Despite all the heat and dust around nicotine vapes and other safer nicotine products, consumer adoption has skyrocketed to 140 million users worldwide, as highlighted in the newly released Global State of Tobacco Harm Reduction 2024 report. Learn why tobacco harm reduction is here to stay.
Featuring:
HARRY SHAPIRO
Lead Author, Executive Editor Global State of Tobacco Harm Reduction
GSTHR.org
@Shapiroharry
Transcription:
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Brent Stafford: Hi, I'm Brent Stafford, and welcome to another edition of RegWatch on GFN.tv. For nearly a century, people who used combustible tobacco products faced a brutal choice, quit or die. But quitting isn't easy, and for millions who couldn't, smoking led to disease, suffering, and death. Now, with safer nicotine products and tobacco harm reduction, a new era has arrived, one that's disrupting the quit-or-die paradigm and offering hope to millions. But there's a catch. Joining us today to unpack the issues around tobacco harm reduction is Harry Shapiro, lead author of the latest report, Global State of Tobacco Harm Reduction 2024, a Situation Report. Since 2018, GSTHR reports have tackled the full breadth of issues in the battle over safer nicotine products. They've exposed compromised science, revealed global funding streams biased against THR, examined the deplatforming of researchers, clinicians, and consumers from the international tobacco control debate. and chronicled significant and growing evidence in support of safer nicotine products now used by over 140 million people across the world. Harry, thanks for joining us again today on Regwatch.
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Harry Shapiro: Well, thank you Brent for inviting me onto your show.
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Brent Stafford: First off, the latest GSTHR report is just out and I highly recommend to our viewers to go check it out at GSTHR.org. So Harry, the 2024 report is titled A Situation Report. What is the status of THR today?
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Harry Shapiro: Well, actually, the progress since we first started these whole series of books has been quite remarkable. I mean, really, if you go back to 2004, you're looking at ground zero with the e-cigarette creeping out onto the Chinese market. But really, the whole enterprise was pretty niche across the world until about 2010. So really, we're only looking at a decade or more of progress. And as you say, we're now in a situation where we've got, you know, if you include vapes and heated tobacco products and snus, and nicotine pouches, although we haven't really got quite the statistics on those yet because it's still relatively new. But nevertheless, 140 million people across the world have taken up these products for the benefit of their own health. It's actually quite a remarkable story, really, given the short space of time that this has happened. What's behind that incredible growth? I think it's a realisation. I think it's a kind of lived experience in a way because there isn't, as far as I'm concerned anyway, there isn't a government anywhere in the world that has seriously gone public with endorsing tobacco harm reduction, encouraging people to switch, removing all the obstacles, allowing companies to advertise the fact that these products are safer. Nobody's doing that. So this is really, if you'll pardon the pun, a word of mouth kind of enterprise. But it's also lived experience. I mean, people hear from other people, you know, you ought to try this, you know, and they do. And they might have been smoking for 5, 10, 15, 20 years. Suddenly they can taste their food. They're not hacking away first thing in the morning. After a while, they realize they can climb stairs instead of gasping when they get to the top. Maybe go back to sports. When we were doing some earlier reports, there were people who used to be quite active in sports, you know, football and running and stuff, took up smoking. All of that went out the window. They take up vaping or some other safer product. And they're back doing what they were doing in their teens and early 20s. So I think it's been a bottom-up, consumer-driven exercise. And governments have done very little except get in the way, as far as we're concerned.
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Brent Stafford: Now, how big is this report? And I ask because for those who don't consume a lot on THR, and there's not a lot of reports out there, how monumental is this work?
