Smoking prevalence dips in countries where people switch to safer nicotine products

Warsaw, Poland—Smoking prevalence has declined in countries where smokers switched to safer nicotine products such as electronic cigarettes, according to public health experts.

“We are moving away from the world of combustion. From internal combustion engines and cigarette combustion, we are moving to new ways of delivering energy and delivering pleasure,” says Prof. Gerry Stimson of the London School of Hygiene and Tropical Medicine and the program director of the 6th Global Forum on Nicotine.

More than 650 public health experts, academicians, industry executives and consumer advocates from 70 countries including the Philippines met in this city to push for safer nicotine products in place of conventional cigarettes.

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.

E-cigarettes are estimated to be 95-percent less harmful than smoking cigarettes, and they proved effective in making smokers switch, says Stimson. 

The New Nicotine Alliance says the flavors in e-cigarettes have played a key role in making smokers switch. “E-cigarettes are a proven safer alternative to smoking. The UK boasts of 1.7 million former smokers who have converted from smoking to exclusively vaping instead. Flavors have been a big driver of that success, by distancing smokers from tobacco and providing an incentive to switch, with a wide selection of different options to suit their preferences,” NNA chair Martin Cullip says.

Aside from e-cigarettes, smokers now also switch to other non-combustible products such as heat-not-burn tobacco and Swedish snus.

Japan saw cigarette sales fall 27 percent in two years with the introduction of heat-not-burn products while Sweden has the lowest smoking prevalence of 5 percent among European countries because of snus, according to David Sweanor, a lawyer and chair of the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa.

“Sweden has the lowest rate of tobacco-related illness in Europe – they don’t smoke, they use snus. In the last ten years since snus went on sale in Norway, the sale of cigarettes has halved,” says Sweanor.

When snus also became popular in Norway, the smoking rate among young Norwegian women dropped to a world record low of 1 percent. 

“As snus products became available and popular in Norway, the problem of smoking fell by half in just 10 years.  When Iceland got electronic cigarettes, there was a 40-percent reduction in smoking in three years.  In Japan, with the introduction of heated tobacco products, one third of cigarette market was gone.  We have seen the same thing happen in the UK where vaping is more available and people get better information.  Millions of smokers switched to vaping,” Sweanor says in a news briefing.

“The US cigarette sales are now falling more rapidly than we have seen before because of the availability of vaping products,” says Sweanor.

About 62 countries currently regulate e-cigarettes under tobacco regulation, while 39 countries inappropriately ban safer nicotine products, according to the Global State of Tobacco Harm Reduction Report 2018.

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.

Research firm Euromonitor estimated the global market of e-cigarettes at $2 billion in 2012, a figure that likely hit $14 billion in 2018.  Euromonitor predicts that the vapor market will amount to $34 billion by 2021.

Stimson says smokers are switching because cigarette smoking is the most dangerous and harmful way of consuming nicotine as the combustion process releases highly dangerous toxins.  “The cigarette is a very dirty nicotine delivery system,” he says. It is the tar and gases from smoking and not nicotine that contains dangerous chemicals, he adds.

“Half of those who smoke will die prematurely from smoking-related diseases.  This means that about 6 million people die from smoking-related diseases every year,” he says.

“More people die from smoking cigarettes than from malaria, HIV and tuberculosis combined – and the World Health Organization estimates that by the end of the century, one billion people will have died from a smoking-related disease. This is a public health emergency on a global scale. It’s essential that people around the world have access to and are positively encouraged to switch away from cigarettes to safer nicotine products,” says Stimson.

The World Health Organization also placed the global cost of smoking-related diseases and lost productivity at $1 trillion annually.  The WHO, however, does not endorse e-cigarettes.

Dr. Riccardo Polosa, a professor of Internal Medicine at the University of Catania in Italy, cites studies showing the benefits of switching exclusively to electronic cigarettes.  “Studies clearly show that those people who make the switch away from cigarettes to exclusively non-combustible nicotine products experience the same health benefits as those people who quit smoking,” says Polosa.

“We did a number of studies on COPD, asthma and other respiratory diseases and it clearly showed up to 50-percent reduction in respiratory exacerbation rate which is amazing.  You cannot get that level of reduction even with antibiotics,” he says.

Polosa explains that vaping is not a form of smoking. “Tobacco smoke contains tar, while aerosol from electronic cigarette does not contain any tar. Tobacco smoke contains 7,000 chemicals while aerosol from electronic cigarette emission has only 150 chemicals that today have not shown any major harmful effect,” he says.

“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,” says Polosa.

Public Health England reported in 2015 that e-cigarettes are 95-percent less harmful than smoking, as the harmful chemicals present in cigarette smoke are either not in EC vapor or only found at much lower levels.

Stimson says while many smokers want to quit smoking, they find it difficult to do that because the existing nicotine replacement therapies or smoking cessation medications endorsed by health authorities are not very effective with only about the 5-percent success rate.  “That is clearly not good enough,” he says.

A study published in the New England Journal of Medicine found that smokers are nearly twice as effective at helping smokers quit than nicotine replacement patches and gums.  Stimson says e-cigarettes, heat-not-burn tobacco products, and Swedish snus have higher success rates because they deliver the same pleasure as smoking does.

“What characterize all of them is that there is no combustion.  There is no fire, no smoke.  They have significantly lower risks than smoking cigarettes.  Products like snus which have been here for a very long time are risk-free,” he says.