Global Forum on Nicotine Seeks to Accelerate Harm Reduction for All

    At a hotel in central Warsaw, hundreds of public health experts, consumer advocates for safer nicotine alternatives, industry representatives and drug policy reformers from across the world gathered to discuss the fact, as the event’s tagline had it, that tobacco harm reduction (THR) is “here for good.”

    For a few days in mid-June, at the annual Global Forum on Nicotine (GFN), these stakeholders grappled with the many imperfections of this ostensibly cheering reality. They spent dozens of hours in panels and side meetings, and loitering in the halls of the Marriott, swapping ideas on how to change public and political perceptions of e-cigarettes and other nicotine options that are much less harmful than smoking.

    “Yes, tobacco harm reduction is here for good. But for how many people?”

    “Yes, tobacco harm reduction is here for good,” Dr. Konstantinos Farsalinos, a leading THR researcher at the University of Patras and the School of Public Health-University of West Attica in Greece, said in one plenary discussion. “But for how many people?”

    Like many others at GFN, he went on to describe attempts to block access to these products: Because in a world where more than 80 million people vape and millions more use harm reduction alternatives like oral snus and heated tobacco products, there are still 1.1 billion smokers and 8 million annual smoking-related deaths.

    For THR proponents in many countries who find themselves on the defensive, combating stigma and misinformation, GFN was a welcome opportunity for solidarity and strategizing. While acknowledging the past—including the flagrant misdeeds and lies of the tobacco industry—its chief concern was imagining a future of pragmatic solutions for reducing what is still the biggest cause of preventable death.

    The dialogue, then, started from a place of mutual understanding. An ever-growing body of science makes the broad efficacy of THR indisputable, so the lectures and conversations addressed how to expedite it: how to advance, as quickly as possible, public health policy grounded in both science and human rights. The issue was when more people—politicians, influential philanthropists and the public at large—would finally accept it, as every year of delay costs millions more lives.

    “For me, being at GFN was like one of those movies that suddenly switches from black-and-white to color,” Amanda Wheeler, owner of vape shops in Arizona and president of American Vapor Manufacturers, told Filter. “Most of the time, all the impressive voices we hear are up against forces trying to push them to the margins.”

    “But this time they were front and center and right in the spotlight,” she continued. “It was so inspiring to see a veteran journalist like Marc Gunther explaining how shining a reporting light on the prohibition movement exposes a mosaic of intolerance and corruption. Or Professor Marewa Glover detailing how she and her fellow academics face intimidation and blacklisting for simply following their scientific research objectively.”

    GFN was a breath of fresh air, featuring some of the most respected minds in tobacco science engaged in an open dialogue which, as several panels discussed, is sorely lacking on the issue of tobacco and nicotine,” echoed Michelle Minton, a lifestyle regulations expert. “Rather than defending the status quo or egos, everyone at GFN seemed truly interested in finding solutions to improve population health, protect human rights and restore dignity and autonomy to nicotine users around the world.

    GFN is notable for its truly international makeup, with large numbers of delegates from Africa, Asia and South America joining counterparts from Western countries. “It was good to see larger consumer representation at GFN, where the global consumer body INNCO also held its general assembly,” Samrat Chowdhery, the director of the Association of Vapers India, told Filter. “There were many voices from the developing world.”

    “Before vaping, there was no parallel universe in which I did not smoke.”

    “Attending my first in-person GFN I found to be more like a pilgrimage for anyone involved in tobacco harm reduction,” Jagannath Sarangapani, another vape advocate from India, which prohibits vapes, told Filter. “Getting updated on the science, meeting advocates from around the world fighting the same battles, experiences and ideas rejuvenates you. I was burnt out last year, and this is exactly what I need.”

    Among these consumers and advocates was a man named Slaven Kalebic from Slovenia. Years ago, he switched from smoking to vaping, just months before his doctor diagnosed him with emphysema. He was lucky, he said, that he didn’t have to learn the news while attempting the switch. He already knew that vaping worked for him, that he could feel the health benefits, and after some experimentation, he landed on his preferred product: a light-nicotine e-liquid with no flavor at all. “Before vaping, there was no parallel universe in which I did not smoke,” he told Filter. As a smoker, Kalebic would finish at least three packs a day.

    These sorts of stories, told around a cup of coffee between meetings, were at the heart of the entire endeavor.

