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Countries are increasingly adopting tobacco harm reduction policies as part of overall tobacco control measures to reduce deaths and diseases associated with smoking.

While preventing smoking and promoting cessation are considered key pillars to eliminating risk, current trends show that there are still a significant number of smokers — about one billion worldwide — despite continued emphasis on World

Health Organisation (WHO)-led tobacco control policies.

Scientists believe public health outcomes among smokers can be significantly improved if they switch to non-combustible alternatives such as heated-tobacco products, snus and vapour products or e-cigarettes.

More than eight million people die from smoking-related diseases every year.

“Our ambition is to convince all current adult smokers that intend to continue smoking to switch to smoke-free products as soon as possible,” said Dr Ignacio Gonzalez Suarez, who is a senior scientist at Philip Morris International (PMI), at a recent webinar with the Africa Reporters Network.

“The science is very clear: Smoking is harmful, smoking increases the risk of serious diseases of the heart, the lungs, cancer, et cetera. The science is also very clear on the fact that the best thing that one can do to prevent smoke-related diseases is to stop smoking, to quit smoking as soon as possible; better yet, not to start,” he said.

PMI is the largest tobacco company in the world.

Since the adoption of WHO’s Framework Convention on Tobacco Control in 2005, governments across the world have been implementing measures based on preventing smoking and encouraging cessation.

Although the measures have been somewhat successful, the number of smokers is still considered to be unacceptably high under these circumstances, providing smokers with an option to switch to alternatives that are scientifically proven to reduce risk is considered to be viable insofar as it saves lives and provides a pathway to quit.

“Tobacco harm reduction is based on the idea of providing those smokers who would otherwise continue to smoke with alternative products; products that science tells us are less harmful. These can really complement the other two pillars — prevention and cessation,” said Dr Suarez.

“If we want to reduce the harm at the population level, we need two things: On the one hand, we need products that are scientifically substantiated to be less harmful . . . At the same time, something that is very important is acceptability.

We need those smokers that would otherwise continue to smoke to switch to these products, because no matter how good your products is in terms of risk profile, if nobody is interested in switching to them, then you are not going to have any effect, any benefit at the population level.”

While nicotine is largely perceived to be the primary cause of smoking-related diseases, research has shown that it is actually toxicants that are present in the smoke — the majority of which are generated when cigarettes are burned — that are harmful.

Reputable global public health bodies such as Public Health England, the US Food and Drug Administration (FDA) and the Royal College of Physicians (UK) have been swayed by growing scientific evidence proving that tobacco harm reduction can effectively complement existing tobacco control measures.

Over the past 15 years, PMI has invested more than US$8 billion in research and development, and employed more than 400 scientists and experts from across the world to come up with alternative products that help reduce risk.

It is the 45th largest filer — and the only tobacco company — for patents in the European Union (EU).

As a result, it has been able to produce heated-tobacco products such as IQOS, that is a heat not burn technology, and vaping products such as the IQOS VEEV.

Clinical studies conducted around the world, including the US and Japan, indicated a marked reduction in toxicants and exposure to risk for smokers who switched from combustible smoking to IQOS products.

Dr Gonzalez said: “There was a difference between those who switched to IQOS and those who continued to smoke. When you reduce your exposure to toxicants, you start to see some favourable changes.”

In Japan, which began the commercial use of IQOS in 2015, it was established that “heated-tobacco products are effectively replacing cigarettes”.

Most importantly, post-marketing surveillance indicated that 98 percent of those who switched were already using tobacco products, while only 0,1 percent of two-year quitters started using the new products.

It also claims that there was low use among new smokers, including declining cigarette sales that coincided with the introduction of the alternative products.

Regulations

According to Dr Mojisola Oluwasanu, a Nigerian-based public health expert, effective tobacco harm reduction legislation should ensure that smokers “have access to and receive information on the less harmful products that are available to them”.

Regulation, she added, should ensure access and acceptability while minimising access to youth and non-smokers. Nigeria, through the Federal Ministry of Industry Trade and Investment (FMITI), is in the process of formulating a Non-Combustible Tobacco Policy.

It is envisaged that it will incorporate tobacco and nicotine products.

The Standards Organisation of Nigeria — a federal government parastatal responsible for standardising and regulating the quality of all products in the West African country  is also developing draft standards for electronic heated tobacco.

Countries such as the US, UK, Norway, Greece, Uruguay and Switzerland are already harnessing harm reduction as a critical intervention to reduce smoking-related deaths and disease.