Warsaw, Poland—A former consultant of the World Health Organization expects tobacco companies to invest in safer nicotine products such as vapes or electronic cigarettes, heat-not-burn sticks and snus amid rising demand from consumers.
“Companies are constantly looking at where the market is going. If you miss the change, you will go broke like Kodak on film or Blackberry on smartphone. They missed the transition. Tobacco companies now see the new technology [electronic-cigarette]. The people could now get what they want from cigarettes in a far less hazardous way. And that was a threat to the cigarette business,” says David Sweanor, a former WHO consultant who now chairs the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa in Canada.
“Cigarette smoking kills 20,000 people a day. How do we reduce that risk? Where does the risk come from? It comes from inhaling smoke. You get rid of the smoke and you get rid of the risk. And we now know how to do it,” he says.
Sweanor is one of the more than 80 public health experts who spoke during the 6th Global Forum on Nicotine held at Marriott Hotel in this city on June 13 to 15, 2019. More than 650 delegates from 70 countries including the Philippines attended the event that highlighted the message that e-cigarettes are 95-percent less harmful than smoking cigarettes.
“I don’t think they [tobacco companies] have any choice. They have to move. I think it is gonna be innovative small companies that take risks that will end up benefitting the most. That is the nature of the market,” he says.
He says that in the United States, a start-up e-cigarette company called Juul Labs Inc. that nobody heard of two years ago is now estimated to be worth around $40 billion.
“What we have now is still the early stages of replacing products. And the potential is so great because the global cigarette market is the equivalent of about $850 billion a year. For a business to look at getting involved in this is very lucrative. You could get just a fraction of 1 percent of the global market and you could become a billionaire. That incentive is there,” he says.
“We know enough science to know that we can have enough products that have a tiny fraction of the risks of cigarettes. We have seen examples around the world that many smokers will move to these products,” he says.
Cecilia Kindstrand-Isaksson, the director for public affairs of snus manufacturer Swedish Match, also predicts the growth of demand for other non-combustible nicotine products such as snus.
“I don’t think regulators and policymakers will be able to stop it…We are not going back to combustible cigarettes without filter. The more products that we use, the more scared the industry gets because we need to compete with each other. I think it is all down to consumer,” she says.
Gregory Conley, the president of the American Vaping Association, also supports this view. “I definitely believe that we are going to see harm reduction products take off and make great changes not just in the first-world nations of Japan, South Korea, Australia, New Zealand. I think we will have technological developments in Indonesia and China where we are actually going to save lives,” he says.
Sweanor says that in the United States, cigarette sales are falling markedly and the number of vapers is going up. “Amazing things are happening, despite all the opposition,” he says.
Sweanor says the switch to vaping will have a tremendous impact on public health globally. Vaping refers to the act of inhaling and exhaling the vapor produced by an electronic cigarette which is a battery-operated device that vaporizes a flavored liquid made of nicotine, propylene glycol, glycerine and flavorings.
Public Health England reported in 2015 that e-cigarettes are 95-percent less harmful than smoking, as the harmful chemicals present in cigarette smoke are either not in EC vapor or only found at much lower levels.
“Cigarette smoking and air pollution are the biggest cause of deaths. They are killing about 7 million people a year each. That means smoking cigarettes kills roughly 20,000 people every day. That number has been going up and it is killing people because they are inhaling smoke. It is smoke that is the problem, just like inhaling smoke from dirty air,” says Sweanor.
“So we have the ability now through technology [e-cigarette] to end that, just like we learned through technology how we could get clean water or how we could get sanitary food manufacturing, or how we could get science-based pharmaceuticals. We are on the verge of something really, really significant from public health standpoint,” he says.
Sweanor says countries such as Japan, the UK, the US, Canada, Sweden, Norway, Iceland, South Korea and New Zealand saw a more rapid decline in smoking because of the use of safer nicotine products such as vapes, heat-not-burn devices and oral nicotine products such as Swedish snus.
He says the WHO and other health authorities, however, oppose these safer alternatives because of the moral aspect. “I have worked with the WHO earlier in my career in many countries. The WHO used to be more of a health body on issues about tobacco and nicotine, but became much more controlled by people who see it as a moral issue. They are seeing it more like sin. That is a critical problem and the WHO is not following science and that they are seeing it more as a moral issue. Many of the people whom I have worked with in my career in reducing cigarette smoking do see this as an ideological battle rather than a health battle,” he says.
“Any form of innovation will be opposed by people with financial interests in the alternative, people who just don’t like change, people who have some sort of political and personal standings that they are afraid will change. In the past, people opposed refrigeration, opposed farm mechanization, opposed automobiles, opposed any innovation,” he says.
“It will be opposed regardless of what the scientific merits are, regardless of the ethics. It requires a battle against somebody’s vested interests,” he says.
The WHO refuses to endorse e-cigarettes. Armando Peruga, who has two decades of experience in tobacco control, is quoted on the WHO website that “these devices have become popular over the last four or five years, so there are only a few studies on the health risks and we don’t know the long-term effects.”
Dr. Riccardo Polosa, a harm reduction researcher and a professor of Internal Medicine at University of Catania in Italy, says waiting for 30 years to validate the health benefits of e-cigarettes would be costly.
“Do we have 30 years to demonstrate that? In the meanwhile, having people smoking and dying from cancer, pulmonary disease and all these nasty diseases that we know deadly tobacco cigarettes are causing, that is the key question. It becomes more moral and ethical rather than scientific but my studies in people who already have the disease already show reversal of damage,” says Polosa.
Fiona Patten, a leader of the Reason Party and a member of Northern Metropolitan Region in the Victorian Parliament’s Legislative Council, says 64 scientific studies now demonstrate that vaporized products reduce risk.
“Using the evidence, speaking the truth, it’s our strongest weapon. And it will work,” Patten says.
Heneage Mitchell of Bangkok-based consumer advocacy group Fact Asia Consultants Ltd. says countries like the Philippines can reduce smoking by regulating the use of e-cigarettes, heat-not-burn products and Swedish snus which are known to be significantly less harmful than conventional cigarettes.
Clarisse Virgino, a member of the Coalition of Asia-Pacific Tobacco Harm Reduction Advocates and a Filipino vaper, however, warns that a proposal by the Department of Finance in the Philippines to tax e-cigarettes like tobacco products could prevent more Filipinos from quitting smoking.
“We want reasonable tax system and tax implementation so as not to impose a de facto ban on e-cigarettes as well as heat-not-burn products,” says Virgino.
Virgino says the Department of Health maintains its position that e-cigarettes should be treated and regulated no differently than other tobacco products until these alternatives to smoking are proven safe for consumption. She says fortunately, some senators who see the benefit of safer nicotine products aim to tax e-cigarettes properly.
About 62 countries currently regulate e-cigarettes under tobacco regulation, while 39 countries inappropriately ban safer nicotine products, according to the Global State of Tobacco Harm Reduction Report 2018.
The report estimates that by 2021, over 55 million people will be using e-cigarettes or heat-not-burn tobacco products and that the global market will be worth $35 billion.
Prof. Gerry Stimson of the London School of Hygiene and Tropical Medicine and the program director of the 6th Global Forum on Nicotine, says it is important that smokers switch to safer alternatives because “half of those who smoke will die prematurely from smoking-related diseases.”
“This is a public health emergency on a global scale. It’s essential that people around the world have access to and are positively encouraged to switch away from cigarettes to safer nicotine products,” says Stimson.