As we get closer to the UK’s stated ambition to be ‘smoke free’ by 2030 and subsequently the EU’s recently announced 2040 ‘Beating Cancer’ Plan, which includes the objective of a ‘tobacco free generation’, nicotine industry participants, governments and regulators need to reflect on the technology and policies that will help achieve these goals.
By focusing on ‘The Future of Nicotine’, this year’s Global Forum on Nicotine, to take place in Liverpool on June 17th and 18th 2021, will play its part in considering the emerging themes, trends and issues in Tobacco Harm Reduction (THR) which should form a key element of any realistic approach to population level health goals.
GFN is also taking place ahead of the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) COP 9 meeting in November which will give direction on the WHO’s influential global tobacco control policy recommendations for coming years. The WHO’s stance towards THR is regarded by many stakeholders as not constructive or cognizant of the science on next generation products like vapes, suggesting evidence on vaping is “inconclusive”. Nevertheless “harm reduction” remains in the WHO’s Framework Convention on Tobacco Control definition of tobacco control so there is always hope they will change tack as the independent body of evidence supporting THR continues to grow.
Fontem Ventures is working to make further strides in the realm of THR with vaping technology that may be more satisfying to more adult smokers in their transition away from combustibles. We believe that showcasing the high quality standards our blu vaping products adhere to can help convince adult smokers that vaping is a viable and potentially less harmful alternative to combustible cigarettes.
At a minimum we, along with other stakeholders like health authorities, need to provide adult smokers with accurate and digestible information about potentially less harmful alternatives to cigarettes so they understand the choices they have if they are uninterested or unwilling to stop using tobacco or nicotine entirely.
It is important that science remains central to all conversations. It’s also important to consider targeting communication and support to different socio-economic groups in order to access the greatest number of individuals.
The good news is health authorities are beginning to see the value in THR policies as demonstrated by the recent NHS vaping trial in the UK.
Research and data continues to validate this approach and support the efficacy of e-vapour products, with last year’s Cochrane Review finding that vapes containing nicotine were the more effective in helping to replace combustible cigarette smoking, than traditional nicotine replacement therapy. While this is promising and encouraging, ultimately these results need to be communicated effectively to adult smokers, allowing them to make an informed choice.
The success of THR in contributing to long term country, regional and global government health objectives hinges on the trust and adoption of potentially less harmful products by adult smokers. Without effective communication and awareness building, the opportunity for THR will be lost.
The Global Forum on Nicotine (GFN) is the only international conference which focuses solely on the role of nicotine-containing products such as vapes, nicotine pouches, and heated tobacco products which scientific research shows have significant tobacco harm reduction (THR) potential and can help adult smokers move away from combustible cigarettes.
The theme for this year’s GFN is the Future for Nicotine, and organisers aim to examine the developing science in nicotine and the issues around policy and regulation.
Following recent studies and reports, the event will delve into all aspects of THR in a bid to amplify public voices and showcase scientific research to educate a wide range of stakeholders who continue to doubt the effectiveness of next generation products (NGPs) as a potentially less harmful alternative to continued tobacco smoking.
Event attendees are all, in some way, involved with the debate over potentially less harmful nicotine-containing products, from public health experts to media representatives, and consumer advocacy groups who are rarely consulted by policy makers and regulators on these issues, despite having a critical role as existing and potential users of these products.
Professor Michael Russell, whose research and memory is honoured at the event, said that there is no good reason why adult smokers transitioning from combustible tobacco products to less harmful nicotine delivery systems should not be encouraged.
And now, at a time when the number of smokers worldwide reaches an all-time high of 1.1 billion, government officials and public health bodies must acknowledge the totality of the findings from scientifically led studies, which demonstrate that NGPs have an important role to play in tobacco harm reduction strategies.
This also means that access to educational information on vaping and other potentially less harmful nicotine-containing products should be widely available to ensure that adult smokers can learn about the potential benefits of transitioning to such products.
A great place to start in understanding THR is with nicotine itself. The science team from our parent company Imperial Brands has produced a video explaining what nicotine is and answering the basic questions: where does it comes from, what are its effects and what are its potential risks?
