Tobacco harm reduction offers lessons to Asia

Success stories in tobacco harm reduction can serve as “templates” that other Asia Pacific countries could adopt to stem the smoking epidemic in the region.

“The Philippines and other countries in the region would do well to emulate the successful tobacco harm reduction approaches presented during the 2nd Asia Harm Reduction Forum held in Makati City last year,” said Peter Paul Dator, president of The Vapers Philippines. 

“These success stories in tobacco harm reduction show that we don’t have to settle for the grossly ineffective ‘quit or die’ approach. Significantly less harmful products such as e-cigarettes or vapes and other heated products do have an important complementary role to play in current tobacco control efforts,” said Joey Dulay, president of the Philippine E-Cigarette Industry Association. 

“Smoking prevalence in New Zealand is now down to 15.7 percent nationwide, but there are inequities in tobacco control,” according to Dr. Marewa Glover, director of the Centre of Research Excellence: Indigenous Sovereignty & Smoking.

“The Māori, the indigenous people of New Zealand, have the highest smoking prevalence among cultural groups at 35 percent. This was down from 54 percent in 1993, which means the reduction of Maori smoking prevalence has been very slow at about 1 percent per year,” said Glover, speaking during the 2nd Asia Harm Reduction Forum in Makati City on Nov. 15, 2018.

The New Zealand government was previously opposed to e-cigarettes and other reduced-risk products. Its position has changed recently. Its Ministry of Health now believes that vaping products have the potential to make a contribution to New Zealand’s Smokefree 2025 goal and could disrupt the significant inequities that impact the Māori. 

According to the MoH, vaping products can act as a route out of smoking for New Zealand’s 550,000 daily smokers. The agency encourages smokers who want to use vaping products to quit smoking to seek the support of local stop smoking services. 

Citing expert opinion, the MoH stated that vaping products are significantly less harmful than smoking and that smokers switching to vaping products are highly likely to reduce their health risks and for those around them.

“I am sharing New Zealand’s approach with the hope that it will provide encouragement and motivation to other tobacco harm reduction advocates to continue their work,” said Glover.

“Asia is home to great innovations in tobacco harm reduction. In particular, Japan is a leading example of how policies can help smokers switch to reduced-risk products,” said Prof. Helen Redmond, adjunct professor at the New York University – Silver School of Social Work.

In 2005, 49 percent of men and 14 percent of women in Japan were smokers. Today, the country’s smoking rate has decreased to around 18 percent of the total population. “The decline in Japan’s smoking rate has accelerated in recent years with the entry of heated tobacco products in the market in 2014. As of June 2018, three new heat-not-burn nicotine products have been launched in the country,” said Dr. Hiroya Kumamaru, vice director at AOI Universal Hospital in Kanagawa, Japan.

Redmond and Kumamaru were among the speakers during the 2nd Asia Harm Reduction Forum. Also called heated tobacco products, heat-not-burn products only heat tobacco, which generates a flavorful nicotine-containing vapor. Because the tobacco is not burned, the levels of harmful chemicals produced by heat-not-burn products are significantly lower compared to combustible cigarette smoke.

“Initially, I was suspicious of tobacco harm reduction. However, the results of several clinical studies convinced me about its positive impact. Heat-not-burn products have the potential to help smokers switch to less harmful alternatives and eventually quit smoking,” said Kumamaru. 

According to the 2018 State of Smoking Survey, the rising popularity of heated tobacco products in Japan is partially due to growing awareness about the health risks associated with smoking, as well as the high cost of traditional tobacco products and Japanese smokers’ desire for cleanliness and to avoid smelling like cigarette smoke. 

Employers, restaurant owners and public facilities throughout Japan have increasingly banned cigarettes since the passage of a bill discouraging passive smoke. Smoking is also banned in many outdoor locations in the country; smoking while walking outdoors is likewise prohibited.

In 2003, the Japanese government required cigarette packaging to display warnings that use 30 percent or more space of their main surface. Combustible cigarettes are heavily taxed. The tax rate on conventional cigarettes is more than three times higher than the tax rate for smokeless tobacco. Heat-not-burn products are currently taxed less than cigarettes.