Experts support differentiated regulations for cigarettes, novel products

MANILA, Philippines — Cigarettes and novel nicotine products should have different sets of regulations, public health experts urge, stressing that smoke-free alternatives are far less harmful and could help address the global smoking problem.

Prof. David Sweanor, chair of the advisory board of the Center for Health Law, Policy and Ethics at the University of Ottawa, said regulations on vapes, heated tobacco, oral nicotine products, and other smoke-free alternatives shouldn’t be as strict as those for conventional tobacco.

This is because the annual reviews by the Office for Health Improvement and Disparities in the UK, have consistently shown that novel tobacco products carry significantly lower risks than smoking.

Sweanor, the first lawyer in the world to work full-time on policy measures to reduce the harm from cigarette smoking, said if the same stringent regulations are imposed on novel products, far fewer people can be expected to attempt to switch away from cigarettes.

“Such regulations give the incumbent deadly products a marketplace advantage and reinforce misinformation about cigarettes being no more hazardous than smoke-free alternatives,” he said.

Experts pointed out that it’s the smoke from burning tobacco, not nicotine, that causes major health problems linked to cigarettes. By switching to smoke-free alternatives like heated tobacco, vape or oral nicotine products, the harm is significantly reduced, they said.

“It is the inhalation of smoke that is causing a global pandemic, and smoke-free alternatives can replace cigarettes. Empowering and facilitating the move to smoke-free products for people who smoke cigarettes would lead to one of the greatest advances in the history of global public health,” Sweanor said.

Dr. Jamie Hartmann-Boyce, senior research fellow in Health Behaviors at University of Oxford, agreed that while nicotine is addictive, it doesn’t cause the harm from smoking. “Evidence shows e-cigarettes with nicotine can help people quit smoking, and that they are considerably less harmful than smoking,” he said.

Prof. Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, also criticized the World Health Organization (WHO) for its strident anti-vaping stance, arguing it hinders the transition to safer alternatives.

Hajek said the WHO’s position is in contrast to the progressive policies adopted by countries like Sweden and Japan, which saw some of the biggest declines in smoking rates in recent years.

Experts have long advocated for a shift towards harm reduction policies that allow smokers access to safer alternatives while promoting public health. They criticized the WHO Framework Convention on Tobacco Control (FCTC) for its ineffectiveness and called for its revision to adopt harm reduction strategies.

“We already see in Sweden, Norway, New Zealand, Japan, and many other countries that, given a chance, people who smoke cigarettes will switch their consumption to low-risk alternatives. Cigarette use has been cut in half in just a few years. If we used risk-proportionate regulation and taxation to empower this transition, we could hugely accelerate a healthier future,” said Sweanor.

He also criticized several countries that imposed high taxes on novel nicotine products. “It is like giving the same penalties for driving while sober as for driving while intoxicated. How could that possibly do anything other than encourage the continuation of drunk driving?” he said.

“The bottom line is that we have known for decades that the reason people die from smoking is because of inhaling smoke, not from nicotine. We know that the countries that have had the biggest declines in cigarette smoking in recent times are countries that are essentially ignoring the advice of the World Health Organization—places that have allowed substitutes to replace cigarettes,” Sweanor said.

Dr. Riccardo Polosa, professor of Internal Medicine at the University of Catania and founder of the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) in Italy, said current tobacco control policies need innovation.

READ: Study: Switching to vape, heated tobacco can lower smokers’ healthcare expenses

“Beyond advocating the actions like increasing tobacco taxes, implementing public smoking bans, promoting accessible cessation programs for all, these tobacco control policies should also take into account the integration of the principle of risk reduction through the promotion of non-combustible alternative products for adult smokers. You see this happening already in places like Japan, Norway, Sweden, England, and Iceland,” said Polosa.

Hajek said in fact he sees a future where “smoking-related cancer, heart disease and lung disease will eventually disappear as smoking is made obsolete by much less risky nicotine products that do not include combustion.”

Representatives from countries that are signatories to the WHO FCTC will meet in Panama for the 10th Conference of the Parties (COP) this year, after the meeting was canceled in November 2023, to tackle major topics such as how to treat “novel and emerging tobacco and nicotine products.”