You can find a summary of the video on this infographic. To further explore this topic the GFN website itself is a great resource with content from all kinds of stakeholders including scientists and health professionals, as well as industry participants like Imperial Brands.
We believe sharing information like this will ultimately help adult smokers who are looking for high quality products they can understand and trust. The innovation behind NGPs in THR means that products are more in line with adult smokers’ needs and, as current science shows, are increasingly effective in helping adult smokers reduce their exposure to tobacco smoke, including replacing combustible cigarettes entirely.
A survey published in early 2021 conducted by the Independent European Vape Alliance (IEVA) revealed more than 80% of smokers who switched to e-cigarettes have completely stopped smoking.
The survey, which polled more than 3,300 European e-cigarette users, also found that around 65% of vapers use fruit or dessert flavoured liquids.
The IEVA, a pan-European association aimed at uniting and representing national associations, companies, manufacturers and wholesalers in the vaping industry, found 81% of vape users surveyed have completely stopped using tobacco, with a further 12% having reduced smoking with the help of e-cigarettes.
Numerous health bodies agree vaping poses a significantly reduced risk than traditional combustible cigarettes, with Public Health England asserting e-cigarettes are at least 95% safer. The public health benefits associated with adult smokers transitioning to vapes could be enormous.
The study also reveals that the wide variety of flavours available to adult vape users appears to be an important reason for their use. 40% of respondents use fruit flavoured liquids, while a quarter prefer other non-tobacco flavours. Just over a third (35%) vape with tobacco-flavoured e-liquids.
Participants were also asked how they would react if all e-liquid flavours except tobacco were banned, an increasingly common but misinformed proposal some government bodies globally have opted to take up under the pretext of preventing youths from vaping.
Youth access prevention is an serious issue, but the idea that teens are overwhelmingly drawn to vaping because of the flavours has already been debunked. Worse still, banning e-liquid flavours has demonstrably shown it can push adult vapers into using black market alternatives or even return to smoking.
The figures from this survey bear out – alarmingly, just under one in 10 said they would even start smoking again, while 31% said they would simply buy other liquid flavours on the black market. Only 20% of vape users said they would switch to tobacco flavours.
Yet some governments fail to recognise this as a cause for concern. The Netherlands is pushing forwards with a ban on flavoured e-liquids, despite the startling risks of pushing adult vape users back into smoking.
Imperial Brands, Fontem Ventures’ parent company, submitted a response to the Dutch government’s proposal to ban flavoured vaping products, highlighting the negative public health impact a ban could cause.
The submission highlighted that there is no credible or robust evidence that a flavour ban for e-cigarettes would contribute to improving public health, and moreover, real-world data does not support the ‘gateway theory’ that e-cigarettes could be driving young people into smoking. Other, independent, experts also criticised the Netherlands plans for prohibition. It’s crucial we stick to the facts, not fiction, when it comes to responsibly regulating the vaping industry. Limiting consumer access to products that are potentially less harmful than tobacco, such as flavoured vapes, only serves to slow progress towards achieving reduced smoking rates.
Traditionally, before testing the effects or toxicity of a substance – such as a new drug – on humans, scientists would first examine its effects on other living animals in preclinical studies. Today, even as new methods in research have evolved, mice, rats, rabbits, primates, cats, dogs, and other animals continue to be routinely subjected to testing.
Typically in preclinical toxicity studies, laboratory animals are exposed to high doses of a substance under controlled conditions. The results are then extrapolated to draw conclusions on their potential impact on humans.
The ethics of animal testing remains a contentious issue. Critics of animal testing argue that it causes suffering, while the benefits to humans are not conclusive, and any human benefits that animal testing does provide could be produced in other ways.
Indeed, modern developments in toxicity testing, often referred to as TT21C (short for Toxicity Testing in the 21st Century), can now evaluate changes in biological processes using cells, cell lines or cellular components of human origin – rather than relying on traditional methods using live animals.
You can find a in-depth interview about TT21C on the Imperial Brands Science site if you want a more technical and strategic overview.
Despite the development of this new testing framework, animal testing remains ubiquitous in research studies – and we believe it’s important to recognise that there are limits to the information we can gather from these methods. It goes without saying that there are vast biological differences between humans and, for example, mice. Simply put, the best predictive model for a human is a human.
