STRINGENT regulations on novel nicotine products like vapes, heated tobacco and oral nicotine could be giving traditional cigarettes a market advantage and discouraging smokers from switching to less harmful alternatives, according to health policy experts.

Professor David Sweanor, chair of the advisory board of the Center for Health Law, Policy and Ethics at the University of Ottawa, said such regulations essentially hand the market to the incumbent, deadly products.

“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.

Prof. Sweanor and other experts emphasized the need for different sets of regulations for combustible cigarettes and novel nicotine products, because smoke-free alternatives are far less harmful and could help address the global smoking problem.

Prof. Sweanor, the first lawyer in the world to work full-time on policy measures to reduce the harm from cigarette smoking, said regulations on vapes, heated tobacco, oral nicotine products, and other smoke-free alternatives shouldn’t be as strict as those for conventional tobacco.

This is because 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.

He warned that imposing equally strict regulations on both categories could significantly hinder smokers’ attempts to switch away from cigarettes.

Experts pointed out that it’s the smoke from burning tobacco, not nicotine, that causes major health problems linked to cigarettes. By switching to smoke-free alternatives like heated tobacco, vape or oral nicotine products, the harm is significantly reduced, they said.

“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, concurred that while nicotine is addictive, it doesn’t cause the harm associated with smoking. “Evidence shows e-cigarettes with nicotine can help people quit smoking, and that they are considerably less harmful than smoking,” he said.

Prof. Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, also slammed the World Health Organization (WHO) for its strident anti-vaping stance, arguing it hinders the transition to safer alternatives.

Prof. Hajek contrasts the WHO’s position with the progressive policies adopted by nations like Sweden and Japan, which have witnessed some of the most significant declines in smoking rates in recent years.

“We already see in Sweden, Norway, New Zealand, Japan, and many other countries that, given a chance, people who smoke cigarettes will switch 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.

He also criticized several countries that imposed high taxes on novel nicotine products. “It is like giving the same penalties for driving while sober as for driving while intoxicated. How could that possibly do anything other than encourage the continuation of drunk driving?” he said.

“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.

Experts criticized the existing global treaty, the WHO Framework Convention on Tobacco Control (FCTC), for its lack of transparency and called for its revision to incorporate tobacco harm reduction (THR) principles that allow smokers access to safer alternatives.

Representatives from countries that are signatories to the WHO FCTC will meet in Panama for the 10th Conference of the Parties (COP) this year, after the meeting was canceled in November 2023, to tackle major topics such as how to treat “novel and emerging tobacco and nicotine products”.

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, said current tobacco control policies need innovation.

“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.

Prof. Hajek said in fact he sees a future where “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.”