Smoking is one of humanity’s greatest health problems and more than 8 million people die prematurely as a result of smoking each year. In this regard, the right approach is a comprehensive application of harm reduction. That is, a set of practical strategies and ideas aimed at reducing the negative consequences of certain habits and consumption of individuals, as opposed to the impractical alternative of “Quit or Die”. In the case of smoking, the addictive aspect of the habit often makes it impossible for the smoker to simply quit. The most up-to-date scientific evidence indicates that Nicotine Non-Combusted Products are the most effective method to quit combusted tobacco and avoid almost all the health harms associated with smoking. When we refer to non-combusted products we mean Vape Products, Heated Tobacco Products, Snus and Nicotine Pouches. Unfortunately, positions not supported by evidence from the media and government authorities, however well-intentioned, undermine successful harm reduction strategies for smoking.
The evidence from studies, articles, reports and meta-analyses all agree that these products are substantially (between 95% and 98%) less toxic and harmful to health than tobacco consumed in the traditional way by combustion (whether in pipes, cigarettes or cigars). They also indicate that, although it may cause dependence, nicotine itself does not cause significant harm to health, unlike almost all other elements that are emitted during tobacco combustion. Nicotine is crucial in facilitating the transfer to these products. Flavors contribute in a similar way. The above products are very effective ways to quit smoking, surpassing the effectiveness of Nicotine Replacement Therapy. At the same time, they do not constitute a gateway to smoking and nicotine consumption, even among young people, in a relevant way, while at the same time they allow a substantial reduction in the number of smokers by targeting the most at-risk adult groups.
This report is an index of public policies on these non-combusted nicotine products that covers 59 countries around the world divided into 4 major regions. Ten relevant categories were analyzed and weighted to evaluate the government policies implemented by country in relation to each product class (Vape Products, Heated Tobacco Products, Snus and Nicotine Pouches).
These categories were the policies of:
- Regulatory Framework
- Banning
- Flavors
- Packaging
- Display
- Advertising
- Retail Availability
- Online Sales
- Taxation
- Promoting Tobacco Harm Reduction
By bringing them all together, it was possible to make a general evaluation of each country’s attitude towards the product.
Of the 59 countries surveyed, 10 ban vaping products, 5 ban heated tobacco products, 11 ban nicotine pouches and 27 ban snus. Only in 2 countries do local authorities actively promote switching from combusted products to Vape Products, none do so for Heated Tobacco Products, none do so for Snus and none do so for Nicotine pouches.
Although there are a few cases with particularly good performance, in general most of the 59 countries lag behind the desired scenario. In relation to each of the products, Nicotine Pouches lack their own regulatory framework in most countries (only in 15 countries), Snus is in an intermediate position (38 countries with their own regulatory framework), and Vape Products and Heated Tobacco Products are in a better position (45 and 44 with a regulatory framework, respectively).
As regards the policies on each category analyzed, the main problem is the Promotion of Tobacco Harm Reduction, followed by Taxation, Packaging, Online Sales, Advertising and Regulatory Framework. This is followed by the categories of Display, Retail Availability, Flavors and, lastly, Banning. This leads to the conclusion that, between bans and limitations, most countries in the world uphold particularly restrictive policies for the use of these products as harm reduction tools.
Taking this situation into account…
The case of Australia is paradigmatic, with all products banned, placing it at the bottom of our index of countries with a regulatory framework. Likewise, only England and New Zealand actively promote the use of vaping products as a smoking quitting tool and none do so for any of the other three products, which places them in second and third place respectively, although they maintain bans on Snus. In first place is Switzerland, which has all products permitted and regulated with a specific regulatory framework along with very good policies in terms of the categories analyzed, but without actively promoting the shift from Combusted Products to reduced risk products.
This research suggests that the main aspects to be addressed by public policies are:
- legalization of non-combusted nicotine products
- the immediate solution to the lack of information, including by the health authorities, on these products and their effectiveness as smoking quitting devices
Once these two major challenges have been addressed, particularly the change in health recommendations, it will be possible to move forward with regulatory frameworks that address specific problems.
As regards Vape Products and Heated Tobacco Products, the need to emphasize regulations on advertising, taxation tools and health policy arises. On the other hand, in the case of Nicotine Pouches, attention should be focused on the definition of specific regulatory frameworks and on the modification of the recommendations of the health authorities. Finally, Snus has a somewhat backward situation due to the fact that the European Union countries prohibit it (with the exception of Sweden), which implies a need for a general review of the regulatory policies governing the product in almost all its aspects.
If we focus on regional analyses, Europe needs to advance in the definition of a specific Regulatory Framework for Nicotine Pouches, the legalization of Snus, and the improvement of Taxation tools regulations and health recommendations on all products. The Americas should work on making the use of non-combusted nicotine products viable as a tool against smoking, and on updating the positions of health authorities. Asia-Oceania needs to work on Promoting Tobacco Harm Reduction and Taxation tools, on re-evaluating some Advertising regulations for all products, and on focusing on defining a specific Regulatory Framework for Nicotine Pouches. Lastly, Asia-Africa should work on improvements in health authority recommendations and Advertising regulations, on re-evaluating some general Taxation tools, and on defining a specific Regulatory Framework for Nicotine Pouches and the further legalization of Snus.
In conclusion, intelligent legislation open to innovation is needed to incorporate the costs and benefits of evidence-based policies from a practical perspective, balancing the risks that the measures may pose, understanding that interventions may have unintended consequences, that high bureaucratic and tax barriers nullify positive future transformations, and that the most extreme bans usually create black markets with serious consequences. Thus, states should allow the use of Flavored Non-Combusted Nicotine Products without excessive nicotine limits. Moreover, states should ensure the availability of evidence-based information regarding these products’ low toxicity and high effectiveness as a smoking cessation mechanism. States should also implement promotional public policies, addressed to both health professionals and the general population, as a way to help the 30+ years population to quit smoking and ensure the banning of all uses of these products, with and without nicotine, in minors.