For this reason, Fontem Ventures’ parent company Imperial Brands has a group-wide policy of never commissioning or conducting research involving animals, unless formally required to do so by governments or recognised regulatory authorities.
We believe TT21C research methods could provide us with a deeper understanding of how human cells behave when subject to chemical exposure. Animal studies on the other hand, which often examine a single endpoint, don’t provide the same information.
Nor has there been much innovation in animal testing methods over the years, meaning scientists are still conducting similar studies to those used in the 1950s, with the well-known animal welfare impacts. Meanwhile, TT21C innovations have emerged as a more ethical and more effective means of predicting biological effects seen in people. As we continue in our efforts to offer adult smokers less harmful alternatives to traditional cigarettes, we’re increasingly relying upon and conducting scientific research that even has the potential influence future research outside of tobacco and vaping categories.
For adult smokers unable to give up cigarettes, switching to a less harmful alternative such as vapes can be beneficial at any life stage suggests new peer-reviewed research.
According to researchers at the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) in Italy, smokers with chronic obstructive pulmonary disease (COPD) who switched to vaping reduced the annual reccurence of symptoms by about 50%. Furthermore, their cardio-respiratory health significantly improved, as did their ability to exercise and their quality of life.
COPD is an umbrella term for a number of lung conditions that cause breathing difficulties, such as emphysema and chronic bronchitis. Symptoms include increasing breathlessness, a persistent chesty cough with phlegm, as well as frequent chest infections and persistent wheezing.
COPD affects 1.2 million Britons and 15.7 million Americans, with smoking regarded as the primary cause. Although damage to the lungs is permanent, treatment or stopping smoking can help slow down progression of the condition.
Demonstrating the positive effects of adult smokers changing their habits, the CoEHAR research revealed “significant and constant improvements in lung function [and] CAT scores” (a health questionnaire used for COPD patients) in the study’s vaping group compared with the control group.
The study also notes that adult smokers with COPD have high failure rates in their attempts to quit smoking, with traditional nicotine replacement therapy (NRT) appearing to have only fairly small or variable effects on sustained cessation.
The single most important step smokers suffering from COPD can take is to quit smoking. Many adult smokers may want to quit but find it difficult, and feel they have ‘left it too late’ to make a change for the better.
The implications of the research suggest that we cannot treat adult smokers as a lost cause when evidence shows switching to a less harmful alternative such as vapes, even at a late stage in life, will potentially help them.
What’s more, the study revealed only 8.3% of patients from the COPD vape user group relapsed to cigarette smoking over the five year duration of the study, suggesting that “relapse prevention may be an important mechanism by which vaping contributes to long-term smoking abstinence.”
Adult smokers living with conditions such as COPD may view their attempts to quit as a non-starter – but this mindset becomes a self-fulfilling prophecy. This study suggests that switching to vaping can keep adult smokers on track in their efforts to kick their smoking habit for good.
Our answer is no! There is currently no evidence to suggest SARS-CoV-2, the strain of coronavirus responsible for Covid-19, has a greater risk of spreading through e-cigarette vapour than, say, just breathing out normally.
If a person infected with coronavirus was using an e-cigarette, they would, of course, be emitting viral particles during the act of vaping – but the result would be just the same as if they were exhaling, talking, laughing or singing.
Vaping merely makes our breath more visible, as the vapour clouds – a by-product of vegetable glycerin, a non-toxic, colourless, odourless liquid that acts as a thickening agent in e-liquid – have the effect of demonstrating just how far our exhalations can carry.
As coronavirus can spread in droplets and aerosols from a person’s mouth or nose, these particles can then be inhaled into the nose, mouth, and lungs of others, causing infection. But regardless of whether we are vaping or not, we should always be conscious of our surroundings and practicing social distancing.
People should refrain from vaping in close proximity to others under the current circumstances, just as they should always adhere to guidance from local health authorities, but the principle guidelines for combatting coronavirus do not change – we should be sensible about when we vape, and should not vape in confined public spaces where masks are mandatory.
It’s important to also note that, in addition to there being no evidence of coronavirus being more transmissible through vapour particles, there is no direct, clinical or epidemiological, evidence that being a vape user increases chances of becoming infected with SARS-CoV-2, or subsequently developing Covid-19, or having a poorer prognosis.
