Non-combustible tobacco products such as heat-not-burn devices offer the best way to end the smoking epidemic that kills 20,000 people a day, according to health experts.
Japan saw cigarette sales fall 27 percent in two years with the introduction of heat-not-burn products, according to Prof. Gerry Stimson of the London School of Hygiene and Tropical Medicine and the program director of the 6th Global Forum on Nicotine. Around 17% of the Japan cigarette market have switched to IQOS, the heated tobacco system of Philip Morris Internal.
David Sweanor, a lawyer and chair of the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa, said this is because electronic nicotine delivery systems such as heat-not-burn products, electronic cigarettes and Swedish snus are much safer alternatives to cigarette smoking.
“In Japan, with the introduction of heated tobacco products, one-third of the cigarette market was gone,” Sweanor said in a news conference at the sidelines of the 6th Global Forum on Nicotine in Warsaw, Poland in June 2019.
“We know enough science to know that we can have enough products that have a tiny fraction of the risks of cigarettes. We have seen examples around the world that many smokers will move to these products,” Sweanor said.
About 62 countries currently regulate electronic nicotine delivery systems under tobacco regulation, while 39 countries inappropriately ban safer nicotine products, according to the Global State of Tobacco Harm Reduction Report.
The report estimates that by 2021, over 55 million people will be using e-cigarettes or heat-not-burn tobacco products and that the global market will be worth $35 billion. The top five markets today are the US, the UK, Italy, Germany and France.
Japan is the leading market for heat-not-burn tobacco products. Sweanor said tobacco companies are now forced to offer safer nicotine products because of the rising demand from consumers.
“Companies are constantly looking at where the market is going. If you miss the change, you will go broke,” he said. “Tobacco companies now see the new technology. The people could now get what they want from cigarettes in a far less hazardous way.”
“So we have the ability now through technology [e-cigarette] to end that, just like we learned through technology how we could get clean water or how we could get sanitary food manufacturing, or how we could get science-based pharmaceuticals. We are on the verge of something really, really significant from public health standpoint,” Sweanor said.
Sweanor said countries such as Japan, the UK, the US, Canada, Sweden, Norway, Iceland, South Korea and New Zealand saw a more rapid decline in smoking because of the use of safer nicotine products such as heat-not-burn devices, vapes and oral nicotine products such as Swedish snus.
He said the consumers are massively switching to these new technologies that offer much less risks. “Consumers are using these products. We are seeing the biggest declines we have ever seen in smoking because of the substitution and we are seeing this in numerous countries.”
“We point to the example of what is happening in Japan. What is now happening in the US. What happened in Norway. What is the history in Sweden. What happened in Iceland or even here in Europe. We are seeing huge breakthroughs in cities around the world,” Sweanor said.
Sweanor said it is important that health authorities like the World Health Organization recognize the gravity of the smoking epidemic and accept harm reduction tools such as e-cigarettes, heat-not-burn devices and other non-combustible products as a way to end the epidemic.
The WHO predicted that about a billion people would die of smoking-related diseases by the end of the century. It also placed the global cost of smoking-related diseases and lost productivity at $1 trillion annually.
Sweanor said cigarette smoking and air pollution are the biggest contributors to lung cancer. “They are killing about 7 million people a year each. That means smoking cigarettes kills roughly 20,000 people every day. That number has been going up and it is killing people because they are inhaling smoke. It is smoke that is the problem, just like inhaling smoke from dirty air,” Sweanor said.
The Global State of Tobacco Harm Reduction Report 2018 states that the arrival of electronic cigarettes (vape) and heat-not-burn devices as well as the renewed interest in Swedish snus have disrupted the tobacco industry.
Experts said these electronic nicotine delivery systems have become much safer over the years as industry players embraced regulation and tobacco players began to switch to non-combustible products.
“The industry itself embraced the kind of self-regulation, self-standards. This is an evolving story. This story will lead to better quality and safer products. This is not like the old combustible, conventional cigarettes where you cannot innovate,” Dr. Riccardo Polosa, a professor of Internal Medicine at University of Catania in Italy, said.
Polosa said that unlike traditional cigarettes which involve burning that produces the hazardous tar, e-cigarettes, heat-not-burn devices and other non-combustible products continually undergo innovation. “These are products that you can constantly innovate. As soon as you identify the problem, you can solve the problem. Any problem that we identify today will be disappearing tomorrow,” he said.
Polosa said as these alternative products have become popular over the past decade, they have also become much safer today. “If you compare the toxicology of the area product of 2009, it is very different from what we see today. Traces of metals are not there anymore. Traces of aldehydes are disappearing,” he said.
“These products are becoming safer all the time; this is an area in which innovation can and is occurring. The potential improvement in individual quality of life offered by safer nicotine products as well as the wider population health benefits, are immense,” said Polosa.