A summary of selected sessions

October 14, 2020

The 3rd Scientific Summit on Tobacco Harm Reduction featured 50 renowned speakers from 26 countries. About 300 attendees from 38 countries* worldwide participated in the event. The key message of the Summit is that for ‘hardcore’ smokers who cannot quit despite the risk, there is no dilemma, doctors have to help them at least to reduce the harm. There is increasing interest on Tobacco Harm Reduction as a tool to reduce the detrimental consequences of cigarette smoking to the human population of the planet. More data is needed and appropriate public health risk communication in tobacco control policies and programs.

Download a full summary of the 3rd Scientific Summit here.


The key messages from selected lectures and panel discussions

In the case of cigarette smoking, we have known for decades that, while people smoke for the nicotine, they die from the smoke. David T. Sweanor J.D., chair of the Centre for Health Law, Policy and Ethics, adjunct professor of law, University of Ottawa, Canada, tobacco and health policy issues expert, keynote speaker at the Summit, talked about how “Risk proportionate regulation and the science to support it” can be used to get rid of the of cigarette-caused epidemic. The product itself—cigarette—is the problem, so risk-proportionate regulation should be implemented, to transform the cigarette business and potentially achieve one of the biggest public health breakthroughs ever: lower-risk products should have an advantage over more hazardous products, such as cigarettes using risk-proportionate taxation and different points of access; also, information on alternative products needs to be more accurate, to reverse the current misinformation on their risks. [READ MORE]


The international convention with the goal to eradicate smoking, signed in 2005, is based on the principle “quit or die”; however, this is not acceptable by doctors as the only existing option for their patients. Harm reduction—embraced by many countries today—acknowledges the patient’s values as a strength not a weakness, accepts people’s freedom to choose unhealthy behaviors, but reduces their harm through innovation. Doctors owe to their patients to provide them with the best available care. This was the key message of Professor David Khayat, Medical Oncologist, Former President of the French National Cancer Institute in his keynote lecture addressing the question whether the scientific and medical community could play a role in making policy makers to reconsider the tobacco control strategies. Doctors have to be empowered to improve tobacco control in the future, since they are the ones who know the science and care for the patients. [READ MORE]


Novel products must submit scientific evidence to support their claims for reduced harm, to the relevant Ministry of Health Committee according to the new legislation on smoking control in Greece, namely Law 4715/2020, which introduced the “harm reduction” principle. That was the subject of the presentation of Mr. Ioannis Faropoulos, Scientific Advisor to the General Secretariat for Public Health of the Hellenic Ministry of Health. A fourth pillar was added to the National Action Plan for the control of tobacco of 2019, i.e. the “Assessment of Novel Tobacco Products” based on the above principle, given that traditional measures (smoking prevention, protection of the population from passive smoking, Smoking Cessation programs) have been inadequate to control the cigarette smoking epidemic. By the new Law, Greek State recognizes the right of smokers to have accurate information on and access to better choices, and welcomes efforts being made with the help of technology to produce potential better products (e-cigs, heated tobacco products, etc.). The new law does not favor the tobacco industry; on the contrary, the sector of novel tobacco products is extensively regulated and monitored. [READ MORE]


Prominent figures in smoking control strategy discussed “Public Health Policy & Regulation and what is expected in the future?” in a session chaired by Professor Panos Vardas.

Nicotine/Tobacco is an ideal area for harm reduction, since it is used largely because nicotine and even not-burned tobacco, create lesser problems to health than combustible cigarettes. According to Professor Karl Fagerstrom

The final battle for harm reduction is not so much on how safe the harm reduction products are, but if nicotine can be eradicated or will be accepted.

WHO FTCT (Framework Convention on Tobacco Control) policy provides a comprehensive strategy to combat the tobacco epidemic but does not adopt harm reduction strategy. Dr. Michael Toumbis, although he acknowledged progress in tobacco control based on recent data, he suggested that many lives could be saved that would otherwise be impossible, if THR complemented proven current tobacco control efforts of prevention and cessation and prevented youth from starting to smoke.

The role of public health risk communication in tobacco control policies and programs, which is key since perceptions of the targeted population can largely affect policies results and efficacy, was stressed by Mr. Clive Bates. “Public health risk communication should be based on the consumers perspective, and convey a clear message that novel harm reduction products are clearly anti-smoking technologies; they are not risk-free, but we are certain that they cause less harm compared to combustible cigarettes”. [READ MORE]


In a panel discussion on whether Tobacco Harm Reduction should become a Public Health Policy tool globally, Public health officials and harm reduction advocates agreed that regulatory authorities and the WHO need to be persuaded to adopt a more realistic approach, and use the many choices and new technologies at hand, based on the fact that human nature is such that we will always have catastrophic habits, even though we shouldn’t have any.