It’s only natural that vape users may be concerned and eager to know best practices when using e-cigarettes, but it’s critical we separate fact from fiction when approaching these issues. Adult smokers must feel confident in using vapes, otherwise there is a real risk they could relapse and take up smoking combustible cigarettes again. We simply cannot afford to take a backwards step in helping adult smokers transition to less harmful alternatives.
In an attempt to curtail youth vaping, the state of California has proposed prohibiting the sale of all flavoured products that contain nicotine, including vapes. The regulation will be voted on by Californians in state elections in 2022 so is not yet in place.
We believe the very premise of this ban is flawed – it hinges on a fallacy that teens are overwhelmingly attracted to vaping for its flavours, even though a study conducted by the Centers for Disease Control and Prevention has debunked this.
Young people vaping is a serious problem and one that needs to be tackled head-on, with a concerted effort from the e-cigarette industry, retailers, regulators and parents alike.
However, California’s ‘Stop Tobacco Access to Kids Enforcement’ Act is an unfortunate step in the wrong direction. The act follows local bans in Los Angeles County, as well as the city of San Francisco, where an Addictive Behaviours Report by analytics company Elsevier revealed it was not only relatively ineffectual, given many users of flavoured vaping products found ways to circumvent the policy, but alarmingly gave way to a rise in cigarette smoking rates.
The San Francisco study paints a damning picture: if the overall goal of banning flavoured nicotine products is to contribute towards smoking cessation, then the policy is flawed. Rising smoking rates in San Francisco should have alerted Californian legislators to the likely consequences of a flavour ban, but instead, lawmakers have promoted a policy of prohibition on an even larger scale.
The reality is that restricting consumer choice only hinders the likelihood of adult smokers making a switch to less harmful products such as vapes. Flavours are associated with positive smoking cessation outcomes for adults and vapes must be an attractive alternative for adult smokers in order for their potential public health benefit to be truly realised.
In an age of e-commerce, it’s a challenge to effectively police state-wide bans. But worse still, prohibition can lead to a slew of poor quality black market products – the consequences of which, as evidenced by last year’s EVALI outbreak, can be catastrophic. EVALI was caused by unregulated vaping liquids containing THC (the psychoactive constituent of cannabis) cut with an additive, Vitamin E acetate, that has never been used in nicotine-containing vape liquids sold legally.
Better enforcement of existing regulation is the answer to youth vaping, not draconian bans that limit access to legitimate, high quality vaping products and put adult smokers off transitioning to less harmful alternatives.
Hon Lik is famous for inventing the e-cigarette or vape in 2003, and commercializing it in 2004 but he wasn’t motivated by making money, his objective was harm reduction. In a recent interview he said:
“By 2002, I had tried to quit smoking several times. For health reasons, I wanted to quit smoking with the help of nicotine patches which were then available on the Chinese market. However, after using them for a while, I didn’t think this product was suitable for me. So I wondered if I could make a device which could atomize the dilute solution of nicotine into smoke-like condition, then inhale the nicotine vapor into the lungs and absorb it, like smoking a cigarette, to help alleviate the desire to smoke.”
From this spark of inspiration a whole industry has grown and it’s estimated that globally more than 40 million ex-smokers now vape. This is a source of pride for Hon Lik and he continues to bang the drum for tobacco harm reduction and the possibilities vaping brings to smokers that cannot or will not quit through a medical pathway (nicotine patches or gums) or willpower alone.
He has received recognition for his work, especially at the annual Global Forum on Nicotine, where he is a patron. The forum features both the tobacco and vaping industry participating alongside academics, medical and healthcare professionals who specialize in addiction, substance abuse and harm reduction.
In 2019 he featured in a Netflix documentary ‘Broken’, focused on the problem of teen vaping among affluent youth in the US, a brave move considering the show’s criticism of some participants in the vaping category. In his interview he gave a strong defence of tobacco harm reduction but is always unambiguous that these products, and any nicotine products, are for adults only.
The frustration for Hon Lik is that he believes the case for vaping as a harm reduction tool has been scientifically substantiated but the message has failed to get through to most adult smokers, journalists who cover health topics, and the wider public.
