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BURNING ISSUES: GLOBAL STATE OF HARM REDUCTION NEW REPORT. 17th 11 2020

News
The recent GSTHR conference on November 4th 2020 concluded with the launch of the Tobacco Harm Reduction Report dubbed Burning Issues: The Global State of Tobacco Harm Reduction 2020’.

The recent GSTHR conference on November 4th 2020 concluded with the launch of the Tobacco Harm Reduction Report dubbed Burning Issues: The Global State of Tobacco Harm Reduction 2020’.

The report includes studies form several passionate scientists, data analysts, researchers and media personnel together with other stakeholders and disciplines from around the world who have over the years studied the tobacco industry, the myths and challenges around it and decided to discover the truth through vigorous research and tell it to the world with an intension to educate and improve public health.

Scientist and researcher Harry Shapiro together with data analyst Tomasz Jerzynski headed the compilation of Burning Issues and based the report on the right to health and Tobacco Harm Reduction. Using case studies in low and middle income countries, Europe, Asia and the Southern Pacific to compile the data, the goal was to reduce the risks that occur as a result of combustible cigarette smoking, thereby enabling people to survive and live better. In this case it would be through access to Safer Nicotine Products (SNP) aimed at encouraging people to switch away from cigarettes, one of the most dangerous ways of consuming nicotine.

Giving the opening remarks to the launch, Gerry Stimson, a public health veteran remarked that “Nicotine is one of the top 3 drugs alongside caffeine and alcohol and unfortunately it’s the only one that is smoked. THR matters: because people who use nicotine have a right to protect their health and an end to smoking can be achieved at no cost to government’s which is very rare in public health. It matters because, if played right it can bring an end to the tobacco as we know it because it will bring a transformation from combustibles – to non-combustibles, and very importantly it puts people at the center of change, a positive route to a happier, healthier life.

Also speaking during the virtual launch, the author and editor of Burning Issues, Harry Shapiro shared key points on the main themes of the report stating that “there’s been an appalling state of affairs which is indicative of the witch hunt in both the academic and clinical world of international tobacco control aimed at those who support THR on the assumption that this is a proxy for being in the pocket of big tobacco. That’s why we had to be positive about progress towards a humane and compassionate tobacco control policy narrative which should be squarely and solely aimed at reducing the death and disease toll from smoking. It should be an environment which has no religious or moral considerations which are mostly at play in the current THR narrative.” He said.

Tomasz Jerzynski gave a brief on the key data and how they got the numbers in the report while Grzegorz Krol explained how to navigate through the new launched GSTHR website.

Some of the takeaway themes from the report include:

The estimated total number of smokers globally – at 1.1 billion – is static, the same number as in 2000 and predicted it to be the same in 2025, disproportionally affecting poor and marginalized groups, especially in LMIC. The World Health Organization (WHO) has not revised downwards it estimates that one billion lives could be lost to smoking-related disease by the end of the century. This is equivalent to the combined populations of Indonesia, Brazil, Nigeria, Bangladesh and the Philippines dying from COVID-19.

The global smoking problem continues unabated, but there are glimmers of hope in some countries and while daily adult smoking levels have fallen across the world, the rates of decline have slowed in some countries. In others, the number of smokers has increased, often due to population growth. The highest reported levels of smoking occur mainly but not exclusively in low and middle-income countries (LMIC) which consequently shoulder the heaviest burden of disease and mortality.

Despite a more globally hostile environment for THR, the exclusive survey of global prevalence of safer nicotine products estimates that the overall figure stands at approximately 98m, of whom 68m are vapers. While from a public health perspective this is good news, it still means that after more than a decade of product availability, there are only nine users of SNP for every 100 smokers.

After decades of tobacco research which failed to demonstrate adverse effects of nicotine on the developing brain, recent claims to this effect about vaping are not credible. Failing to demonstrate a gateway effect from vaping to smoking, anti-THR campaigners majored on nicotine ‘addiction’. However, given the lack of evidence about the physical and psychological harms of nicotine, concerns about ‘addiction’ belong more to the realm of moral objections than public health. Finally, and without any evidence, it has been claimed that vaping puts users more at risk from COVID-19.

The number of countries in which heated tobacco products are sold has increased from 37 (in our 2018 report) to 54. Like vaping devices, there is a back story of industry attempts to bring a successful heated tobacco device to market. Vaping technology was relatively simple, allowing several small start-ups to enter the market. By contrast, the cost of HTP development meant the field had been left to the major tobacco companies who have had the resources necessary to pioneer this technology. IQOS (PMI), Ploom Tech (JTI), Glo (BAT) and Pulze (Imperial) were the first to market. However, new players are now joining the Image: Michael FALLON on Unsplash etc.

The WHO continues to express concern that the unabated levels of smoking will undermine attainment of the Sustainable Development Goals and ensure that the 2030 targets to reduce levels of non-communicable disease will be missed. Clearly then, traditional tobacco control interventions elaborated in the WHO Framework Convention on Tobacco Control (FCTC) are not enough. Tobacco Harm Reduction (THR) policies therefore should be regarded as complementary rather than inimical to reducing the global death and disease from smoking. The glimmer of hope is that some countries have taken a more inclusive approach to THR as part of the overall strategy towards a smoke-free world. Burning Issues: Global State of Tobacco Harm Reduction 2020. London: Knowledge-Action Change, 2020.