evidence suggests they‘re around 95% safer than smoking”.

August 2017

In New Zealand

The Associate Health Minister says there are various products ‘including heat-not-burn, snus, moist snuff, dissolvables and inhaled nicotine that may be significantly less harmful than tobacco smoking’.

July 2017

In the UK

The government embraces vaping in its new tobacco control plan‚ “Toward a Smokefree Generation”.

July 2017
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The US

The Food and Drug Administration states nicotine is delivered through products on a “continuum of risk” with combustible cigarettes being the most harmful, and nicotine replacement therapy the least.

June 2017

In Sweden

In Sweden, where snus and other oral products have been popular for decades, it’s reported that the smoking rate has dropped to just 5% – the 2040 smoke-free target of multiple European states.

June 2017

In the UK

The  Office for National Statistics announces the UK’s smoking rate has fallen to 15.8%.

May 2017

In the UK

Action on Smoking and Health (ASH) reports there are now 2.9 million UK vapers and that – for the first time – there are now more ex-smokers who vape (1.5 million) than current smokers (1.3 million).

March 2017

In New Zealand

The Associate Health Minister announces vaping is legalised, even though official regulation is still being drafted, based on “general consensus that vaping is much less harmful than smoking.”

April 2017

In Canada

Following public consultation, the Canadian Government’s report “Seizing the Opportunity’ recognises THR. New legislation will allow people to access “vaping products, which expose them to fewer harmful chemicals than cigarettes”. This marks a significant shift from 2009 when Health Canada advised people “not to purchase or use electronic smoking products”.

2016
December 2016

In Norway

Based on evidence it’s potentially less harmful than smoking, Norway announces it will lift its ban on vaping.

November 2016

In Canada

Public consultation is opened on a new regulatory framework for vaping products in Canada.

November 2016

The World Health Organisation

WHO FCTC recognises that if “the majority of tobacco smokers” who are unable or unwilling to stop smoking, were to shift to using alternative sources of nicotine, this would represent a “significant contemporary public health achievement”.

August 2016

In New Zealand

The Ministry of Health opens for consultation on policy for vaping, recognising the “emerging evidence that e‑cigarette use may substantially reduce the burden of disease caused by smoking”.

July 2016

In the UK

Action on Smoking and Health (ASH), British Lung Foundation, Cancer Research UK and multiple others agree vapes are “significantly less harmful than smoking.”

July 2016

In the UK

Public Health England (PHE) says employers should allow vaping in the workplace where possible.

April 2016

In the UK

The Royal College of Physicians (RCP) report says in the “interests of public health it’s important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as substitutes for smoking.”

2015
December 2015

In the UK

The  Prime Minister says it’s promising around one million people “have used e-cigarettes to help them quit or have replaced smoking with e-cigarettes completely”. “We should be making clear this is a very legitimate path for many people to improve their health,” he adds.

August 2015

In the UK

Public Health England’s (PHE) landmark review finds vaping “[is] 95% less harmful than smoking”, “presents about 5% of the risk” of smoking and doesn’t create a ‘gateway’ to smoking for non-smokers and young people.

March 2015

In Canada

The Standing Committee on Health reviews the evidence on vapes and finds that they may be “be a less harmful nicotine product, containing fewer carcinogens than combustible cigarettes”, and as such, “could help smokers reduce their health risks, and may help them quit.” It recommends the government create a new regulatory framework, legalising vaping products.

2014
June 2014

In the UK

The Royal College of Physicians (RCP) says vaping could lead to significant falls in smoking prevalence.

April 2014

In the UK

Almost a decade since vaping arrived in the country, Action on Smoking and Health (ASH) data shows the number of vapers tripled between 2012-14 to 2.1 million. It also reports vapes are overwhelmingly used by past or current smokers.

April 2014

In France

The High Council on Public Health endorses vapes as a potential route away from smoking, whilst recognising that they should not also act as a gateway to nicotine use and combustible cigarettes for never-smokers.

2011
February 2011
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In the US

The American Association of Public Health Physicians (AAPHP) endorses harm reduction and argues it should be used “as an addition to current tobacco control policies… in a way that will minimise initiation of tobacco/nicotine use, maximise quit rates and assure that dual use does not increase potential harm to the user.” They also recognise vapes and snus as THR tools.

2008
February 2008

In the EU

The European Scientific Committee on Emerging and Newly Identified Health Risks review finds “smokeless tobacco products (including snus) are clearly less hazardous than cigarette smoking”.

2007
October 2007

In the UK

The Royal College of Physicians (RCP) says snus demonstrates significant harm reduction potential, stating it’s “around 90% less harmful to health” than combustible cigarettes).

2001
June 2001
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In the US

The Institute of Medicine’s ‘Clearing the smoke — Assessing the Scientific Basis for Tobacco Harm Reduction’ report recognises the potential of NGPs by stating tobacco and nicotine products that substantially reduce exposure to tobacco and smoke toxicants should be developed and studied to determine any reduced health risks compared to cigarette smoking.

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