International health policy experts called for less stringent regulations on novel nicotine products—like heated tobacco, oral nicotine and vape products—arguing they pose significantly lower risks than conventional cigarettes and could help millions of smokers quit.
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, criticized the current “one-size-fits-all” approach to tobacco control policies promoted by the World Health Organization (WHO).
“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 Dr. Polosa.
Professor David Sweanor, chair of the advisory board of the Center for Health Law, Policy and Ethics at the University of Ottawa, echoed this sentiment, arguing that regulations on vapes, heated tobacco, oral nicotine products and other smoke-free alternatives shouldn’t be as strict as those for cigarettes.
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.
Prof. 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 emphasized that nicotine itself is not the primary culprit behind smoking-related health problems; it’s the inhalation of smoke from burning tobacco that causes the most harm. Switching to smoke-free alternatives like heated tobacco, vapes, or oral nicotine products significantly reduces risks, they argued.
“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,” Prof. 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.
Professor Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, said smoke-free alternatives can replace cigarettes and empower smokers to make a healthier choice.
He also criticized the WHO’s “strident anti-vaping stance” for hindering the adoption of safer alternatives and pointed to countries like Sweden and Japan as examples of successful harm reduction policies leading to declining smoking rates.
Prof. Sweanor said that in countries like Sweden, Norway, New Zealand and Japan, people who smoke cigarettes, given a chance, switched 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 Prof. Sweanor.
At the same time, he expressed concern over other countries’ decision to impose high taxes on novel nicotine products, comparing it to “penalizing sober driving as harshly as drunk driving.” He also highlighted the lack of transparency in the WHO Framework Convention on Tobacco Control (FCTC) and called for its revision to incorporate harm reduction principles and facilitate smokers’ access to safer alternatives.
“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. Sweanor said.
Representatives from countries signatory to the FCTC are set to meet in Panama for the 10th Conference of the Parties (COP) later this year, where “novel and emerging tobacco and nicotine products” will be a key topic of discussion.
Prof. Hajek expressed optimism that with differentiated policies in place, “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.”