Countries embracing innovative products log biggest decline in smoking


Several countries including the United Kingdom, Japan and Sweden have witnessed a significant decline in smoking rates after embracing innovative smoke-free products like vapes, heated tobacco and snus, according to international public health policy experts.

“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,” Prof. David Sweanor said during the virtual event hosted by Formiche and Healthcare Policy on November 24, 2023.

Experts made this point in a virtual event following the postponement of the Conference of the Parties (COP) meeting of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in Panama in November.

Describing the restrictive WHO tobacco control approach as ineffective, they called for a shift towards harm reduction strategies that allow smokers access to safer alternatives while promoting public health.

Prof. Sweanor, Chair of the Advisory Board of the Center for Health Law, Policy and Ethics at the University of Ottawa, said a number of countries opted to disregard the WHO’s advice in favor of policies allowing “safer alternatives” to replace cigarettes.

The virtual event focused on the WHO FCTC, whose COP meeting in Panama was abruptly postponed in November. Prof. Sweanor, one of the international experts who signed a letter to the WHO criticizing its opposition to tobacco harm reduction, spoke out about the organization’s “problematic” stance.

“We know that we can eliminate or largely eliminate the smoking problem globally by substituting low-risk products,” said Prof. Sweanor, the first lawyer in the world to work full-time on policy measures to reduce the harm from cigarette smoking.  He is among international experts who wrote a letter to the WHO to point out the problems it is facing because of its opposition to tobacco harm reduction.

Prof. Sweanor said many countries are now ignoring the WHO’s advice because of the latter’s prohibitionist and extremist policies. “Countries end up ignoring protocols that are anti-health, that are anti-consumer rights. What happens is that people also lose faith in authorities. They stop believing the World Health Organization. And that’s a huge cost.  We’re seeing that happening globally now, where authorities are no longer trusted,” he said.

Prof. Sweanor emphasized that nations can implement policies that prioritize their citizens’ health, even if they contradict WHO dictates. “We’re seeing a growing trend of countries prioritizing what works for their people,” he stated.

He criticized the WHO FCTC for its lack of transparency and scrutiny. with members meeting behind closed doors to come up with rules for its members. “But many of what they were saying really didn’t make sense on the basis of the science that already existed and the practicalities that we know work in public health,” he said.

Dr. Anders Milton, a physician and former president of the World Medical Association, highlighted the urgency of addressing the global smoking crisis involving a billion users. “Fifty percent of them [smokers] will die unless we do something. So 500 million will die without us doing anything.  As you know, the World Health Organization wants to forbid everything but cigarettes, really, and I think that’s the wrong way to go. I think we should use harm reduction instead,” he 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, emphasized the substantial evidence supporting the reduced toxicity of vapes and heated tobacco compared to combustible cigarettes.

“In our experience, we are producing excellent science that is completely snowed under by junk science that is constantly being produced, particularly by US-centric narratives and US-centric funded institutions,” Dr. Polosa said.

“Tobacco control policies today need innovation. 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,” he said.

Dr. Polosa stressed the need for innovation in tobacco control policies. “Beyond traditional measures like taxation, public smoking bans, and cessation programs, we must embrace the principle of “risk reduction” by promoting “non-combustible alternatives” for adult smokers. This successful approach is already evident in countries like Japan, Norway, Sweden, England, and Iceland,” he said.

Maria Alejandra Medina, coordinator of Corporación Acción Técnica Social in Colombia and Latin America, criticized the WHO FCTC’s attempts to hide the truth.

“I want to say that the COP is not telling the difference between nicotine and tobacco and the alternatives that are potential solutions for too many people. This sows misinformation and confuses users about the profile rates between different products. By not giving information about differentiation between various smoke-free nicotine products, this COP hides too many evidence of developments and this is really bad to new approach to smoke or tobacco use and even for drug use too,” Medina said.

“Not involving nicotine consumers in the regulation process violates their human rights of users, because we are trying to understand new approaches in health policy, new approaches in human rights, and COP,” she said.

“We need to be very aware of the intensified discussion due to COP postponement. And we must emphasize that the current tobacco (control) policies are creating more harm than many products that today represent harm reduction alternatives for many users,” Medina said.

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