    Perhaps, to an outsider, GFN could mirror the frequently lambasted conferences of organizations like Parents Against Vaping E-Cigarettes (PAVE), in which well-funded lobbyists—the mothers of children caught using nicotine—gather a chorus of voices to advocate for prohibiting vape sales in the United States and across the globe. It’s easy to imagine a prohibitionist lobbing the critique that GFN, too, is simply an event for people who already agree—a band playing just for its friends. Delegates acknowledged this, but pointed out one significant difference: that tobacco control and anti-vape public health voices are at least invited (unsuccessfully) to GFN, whereas people with pro-THR views or perceived industry ties are routinely banned from anti-vape forums.

    In any case, such a dismissive characterization would be a disservice to GFN’s movement-building role, and to the collective, serious thought delegates put into advancing THR beyond its current, passionate echo chamber.

    That question again—“for how many people?”—informed much of the scheduling. One panel, hosted by Filter’s Helen Redmond, explored how to involve more women in a field that is still dominated by men. Others questioned how to encourage the larger harm reduction community—often lukewarm about THR, for reasons including industry involvement—to embrace the key importance of reducing smoking-related deaths, including among heavy-smoking populations of people who use banned drugs. Still more urged greater focus on low- and middle-income countries (LMICs), where the vast majority of the world’s smokers live, and where THR access is scarce.

    Dr. Farsalinos had kicked off GFN by giving the Michael Russell Oration, named after the late “father” of THR, a British psychologist whose famous words—“people smoke for nicotine but they die from the tar”—have come to symbolize developments in subsequent decades. Invoking thinkers as wide-ranging as Ulrich Beck and Bertrand Russell, Farsalinos placed THR within a historical context, offering a philosophical framework for how tobacco control operates within a “risk society.”

    The biggest difference, Tyndall emphasized, was the global uptake in treatments. For HIV, it’s reached more than 80 percent; for smoking, it’s still not more than 1 percent.

    Two further keynote addresses—one by journalist Marc Gunther on the unchecked power of philanthropy like Michael Bloomberg’s anti-vape funding; another by the Canadian safe supply pioneer Dr. Mark Tyndall on contradictions in the health debate around vaping—respectively offered critiques of monied interests corrupting public health and lessons from previous epidemics.

    Tyndall, for example, linked the fear, blame and stigma around smoking to that aimed at HIV/AIDS in the 1980s and ’90s. Drawing numerous parallels, he noted that 40 million people have died from HIV/AIDS in the past 40 years, whereas 320 million have died from smoking-related disease; that premature death among people with HIV/AIDS has been 90 percent, whereas with smoking it is 60 percent; and that the effectiveness of treatment is about 90 percent for HIV and 95 percent (per Public Health England’s oft-cited analysis of vapes) for smoking. But the biggest difference, he emphasized, was the global uptake in these treatments. For HIV, it’s reached more than 80 percent; for smoking, it’s still not more than 1 percent.

    The rest of the program—which included the assault on academic freedom on THR, the transformation of the tobacco industry toward non-combustibles and misinformation around nicotine—largely centered on THR as an arm of the universal right to health.

    It’s a right that Professor Gerry Stimson, cofounder of KAC Communications, which organizes GFN, both spoke about in Warsaw and recently elaborated on for Filter. And as so much of GFN reflected, it’s a right that is currently afforded to some far more than others.

    Yet rapid, consumer-driven uptake of THR and an overwhelming body of evidence are grounds for cautious optimism in the longer term.

    “It’s a matter of staying with it,” David Sweanor, a tobacco industry expert and chair of the Advisory Board for the Centre for Health, Law, Policy, and Ethics at the University of Ottawa, reminded the crowd. “As litigation works in some places, or legislation works in other places, it gets picked up elsewhere. And we can see good policy is contagious. Good legal reasoning is contagious. It starts spreading around the world.”

     


     

    Photograph courtesy of GFN

    Filter was an official media partner of GFN. The Influence Foundation, which operates Filter, has received grants and scholarships from Knowledge-Action-Change (KAC), the sister company of KAC Communications, which organizes GFN. KAC, INNCO and The Influence Foundations have received grants from the Foundation for a Smoke-Free World (FSFW). Some of the individuals named in the report have also received grants or scholarships from FSFW or KAC. Filters Editorial Independence Policy applies.

    • Alex is Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in The New York Times MagazineThe Columbia Journalism Review, The Los Angeles Times and The New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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