Tobacco harm reduction (THR), especially in the context of electronic cigarette (EC) research, remains highly contested within public health, often due to studies compromised by methodological flaws. These shortcomings in study design, analysis, terminology, or interpretation can distort scientific record, erode public trust, and generate misleading or uncritical media coverage and policy reports. These challenges become especially consequential when flawed evidence is aggregated and amplified through meta-analyses, which play a central role in shaping policy and clinical guidance.

In this issue of Internal and Emergency Medicine, Rodu and colleagues critically assess a widely cited 2024 meta-analysis by Glantz et al., published in NEJM Evidence. Glantz and coauthors concluded that e-cigarette use is associated with disease odds similar to those of cigarette smoking for cardiovascular conditions, and still substantial, though lower, for asthma, COPD, and oral diseases. Rodu et al. identify major methodological flaws that call these conclusions into question. This underlines the urgent need for rigorous and transparent evidence synthesis in tobacco harm reduction science.

When meta-analysis misleads: the need for methodological integrity in e-cigarette research

The terminology used to describe e-cigarette-related behaviours in academic literature is critical for accurate communication and interpretation. Despite fundamental differences between e-cigarette use (vaping) and tobacco smoking, terms such as ‘e-cigarette smoking’ have been used to refer to vaping, potentially conflating the two behaviours. This study aims to assess the use of the term ‘e-cigarette smoking’ and its variants in peer-reviewed literature and discuss the implications of their usage.

A review of academic literature published between 2015 and 2024 was conducted using Embase, Scopus, Web of Science, ScienceDirect, and ProQuest databases. Searches included terms such as ‘e-cigarette smoking’ and related variants, with database-specific filters applied to exclude irrelevant document types. A supplementary search in Google Scholar was performed to capture broader usage, including grey literature. The search identified 613 articles in Embase, 462 in Web of Science, 407 in ScienceDirect, 282 in Scopus and 121 in ProQuest, highlighting the widespread use of ‘e-cigarette smoking’ and related terms. The Google Scholar search returned approximately 4,680 results, reflecting the widespread and informal use of ‘e-cigarette smoking’ across diverse publication types, including grey literature. The term has also appeared in highly cited and recent studies in ways that conflate e-cigarette use with smoking, obscuring the fundamental differences between these distinct behaviours.

The use of ‘e-cigarette smoking’ and its variants in academic literature has notable implications for research integrity, addiction science, public health, and policy. Misleading terminology can contribute to distorted understandings of nicotine dependence, complicate harm reduction strategies, and risk shaping restrictive policies that fail to differentiate e-cigarette use from smoking. Standardising terminology in academic literature is essential to ensure accurate communication, support evidence-based policymaking, and enhance public health initiatives.

‘E-cigarette smoking’ is a misleading term: a critical review of its use in academic literature

Saturday 21st June 2025

Keynote #3

What I Hear vs. What I Know: Battling Misinformation from the Newsroom to the Facebook Comment Section

Maria Papaioannoy-Duic, founder and spokesperson of Rights 4 Vapers, said, ‘What I’ve learned is when science doesn’t back tobacco control’s story, they don’t revise the policy, they rewrite the story, not with facts, but with fear, drama and deliberate misinformation. In the fight for access to safer nicotine products, the truth isn’t just ignored, it’s attacked, silenced and mocked. A health official makes a statement, a journalist runs with it, a politician amplifies it, and suddenly it’s viral. Meanwhile, we, consumers, advocates, we’re in our chat groups, we are sharing sources, correcting headlines and trying to hold the line with science, evidence and facts.’

‘The misinformation is institutional, not only in Canada, but around the world. Health agencies, regulators, even doctors, often repeat outdated or debunked information, sometimes out of fear, sometimes out of habit, and most times because they just don’t have the time to learn. And the thing is, tobacco control knows this, and they capitalise on it. No one wants to really defend nicotine, because it’s not sexy. But this isn’t about being liked, it’s about eradicating smoking, and that means telling the truth even when it’s uncomfortable.’

