The number of smokers switching from cigarettes to other nicotine products is increasing. At the same time, the political climate for harm reduction has hardened worldwide. This is according to Harry Shapiro, author of the report "Burning Issues: Global State of Tobacco Harm Reduction 2020"
Sweden currently has one of the lowest cigarette consumption rates in the world. Between 5 and 7% of the country's population smokes. The use of e-cigarettes is also low: two percent of the population vejpar, half of which daily. At the same time, Swedes use as much nicotine as the European average.
"Some commentators argue that the low number of smokers is due to men taking more parental leave and thus quitting smoking. But this is clearly not the whole explanation" says Harry Shapiro, journalist and author, who on behalf of the organization Knowledge Action Change, compiled the report "Burning Issues: Global State of Tobacco Harm reduction - 2020".
Snus has an impact on public health
Harry Shapiro, and several other international analysts, see the explanation in the use of snuff. Up to 20% of Swedish men use snus. A large proportion of snus users are also former smokers. How many is unclear, but between 25 percent and 80 percent are figures that are spinning in the debate.
"In other countries, where snus is not available, the situation is different. Certainly, the availability of e-cigarettes has meant a lot. But in Sweden, snus is established and ingrained in the culture, it has a different effect on public health," he says.
Smoking is the world's biggest health issue
The report is the second of its kind and summarizes the tobacco harm reduction (THR) phenomenon from a global perspective.
"Reducing the harm from smoking is one of the world's biggest concerns. And although harm reduction products such as e-cigarettes have been on the market for over a decade, progress has been slow. But we are making progress" says Harry Shapiro to Vejpkollen.
100 smokers on one vejpare
Today, more than 98 million people use various products to reduce the harm caused by their nicotine use. 70% of them use e-cigarettes, the rest use heat-not-burn products, snus, nicotine pouches and the like. This is an increase compared to 2018, when the first report was published.
"From a public health perspective, it is a success. But we have 1.1 billion smokers in the world. There are 100 smokers for every vejp. Even though the forecast two years ago said there would be fewer, there are still very few." says Harry Shapiro.
"Dismissing e-cigarettes is stupid"
E-cigarettes have waxed and waned in popularity over the ten years they have been on the market, in line with scientific findings and political shifts.
"Science supports vejpning as a tool for injury reduction. That is clear, clinically proven. But it has become a question of something else. The debate collapses when the only argument needed to restrict e-cigarettes is that they are part of a conspiracy by tobacco companies to attract new customers." Harry Shapiro.
Compare with greener cars
According to Harry Shapiro, it is perfectly understandable not to trust tobacco companies. But to dismiss harm-reduction products solely because of the companies' interest is borderline stupid, he says. At least from a public health perspective.
"It's as if we don't see the environmental benefits of electric and hybrid cars from Toyota, just because the company made big profits from gasoline cars in the past. Public health must be based on science, not moralistic attitudes towards nicotine, as is the case with both snus and e-cigarettes."
Moral panic and e-cigarettes
An example of moral panic, driven by anything but science, was last year's outbreak of EVALI; a disease caused by illegal e-juices with cannabis. It triggered a series of bans and restrictions on e-cigarettes worldwide. And this despite the fact that EVALI was actually about a completely different product. But the United States is like a beacon to the world, says Harry Shapiro. For better or worse.
"If states in the US ban flavorings in e-juice, which are so important to make e-cigarettes effective as a smoking cessation aid, it will be hard for us in the rest of the world to convince our politicians not to do the same. This is especially true in the developing world, where smoking is most prevalent and the need for change is greatest." says Harry Shapiro.
Success for tobacco harm reduction in the US
At the same time, the US FDA has decided this year that both the heat-not-burn "IQOS" and Swedish snuffcan be marketed as 'less harmful tobacco products' in the country. And while regular e-cigarettes (which don't even contain tobacco) are still awaiting the same treatment, it does spark hope for the future of harm reduction, says Harry Shapiro.
"The FDA reviewed and accepted the research, even though in these cases it came from the tobacco companies. The price tag was also huge. But what is happening in the US is spreading, and from a public health perspective, it is good news"
Researchers must become aware of responsibilities
Public health authorities should do everything in their power to reduce smoking, says Harry Shapiro. Even if it means that smokers maintain their nicotine use by other means. Authorities in his native UK, Public Health England, already did so in 2016, when, with the support of the country's prestigious Royal College of Physicians, they found that Nicotine e-cigarettes reduce a smoker's risk of harm by 95%.
"Those of us fighting for this rely on researchers remaining aware of their responsibilities and continuing to produce good and robust studies. At the same time, it requires political commitment. It took 100 years for cannabis to become accepted and partly legal in some US states. And it was ultimately suit-clad activists in the White House that made it possible, not banners in town"
Sweden a good example
He believes that snus in Sweden is an example of how harm reduction is becoming part of society. Swedish culture plays a role, but also widespread use that has existed for a long time.
"Even if e-cigarettes are regulated more tightly than they are today, smokers will find them. The interest to quit smoking remains and when a good alternative is available, consumers will lead the way. In the end, there will be so many users, that politicians need to take notice and understand how important it is for public health. And for smokers" says Harry Shapiro.
