THE revolution in nicotine delivery technology encourages millions of smokers to switch to less harmful alternatives and presents an opportunity to reduce up to four million deaths from smoking each year, according to a global health expert.
Dr. Derek Yach, president of the Foundation for a Smoke-Free World, said during the 8th Global Forum on Nicotine on June 18, 2021, that the world is experiencing a revolution in nicotine delivery technology, as there are now more than a hundred million people using harm reduction products.
“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 three and four million, if we acted more vigorously,” Yach said.
One example of a novel nicotine delivery system is the heated tobacco product IQOS developed by Philip Morris International. Heated tobacco products or HTPs, heats tobacco without burning it to release a flavorful aerosol, not smoke. HTPs eliminate the process of combustion, which has been found to cause the production of thousands of harmful chemicals in smoke.
The heated tobacco device and the tobacco sticks called HEETS were made available last year for adults 21 years old and above in the pilot area of Metro Manila. The online store IQOS.com now also covers delivery in key cities across the Philippines including Baguio City and La Trinidad; Calumpit, Bulacan; Cabanatuan City, Santa Rosa, Aliaga, Jaen, Peñaranda, Palayan, Zaragoza in Nueva Ecija; and San Fernando City, Bacolor, Santa Rita, Guagua, Apalit, Mexico, Santo Tomas, Santa Ana, Arayat, Floridablanca, Minalin and Clark Freeport Zone in Pampanga.
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, the 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.”
“In short, the present technological revolution demands an accompanying ideological revolution. Currently, many in tobacco control are skeptical, even hostile towards the contributions of the 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.
He said that some tobacco executives and companies, in recognition of the public desire for safe and nicotine options, have begun 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 the 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 the massive health crisis,” he said.
Yach said other public health experts have described the phenomenon as the tobacco industry’s actual and perceived transition into a 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 review research and have disseminated these findings by a monograph report,” he said.
“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.”