The data across the world shows a remorseless trend with trust in vaping actually lower now than in previous years, mainly due to inaccurate media coverage of events totally unconnected to regulated nicotine vaping like the EVALI lung disease outbreak in the US. Vaping products containing nicotine available commercially, based on Hon Lik’s basic e-liquid formula of propylene glycol, vegetable glycerin and flavourings, have never contained Vitamin E Acetate, the additive identified by the US Centers for Disease Control, as the trigger of the outbreak. This fact was never highlighted in media coverage, resulting in consumer confidence in products that had been used for nearly a decade without lung injuries, being severely impacted. Educating adult smokers on the relative risk of alternative nicotine products is difficult if the facts are not presented clearly.
The evidence is out there though and Hon Lik believes the inexorable progress of science will ultimately help the category be regulated and promoted properly to adult smokers. October 2020 saw the publication of the Cochrane review of evidence for and against Electronic Cigarettes as a smoking cessation tool. The review of more than 50 completed studies from all over the world was unambiguous in its conclusion; “The randomized evidence on smoking cessation has increased since the last version of the review and there is now evidence that electronic cigarettes with nicotine are likely to increase the chances of quitting successfully compared to nicotine gum or patches.”
It only received modest media coverage, which is understandable given the ongoing media focus on Coronavirus. Nevertheless where the academic world leads, the public health world will follow and even sceptical organisations like the World Health Organisation will surely be forced to positively engage in the vaping debate. If that happens it will be a testament to Hon Lik’s work in giving some agency back to adult smokers who have traditionally been offered only willpower or medical treatment to quit.
Hon Lik is a consultant to Fontem Ventures B.V., based in Beijing, China. You can find a recent interview with him on the Imperial Brands Science website.
Misinformation on the effects of vaping continues to dominate the media landscape and it’s our belief that, if left unchecked, it could undo years of progress in helping adult smokers switch to less harmful alternatives.
Research recently published in The Times paints a concerning picture: the number of vape users in Britain has declined from 3.6 million to 3.2 million, a drop of 400,000 in just one year. The charity Action on Smoking and Health (ASH) laid the blame squarely at the huge amount of often inaccurate and negative information about vaping in the past 12 months.
Clearly there is still a mountain to climb in encouraging adult smokers to transition to less harmful ways of enjoying nicotine. This challenge is compounded by a fundamental misunderstanding among many adult smokers as to the benefits vaping offers – according to the same report in The Times, only 39% of smokers correctly believe that vaping is less harmful than smoking.
Coupled with the reports of lung injuries (EVALI) and deaths in the US in 2019 linked to vaping – which were due to black market vapes containing THC liquids cut with vitamin E acetate – misinformation and continuous negative media coverage have undermined the reputation of the vaping industry and the role vaping can play in tobacco harm reduction. Vitamin E acetate, the additive linked to the EVALI outbreak in the US, is not used in e-liquids made by reputable manufacturers like Imperial Brands.
The news of the decline in vaping rates in Britain coincided with the publication of a Cochrane Review, the gold standard in collating evidence on topics such as medical research, which revealed e-cigarettes were more effective than traditional nicotine replacement therapies as a tool to help adults transition away from smoking. You can find Imperial Brands summary of the review here.
This year, the UK passed a further milestone in its efforts to reduce the prevalence of smoking, which fell to an all-time low of 13.9%. However, this achievement could be undermined if adult smokers lose confidence in vaping as a less harmful alternative to smoking cigarettes.
It’s essential that adult smokers fundamentally have confidence in vaping and the benefits it can bring as a less harmful alternative to smoking. Without having this trust and easy access to objective information, the potential of next generation products such as vaping will never be truly realised.
We expect science to be even handed and rational. A search for truth that builds consensus, informing decisions and guiding effective public policy. Unfortunately, this isn’t always the case for many reasons – from limitations within the scientific process itself (data, methodologies etc.) to conflicts of interest outside the world of science. And what about the motivation of the individuals and institutions that commission and fund research?
One of the Next Generation Product (NGP) categories that Imperial Brands operates in – vaping – has been negatively impacted by an apparent absence of scientific consensus in recent years. This has been highlighted recently by an unusual and though provoking paper published by a group of junior scientists based in the US. The paper, entitled ‘Polarization within the field of tobacco and nicotine science and its potential impact on trainees’ suggests junior scientists effectively have to pick a side when doing research into subjects like vaping.
