A global health expert said the transformation of the tobacco industry and the rise of alternative nicotine products offer an opportunity to save up to 4 million smokers annually.
“We are truly facing a revolution in nicotine technology. Thanks to massive investments in research and patents being fathered, the ramifications of this intellectual property are being felt in the real world. Already, a hundred million people are using harm reduction products and projections suggest that if these tools were more widely available, we would be able to cut the long-term trends of deaths by maybe between 3 and 4 million, if we acted more vigorously,” Dr. Derek Yach said during the 8th Global Forum on Nicotine on June 18, 2021.
Yach, president of the Foundation for a Smoke-Free World, shared his insights as a speaker in the Michael Russell keynote titled “Why has the WHO FCTC failed to reduce adult smoking and its health impact?” The session was hosted by Prof. Gerry Stimson, with tobacco policy expert Cliff Douglas as the responder.
Yach noted the transformation of the tobacco industry from one that denied the damage caused by smoking on health in 1954 to its “pharmaceuticalization” today, supported by research and science.
He said, however, that despite such changes made possible by investment in innovation, policy has lost touch with science. “Industry has created tools that have the potential to create one of the most profound public health shifts in history,” he said.
“In short, the present technological revolution demands an accompanying ideological revolution. Currently, many in tobacco control are skeptical, even hostile towards the contributions of industry. The origins of this hostility are not terribly difficult to identify… For generations, the tobacco industry has created products that have killed millions of people,” said Yach.
“A notable offense, if you may remember, came in 1954, when a group of tobacco companies published a Frank statement to cigarette smokers. This appeared in 400 American newspapers that claimed that there was a lack of scientific consensus on the damages of smoking,” he said.
He said that in the 1990s, as part of the US Master Settlement Agreement between American tobacco companies and attorneys general from 46 states, the industry was forced to disband the so-called research groups. “The settlement marked the beginning of a new era in the treatment of industry and endeavors at funds, including, and especially research,” he said.
Yach said that throughout the 1990s and into the new millennium, anti-industry attitudes and policies became the default. In 2005, the World Health Organization codified this stance in the Framework Convention on Tobacco Control.
“Today, this assumed conflict is often justified as justification for a hostile attack and attitude toward the industry,” said Yach. He noted that over the past two decades, action against industry evolved into perfunctory bands, boycotts and attacks.
He said, however, that some tobacco executives and companies, in recognition of public desire for safer nicotine options, began prioritizing research on harm reduction. “A few companies made a bet that investment in harm reduction will pay out in the long run. This was a shrewd business decision and incidentally, it’s proving to be an excellent contribution to science and health. Though the transition to safer products remains incomplete, many tobacco companies have diverted resources away from combustibles and towards reduced risk portfolios,” he said.
Yach said this gave rise to companies that are responding to consumers demand for nicotine products that are not deadly.
“In many respects, the nicotine industry now functions in a manner, some say like pharmaceutical industry. To be sure they’re self-interested and profit driven. At the same time, they are leaders in scientific innovation and essential to actually address massive health crisis,” he said.
Yach said the other public health experts described the phenomenon as the tobacco industry’s actual and perceived transition into pharmaceutical-like industry through the manufacture and sale of non-combustible tobacco and nicotine products for smoking cessation or long-term nicotine maintenance.
He said these companies are completing exhaustive studies to meet the scientific standards and rigor set by major regulatory bodies including the US Food and Drug Administration. “To satisfy the FDA’s strict rules of evidence, tobacco and e-cigarette companies have conducted extensive peer reviewed research and have disseminated these findings by a monograph report,” he said.
Yach said, however, that to complete the transformation of the industry, a new Frank statement is needed, including a commitment from all parties to prioritize the end of the tobacco epidemic.
“Industry must commit to ending the sale of combustible cigarettes and act accordingly through their investments. Industry must commit to ending youth nicotine use in all forms and there are many strategies that could be done to achieve that. Industry must commit to sharing IP (intellectual property) with companies and countries currently selling combustibles in lower middle-income countries to show that we make these products affordable and available to all. The WHO and governments must commit to revising the Framework Convention, which explicitly builds a risk proportionate regulatory system that doesn’t require major changes to the text,” he said.
“All of the above is feasible,” he said. “From a scientific perspective, a lot of the hard work has already been done. What remains, then, is a bigger challenge—which is challenging and changing cultural and political attitudes.”
Cliff Douglas concurred with the goals outlined by Yach, starting with the need for a genuine and clearly demonstrable commitment by industry to ending combustible tobacco use.
“I agree with Derek and many leading scientific researchers and colleagues that more engagement with industry is needed. And science produced by industry should not be summarily dismissed or canceled, but rather given due consideration under careful peer review with full disclosure of conflicts of interest,” Douglas said.
The 8th Global Forum on Nicotine was held in Liverpool and online on June 17 and 18, 2021 under the theme “the Future for Nicotine”. It addressed some of the concerns prompted by recent reviews and reports that will have an impact in different parts of the world and the implications for discussions at the FCTC COP 9 meeting later this year.