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Tobacco harm reduction advocates call for science-based, innovative regulations 

Tobacco harm reduction (THR) advocates urged governments and regulators to come up with science-based and innovation-driven regulations in order to help reduce tobacco-related sickness and deaths.

The call was made during the three-day 2020 Global Tobacco and Nicotine Forum (GTNF) held online from September 21 to 24, a GTNF news release said.

“Regulations must be based on sound science and not be driven by politics, which unfortunately is not always the case. Regulations must be progressive and allow innovation as new facts emerge,” said Chris Allen, chief scientific officer at Broughton Nicotine Services.

Derek Yach, president of the Foundation for a Smoke-Free World said 7 million people die every year due to tobacco-related diseases, the GTNF said.

Yach added that 1.3 billion people are using tobacco products, most of them in a toxic, combustible form.

“The goal of a regulator should primarily be to reduce that harm in the fastest possible time,” Yach said.

For her part, Elaine K. Round, senior director of scientific and regulatory affairs at RAI Services, said there’s an evolving set of state and local tobacco regulations in the US that are “based more on emotion than on science” which are “almost evolving toward a 50-country approach rather than a unified federal approach.”

Meanwhile, the European Union Tobacco Products Directive (EUTPD) is “an inclusive process” and “evidence-based approach” that other countries can look to for guidance, according to trade law consultant Abrie du Plessis.

The EUTPD places limits on the sale and merchandising of tobacco and tobacco-related products in the EU. It aims to improve the functioning of the internal market for tobacco and related products while ensuring a high level of health protection for European citizens, the GTNF said.

“It is important to be able to critique the way governments have responded to Covid-19 so we can learn and strive for strategies that will cause as little harm as possible to as many people and equitably across our society,” said Marewa Glover, director of the Centre of Research Excellence on Indigenous Sovereignty and Smoking.

‘Some progress’ in the acceptance of ATPs

“The debate on the value of THR interventions remains controversial, ideological and often emotional, [which] continues to [hinder] constructive dialogue,” said Prof. Tikki Pang, visiting professor at the Yong Loo Lin School of Medicine at the National University of Singapore.

Pang expressed disappointment at how THR policies continue to vary greatly between countries, the news release said.

“There is at this point no unanimous agreement on what are the best policies,” said Pang, a former 13-year director for Research Policy and Cooperation of the World Health Organization (WHO).

He cited that there are countries where e-cigarettes are allowed/regulated or banned, countries where there is pending legislation on e-cigarettes, countries with no specific law on e-cigarettes, and countries with no information about e-cigarettes.

On the positive side, Pang noted “some progress” in the acceptance of alternative tobacco products (ATPs), citing recent developments at the WHO and the US Food and Drug Administration (FDA).

“Since I used to work for the WHO, I was very heartened by a WHO report released earlier this year, the ‘WHO study group on tobacco product regulation,’” he added.

He quoted leading THR advocate Clive Bates who, commenting on the WHO report, wrote, “Though there is much to disagree with, there is also a reasonable attempt to recognize harm reduction concepts and not treat them like witchcraft…”

According to Pang, ATPs were discussed at the meetings of the WHO Governing Bodies and the Framework Convention on Tobacco Control Conference of Parties.

“I believe there’s a little bit of an opening here. Countries, especially in the developing world, do look to the WHO for guidance on policies. Although overall the WHO position on ATPs is still fairly negative and unsupportive, I want to be optimistic. We’re beginning to see light at the end of the tunnel,” Pang explained.

He highlighted the significance of the US FDA decision in July 2020 to authorize the marketing of the heated tobacco product IQOS in the US as modified risk tobacco products (MRTP), an authorization that the agency designated as “appropriate for the promotion of public health.”

The US FDA decision marked the first time that the agency has granted MRTP marketing orders for an innovative electronic alternative to cigarettes, the GTNF news release said.

“This is another step forward. Many developing countries look to the US FDA for guidance not just in ATPs but in medicines and vaccines,” Pang said.

More smokers switching to reduced-harm alternatives

The smoking prevalence in Japan has gone down by 30 percent in three years since heated tobacco products (HTPs) became available in the country, with HTP penetration among Japanese smokers currently at 25 percent, according to Dr. Hiroya Kumamaru, a cardiovascular surgeon and vice director of AOI International Hospital in Kanagawa, Japan.

“Overall tobacco sales volume covering cigarettes plus HTPs is still decreasing, while HTP sales are increasing. This indicates that switching from cigarettes to HTPs is happening very quickly,” Kumamaru explained.

He noted that HTPs are so far not causing the gateway effect on younger Japanese.

Besides Japan, dramatic and historic drops in cigarette sales following the introduction of ATPs have also been seen in the UK, US and Korea, according to Pang.

“There is a growing evidence base on the value of ATPs in smoking cessation. Evidence from the UK, US and Europe shows that the gateway effect of ATPs is limited and negligible. Public Health England notes the increasing trend in vaping is happening against a backdrop of decreasing smoking rates,” Pang said.

Launched in Rio de Janeiro in 2008, the annual GTNF has become the global exchange for views and ideas among public health experts, government representatives, investors and members of the tobacco/nicotine industries.

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