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Many scientific and public health communities say that most of the harm associated with smoking is caused by smoke that is inhaled from combusted tobacco — not, as some incorrectly believe, by the nicotine contained in conventional cigarettes.
A tobacco harm reduction strategy is about minimizing the negative health impact of conventional cigarettes by providing adult smokers — who would otherwise continue to smoke — the opportunity to switch to an alternative source of nicotine that has the potential to reduce risk. Alternatives that do not involve the burning of tobacco and associated toxicants include vapor products (such as e-cigarettes), oral nicotine pouches, and tobacco heating devices.
The growing body of evidence confirms that these alternatives to smoking emit fewer and lower levels of toxicants compared to conventional cigarettes and have the potential to reduce risk compared to continuing to smoke. Recognizing the science and role of these alternatives, a growing number of health bodies are calling for the wider acceptance of tobacco harm reduction as a public health strategy.
As a relatively new public health concept, universal acceptance of tobacco harm reduction is yet to be achieved, but with countries such as the UK, Canada, and New Zealand all recognizing it as a powerful tool to reduce smoking, progress is being made.
Misperceptions that these alternatives are as harmful as, or even more harmful than combustible tobacco, are perpetuated by a lack of understanding of the science and the available alternatives. This disconnect between public perception and science is one of the key challenges facing the widespread acceptance of these programs.
But there is a cause to be optimistic, especially in the Gulf where more governments are developing regulatory frameworks to allow a pathway for current adult smokers, who would otherwise continue to smoke, to access alternative nicotine products that have the potential to reduce the risks of smoking.
Ƶ has made great inroads. In 2019, the Kingdom legalized the sale of vapor products, which was an important step toward ensuring adult smokers have access to these alternative products. Vapor products are now a popular and growing product category in the Kingdom. By continuing to take a pragmatic approach and allowing the scientific evidence to inform its approach toward curbing smoking rates, authorities have recognized the long-term potential of switching to these products compared to continuing to smoke cigarettes.
UK health authorities are further along the path toward tobacco harm reduction. The UK’s National Health Service encourages adult smokers to switch to e-cigarettes as part of its approach to move smokers away from cigarettes. It acknowledges the role vapor products have to play in reducing smoking rates, saying, “they’re not completely risk free, but they carry a small fraction of the risk of cigarettes.” This is complemented by scientific findings from research bodies, such as Cancer Research UK, the world’s leading independent cancer charity, which adds, “nicotine does not cause cancer.”
A 2020 UK study by the UK government advisory body the Committee on Toxicology of Chemicals in Food, Consumer Products and the Environment, concluded that smokers who switch completely to vaping can expect to reduce their risks of catching smoking-related diseases.
A number of scientific bodies endorsed the study’s findings, including the Nicotine Research Group at King’s College London. Dr Debbie Robson from the NRG welcomed the study’s recommendations. She said: “Around three-and-a-half million people in the UK vape and for those who do so exclusively, they can be reassured that by switching completely from smoking to vaping, they are doing the best thing, short of quitting altogether, for their health and wellbeing.”
In yet another endorsement of the potential of tobacco harm reduction, the UK’s Royal College of Physicians has long maintained that, “the hazard to health arising from long-term vapor inhalation is unlikely to exceed five percent of the harm from smoking tobacco.”
From a local perspective, it is important to note the progress being made in the Kingdom in this area, given the increasing body of research supporting tobacco harm reduction. But what next?
Regulation tends to follow technological development. Alternative nicotine products, although still at an early stage, are the result of many years of technological development and research, powered by innovation. There is more to come in terms of product development and adoption of the latest technology in these categories, but regulation is needed to embed tobacco harm reduction and make it a reality in the Kingdom.
As seen in other countries, taking a progressive approach toward embracing tobacco harm reduction as part of their public health agenda, government measures should ensure that tax and other regulatory frameworks for alternative nicotine products are proportionate to the level of risk of these products compared to conventional cigarettes. Also, as we see this category develop, it is imperative that quality standards are put in place, with consistent enforcement efforts to ensure compliance.
BAT sees a future where tobacco harm reduction becomes a widely accepted public health strategy, where momentum takes hold to incorporate it into government strategies, reducing the health impact of smoking around the world. A future where all firms in this market are required to provide the highest quality products, with consumer satisfaction at the forefront of their efforts. A market where responsible marketing practices are the norm, with stringent measures being taken by producers to prevent youth uptake.
The evidence on tobacco harm reduction for public health is compelling. It would be a lost opportunity to ignore it.
• Pavel Bocharov is BAT general manager, Middle East cluster.