What’s next for tobacco harm reduction?

WARSAW, Poland – Around 2.7 percent of total cigarette product sales in Metro Manila are now coming from heated tobacco products as of the first quarter of 2023, representing a 0.99 percent growth compared to the same quarter last year.

These, according to Philip Morris International vice president for internal communications Tommaso Di Giovanni, are powerful numbers and indicate very good growth, considering that IQOS was only introduced in the Philippines in 2020.

IQOS is a line of heated tobacco products (HTP) manufactured by PMI. It was first introduced in 2014 in Japan and Italy. PMI’s product portfolio has expanded to include Bonds and Lil for HTPs, Shiro and Zyn which are oral smokeless products, and e-vapor products such as IQOS Veeva and Veeba.

Since then, the product has been adopted by more than 25 million smokers worldwide in 73 countries. And of the 25 million, around 72 percent have completely switched from smoking combustible traditional cigarettes.

The Framework Convention on Tobacco Control (FCTC), which entered into force in 2005, was the first treaty negotiated under the auspices of the World Health Organization (WTO), ratified by 181 countries as of 2017, including the Philippines. It provided an internationally coordinated response to combatting the tobacco epidemic, setting out specific steps, albeit non-binding and recommendatory, for governments addressing tobacco use, including adopting tax and price measures to reduce tobacco consumption, among others.

Various governments and private organizations have since then adopted and pushed for harm reduction, an evidence-based public health approach consisting of policies, regulations and actions that reduce health risks by providing access to safer forms of nicotine products such as heated tobacco products, electronic cigarettes or nicotine vapes, nicotine pouches and Swedish-style oral snus.

PMI, the biggest cigarette manufacturer in the world and the market leader in the Philippines, said since 2008, it has been working on developing and scientifically assessing less harmful alternatives to cigarettes that do not create smoke because they do not combust.

It noted that there are more than a billion smokers in the world and they should be encouraged to quit. But for adult smokers who would otherwise want to continue smoking, it wants to provide them with access to smoke-free alternatives.

The company said that its long-term vision is for it to be far more than a cigarette company and to evolve into a broader lifestyle, consumer wellness, and healthcare company, commercializing products that go beyond tobacco and nicotine.

Last year, PMI said it plans to invest about P8.8 billion in its Philippine affiliate,PMFTC, over a two-year period to open manufacturing lines that will produce heated tobacco sticks for smoke-free products. The IQOS devices use a patented technology that heats, instead of burn, tobacco-filled sticks wrapped in paper called Heets to deliver nicotine to the user and in the process releasing aerosol instead of smoke.

A newer version of IQOS, called Iluma, uses another brand of heat sticks called Terea, but this has yet to arrive in Philippine shores. A more affordable device called Bonds by IQOS is being sold in the Philippines and uses heat sticks called Blends.

The Global Forum on Nicotine (GFN), the only international conference focusing on the role of safer nicotine products that help people switch away from smoking, has emphasized that while smoking is the world’s leading cause of non-communicable disease, it is not nicotine that causes cancer but the burning of tobacco which releases thousands of toxic chemicals inhaled in smoke. When combustion or burning is removed, the harm is significantly reduced.

There are governments, however, that have continued to disregard the distinction between traditional cigarettes and these non-combustible forms of nicotine products, either due to ignorance or ideology, believing that prohibition is the way to go.

Di Giovanni acknowledged the fact that the Philippines became the first country in Asia to enact legislation that distinguishes between combustible tobacco products and those that do not burn. Republic Act 11900 or the Vaporized Nicotine and Non-Nicotine Products Regulation Act, which lapsed into law last July 25, 2022, regulated the importation, manufacture, sale, packaging, distribution, use and communication of vaping products.

A 2022 report from the UK Office for Health Improvements and Disparities has maintained that vaping would be 95 percent less harmful than smoking, that there is significantly lower exposure to harmful substances from vaping compared with smoking as shown by biomarkers associated with the risk of cancer, respiratory and cardiovascular conditions, that smokers should be encouraged to use vaping products for stopping smoking or as an alternative way of delivering nicotine, and that public perceptions of vaping harm are not in line with the evidence.

PMI CEO Jacek Olczak has emphasized that they are committed to unsmoking the world and creating a better future which is free of cigarettes. For his part, former CEO Andre Calantzopoulos has said that their ambition is to convince all current adult smokers that intend to continue smoking to switch to smoke-free products as soon as possible.

By 2025, PMI aims to generate more than 50 percent of its net revenues from its smoke-free products and to have more than 40 million users switch to these products. As of last year, 32.1 percent of PMI’s net revenues came from smoke-free products, generating more than $12 billion from the sale of IQOS and the Zyn nicotine patch brand.

Meanwhile, during the ongoing GFN conference in Warsaw, experts have called on the WHO to urgently reconsider its approach to the use of safer nicotine products for smoking cessation as they emphasized that these non-combustible alternatives to cigarettes have been demonstrated to be significantly safer and that 112 million people are estimated to use these products worldwide, despite inconsistent regulation and outright prohibition in some countries.

These experts stressed that not only does the WHO oppose the use of safer nicotine products for smoking cessation, its leadership is actively and publicly deriding tobacco harm reduction and the potential of these products to help adult smokers quit and is celebrating the actions of countries that prohibit access to safer products while deadly combustibles remain on sale.

Clive Bates, director of The Counterfactual, stressed during the forum that the WHO is demonstrating an inappropriate and negligent reaction to scientific development and innovations that can significantly reduce health risks faced by over a billion smokers.

He said that WHO’s leaders campaign relentlessly for the prohibition of safer nicotine products while billions of deadly combustible cigarettes continue to be sold worldwide every year, even as they actively spread misinformation about these products.

Bates noted that refusing to integrate tobacco harm reduction into the approach to the smoking pandemic is an appalling dereliction of duty from what should be the world’s apex health organization.

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