Friday 20th June 2025
Keynote #2
Tobacco harm reduction and the media – evidence, narrative and consequences
Jacob Grier, writer and journalist covering tobacco policy, said, ‘When I meet people outside of the field, and they ask me what I write about, and I tell them, I write about tobacco harm reduction, I pretty much always get the same question, and that is, why? And the reason is they probably don’t know many people who smoke. They probably don’t go to places where smoking happens. And so, if they think about smoking at all, they think about it as a problem of the past and a problem that is pretty much solved. So, the first issue that we have is just getting people to pay attention and to care about this issue.’
‘In Portland [Oregon, USA], I can buy candy-flavoured weed, candy-flavoured beers, candy-flavoured or alcoholic ice cream, but I can’t buy a flavoured vape or a flavoured nicotine pouch. You can even buy a regular cigarette. This is obviously a pretty irrational outcome.’
‘No one was standing up to say, we shouldn’t ban [flavoured safer nicotine products] because consenting adults have the right to decide what they put into their bodies. The adults who want to buy these products, including those who are using them to stay off cigarettes, were completely dismissed. Their rights were never seen as even being worth considering in these conversations.’
‘Every time a new restriction is put on smoking or nicotine, it wounds its cultural legitimacy, making it easier to pass the next one, and harder to advocate for people to use it [nicotine]. Now I’m not saying these [restrictions] are all unjustified. I flew here to Poland from the United States. I wasn’t thinking, “man, I wish people were still smoking on planes”. Some restrictions have their use. But there’s a danger in erasing the very idea of smokers and nicotine users as consenting adults, who have rights of their own that we need to consider.’
‘So, what can we do? Our first strategy is obviously to emphasise credible research. The bad news is that having the facts on our side is clearly not enough. Media tends to find research less exciting than stories about the dangers of vaping. Journalists seek novelty, so if something isn’t new, it isn’t news. Millions of people dying from smoking isn’t a story, but a few dozen people dying from adulterated vapes generates months of media coverage.’
‘Almost 4,000 young Americans die every single year because of excessive alcohol use, but you don’t see calls for restricting flavours. Drinking is considered fun and normal, but when teen smoking falls to its lowest rates in history, which should be a tremendous press story, it gets barely any coverage, but a small uptick in vaping is a reason for endless coverage. So, what I’d like to say to you is that we do need to emphasise the facts, but we also need to change the way we talk about nicotine and tobacco use.’
‘A suggestion I’m going to leave you with is you need to push a simpler message that resonates across the political spectrum, which is that consenting adults should be free to make their own decisions. Some of them are going to use nicotine, and they should not be denied the right to access it in its safest forms.’
‘If we can bring attention to the still urgent problem of smoking, we can make a compelling case for safer products, and a big part of that is responding to media alarmism with credible science. We should never stop doing that, but ultimately, we should always approach the problem as liberals… So, we can hope that they don’t smoke, and we can encourage and inform and tax and persuade, but we should always do this in the context of centring the individual and respecting their liberties, approaching them as equals to be persuaded, rather than as degenerates to be controlled’
Harry Shapiro, director of DrugWise, responded, ‘It’s important to consider all the marginalised groups around the world whose smoking rates are far higher than the average smoking rates in those countries. Such as people with drug and alcohol problems, those with mental health problems, First Nation people, LGBTQ+ and others. These groups really need to have much more choice than they currently get. And what it boils down to, is the universal right to health. This is in the WHO founding charter of 1948, and universal means everyone, whether you actually like what they’re doing or not, or you don’t approve of drug use or smoking; everyone’s entitled to the right to health. But for that consumer voice to be heard more than it often is, we do have to try to shift the current narrative, though that’s no easy task.’
‘We hear a lot about teen vaping, but what we’re concerned with is adults in this space. And it’s also important to emphasise that tobacco harm reduction products and interventions are *complementary* to current mainstream tobacco control measures. We’re trying to reframe the public conversation. We’re helping adults to quit smoking.’
‘If you’re talking to journalists, you can acknowledge the concerns… for instance about teen vaping. But you can also point out that in the USA, teen vaping fell by 70% between 2018 and 2024. You can acknowledge concerns about the effects of these products in 20- or 30-years’ time but also say that just because we don’t know everything, it doesn’t mean we don’t know anything. There’s a sufficient medical evidence base now that allows health professionals to be recommending these products to smokers.’
Workshop
A fresh look at flavours
Elizabeth Becker, senior director, population science within the Regulatory Sciences organisation of Altria Client Services (ALCS), said, ‘[Vaping] prevalence can, in fact, go down despite flavours being in the market. I’ve shared with you data from both sides of the coin: those [consumers] who are smokers and the value that these flavours can play for them, as well as the prevalence of underage use going down despite flavours being in the market.’