Professor Panos Vardas, as coordinator, summarized the current dilemmas regarding smoking control: can we guide new generations to avoid smoking and its deadly effects? The “hardliners’” doctrine consists in banning the habit totally, however this has been proved inefficient in other cases, such as cannabis. Another dilemma is whether harm reduction policy is helpful to the young or is it a Trojan horse to other habits.

The case of snus use in Scandinavia was presented as a proof concept of tobacco harm reduction by Karl E. Lund, Professor in sociology at the Norwegian Institute of Public Health, and active in tobacco harm reduction. He also showed that availability of snus in Scandinavian countries produced a net gain to public health. A professed harm reduction advocate, Dr. Karl Fagerstrom stated that smoking prevention, smoking cessation, or harm reduction are complementary methods, and that we need all three against tobacco smoking and in order to minimize Public Health costs. Within nicotine/tobacco products continuum, burned tobacco constitutes a breach, because it is the combustion that causes disease. Less harmful nicotine products are needed, since people are not likely to give up drugs, like coffee or nicotine. Professor Charmaine Gauci, Superintendent of Public Health, Ministry of Health, Malta, focused on measures to control tobacco uptake in youth with methods especially appealing to them; methods such as e-cigs should be introduced, but campaign messages must avoid drawing youth to alternative tobacco products. Smoking has emerged as a new Public Health risk factor that kills not only active but also passive smokers, Professor Andrzej M. Fal, MD, President of the Polish Society of Public Health pointed out; also, it influences most pulmonological diseases, coronary disease, obesity, etc. It is important to introduce reduced harm products to Public Health Policies, as aids to smoking cessation, provided that there are evidence-based data to prove them safer than conventional cigarettes. Fernando Fernandez Bueno, MD and military surgeon, as spokesperson of the Spanish Harm Reduction Platform, presented the Platform’s role in engaging policy makers and informing health professionals and the public. Good examples and new rules in tobacco control and are to be followed to “help smokers who are our patients”. [READ MORE]


There was consent in the panel discussion amongst MDs from different countries, chaired by Dr. Dimitri Richter, entitled “The doctor’s dilemma: Providing guidance on alternative smoking products to adult smokers amid controversy and change”, that if someone cannot quit smoking, they should be encouraged to use any tool available to reduce their health risk.

The views of Professor Manuel Pais Clemente, Porto University School of Medicine, Portugal, & Vice President of the European Medical Association, reflect all panelists’ positions: Doctors must try everything to help their patients; smokers are people at risk, so we cannot deny them our help, no matter what they do to help themselves. Harm reduction came to stay, since there will always be smokers and new alternatives are needed to help them suffer less consequences on their health. There is clinical evidence today, that we have more tools to help people reduce the harm from smoking. Dr. Peter Harper, Medical Oncologist in UK, said that signs are pointing that harm reduction—a strategy aiming to minimize the harms of any risk behavior—works and can be a useful tool to help smokers quit, even if no long-term data exists. Moral issues are raised regarding harm reduction, said Efrain Cambronero, Surgical Oncologist in Costa Rica, but, for ‘hardcore’ smokers who cannot quit despite the risk, there is no dilemma, doctors have to help them at least to reduce the harm. Above all, young people should be prevented from smoking and smokers assisted to quit. Dr. Piotr Kuna, Medical University of Lodz, Poland, spoke about smoking-associated airway diseases and pointed out that smoking cessation even for a limited period of time helps improve lung function in patients. In Poland, a protocol is in place, whereby doctors firstly advise patients to stop smoking and as a last option—for those who are not able to stop—propose the use of heat-not-burn products. In Hungary, where numbers of lung cancer/COPD patients are the largest in Europe, harm reduction is a new concept, Dr. Emil Toldy-Schedel, St Francis Hospital, Budapest, noted; therefore medical community still needs to clarify many matters as to the best way to use them. Dr. Michael Toumbis, Pneumonologist and President of the Cyprus Institute of Respiratory Diseases, agreed that harm reduction tobacco products are new, and their long-term safety is not yet known, but it is a fact that they release lower levels of chemicals compared to combustible cigarettes. Harm reduction products are not yet adopted by WHO and FCTC, he concluded, and scientists should work towards this direction. [READ MORE]

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*Summit’s attendees from: Argentina, Australia, Austria, Bosnia, Brazil, Bulgaria, Costa Rica, Canada, Croatia, Cyprus, Estonia, Greece, Hungary, India, Indonesia, Italy, Jordan, Kenya, Latvia, Lebanon, Lithuania, Malaysia, Moldova, Morocco, Mexico, Norway, Poland, Portugal, Romania, Slovakia, South Africa, Spain, Sweden, Switzerland, Thailand, Tunisia, Turkey, United Kingdom.