Global Forum on Nicotine Conveys Cautious Optimism for Tobacco Harm Reduction

    At the Global Forum on Nicotine (GFN), hosted in Liverpool, England, and broadcast online on June 16 and 17, experts called for the public health and tobacco control fields to unite around a common goal: ending smoking.

    Over the two days, 30 speakers—eminent in harm reduction, law, science, the stock market, consumer advocacy and other areas—reiterated to hundreds of international delegates that lifesaving technology like vapes and heat-not-burn products (HTPs) should be embraced to empower people to stop their combustible cigarette use.

    A hesitant sense of optimism pervaded the conference, as tobacco harm reductionists acknowledged that the demonization they face might slowly—if marginally—be eroding. As they keep speaking up about less harmful alternatives to cigarettes, the scientific literature continues to support their cause, leaving their perspective increasingly difficult to ignore or dismiss.

    Still typically lost, though, in the tit-for-tat, well-financed battle between an industry pushing for safer nicotine delivery systems and abstinence-only, typically Michael Bloomberg-funded nonprofit organizations urging vape bans are the world’s smokers—most of whom live in low- and middle-income countries (LMICs). But soon the industry and harm reduction advocates, each wishing to promote reduced-risk nicotine products, may no longer be talking only to themselves. Many of GFN’s panelists and presenters noted that the US Food and Drug Administration (FDA), which will likely begin authorizing some premarket tobacco product applications (PMTAs) for vape companies in September, seems more and more open to at least discussing tobacco harm reduction (THR).

    The topics at GFN, while expansive, kept returning to coalition-building and how to communicate with the other side—moralistic activists who want to see combustible smoking disappear but refuse to listen to THR arguments.

    Panels included obstacles to tobacco harm reduction in LMICs, safer nicotine product regulation and the orthodoxy, challenges and dissent regarding science. Key speeches, by Foundation for a Smoke-Free World President Derek Yach, and investor and analyst Jonathan Fell touched on the World Health Organization’s failure to incorporate harm reduction into its global tobacco control strategy and the risks and rewards of nicotine innovation, respectively. And the “GFN Fives”—in which scientists, consumer advocates, lawyers and others (including Helen Redmond on behalf of Filter) produced five-minute videos on aspects of THR—also featured a range of testimonials pushing this theme. The International Network of Nicotine Consumer Organizations (INNCO) interviewed vapers from LMICs, for example, who demanded to be involved in the conversation.

    “It feels as though we’re on the right trajectory.”

    “Much of what I have seen and heard over the last couple of days has been encouraging,” Gerry Stimson, an emeritus professor at Imperial College London and a founder of GFN, said in a press statement after the conference. “It feels as though we’re on the right trajectory.”

    It’s a welcome development, even if the continuing price of its delay is 8 million annual smoking-related deaths. For the past few years, much of the dialogue around THR, especially in the United States, has focused on perceived dangers of, and misrepresentations of, vaping. By the fall of 2019, two narratives appeared to coalesce into a single story: The media reported endlessly on the spike in youth e-cigarette use, and the Centers for Disease Control and Prevention failed for too long to clear up the cause of “EVALI”—the string of “e-cigarette or vaping product use-associated lung injuries” that cropped up throughout the US.

    The fear of a new generation dependent on nicotine led abstinence-centered organizations, like Campaign for Tobacco-Free Kids (CTFK) and the International Union Against Tuberculosis and Lung Disease, to push for vape flavor bans and outright vape prohibitions in US jurisdictions and LMICs. The misinformation swirling around EVALI—that it was nicotine vaping, and not the vaping of illicit, tainted THC cartridges damaging people’s lungs—left many confused about the health benefits of switching from traditional cigarettes. Both situations seem to have brought about policies and decisions with adverse consequences: namely, studies have suggested that they led to an uptick in cigarette smoking in the US, while India is one country where a vast population of smokers is denied access to vapes.

    Several GFN speakers made the point, however, that prohibition-minded groups, like CTFK, have recently been on the defensive. They have been attempting to discredit the FDAs regulatory process, insisting that the agency—which CTFK originally fought to give authority over nicotine products—is ill-equipped to handle the growing e-cigarette landscape.

    As the FDA inches closer to soon approving at least some PMTAs this fall, it’s probable that new lines will be drawn. In theory, the FDA—and, consequently, the US federal government—will join the industry and a motley crew of harm reductionists, tax reformists, libertarians and consumer advocates in acknowledging vapes as harm reduction products, leaving the organizations clamoring for outright bans largely on their own.

    “Consumers all over the world are becoming aware of the opportunities offered by safer nicotine products, and innovations in the market will, I believe, lead to the eventual obsolescence of combustible cigarettes,” Stimson said. “The question is how to speed up the process and scale up, so that tobacco harm reduction reaches all smokers, everywhere, as quickly as possible.”



    Photograph by Jon Derricott

    Filter was an official media partner of GFN21, which is organized by KAC Communications. KAC Communications’ sister company, Knowledge-Action-Change, has provided restricted grants and donations to The Influence Foundation, which operates Filter, for projects unrelated to the conference. The Influence Foundation has also received restricted and unrestricted grants from the Foundation for a Smoke-Free World, which has also supported both KAC and INNCO. Filter’s Editorial Independence Policy applies.

    • Alex was formerly Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in the New York Times Magazine, the 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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