Public Health Policy & Regulation – What is expected?

Nicotine/Tobacco is an ideal area for harm reduction, started his speech Professor Karl Fagerstrom, since it is used largely because of nicotine and pure nicotine, and even unburned tobacco, is much less problem than its health consequences.

Giving examples from 4 countries where harm reduction is in practice with different kind of products, Professor Fagerstrom pointed out that in Sweden and Norway tobacco use prevalence has been significantly declined; in Japan tobacco sales have shown a 30% reduction in a three-year period, and UK cigarette smoking prevalence reached a historic low of 15.1% in 2017, with an accelerated annual rate of decline from about 2009.

Today e-cigarette is still the most used aid to quitting, he added, as it is an easier, more gradual approach characterized by high similarity to cigarette smoking. When smokers want to quit cigarette smoking, he explained, they decide which approach they will use considering both the similarity to cigarettes and its harmfulness.

Harm reduction is already happening in Sweden, supported by epidemiological studies, he mentioned, and Swedish snus has been accepted as the first reduced risk product by FDA.

“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”, Professor Fagerstrom concluded.

Dr. Michael Toumbis presented the recent tobacco control data and tobacco control progress, pointing out that although WHO FTCT (Framework Convention on Tobacco Control) provides a comprehensive strategy for parties to combat the tobacco epidemic and sets out a brought range of evidence-based measures to reduce tobacco demand and supply, unfortunately does not adopt harm reduction strategy except the NRTs.

Nevertheless, he continued, the current rate of progress in tobacco control is not fast enough and it is imperative to find additional ways to accelerate the decline of smoking. Multidimensional framework, which evaluates toxicity/harmfulness, appeal or popularity and dependence for nicotine-containing products, provides a roadmap to help inform a harm minimization framework and to guide research, policy, and practice.

Harm reduction approach can complement proven current tobacco control efforts of prevention and cessation, Dr. Toumbis said. The opportunity depends on finding the appropriate balance between product safety, customer appeal and regulations targeted specifically to decrease the use of conventional, combusted tobacco products, he continued.

Tobacco control strategies should adopt the concept of harm reduction in developing coordinated regulations, policies, and interventions to rapidly move smokers, towards less harmful nicotine delivery products, he said, adding that policies and regulations must be aligned on the basis of proportionate harm of the nicotine products.

“Harm reduction is an evidence-based approach to tobacco control, which, along with other proven tobacco control interventions, can simultaneously prevent youth from starting to smoke and help current smokers stop, saving many lives more quickly than would otherwise be possible”, Dr. Toumbis concluded.

Public health risk communication, indicated Mr. Clive Bates, is key for tobacco control policies and programs, since perceptions of the targeted population can largely affect their results and efficacy.

“A recent UK survey”, he explained, “showed that only 12.5% of participants believed that some smokeless tobacco products, such as chewing tobacco and snuff, are less harmful than tobacco smoking and only 3.6% believed that electronic cigarettes are much less harmful compared to smoking cigarettes”. Additionally, 56.5% of participants strongly agreed or agreed that the nicotine in cigarettes is the substance that causes most of the cancer caused by smoking.

Public health risk communication should be based on the consumer’s perspective and not the corporate one, Mr. Bates noted, and warnings should be based on the magnitude of risk. Mangled messages are misleading, he added, as they fail to communicate the real and exact risks to the consumer.

New harm reduction products should de-normalize smoking and not normalize it, Mr. Bates pointed out, since they are clearly anti-smoking technologies. Unfortunately, in the name of uncertainty, we are over-regulating these products, he added. These products have an acceptable risk, not zero risk, they are not risk-free, he continued, but we know for sure that they cause less harm compared to combustible cigarettes.