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0:00 - Intro with Joanna Junak
0:26 - Harry Shapiro talks to us about his newly authored report, GSTHR 2022: The Right Side of History
11:14 - The future of tobacco harm reduction and the role of governments and industry in helping to reduce smoking harms
18:46 - GSTHR 2022: The Right Side of History launches November 16th 2022
19:15 - Closing remarks


Joanna: Hello and welcome. I'm Joanna Junak and today we are inviting you to hear a short interview with Harry Shapiro, the author and executive editor of the Global State of Tobacco Harm Reduction Reports. Hi, Harry. Thank you for joining us today. I've heard that this week a new GSTHR report will be published. Can you tell us what the title of the report is and what are its key messages?

Harry: Well, this is the Global State of Tobacco Harm Reduction 2022. And the title of it is called The Right Side of History. Now, that's a title which it's a bit of a shame, really to have to call a report The Right Side of History because it does imply that there is also a wrong side of history. And that is certainly the case when it comes to what's been happening in tobacco harm reduction through the use of safe and nicotine products. I'll touch on that in a minute. The key messages really are that tobacco harm reduction has caused a massive disruption both in the commercial world but even more so in the world of the tobacco controlled establishment, the medical and the public health community globally. As far as the tobacco companies are concerned, not all of them. And there could be a lot more progress there than there is, but one or two of them anyway, have been spending an awful lot of money, millions of dollars, on producing new products and building new factories and retooling their old factories to produce this new stuff. But in a sense, it's kind of easy for them because they can kind of measure what the size of the market is. It's easy for them. It's part of what they do. And of course, it's driven by the fact that we now have over 100 million users of safer nicotine products. So the demand is absolutely there and the companies and a lot of new companies have been responding to it. So that's the commercial side. But from the public health and the medical side, the disruption has been a lot more profound and troubled for them, okay? Because they've been used to classic tobacco wars. So in other words, over there are all the nasty, evil tobacco companies and their lethal products that kill after people who smoke. And over us, we're the good guys and girls because we're public health and we're medical and we're the angels and they're the devils. But what tobacco harm reduction has done is completely muddied all of that up. You've got this massive gray area in the middle where you have the ability for consumers to use nicotine demonstrably more safe than if they carried on smoking. So the idea of being able to take the nicotine out the cigarette has caused all this disruption and it's also caused a lot of headache for policymakers and legislators as well. They're playing catch up because they've also been mired in this tobacco war where you ban this and you ban that, you ban everything else. And they're trying to catch up with this as well and out of that disruption, unfortunately, rather than embrace what's been happening in technology and embracing consumer choice and the right to choose, which is inherent in a lot of international health treaties, which is another key message of the report, is right to choose. We have what I've called fear, uncertainty and doubt. And this is really similar to what the tobacco companies were doing back in the 50s and the 60s. The doctors, the independent research, They were saying, what causes cancer, causes this, causes everything else. The tobacco companies responded by saying, oh no, you know, there's a lot of doubt about this and here's our science that proves you're all wrong and we need more research and all the rest of it. Doctors smoke, so what's your problem? And this is exactly what's happening now. And this is why I say it's unfortunate to be able to call this the right side of history, because you've got the WHO and a lot of the global tobacco community, the research community, who are definitely on the wrong side of history and are spreading fear, uncertainty and doubt. You have health professionals who don't know if they should be recommending switching to their patients, who may already be ill or want to switch away, and they're also creating doubt amongst people who are currently smoking or think, what should I switch? I don't know. I read this thing in the paper that it causes heart disease and all the rest of it. And sadly, the perceptions now in many countries are that these products are at least as dangerous as cigarettes, if not more dangerous, which is absolutely ridiculous. So you've got disruption, you've got fear, uncertainty and doubt, and much of which is being well funded by Bloomberg philanthropist, Gates to a certain extent, and governments. On one side, and you've got consumers who clearly want these products and actually have a right to these products. Because if you go back to the founding of the WHO, their opening state, one of their opening statements was that health is a universal right. And if health is a universal right, it means that nobody is left behind, whether you approve of what they're doing or not. That includes people who use drugs and all the rest of it, and it includes smokers. They have a right. So another key finding, key message of this report is we need risk proportionate legislation. So nobody is saying that, well, we want to get rid of smoking bans and warnings on packages and all of that. We just want these products to be available and nothing else. That's fine if you want to have all your traditional tobacco control elements in place. Okay, I have to say, they haven't made much of a dent in the death and disease from smoking over the last 30 odd years, but that's in place. What we're saying about these products is don't ban them, don't tax them at the same level as cigarettes or even higher. Risk proportionate legislation means that these products, governments need to make sure these products are safe. So we're not people buying dangerous products. But it's like carrot and stick, really. The stick is to deal with trying to persuade people not to smoke, a carrot is to try and encourage people to switch away. So governments need to, in a sense, step out of the way, because if they can just make these products accessible, okay, by not having ridiculous legislation, then it's up to commerce, whether it's big tobacco, medium tobacco, small tobacco, whatever, the industry generally, to then decide, well, what are the most appropriate products and making sure they're affordable. Because not every country's consumers are going to want exactly the same products. But governments have got to enable all of this to happen. And finally, I suppose we are kind of trying to do a bit of a future shoot as to where we are going. 2023 could be quite a significant year because it's the next conference of the party's meeting in Panama, the meeting of those who have signed up to the Framework Convention on Tobacco Control, and they are going to be discussing these issues at that meeting, postponed from the last one because of COVID. So it's going to be quite important, really, this year. Progress could be a lot quicker. We've got one or two companies, traditional companies, that appear to be committed to this whole project, others less so, not least because of the huge profits that are still being made from selling cigarettes. So it makes it even more important that governments don't slow progress up even more by having bans in place and banning flavors and all of that. Because then the tobacco companies who aren't not really bothered about this can turn around and say, well, look, we really wanted to do this, but hey, they banned this, they banned that, and we're still making millions of dollars from selling cigarettes. Shareholders and investors expect to get some return on their investments. So we'll just carry on because nobody is trying to ban cigarettes. So it's going to be a better balancing act, I think. We think the business is too big to fail now. I mean, it's 800 billion value of the cigarette market, this market analysts differ on what they think it's worth now, but you're talking 25, $30 billion now, which is still small compared to the cigarette market, but it's growing. So hopefully it's too big for to fail. And hopefully at least some governments will take a more risk proportionate approach to this and give cigarette smokers, tobacco consumers of combustible products the right to choose.

Joanna: How does this report built on the previous GSTHR reports?

Harry: Okay, so the first GSTHR report was 2018, and that came out of a decision by Professor Gerry Stimson, one of the KAC directors, who in a previous life had been director of the international Harm Reduction Association, and they'd been producing every two years, a global state of drug harm reduction. And he thought it would be really good idea to have one for tobacco harm reduction. Nobody ever tried to do this before. So the first report was very much setting the scene. What is tobacco harm reduction? Why is it important? I still think there are too many people who even now don't understand what tobacco harm reduction is all about. But they really didn't back in 2018. So we looked at what it was. What products are we talking about? Why do we think they're safer? What's the science behind the idea that these products are much safer than cigarettes? And we look to where are we with the legislation, with regulation and control? So, like I say, it was setting the scene for our whole kind of mission, really. Then the next one, 2020, was the was called Burning Issues. And I think what was clear from that report was we've got all this evidence, we've got all this science, but there is some serious and well funded opposition to all of this. We have what I would call the science of deception. You had junk science that was actually being promoted through the media and all kinds of other outlets to try and suggest that this was all just a big con trick by a big tobacco to get kids to go back to smoking and all the rest of it. So this was really much more focused on which is why we called it burning issues, because the burning issue was to do everything to try and get people to acknowledge independent scientific evidence. Because what was becoming clear was that anybody who supported tobacco harm reduction, whether they were activists or academics, whatever they were, were being accused of being in the pockets of big tobacco. And this was a way of opponents of tobacco harm reduction swerving around the issue. They wouldn't address they wouldn't address the evidence. And I know that KAC invited some of these people more than once to our Global Forum on Nicotine conference in Warsaw to debate the issues in a safe space. And they refuse. And they refuse because all the tobacco companies are going to be there. I don't know what they think is going to happen to them if they happen to share the room with someone from a tobacco company. But this was the excuse, because they couldn't actually engage with the evidence because the evidence was obvious. You set fire to a cigarette, you got something that was really dangerous. If you don't, you haven't you don't have to be an emeritus professor of anything to get the idea that these products are safer anyway. So that was the focus on that. Then we came to this latest report where I kind of thought that we could take a big helicopter view on this, take a much broader approach to this and so not repeat everything that we've done. I mean, we needed to kind of continue to point out the evidence in favor of people switching away. But there had been a long history of trying to find the safer cigarettes and then another separate history about because the tobacco companies realized in secret that they had to develop products that were a lot safer than the ones that were out on the market that they were promoting. So they spent millions of dollars on trying to develop non combustible products, all of which failed on the simple basis that it doesn't matter how much money you spend, if the consumer doesn't like it, if it tastes horrible or it's difficult to use, forget it. So consumers really have been at the heart of all of this. They were really the testbed for all these new products. They were the ones that have been initially driving the whole industry and continue to do so because we can see how many people are more and more and more people are using. So this one was really, I suppose if I had to sum it up in three words, this report is past, present, future. So we're looking to the future as well where we might be going in the sense that it took decades and decades for the dangers of cigarettes to be realized. We don't have to wait decades and decades to realize that we have to do something about the smoking epidemic because 30 years ago there was a prediction that by 2030 there would be 8 million deaths worldwide from tobacco related, smoking related illnesses. We're already there. We've already got to that figure and a longstanding projection of about a billion deaths by 20 by the end of this century. So we can do something about it, but it takes a meeting in the middle. It takes particularly the WHO to show leadership in this and allow a bit like the Cop 27. We got a Cop 27 in Charmel shape now. Everyone is there. Tobacco, the oil companies, the car manufacturers, the mining companies, and all the eco activists and the environmental groups. What comes out of it, who knows? But they are all in the room. 40,000 of them are going to be there and there's going to be all sorts of meetings and conversations and stuff - that doesn't happen in tobacco control. Everyone apart from the favored researchers and academics and so on are allowed in. Anyone who is interested in tobacco, don't forget it. They won't even let you into their cop meetings. They won't even let the media in. So the whole thing is completely anti democratic and that's clearly something that really needs to change. Whether it will or not, we'll have to see.

Joanna: And when would the report be available for our audience?

Harry: Okay, so we are launching the report on the 16 November and I'm assuming that our wonderful technical team will make sure that that report is available either on the day or the next day. Available on to be downloaded.

Joanna: Thank you, Harry. And on Thursday, we are inviting you to watch Brent's interview where Harry will tell us more about the latest report. Thanks for watching or listening. See you next time.