Threat or tool: what’s the future of non-combustible tobacco products?

It’s impossible to deny vapes have helped many people kick their cigarette smoking habit. But the positive value of the ‘tobacco harm reduction devices’ – as those in the sector like to phrase it – is unlikely to get much consideration at the Conference of the Parties (COP10) to the WHO Framework Convention on Tobacco Control (FCTC), in Panama next month.

And some people are extremely upset about that.

The meeting brings together delegates, civil servants and policy wonks and has a huge – and legally ratified – influence on the responses of governments globally to tobacco control. Its aim is clear: to reduce tobacco consumption worldwide and the resulting harm it causes.

Vapes, snus, nicotine pouches and heated tobacco products are not being considered as means to this end by the FCTC, according to analysis of the available agenda and documents by the Global State of Tobacco Harm Reduction (a project ultimately funded by Philip Morris International, according to Tobacco Tactics).

Safer nicotine products – to use another industry phrase – “are presented as a threat to tobacco control, rather than as a potential tool to both support a switch from smoking and reduce high-risk tobacco use”, the analysis concludes. Those alternatives are seen as a “threat to tobacco control”, with nations encouraged to regulate them the same way as cigarettes, it says. And the FCTC risks “mission creep” and “morphing” into a nicotine – not just a tobacco – restricting treaty, it adds.

PMI senior vice-president of external affairs Grégoire Verdeaux bristled in an internal email: “WHO’s agenda is nothing short of a systematic, methodical, prohibitionist attack on smoke-free products,” according to a report in The Guardian.

Smoking rates are declining

His concern is understandable. PMI’s stated mission is to ditch cigarettes in coming years – with smoke-free products accounting for more than 50% of the company’s total net revenues by 2025. Without smoke-free products, it has little left to offer.

But is Verdeaux’s point that FCTC could have “irreversibly compromised the historic opportunity” of recognising “that smoke-free products, appropriately regulated, can accelerate the decline of smoking rates faster than tobacco control combined” a valid one?

Smoking rates are declining. But they were anyway before vaping and heat-not-burn devices truly came of age. Nevertheless, vaping alone – according to the UKVIA – has helped 2.4 million Brits quit cigarettes for good. And the fact vaping is not as harmful as smoking is rarely disputed, with Professor Chris Whitty putting it plainly: “If you smoke, vaping is much safer.”

But there is a second part to Whitty’s key point: “…If you don’t smoke, don’t vape.”

And a generation of children are going against Whitty’s advice. The proportion of under-18s currently vaping is more than double those that currently smoke, according to ASH. And it’s been that way since 2021.

Further, people have simply not vaped for 40-plus years. Some fear it could be ‘the new asbestos’.

The new Big Tobacco

As for heat-not-burn devices, researchers at the University of Bath found the quality of evidence available about them is “substandard” and policymakers should be wary of claims made about their role in harm reduction. “The jury is very much still out on their benefits,” says lead researcher Sophie Braznell.

It is difficult for the FCTC to make long-term decisions faced with so many unknowns. Not supporting alternatives is the safer option. But it is perhaps not the most pragmatic.

Before the alternatives, the goal of reducing tobacco use, addiction and nicotine intake and improving health was a clearly defined goal. Nowadays, “there are now very significant trade-offs between these goals” says former senior civil servant and ASH chairman Clive Bates.

Bates has even gone so far as to consider tobacco control ‘the new Big Tobacco’. “In their frantic opposition to safer forms of nicotine use, the tactics of tobacco control activists seem eerily familiar,” he writes, a touch bombastically.

“The problem with opposing harm reduction is that it is likely to cause harm increase,” he adds.

All eyes on Panama, then, in the hope the right approach is struck.