The paper suggests trainee scientists may: “feel pressure from mentors and senior scientists to declare their allegiance to support or oppose e-cigarettes and therefore draw conclusions beyond what is supported by the data or without consideration for trade-offs.”
The article also noted recent evidence indicating most US adults (inaccurately) perceive e-cigarettes to be as harmful or even more harmful than combustible cigarettes, and speculated this “polarized” academic environment could be a contributory factor to this public misunderstanding. They also claim allegiance to any one side of the debate “can restrict career development, undermine the credibility of research and hinder public health progress,” before calling on senior tobacco and nicotine scientists to “reflect” on the current state of play.
It’s understandable that the prospect of being funded by the tobacco or vape industries, with their apparent conflicts of interest as manufacturers and sellers of the products in question, is not an option chosen by many junior scientists trying to forge a career in an academic environment. However, if the tobacco and vape manufacturers don’t fund this research – who will? At the current time the answer is generally the anti-tobacco and anti-vape industry led by organisations like the Truth Initiative.
This leaves us with no consensus, a polarized debate, pressurized scientists and increasingly confused adult smokers.
Openness and transparency
Fontem Ventures is owned by Imperial Brands which manufactures and sells combustible tobacco products and a wide portfolio of NGPs, including vapes, heated tobacco and tobacco-free oral nicotine pouches. We invite critique of all our scientific research through peer-review in international scientific journals and present our work for feedback at international conferences. We believe openness, transparency and collaboration enhance the scientific understanding of NGPs and best serve adult smoker consumers. We also think the robust and comprehensive scientific assessment of the comparative risk of NGPs compared to cigarettes should form the basis of evidence-based regulation. We inevitably focus our NGP research investments most closely on scientifically substantiating our own product portfolio, while at the same time using the research to contribute to the overall public body of scientific research that supports the role of NGPs in tobacco harm reduction (THR).
A common area of confusion around tobacco and NGP science is undoubtedly relative risk (sometimes referred to as relative harm) and absolute harm.
Imperial Brands’ research has been published widely and considers the harm reduction potential for adult smokers who are considering transitioning from combustible tobacco to NGPs like vapes. We deal in relative risk because our NGPs are intended for adult smokers only.
In contrast, research critical of vaping often focuses on absolute risk, which undermines the public health concept of THR and is considerably less useful when considering population-level public health outcomes. By focusing on the absolute risk of vaping you can justifiably conclude that a non-smoker and non-vaper should not start vaping, but you can’t make any conclusions about what smokers should do.
What’s desperately needed is significant independent funding for further research into the public health implications of vaping and other next generation nicotine products that is free of any perceived conflicts of interest. That means no tobacco/NGP industry, no pharmaceutical industry (the owners of various nicotine replacement therapy products) and no anti-tobacco/NGP lobbyists. It is, a positive sign that young scientists who wish to pursue research into tobacco and nicotine-related subjects feel this strong need to voice their legitimate concerns about the current landscape, with its often-negative consequences for both scientific rigour and public policy. Let us hope that their energy can find a new way to build scientific consensus and help improve the lives of over 1 billion adult smokers across the world.
 Huang J, Feng B, Weaver SR, Pechacek TF, Slovic P, Eriksen MP. Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017. JAMA Netw. Open. 2019;2(3):e191047-e191047.
Our E-Vapour Brand
blu was founded in the USA in 2009 and is one of the original e-cigarette brands. It was acquired by Fontem Ventures in 2015. As one of the world’s most recognizable vape brands, blu offers adult smokers’ choice through high-quality e-vapour products and e-liquids.
Our Technology Partner
Nerudia was established in 2013 and became part of Imperial Brands in 2017. It is the home of innovation and technology R&D for Next Generation Products (NGP) which includes e-vapour, heated tobacco and oral nicotine delivery. Nerudia is dedicated to creating a world where smokers have choice.
Our Parent Company
Fontem Ventures is a subsidiary of Imperial Brands PLC, a global consumer organisation and the fourth largest international tobacco company in the world, operating across 120 markets.