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Harry Shapiro: It's huge. It's a big, big report. And we don't make any apologies about it. In fact, we've broken the whole thing up into a kind of package this time. So we've got a main section on which it looks at global perspectives. And then we've got some regional profiles. We've got one on Latin America and another one on Eastern Europe and the Central Asian republics. And then we've also got another section which looks at particular countries. The whole tobacco harm reduction issue, you have to use the word relative all the time. So these products are relatively safer than combustible products. I mean, there's people out there who claim that vapors say they're harmless. Nobody says these products are harmless. And there are countries that have adopted relatively proportionate and pragmatic responses to tobacco harm reduction. UK, New Zealand, Japan, Norway, Sweden, Iceland, various countries. So we've picked a few of those just to highlight Japan's another very good example. They've all come to this pragmatism in a different way, but they all offer an insight into the fact that there is a way of bringing down your smoking rates if you allow a more liberal regime when it comes to public access to safer products.
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Brent Stafford: The 140 million consumers of safer nicotine products, that's got to be a lot of vapors.
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Harry Shapiro: Yes, yeah. I mean, the vaping constituent, that is about 114 million. But even that, when we did our 2018 report, which was the first one, That was at 58 million. So, you know, we're looking at double in a very, very short space of time. If you think that cigarette has been around since the late 19th century, you know, the dominant force in terms of tobacco consumption. And this is just really, I think you mentioned it in your introduction, been hugely disruptive across the board, not least of the tobacco industry. So it is a... With all the caveats and problems and obstacles which we'll come onto, nevertheless, there is a chunk of a kernel of a success story in there, definitely.
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Brent Stafford: So if safer nicotine products are indeed growing, which they are, does that mean those who are choosing to use these products understand that they're participating in tobacco harm reduction?
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Harry Shapiro: I'd be very surprised if they actually even grasped, probably never even heard the term tobacco harm reduction. It certainly doesn't appear in the media and the sorts of things that they might read. And like I said earlier, I think they're coming to this from a variety of different ways, curiosity, word of mouth. They might have read some reports or, you know, when a friend goes into a vape shop and they go with them. And so I think that's why I say it's very much a bottom-up phenomenon.
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Brent Stafford: Talk for us a little bit about how smoking or other risky tobacco product use affects the user and their friends and family.
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Harry Shapiro: Well, smoking is the number one risk factor for non-communicable diseases, and that's all the various respiratory diseases. That's lung cancer, emphysemia, COPD, implicated in circulatory heart problems as well. The problem with this is that adult smokers, in my view, are kind of hidden in plain sight because we talk about huge figures. We talk about 8 million deaths a year. We talk about maybe a billion smokers, a billion people dying by the end of the century. Nobody can process figures like that. You have to think about it in terms of impact on individuals, on families, on a middle aged person going to the doctor, being diagnosed with stage four lung cancer and being told they're never going to see their grandchildren grow up. It's at that level. It's why when charities do appeals on the television and newspapers, they don't say there are eight million starving people in West Africa or somewhere. They focus on one family and one child. And I think by and large, if you look at the modern day doctors, health professionals, doctors, NGO people, ministry people, they almost certainly don't smoke. They probably don't know anybody who smokes. They probably don't mix in circles where smoking is a regular habit. So I think they don't get it really in terms of what this actually means. Maybe they've had relatives or friends or something who've succumbed to this, but Given the degree of obstruction there is to this, to the implementation of tobacco harm reduction initiatives and access to safer nicotine products, I really don't think They understand. And as you mentioned early on in your startup, you talked about quit or die. And I think that's still prevalent amongst a lot of health professionals and public health people. And it's a kind of what I would call moral values hiding behind public health. They're making judgments on people. Why can't you just stop smoking? Why can't you just quit? Because if you don't, you're going to die. And of course, half the people who smoke are going to die. It's the truth. But 140 million people are looking for the third way. They don't want to quit. They either can't quit or they enjoy using nicotine. They certainly don't want to die. But there is a third way, and that's tobacco harm reduction.
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Brent Stafford: And that's where I see this big catch being because, you know, you've got 140 million people that are using these products. And the more that grows, it seems that public health, tobacco control, you know, turns up the pressure, more product bans, flavor restrictions, excise taxes, misinformation, and, you know, and the overall hysteria around safer nicotine products. And I think that that disconnect between what human beings are choosing to do to take care of their own health and then having public health losing their minds is worrying.
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Harry Shapiro: It's certainly worrying. And I think the two go hand in hand. I think that the more this market grows, and there are all sorts of market analysis in terms of, you know, it's at $30 billion, US dollars now, it could be $50 billion in a couple of years' time. The market is definitely growing. The numbers of people are definitely growing. And I think what's happening here is that the tobacco, international tobacco community, however you define it, is just getting more and more desperate. What's ironic and tragic in all of this is they're getting more and more prohibition. There's groupthink here. There's groupthink around prohibition and obstacles and banning and all the rest of it. Cigarette market proceeds, you know, sedately without anybody really, you know, actually able to do anything about it because this is the the promise of tobacco harm reduction, which is not being evidenced by traditional tobacco control measures. The WHO have got this thing called MPower, which is a kind of formula for looking at, it's a monitoring system. And they claim that 5.6 billion people are protected by one element of this monitoring system. And this is nonsense. It's delusional. Because for the most part, particularly in lower middle income countries where most of the death and disease from smoking happens, they don't have the financial resources. or enforcement structures in order to enforce all the bans and everything that the people are keen on. And they certainly haven't got the health infrastructure to help people. And in fact, if MPOWER, M-P-O-W-E-R, the O stands for offering help, which the WHO admit is the absolute weakest bit of the whole lot, that the actual help available to smokers to quit or move away from smoking is It's abysmal. Across the world, there's hardly any country, European countries, maybe in North America, but really the amount of help there is available for people. just doesn't stand up to any kind of examination, which again is where tobacco harm reduction begins to feel that. No one's pretending this is some magic bullet that's going to cure all smoking diseases and stop all deaths. But it is a viable third way that should be part of the tobacco control armory, really, to fight the epidemic of smoking.
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Brent Stafford: How does the 2024 report handle the issue of the anti-vaping forces?
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Harry Shapiro: Well, we have in the past, for example, in the 2022 report called Burning Issues, or was it the 2020 report, sorry, Burning Issues, we did have a particular focus on this kind of network of intertwined ngos funders who we actually pulled all that apart to expose it for for what it is um we kind of did less of that in in in this one because we had you know we had really mined that field quite heavily before however what we did do there's a section called um challenges to tobacco harm reduction. I think actually it's worth saying that there are, this might pre-empt some of your questions, But there are what I would call active, passive challenges and active challenges. So passive challenges will be the whole global tobacco industry network, which is not just big tobacco, but it's also agriculture. It's all the cottage industries across Central Asia, Asia, Southeast Asia. where the livelihood of millions of people is dependent on creating various types of risky tobacco products, the social, cultural, economic, and political embeddiment, I suppose, if that's the right, if that's the real word, I don't know, of tobacco across all these communities, which has been there for hundreds of years, probably. So that's part of the passivity of all of this. But the active challenges are the misinformation. People talk about a war against tobacco harm reduction, a war against nicotine, a war against vaping. No, because you can't conduct a war against inanimate objects. This is a war against people. You can't see it in any other way. That they don't want people to use these products and they're putting everything in the path possible to stop it from happening to the detriment of the public health of millions of people. And they don't seem to care.
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Brent Stafford: Now, one of the issues obviously for those anti-safer nicotine product campaigners is big tobacco's involvement in the market, but that's only recent, but it is becoming significant, is it not? PMI, BAT, they made some strong inroads and they are converting their combustible business over to the safer products.
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Harry Shapiro: They are, but, despite the impression you get that the whole of this global business is in the pockets of big tobacco, it absolutely isn't. For example, in terms of the vaping market, the big tobacco companies in terms of value, US dollars, have got less than 30% of the market. The rest of it is all out in China, basically. All the companies, the non-tobacco industry companies in China. So They are dominant in the heated tobacco product market simply because of the cost of development. It's hard for small startup companies to actually have the technology. Although I'm pretty certain that can change. The way the market goes, I'm sure there's going to be companies outside of big tobacco. But it's interesting that... Big tobacco, I mean, you mentioned PMI and BAT. PMI is probably out in front by a considerable margin. They've got about 38% of the value of their business is now from non-combustibles, which is basically the heated tobacco product market because those are more expensive than BAT. a second. I think they're looking to get into the nicotine pouch market. Everyone else is kind of dragging their feet to a certain extent because what disincentivizes these companies, of course, is the nature of regulation and control. If they can see that governments are trying to put all these obstacles in the way with taxes and bans and all the rest of it, Why would you bother to invest in those kinds of markets? especially when cigarettes are still massively profitable, something like $800 billion. I've seen estimates of heading towards a trillion dollars. So the tobacco, the cigarette market is still massive. Let's not forget that. It's still huge. So the majority of what we term big tobacco doesn't need that much persuading to stick with the business that they know. Because I'm sure that it's what investors want, it's what boards want. And if a CEO decided to go completely off the radar on something like that, he or she would soon find themselves out of a job.
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Brent Stafford: You mentioned some of the challenges in Central Asian republics. Let's turn to Latin America for a moment. What are the challenges there that are maybe holding THR back?
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Harry Shapiro: It's interesting with Latin America. In fact, particularly, I suppose, because what we don't know and what we don't have the resources to examine is, in a sense, what's going on behind the headlines. We can't do deep dives into the political intrigues that might be happening in Paraguay or Uruguay or somewhere like that in terms of how their tobacco control policies are being developed. I suppose all that we can say is that we understand, for example, that Bloomberg proxies are quite influential in the region, NGOs of various sorts. Other people have suggested to us that because the continent is largely Catholic, that kind of has an impact really on moral judgments about recreational use of nicotine, for example. But we don't really have the wherewithal to really dig deep. But nevertheless, there are some interesting contrasts. So for example, Brazil, which has, in absolute terms, the highest number of smokers of any country on the continent, has been enforcing a THI-SMP ban since 2009. They were one of the earliest ones out of the gate. But then you have to remember, they're a significant tobacco-growing country. So you might not have to dig too deep to come to the conclusion that they don't really want foreign imports of vapes coming into the country. But of course, that's exactly what they've got. Because as soon as you don't have a legal market in these products, what do you get? You get an illegal market in these products. And illegal can mean many different things. It can mean badly made dangerous products, which is what most people would think of when they think of the word illegal. But they're illegal. They could be perfectly wonderful branded products, perfectly made and totally safe, but they're illegal in that country. So automatically they become illegal. Or they might simply be smuggled in to avoid import taxes and duties and so on which is what happens in the uk i mean the uk's got a reasonably pragmatic response to to these uh products but nevertheless um the the uh the manufacturers and retailers in this country are being undermined by cheaper products coming into the country and our border force sees tens of thousands of these things so that even in countries where as a reasonably liberal approach, you still get an illegal market, which was inevitable. I mean, if you think about it, the world is awash with fake perfume, fake watches, fake fashion accessories. It's what happens when you get small items like this that are easily smuggled in.
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Brent Stafford: So there's definitely, though, some good news in this report when it comes to certain countries. You'd mentioned Japan, which obviously has done an incredible job with heat, not burn products, but also UK, New Zealand. Tell us a little bit about that. And let's move into that discussion about the UK and disposables, because it seems that it's cracking there a bit.
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Harry Shapiro: Well, I said this earlier in our conversation that anything about this subject is relative. So all the countries that we've identified as being not exactly poster countries for tobacco harm reduction, but definitely taken a more... reasonable approach, a recognition. This is the point, I suppose. Unlike many countries that deny that these products have any better, they're equally dangerous. Vapes are equally dangerous to smoking, even more dangerous than smoking in some cases. you will hear. But they have absorbed and accepted the science, the clinical evidence that these products can help people move away from smoking. And for example, some of the research in the UK shows they're more effective in that respect than things like nicotine replacement therapy. But they've all come to it from different ways. So the UK does have a good history of harm reduction generally. Drug and HIV harm reduction goes back to the 1980s. New Zealand has taken a pragmatic response approach to all of this. Japan is interesting. Essentially, because the government didn't do anything. The government kind of got out of the way. Now, they have banned vapes. They have banned nicotine liquid because it's in their poisons legislation. So they haven't done anything about that particularly. But they didn't stop the arrival and promotion of of heated tobacco products. And that's been taken up mainly, I suspect, by younger elements, you know, young adults and adults in their maybe 2030s, rather than the older traditional smoker. But cigarette sales in that country have plummeted by over 50% in five years. Now, there's no tobacco control intervention anywhere in the world that has come up with a collapse in sales anywhere like that. Norway has seen a significant collapse as well because of snus. But again, you see, as far as I'm aware, the Norwegian government and the Swedish government come to that, don't particularly endorse snus. And the Swedish government have come up with all sorts of weird reasons why smoking has fallen. But But again, it's consumers have taken up these products. The products have been allowed in the country and consumers have responded. So Norway has seen, I mean, I think it's down to about 1% of women who smoke. Again, nowhere in the world is anywhere close to that. I mean, there are plenty of countries in the world where female smoking is in single digits, but nothing really as low as 1%, whereas about 15% of women in Norway use snus. So they want the products, but they realize the dangers of smoking. So they've all come to this in different ways. But there is a but. is a but and if you look at you look at the uk which is where i'm sitting right now um you have this you know history of pragmatism and and support for tobacco harm reduction uh the uk was the kind of research pioneer really in terms of tobacco harm reduction um you know going back into the 70s and and reports from public health england in 2015 which were we got dismissed by by by americans as if we were sort of some lunatics in the pockets of big tobacco and all the rest of it but and the butt is that um there's a planned proposal to ban single-use vapes i think in 2026 And as a result of the very recent budget from the new government, they're going to slap a flat rate tax on vaping liquid.
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Brent Stafford: I think the disposable ban is June 2025.
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Harry Shapiro: 2025, right. Okay. It's coming anyway. Yeah. It's coming. And then you think, well, are they really taking this as seriously as they should? Because far as i can work out the people who are most likely to be affected by this are going to be people who are thinking about transitioning because if because they're likely to come in at the budget level of e-liquid because e-liquid there's premier brands and there's budget brands budget brands are likely to be hit by the biggest impact in terms of the flat rate tax it's going to push the price up considerably and of course single-use vapes we were talking earlier about people who were not sure, shall I try this? Let's see how it goes. I might like it. I might not. They're not going to go and spend a huge amount of money on vaping kits and things that look like they've been developed by NASA. You know, they're going to want, they're going to want the simplest thing to try out. And if you can't get it, you know, um, the most likely scenario is to think, well, you know, if it's going to cost me this much, or if I can't get it, what's the point? I might as well carry on smoking.
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Brent Stafford: Well, protecting the youth, that seems to be the raison d'etre for everything.
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Harry Shapiro: Indeed it is. And this is something we examine in the report. And the conclusion we come to is that it's, It's understandable. It's understandable that parents and politicians and whatever would worry about young people vaping. So you wouldn't necessarily decry them for that. But to talk about a global vaping epidemic is just complete nonsense. Not only is it nonsense, but if you look in America, which is where the biggest vaping market is, where all the heat and dust about teen vaping seems to emanate, and you actually look at the government's own figures on vaping amongst young people, They've tanked from 2018. You look at the graphs from the health, and it's gone down significantly since 2018. Yes, it was quite high in 2018, no question. It was on the up, but it's just plummeted since then. Now, what that doesn't stop countries from claiming that their their regulation and control are all about protecting the youth the best example i've got of this is india which has banned dates and everything they could back and it was the finance minister interestingly not the health minister the finance minister who made the public announcement that they were doing this to protect the youth in a country where hardly any young people vape, where they have millions of young people using combustible products, and where I think they're the second largest producer of tobacco in the world. So I think that young people are essentially being weaponized here in this war against. Well, I'll say the war against tobacco harm reduction, even though I said earlier that it's really a war against people. But it's part it's part of that. It's part of this. Oh, my God. When somebody think about the kids now, this isn't in the report. But there was a very interesting news item on the BBC news website over the weekend where they'd done a bit of investigation and found that there are what they call social influences, God help us, but social influences and celebrities that are beginning to make smoking cool. And they gave various examples of this. And they interviewed a young person, a university student from the UK. So, yeah, yeah, this is like in the 18 to 24 age group. This is not 10 year olds. And they said, well, yeah, you know, we used to fight. But, you know, now everybody's doing it. It's not cool anymore. So if they start smoking, this has got nothing to do with gateway theory or nothing to do with pharmacology or clinical whatever. It's lifestyle choices. It's the aesthetic. It's doing what's cool. Tobacco companies will love this because they don't have to spend any money on advertising and just leave it to celebrities and social influencers to start getting, you know, which is fairly horrific. But The problem with all of this, I mean, that's a bit of a sideline, but the problem with all of this, if they continue, governments continue with this mythology about the teen vaping epidemic and introduce single-use bans, flavor bans, tax hikes, all the things that are supposed to dissuade young people from vaping, the main victims in all of this are going to be current adult smokers who are being blocked off in various ways, discouraged, disincentivized by blocks of legislation to deal with a problem which I won't say doesn't exist, but is really not the key issue here. It's not what public health prevention should be all about when you're talking about smoking.
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Brent Stafford: Is there a good news story? Is there any hope for the future?
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Harry Shapiro: Oh, yes. This is stretching the analogy a bit, but there's a sort of a cliche in public policy when they talk about, is this the light at the end of the tunnel or is it the train heading towards us with big headlights? And I kind of think, well, if you think about it like that, you know, if you think about the train coming towards you, You know, there's got to be a little track, a little path between the train tracks and the wall, otherwise the train crashes, right? There has to be this path. And I would say that along one path is product development, is the things that the products will get better, they'll get cheaper probably, and they'll be more acceptable to people and so on. So you've got a product development line heading towards the line. And you've got consumer engagement. And I can't believe that that's not just going to keep growing and growing and growing. So yes, the challenges and the lies and the smears and the propaganda and all the stuff that's hurled at the tobacco harm reduction community, whether that's activists or researchers or business people, like you're all in the pockets of big tobacco and you want to addict our kids forever trope. I can't see that necessarily stopping. But in the same way that consumers got all this off the ground in the first place, I think they will continue moving towards the light and the products will be there guiding them towards that light in the end. And the thing will just grow. So... Here to stay, I think, is the way to end this discussion.
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Brent Stafford: Yeah. I can't help but be pessimistic.
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Harry Shapiro: Oh, yes. I'm not saying it's going to be easy. I mean, yes, but I suppose the other thing I suppose you have to say is that because of the People will have always access to these products, whether they're legal or not. And Mexico is another good example of a country that's awash with illegal vapes. But, you know, people will find a way. And it's just, it is a shame that they might have to resort to the grey market, the illicit market or whatever in order to get these products. But I think, you know, genius out the bottle, whatever cliche you want to use. um i don't these products are not going to go away um because it's too valuable it's too it's not as valuable as cigarettes um but um you know it's going to be it's always going to be two steps forward and one back i think with all of this um and you know and it might be that the markets that are most buoyant at the moment stay the most buoyant and huge sways of the world like Africa won't really see any of this stuff at all because they can't afford it. So the big markets will continue doing their thing and I suspect where these products have made no inroads that is unlikely to change anytime soon. So, you know, it's paradoxes, contrasts and conflicts is what it is. And it ain't straightforward.