Stakeholders clash on need for EU plan on tobacco harm reduction

Read this article in Romanian.

Public health stakeholders are divided over whether the EU needs a strategy to reduce harm from smoking, which according to the World Health Organisation (WHO) costs Europe nearly 700,000 deaths annually.

Novel tobacco products have emerged as alternatives to traditional cigarette smoking, and advocates cite several studies worldwide, insisting these products are much less harmful than conventional smoking and should be used as harm reduction products.

On the other hand, the EU and a large part of the scientific community remain cautious, emphasising the lack of clear evidence regarding their long-term effects.

“Wearing your seat belt is harm reduction. You don’t forbid people using their cars because it entails some risks […] You don’t eliminate risk, you reduce it”, Dr Konstantinos Farsalinos, a research fellow at Onassis Cardiac Surgery in Greece, told EURACTIV.

David Sweanor, a Canadian lawyer and professor at the University of Ottawa, explained that everything people do carries a risk.

“We know that having sex with a stranger is still dangerous. But if you use precautions, you can greatly reduce the likelihood of a sexually transmitted illness,” he said.

Sweanor said we’ve known for over 50 years that people get sick and die not from the nicotine they’re seeking but from how they get it through smoking into their lungs.

“And we know that there are ways you can deliver nicotine that is acceptable to consumers, without requiring the inhalation of smoke […] we know we can reduce the risk by probably close to 99%, simply by moving to non-combustion products that meet some basic standards on ingredients,” he added.

However, Cornel Radu-Loghin, a public health advocate for the European Network for Smoking and Tobacco Prevention (ENSP), disagrees in principle that “harm reduction” is used as a term in the field of tobacco control.

“It’s like when you decide not to kill people by shooting, but with ten knives. In fact, this is when we speak about tobacco. It’s just to delay the harm, not to reduce it”, he said.

Loghin insisted that no matter how much less, novel tobacco products are still harmful.

“At the end, and we can see that the new products are not on the market to help people quit traditional smoking, the new products are there to keep the business for the industry.”

“And it’s obvious that a lot of smokers decided to switch to new products and to use them only in places where they cannot use the traditional cigarettes. So, they ended up doing both,” Loghin added.

EU Commission watches closely

At the EU level, the Commission’s Beat Cancer Plan aims to create a tobacco-free generation by 2040, and for now, not all novel products are part of Brussels’ plans.

“The Commission is aware of the ongoing public debate on tobacco harm reduction. One of the goals of the Commission’s Europe’s Beating Cancer Pan is to ensure that less than 5% of the population uses tobacco by 2040,” an EU Commission official told EURACTIV.

The Commission is currently working on the evaluation of the Tobacco Products Directive, which regulates, among other, electronic cigarettes, refill containers and novel tobacco products.

“Any scientific evaluations concerning novel and emerging nicotine and tobacco products will be carefully considered,” the EU official added.

However, the official said as minimum requirements; these should follow the relevant WHO recommendations, such as only relying on independent data sources or analysing risks of dual use with conventional tobacco products.

“WHO highlights challenges regarding the scientific assessment of these products (e.g. wide variation of emissions, devices-content interactions, and specific features resulting in different levels of nicotine and toxicants), which should be taken fully into consideration,” the official added.

For his part, Dr Andrzej Fal, a Polish medical professor, said decision-makers always ask for more research but do not want to fund them.

“They say we need more research, but at the same time, they don’t finance any research invoking the high cost, and consequently, this research comes from the industry. And then they say it’s not reliable,” Dr Fal said.

The Polish professor said the only way to create a smoke-free society is to start educating people at birth; then, at 18, they will not buy cigarettes.

“In 18 or 20 years, we can dream of a smokeless society in Europe. Look at Norway or Sweden, which started in the late 70s and now has 5% to 7% of smokers. But it took them 40 years,” he said.

Before we reach that level, Fal said. There are quick solutions such as novel tobacco products which could be introduced and used quickly to help smokers. “In the meantime, we need to present something and describe harm reduction,” he said.

Solution for heavy smokers?

Centre-right MEP Maria Spyraki told EURACTIV that the objective should be dual.

First, help heavy smokers move away from traditional smoking through novel tobacco products, but the “access to these products should be done under very strict conditions”.

“You should allow heavy smokers to use these types of products, but this does not mean this is the way out”.

“The second goal is to protect younger people, so we don’t create a new generation of smokers who are related to the new products,” the EU lawmaker said.

Asked about the case of heavy smokers, Loghin from ENSP commented that novel tobacco products could be a solution for hefty smokers if a doctor recommends so.

“But again, as a public health organisation, we cannot and will not promote tobacco products. It’s a clear position inside the ΕNSP that any medical professional can assist the smokers in quitting in the way they consider the best for the smoker,” he concluded.

[Edited by Alice Taylor]

Read more with Euractiv

Health Brief: Long TRIPS must come to an end

The deadline is fast approaching for deciding whether to include COVID-19 diagnostics and therapeutics in a waiver of intellectual property rights at the World Trade Organisation (WTO) level. The EU is ready to engage constructively, the European Commission says.