‘In 2022, the Canadian Tobacco and Nicotine Survey broke down the numbers on relative risk and beliefs among Canadians and found that 81% of Canadians either misunderstood or had no idea that vaping is safer than smoking. And when we look at people who smoke, 79% didn’t know that vaping is safer, and among those who smoke but have never tried a vaping product, a staggering 90% believed vaping is as bad or worse. These are the very people who stand to benefit the most from switching to safer alternatives, yet misinformation has left them stuck, misled, confused and still smoking. They truly believe, because of where they go to get their information, that smoking that cigarette will keep them alive longer and healthier than switching to a vape.’

‘My 2009 self would never believe what is happening in 2025. Millions of us who quit smoking with safer alternatives are now being told we’re wrong. Instead of tobacco companies being the villains, it’s us, people who use safer nicotine products and speak up and out about it, we are cast as the threats. Globally, governments are pushing their citizens to break the laws just to access a vape or pouch because the alternative to them is going back to smoking.’

‘When it comes to policy, science should take the lead, but in this space, emotion seems to win. Panic spreads faster than peer-reviewed studies. Tobacco Control is a well-oiled and frankly spoiled machine. It has no hesitation to reframe the narrative, to make anyone that goes against them the enemy, including folks who speak up for safer nicotine products. To them, we’re the enemy, because we’re telling the world nicotine isn’t the problem, combustion is.’

‘So, what do we do? We continue to push back with facts, with strategy and with heart, and most importantly, with action, from rallies to letters, from bus tours to social media, from simple pop ups to emails, we find a way to tell our story. When you show up calmly with credible information and lived experience, that’s when cracks start to form.’

‘When voices come together, when harm reduction meets medicine, meets policy, meets lived experience, that’s when we get traction. So, whether you’re an advocate, a policy maker, a health professional, someone trying to make a difference in your own circle, facts matter. Continue to share them, because lives depend on them.’

‘We are the public health heroes. We’re the ones that have to push the narrative and we’re the ones that have to keep moving forward.’

Konstantinos Farsalinos, a physician at the Universities of Patras and West Attica in Greece, said, ‘In 2021, a study of more than 1,000 US physicians said that 83% strongly agreed with the statement nicotine causes cardiovascular disease, and 80.5% strongly agreed with the statement that nicotine causes cancer. You understand that this level of misinformation and misperception is not only widely present in society and among non-experts, but also among experts. And experts have been the source of information for consumers.’

‘I think that we have underused social media. When I say we, I mean the supporters of tobacco harm reduction and, even more so, those who have been involved in research. We haven’t made any consistent effort to educate consumers. We have been doing it sporadically and we have lacked consistency.’

Panel Discussion #5

Who else should be in the room?

Garrett McGovern, medical director of the Priority Medical Clinic in Dublin, said, ‘A patient of mine had COPD and had to get a pneumonectomy and was on all sorts of treatments. But she could never really stop smoking 30-40 cigarettes a day. After a follow up with her respiratory specialist I asked whether the subject of electronic cigarettes had come up? They said that the respirologist when asked about electronic cigarettes, he recoiled and said, under no circumstances, take electronic cigarettes or try them and if you do, you’re no better off than smoking. This is a somebody who is very, very versed and experienced in lung health and the damages of smoking. How could anybody give that misinformation to somebody who’d lost their lung, who has COPD, who’s a heavy smoker?’

Adriana Curado, community researcher at the Grupo de Ativistas em Tratamentos (GAT) in Lisbon, said, ‘We tried to reach out to some senior top officials in the Ministry of Health to talk about this, and they were just suspicious. And the reason is that they are thinking that they might be contaminated by this industry plot. And I think we also have a problem with health professionals often spreading misinformation.’

Sharifa Ezat Wan Puteh, chair of the Malaysia Society for Harm Reduction, said, ‘We can raise awareness in the community. We can train frontline staff in tobacco harm reduction. But if we don’t have the safer nicotine products available, and if we are not able to give them for free to people who use drugs, to people who are living in the streets, to people who are facing very tough conditions in their lives. We are not achieving the change we need to achieve.’

Jessica Harding, director, Global Forum on Nicotine Limited, said, ‘We do try very hard to encourage people in other areas to come to GFN. I think the biggest barrier to this is the toxicity of this debate. To be honest, some people fear that they will suffer reputational damage if they come here to talk about consumer products that are unfortunately associated with an industry that (deservedly) has a bad reputation for what they have done in the past.’

Carolyn Beaumont, an Australian GP specialising in rural medicine, and founder of SmokerHealth national telehealth clinic, said, ‘I’ve had a significant number of patients referred to me from their psychiatrist, because they want them to continue nicotine, and stop smoking, but they don’t know where to start. They don’t know what product to recommend or how to prescribe it. So, psychiatrists are a very important and a receptive group to involve.’

Panel Discussion #6

Media, misinformation and public health

Will Godfrey, founder & editor-in-chief of Filter magazine, said, ‘The majority of tobacco harm reduction coverage, as we know, is awful and harmful. I would posit that while there are some people who know exactly what they’re doing and are very, very cynical about it and are spreading disinformation rather than misinformation, I think that the majority of the bad media coverage we’re talking about is simply regurgitated. It’s based on ignorance, on credulity towards public health institutions that should be trustworthy, towards, in some cases, prestigious academic organisations and flawed and often unpublished studies.’

‘When you consider that very few journalists are tobacco harm reduction beat journalists, they’re expected to cover multiple subjects quickly, which doesn’t lend itself to depth. In some cases, they’re churning out four or five stories a day, so seeing them trust what some academics tell them, or what the World Health Organization says, is sad and disappointing, but not that surprising.’

‘People are inspired by human stories. Most people don’t read studies and aren’t very interested in data. I do think that so many consumer stories are so incredibly inspiring, they’re also quite easy for journalists to write, compared to more deeply reported or data driven stories. It’s always vital that our messaging is underpinned by evidence and data, but aiming on a human level is one way that you can get clicks from a positive story.’

‘Harm reduction as a concept, as a movement, has always been a bottom-up phenomenon, and that’s why consumer voices are so important. I think building the intersections with other movements, where there are obvious alliances, is not only a good thing for this movement, but also for a way of telling stories in journalism that can appeal to different constituencies. For example, mental health, when we know that smoking rates are extremely high in that population, or homelessness and also broader drug policy reform and harm reduction, which is why it’s so great to see increasing numbers of people from a drug harm reduction background engaging in this area.’

David Zaruk, a risk-communication expert from Brussels, said, ‘Most other industries are facing the same problems, but I think one of the things I’d like to look at instead is the money. That’s where the narratives get control. That’s where the narratives that weave the stories that the media pick up. That costs a lot of money. As a lobbyist for the chemical industry for about 17 years, I knew enough that if you didn’t have the money, then your campaign is lost. And I’ve also seen your budgets for advocacy, and it’s not a good foretelling of the type of challenges you’re going to have.’

‘When you look at a lot of NGO campaigns and you wonder, how is it possible that they’re able to get these studies done? How is it possible to get the media to report on this? How is it possible to get the academics to talk about it? How is it possible to get the regulators to talk about all these things when all of it is false? Follow the money.’

Fiona Patten, a politician and activist from Australia, said, ‘I know a lot of the journalists who write these stories [containing misinformation], and they’re not bad people, but when I talk to them about these articles, they say they’re too scared to print anything else. Really knowledgeable health reporters are frightened of our Cancer Council, they are frightened of our Health Ministry. They are frightened that if they contradict the health department, if they contradict the cancer councils, then a great wrath will come upon them. Even for the political reporters who are reporting on this, if they contradict the minister, if they try to correct or ask difficult questions of the minister, they are no longer invited to have interviews with the minister. So, it is really difficult for journalists. I have some sympathy for them, and I think this is part of maintaining those relationships.’

‘In Australia we’ve seen the health minister congratulating himself on how successful our “world-leading programme” has been, with articles saying they’ve seized eight million illicit vapes, and that this proves that it’s working. In an article they interviewed a pharmacist who said he had sold one vape in a month. Then when you drilled down into the numbers, it was found that for every one legal vape that is supplied in Australia, 1,700 are supplied illicitly. Very successful, wouldn’t you say?’

Lynne Dawkins, director of Dawkins Analytics Ltd, said, ‘We’ve seen throughout this conference so many examples of misinformation. It’s everywhere. So, does this matter for public health? There have been numerous academic studies now that have shown that misperceptions are associated with a reduction in the trying of reduced risk products and reduced switching rates. But even worse than that, we’re now seeing evidence of people actually switching from vaping to smoking because they think that smoking is less harmful. So yes, I’d argue it really does matter for public health. If you are promoting information about the dangers of vaping, it leads to more smoking, more death and disease.’

‘Why is misinformation so common? Alarmist and negative stories generate interest, generate clicks. Humans are drawn to negative media stories much more than they are to positive ones. They’re more likely to be shared on social media. And of course, the media are very well aware of this, so you can’t blame them, in many ways, for feeding that information to the public, and of course, that will also be self-serving for them.’

‘During any involvement with the media, I think we need to bring the focus back to smoking. Smoking kills, and we know it.’

‘Academics need to build rapport with the media, but it’s also about telling stories. Brains are attuned to powerful, emotive stories.’

Closing Remarks

David Sweanor, adjunct professor, Faculty of Law, and chair of the Centre for Health Law, Policy & Ethics at the University of Ottawa, said, ‘I go to an awful lot of conferences. I like GFN more than any other, and the reason is that you get such a cross section of people and ideas. We have advocates here, but we also have consumers, researchers, scientists, entrepreneurs, business, and analysts. We have so many different ideas, and you keep getting challenged, and that’s helpful, because, you know the line that says, “respect those who seek the truth, be very suspicious of those who claim they’ve found it”. We’re dealing with an issue where a lot of people really think they’ve found the truth, and that’s why they don’t need to talk to anybody who has different views, or they vilify them.’

‘Two months ago, Goldman Sachs came out with a report following up on the very rapid decline of cigarette smoking in the United States and the uptake of alternatives. And Goldman Sachs says that alternative products, non-combustion products, are going to overtake the sales of cigarettes in the United States of America this year. That’s amazing, and it’s very much to the credit of those of you are sitting here, and others. We’re moving. Consumers are moving. It doesn’t matter what other people are saying, and we’re seeing this in country after country.’

‘We’re still talking about over a billion people on the planet smoking cigarettes, over eight million deaths a year. Projections of that number will be going up, not down. We have an awful lot to do. If we can speed this up, and we have the momentum, it’s unstoppable now. The question is, how fast can we move it ahead? And that’s what meetings like this help us accomplish.’

gfn.events

Watch the day’s proceedings here:

Friday 20th June 2025

Panel Discussion #4

Evaluating WHO tobacco harm reduction science

Thomas Nahde, global head of harm reduction and engagement at Imperial Brands, said, ‘Smoking is not a communicable disease, it’s a consumer behaviour. A narrative of war on a behaviour is misapplied, I believe. I’m conscious that it’s about urgency, but it demonises smoking, and stigmatises people who smoke. It also substantially limits the options, if you’re using a narrative of eradication rather than control. We need way more focus on the consumer, to really understand the behaviour of people who smoke.’

Riccardo Polosa, founder of the Center of Excellence for Accelerating Harm Reduction (CoEHAR – University of Catania, Italy), said, ‘It’s not true that the WHO is doing everything wrong. But in tobacco control, it is doing badly, in my opinion, particularly in the way it is creating misinformation. And unfortunately, most of the time WHO is doing this on purpose: it is actively misleading. They select their references, they distort evidence. They use tactical omission. There is one single objective in my opinion, which is to create their own science that supports the abstinence-only narrative and paradigm. But this has terrible consequences for millions of smokers who would otherwise switch to much less harmful products. In the clinical world, this would be called negligence.’

Summer Hanna, head of scientific regulation at BAT, said, ‘I believe that [when the FCTC was being drawn up], WHO recognised that progress and technology transformation would evolve to change and transform smokers’ lives, and that harm reduction strategies would then become the third leg of their approach. That’s why harm reduction is reflected in the FCTC. Unfortunately, over the last 20 years, we’ve seen that scientific mindset and curiosity erode. We now have leading jurisdictions of tobacco control – countries like the UK or New Zealand – with progressive regulatory frameworks and remarkable declines in the rate of cigarette smoking. Meanwhile, the FCTC is still reporting, 20 years later, over one billion smokers. To me, that’s a failure of creativity and scientific process.’

‘There might be many views on the best approach to tackling smoking, but it is in everyone’s interest to be a part of the solution. That’s only possible through open dialogue, a robust scientific exchange that includes all viewpoints and collaboration to truly end cigarette smoking.’

‘We think a lot about FCTC, but we also should think about other specialist agencies within the WHO that develop scientific insights for their use, for example the International Agency for Research on Cancer (IARC). ENDS are listed as a priority for evaluation with the IARC. This is a tiny specialist agency in France, but you see the impact of their work regularly in the media – the idea that Diet Coke and aspartame causes cancer, grilled meats cause cancer, aloe vera causes cancer — all these are insights from the work of IARC. But the agency does not contextualise the risk of cancer, only the hazard of it. And so the utilisation of science in the specialist agencies, uncontextualised but with wildly outsized media and public influence, is also a huge threat to the [safer nicotine] category and the public health opportunity they offer.’

Roberto Sussman, senior lecturer at the Institute for Nuclear Sciences of the National University of Mexico, said, ‘We essentially have to recognise the FCTC as the first international treaty on a health issue. It was a great victory at the time, that encoded years of struggle against the spreading harms from smoking. And at that time, the tobacco industry played a role that was not honourable. But now it has become a war on the industry. The COP meetings are closed because [WHO believes] industry might disrupt the whole thing. So it’s become a parallel situation: an old narrative, and a reality that completely denies that narrative, and a technocracy that resists the change. My hope is that the growing market in [safer nicotine] products will lead to a point where things will have to change, and that will also include at the WHO.”

Clive Bates, director of The Counterfactual, said, ‘What matters is how harmful and how safe or unsafe [safer nicotine products] are compared to the other risks that people bear, either as smokers or in society in general. We don’t have a zero risk appetite, and the evidence suggests these products are much less harmful than smoking.’

From the floor, in response to a WHO statement that ‘Nicotine is highly addictive’:

Lynne Dawkins, Dawkins Analytics and Pinney Associates, said, ‘It’s more nuanced than this [statement]. It depends on how the nicotine is delivered, and in the form of cigarette smoke, yes, it’s highly addictive, I would agree. But hardly anybody gets addicted to nicotine in the form of a patch, for example. There’s also the issue of a distinction between addiction and dependence. Addiction causes harm. Maybe we should be using the word dependence when we’re not talking about addiction in relation to cigarette smoking. When you talk about physical dependence, that is linked to experiencing withdrawal symptoms when you stop. Addiction comes with that unique extra bit about causing harm. Of course, that’s not the way it’s used among the general public.’

Discussing the statement ‘There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests’ from the WHO FCTC Article 5.3:

Clive Bates, director of The Counterfactual, said, ‘When this was agreed in 2008, I remember saying “who’s thinking about the snus experience?” By then, we had a tobacco product made by a tobacco company, which was responsible for the lowest rate of smoking in Europe. It also had a measurable impact on cancer, which was much lower in Sweden than it was in the rest of the European Union, where snus products were banned. If you have a principle, and you say it’s fundamental and irreconcilable, what happens when you have a counter case like that? What happens is the principle needs to change.’

‘Most people, including in the WHO, including in the industry, do not get up and go to work saying “I’m going to tell lies all day”. What they do is form a set of beliefs that are reinforced by the influences around them. One of the reasons people interested in tobacco harm reduction and consumers are excluded from the FCTC COP is that they don’t want dissonant views in the room, because that breaks the bubble of thinking. I think most people are trying to be honest and form a view that is reinforced by everything around them, but, as a professional, you have to listen to other points of view – or you’re going to miss things.’

Roberto Sussman, senior lecturer at the Institute for Nuclear Sciences of the National University of Mexico, said, ‘It’s part of a combat narrative. When you are in war, the enemy is bad. Today, being more pragmatic, the industry should be part of the discussion. It cannot be excluded. And to keep this as a timeless, eternal, absolute proposition is in the end itself defeating, because the industry is not the same. The conception of this type of statement is that industry is like a monolith. What is the biggest of all Big Tobacco? It’s the [state-owned] Chinese tobacco industry. The Chinese industry is not alluded to. It goes into the COP meetings, sits down there, and nobody says anything. This is the real Big Tobacco.’

Summer Hanna, head of scientific regulation at BAT, said, ‘I’m not confident how many of the people who are working in [the tobacco control] space actually know any smokers. As smoking becomes less of a middle class or upper class phenomenon, people who sit and learn at institutions do not ever interact with these people in their personal lives. They become an abstract entity. In the same way that the tobacco industry becomes a monolith, the smoker also becomes a monolith in this.’

gfn.events

Watch the day’s proceedings here:

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.’

gfn.events

Watch the day’s proceedings here: