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Non-combustible nicotine delivery technology can reduce 4M deaths, says expert

Up to 4 million deaths from smoking each year can be avoided with the advancement of non-combustible nicotine delivery technology, which encourages millions of smokers to switch to less harmful alternatives, according to a global health expert.

The world is experiencing a revolution in nicotine delivery technology, as there are now more than a hundred million people using harm reduction products, said Dr. Derek Yach, president of the Foundation for a Smoke-Free World said during the 8th Global Forum on Nicotine on June 18, 2021.

“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,” Yach said.

E-cigarettes or vapes, and heated tobacco products (HTPs), such as Philip Morris International’s IQOS are non-combustible nicotine delivery alternative. The IQOS system use a patented HeatControl™ Technology that precisely heats, without burning, tobacco-filled sticks wrapped in paper called HEETS™ to release a water-based aerosol. Unlike cigarettes, IQOS does not burn tobacco and therefore produces no smoke and no ash. 

The device and heat sticks 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 of the device and heat sticks to key areas in Minadanao including Davao City, General Santos City, Palomok, Cagayan de Oro City, Opol, El Salvador, Tagoloan and Villanueva in Misamis Oriental.

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.”

“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.

He said that some tobacco executives and companies, in recognition of public desire for safe and 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 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.”

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