‘We believe that a consumer-centric approach makes sense: availability and choice of flavours in the marketplace can help accelerate harm reduction while also minimising those unintended consequences.’
Christopher Russell, director of Russell Burnett Research and Consultancy Ltd, said, ‘There is essentially no clear evidence that e-liquid flavours affect smoking or vaping outcomes at six months or longer. But this, I emphasise, is not evidence of the absence of an effect, but rather to do with an absence of high-quality evidence.’
‘It’s also important to emphasise that ENDS [electronic nicotine delivery systems] users are heterogeneous. Their reasons for using ENDS are varied, as are the experiences that they’re seeking from using ENDS. And most importantly, most people who use ENDS products don’t use these products in the narrow stable ways that may be required of participants in an RCT [randomised control trial].’
Autumn Bernal, founder & principal scientist, ToxCreative, said, ‘We’ve conducted a lot of risk assessments on flavoured products. Fruity flavours can demonstrate just as much of a reduced risk potential as menthol and tobacco-flavoured products. So what I want people to really take home is that identification of hazards does not equal risk.’
Piotr Kozarewicz, senior advisor, US regulatory policy & director, US post-market regulatory affairs, at PMI USA, said, ‘The reality is that the flavours that are liked by adults are almost identical to the flavours liked by youth. So there is a problem: tobacco harm reduction is all about successful transition from combustible cigarettes to better alternatives. We need flavours then to facilitate the switch, and we cannot base the policy on assumption that blueberry flavours are just a youth appealing flavour.’
‘More well-defined studies are needed – well-defined risk assessment, consideration, what’s in the product, and analysis, who is using the product and why are they using the product. And with this, I believe we can have really successful regulatory policies implemented, not only in the United States, but also the rest of the world.’
Panel Discussion #3
Innovation and Regulation – shaping the landscape for safer nicotine products
Jonathan Fell, an independent investment analyst, said, ‘In the last 15 years or so we’ve had this explosion of innovation, and of new tobacco and nicotine products being marketed, which I think everyone in the room would agree have the potential to enormously reduce the public health burden of smoking-related diseases. But arguably the regulatory framework for tobacco and nicotine hasn’t really caught up with these developments yet, or in some places it might have caught up but in the wrong sort of way, in a way that is choking off innovation and actually denies consumers access to these potentially life-changing and life-saving products.’
Asanda Gcoyi, CEO of the Vapour Products Association of South Africa (VPASA), said, ‘What’s quite unique about South Africa is that we are currently in a legislative vacuum. There’s absolutely no law that is governing safer nicotine products. The current draft bill that is sitting with parliament… was first introduced in 2018. So, we are now in 2025 and we are still talking about the bill and what it should contain and what it should not contain.’
‘We have over 12.7 million tobacco users in [South Africa]. That should be the focus. So, whatever it is that we do, we need to keep them in the centre of the discussions.’
‘So overall, I think regulation is good, but the question is, what kind of regulation? And obviously it should be regulation that is conducive, that is not too prescriptive and not too restrictive, that still affords consumers that freedom and liberty to choose for themselves from what is available.’
‘At the end of the day, South Africans need assurances that whatever policies are devised for South Africans [are devised] by South Africans and are not something that is simply transplanted from the WHO.’
Sam Tam, president of the Canadian Vaping Association, said, ‘I think the most important thing is we have to have balanced regulations, ones that allow products to be accessible as a harm reduction tool for adults. And there’s also a need to protect youth from exposure [to these products] and make these products less appealing.’
‘Canada has changed their approach. They have decided that harm reduction has its place in helping Canada reach a [smoking rate of] less than 5% by 2035. And they see harm reduction as the most effective tool getting them there, besides smoking cessation products.’
‘[Prohibition] doesn’t work, it’s not effective, and it creates a major problem for governments, which is that it fuels illicit trade and impacts harm reduction. And of course, for our government, if they have a goal to reach less than 5% smoking rate by 2035 they’re not going to be able to get there without vaping.’
Deborah Binks-Moore, chief corporate officer, Imperial Brands plc, said, ‘In our sector, the big challenge faced by all of us, industry regulators and policy makers, is how do you provide choices that encourage adults to transition away from smoking, while banishing the rogue actors who undermine trust and encourage unintended or youth use.’
‘To give you an idea of some of the data, in one of our studies, 29% of smokers who switch from tobacco exclusively used fruit flavours, and where we see restrictions on flavours, either through regulatory inertia or legislative bans, we see a proliferation of the illegal, unregulated market. And once the market moves into the hands of criminals, there is a greater risk of unintended or youth use and consumption of harmful products.’
‘There are around one million vapers in Australia, and more than 90% of the vapes that those people consume are bought illegally, so a staggering number of law-abiding consumers who want to make a choice to improve their health have effectively become criminals through bad policy, and it’s enriching criminal gangs. It just is nonsensical.’
Watch the day’s proceedings here: