The Global Forum on Nicotine (GFN) was held over four days, with eighty panelists worldwide discussing the past decade of safer nicotine use and looking ahead to the next ten years.
“Despite decades of global efforts to control tobacco, one billion people still smoke around the world. With eight million annual deaths related to smoking, tobacco use is the leading cause of non-communicable diseases. Nicotine vapes, Swedish snus, nicotine pouches, and heated tobacco products are substantially less risky than smoking, and they have an important role in helping those who cannot quit smoking to switch to safer alternatives, in an approach known as tobacco harm reduction.”
The program discussed the key milestones of the last ten years, evaluated the complex political, regulatory, and scientific environment, and debated the challenges and opportunities of the future. Topics such as scientific publication policy, what we have learned in the last ten years about nicotine science, and reducing the environmental impact of tobacco harm reduction were addressed in the sessions.
It was the first GFN with panels in Spanish. Among them, in the panel “COP10: Right to Harm Reduction and Practical Guide to Encourage Participation”, discussions were held about the measures to be taken in November 2023 at the Conference of the Parties to the Framework Convention on Tobacco Control. Concerns were raised about the lack of participation and transparency affecting small and medium-income countries where harm reduction has been shown to be urgent due to the ineffectiveness of cessation and prevention measures and the high rates of persistent smoking. Panelists also discussed regulations in Latin America, activist experiences, and strategies that should be led to participate in COP 10 of the FCTC effectively.
In the other Spanish panel, “Latin America: A moral and ethical obligation of health professionals to promote Harm Reduction?” the persecution of research and medical professionals who advocate for harm reduction in tobacco was highlighted. Medical panelists and researchers also emphasized the need for a patient-centered perspective in this field.
One of the panels discussed the global context of regulation, “Regulation – the global picture.” The global landscape of regulation for less risky nicotine products shows great variations in both policies and their implementation. Many jurisdictions impose absolute bans, while others adopt more balanced approaches, recognizing the growing scientific evidence of the effectiveness of safer products in addressing a global tobacco epidemic. The speakers shared, through examples, key issues for regulators and how they should be addressed. They also debated what constitutes adequate and proportionate regulation and will determine which international models could be adopted to ensure smokers’ critical access to safer alternatives, such as Sweden, New Zealand, the UK, France, and even the Philippines’ foray into differential regulation. Several speakers disapproved of the lack of choice for all, as some countries already enact laws against smokeless products, thus limiting the right to choose.
In different panels such as “Science, regulation and morality” and “Ten years of science: what have we learned?” scientists presented their reflections on the efficiency of less risky products to reduce risks and harm in smokers, the evidence for such effectiveness, as well as addressing criticisms of the origins of some of the research and methodologies used.
Finally, the “Tobacco harm reduction – the next decade” panel addressed key issues of tobacco harm reduction in the next decade. What will the regulation be like? What new types of products can we expect? How will the political landscape evolve, and will tobacco harm reduction continue to play a central role in public health policy? How will tobacco harm reduction develop as a distinct discipline within public health, and who will be its leaders? Some conclusions were:
- A medical community that can and decides to be more committed and involved in tobacco harm reduction.
- Regulations and approaches recognize that some people consume nicotine or do not quit their consumption as part of managing pleasure and enjoyment of the substance.
- The mistakes of the most restrictive jurisdictions, such as the prohibition of products in a very short period, have been demonstrated, with lessons learned of what not to do.
- There is evidence, and even more in the next 10 years, of the cost-effectiveness of countries implementing tobacco harm reduction measures.
- Consumers will choose, and that will shape the design of products, safety, quality, and characteristics, causing some types to leave the market and new ones to arrive.
- Tobacco harm reduction will continue to advance to focus not only on products but on more holistic strategies.
- Strategies must be reoriented and strengthened to find more allies in tobacco harm reduction.
- Scientific studies will explore scenarios where consumers do not seek to stop consuming nicotine and the opposite case when they seek to reduce risks and harms or even cease vaping.
