What happens when governments ignore science and choose outright prohibition over evidence-based public health? In this panel discussion, international experts and harm-reduction advocates break down the global shift toward nicotine prohibition and the severe, unintended consequences of banning safer nicotine alternatives.
Transcription:
00:03 - 01:39
[Reem Ibrahim]
It's so great to be in a room full of absolutely incredible, wonderful people that all care about freedom of choice, public health, and ensuring that we really are talking about these issues from an evidence-based perspective. I am so delighted to be in a room full of amazing people. And speaking of brilliant people, my wonderful panel. So we have the wonderful Carissa During, Carissa is absolutely incredible. She's from Sweden. She's the director of Considerate Pouches, and that is an advocacy group promoting smoke-free policies and the rights of consumers to access alternative nicotine products. We also have the wonderful Asanda Goy. Is that how you pronounce it? Wonderful. who is an independent advisor and former CEO of the Vapor Products Association of South Africa, with extensive experience in nicotine regulation, public policy, and harm reduction across Africa. We also have the fantastic Jacob Greer, who is a writer and journalist covering tobacco policy, and the author of The New Prohibition and the Rediscovery of Tobacco. And last but certainly not least, we have the fantastic Juan Jose Sirion, who is a lawyer, academic, and human rights advocate, who focuses work on individual freedom, consumer rights, and harm reduction policy in Mexico and Latin America. So without further ado, we are going to go from the first panelist here at Carissa, go to the end, five minutes each, and I will be strict with those five minutes. And we'll go into our panel discussion and then hear from all of you fantastically intelligent and wonderful people. Carissa, we'll start with you, five minutes.
01:41 - 06:40
[Carissa Düring]
Thank you so much. So when I was thinking about what am I going to bring up, there was so much to talk about. There is a lot of topics that you can bring up, a lot of examples, a lot of beautiful life stories, and some sad that you can bring up to put a face on all of this. But I looked at the panel title and I was like, wait, I think I have an example from the Nordic countries that puts the finger on something very interesting here. So I want to talk about Finland. Finland is the neighboring country to Sweden. We are very similar in very many ways, but one thing that we are very different is that snus, tobacco snus, is legal in Sweden, but it is not legal in Finland due to the EU directive. However, a lot of people in Finland still use snus. Year 2020, 7% of men and 4% of women, they used snus. And of course, this has created a very interesting phenomena because there is a market that needs to be saturated, but it's illegal. So in Finland, we have snus gangs, we have organized crime, which to me as a Swede is It's hilarious, to be honest. A friend of mine calculated that the tax revenue loss in Finland is 70 million euro, so it's a lot of it. Recently, nicotine pouches was legalized in Finland, which has shifted Some of the black market, the usage of snus has shifted to nicotine pouches instead. So the usage of snus is down, but nicotine pouches is up. And we need to think a bit here about the consequences, the health benefits, because in Finland you see a decrease in smoking from 23% year 2000 to 9% of adults now. But this is not as good as Sweden. even though they also have access to nicotine pouches, a big part of the population uses snus, although not as many as in Sweden. Why is that? Why are they not reaping the same health benefits that we are? This is because bands, prohibition, restriction of flavors and high taxation, it brings a certain rhetoric. It changes the perception in society. It kind of distorts the risk perception. And of course that matters. I want to read to you my favorite quote ever said. It's the leader of the group that was investigating how Finland will become tobacco-free in 2030. He said, While the usage of cigarettes has decreased in all groups of society, the usage of snus has increased. Snus has started to replace cigarettes. So far, so good, right? Then he says, we need to stop it. And we need to stop it now. And I think this quote perfectly sums up the culture around snus and nicotine parties that you have in Finland and how that is in a large way very different from what we have in Sweden. Bans are not only trying to restrict something. It changes the culture. It changes the perception. And the culture then affects the actual health outcomes and the benefits that you will get out of it. So it's a big question that's much larger than just the bans. There's a lot of effects of it, too. As a last note, I want to bring up Milton Friedman. if I may be bold. He argued famously that the FDA was killing tens of thousands of Americans by not releasing medications that could save people, American, they could save their lives. So by not releasing it, they were indirectly causing this death. And you can have a lot of opinions about this, but the unintended consequence of bans that are supposedly meant to do good, it is killing them instead. Thank you.
06:44 - 07:13
[Reem Ibrahim]
That was fantastic. I think it's so interesting, especially because Sweden is now seen, of course, as the beacon of tobacco harm reduction. And I come from the United Kingdom originally, where the UK used to be seen as a world leader in tobacco harm reduction and unfortunately has fallen off, which is why it is so important that we continue to make those particular arguments, especially when it comes to the fundamental point here, which is about saving people's lives. Assanda, your five minutes.
07:13 - 12:57
[Asanda Gcoyi]
Thank you. Good afternoon. Over the past couple of years, I've had a front row seat to what I would call the most significant public health experiments in South African modern history. And that is the banning of tobacco products and related products during COVID-19. What was meant to be an emergency, a precautionary measure by government, has, in my view, produced one of the most consequential public health catastrophes, dare I use that word, in South Africa. When the government decided to ban tobacco products as non-essential products during COVID-19, they did so with the view that they were protecting bed capacity. They were protecting the risk of individuals developing respiratory diseases and therefore banning cigarettes and related products was the right thing to do. This ban took five months. And in that five months, where smokers would ordinarily have had off-ramp products in the form of safer nicotine products, there was absolutely no substitute. And we know what happens when you ban something. We've heard this time and again. It does not mean that the need disappears, but rather where that need is met and where those products are found tends to be in very dubious spots. And as a result of that, we are currently amongst the leading nations when it comes to the percentage of illicit tobacco in the entire world. Smokers continue to smoke. I understand that the rate of people who did quit was less than about 6%. But the danger of that and what has happened is that smokers were buying these products via the black market. They were getting vaping products, cigarettes, via WhatsApp groups, telegraph groups. There were informal delivery networks that were created. And that obviously has detrimental effects in terms of the quality of those products. So you had absolutely no standards, no age verification. And overnight, the legal supply chains in the tobacco and vaping industry disappeared and what was left was a flourishing illicit market where illicit traders, criminal networks have benefited to this day. But not only that, I think the biggest consequence of that burn was the blurring of the lines between the profile of these different products. So in the minds of the public, these products ought to have been the same. Why else would they both be burned if the other one was less harmful than cigarettes? And that is taking a lot of time to undo because you now have smokers who are reluctant to switch because they believe, as per what the government said, that these products are the same in terms of their risk profile and what they can do to you. And not only that, I think for me the biggest travesty following that ban was what happened two years after when we had the tobacco and electronic delivery systems bill that was tabled in Parliament, which continued with this conflation of vaping products and other safer nicotine products being just as dangerous as tobacco products. So this came from the drafters of the bill. So that takes a long time to undo when you not only give misinformation, you also don't want to allow the advocates of these safer nicotine products to advocate for them. You make it almost impossible for smokers to want to switch. And another big area that I just want to touch on very briefly is the issue of inequality in South Africa. majority of smokers come from lower LSM groups. So they tend to be the ones who unfortunately carry the bigger burden of smoking and its consequences. And that is where we're sitting right now. South Africa has 70% of the tobacco industry in illicit hands, where a pack of cigarettes from the illicit trade costs half a dollar. And a pack of cigarettes from a legal company, say, costs five times that amount. But the sad bit is that safer nicotine products cost ten times more. than an illicit pack of cigarettes. So the question we ask, and I've asked it numerous times to regulators, when you want to ban or even have, what's this, harsher restrictions on these products, what is the end game? Are you saving tobacco? Are you trying to make sure that people stay addicted to tobacco? Because that's exactly what is happening.
12:58 - 13:47
[Reem Ibrahim]
I definitely think that we can't talk about the social impacts of prohibition and restrictions on these products without talking about the fact that the poorer you are, the more likely you are to smoke in the majority of countries. I think that South Africa is such a fascinating example because it was this COVID era restriction where it was like, okay, we want to try and stamp out tobacco and therefore we're just going to ban it. And of course, as you very eloquently described, Assange, that differential between the reduced harm nicotine products, these safer products that are legal but far, far more expensive than the illicit markets tobacco products. And it really is that difference. And I think that fundamentally it's about the economics. If the safer product is cheaper, then people will be more incentivized to switch and ultimately potentially save their lives. Let's move on to Jacob.
13:47 - 18:41
[Jacob Grier]
All right, thank you very much. My name is Jacob. I write primarily in an American context, which unfortunately we export to much else of the world when it comes to vaping regulation. So I've written about tobacco policy for a really long time. I think going back to about 2004 is when I first started with smoking bans. And then in 2022, the focus of what I've covered shifted quite a lot, writing an article actually for a reason, which Reem writes for on... Thank you for publishing it. That goes before your time. It was called Welcome to the Nicotine Prohibition Era. And what I was seeing was a phase shift in how governments are approaching tobacco and nicotine policy, where up for most of this century, the focus has been on various types of regulation, whether that's taxing products, putting on warning labels, restricting advertising, restricting where people can smoke. But always having this background context of consenting adults being allowed to make their own choices on it. And then starting around in the 2020s, we've really seen a shift, especially in the United States, but also throughout the world, towards a more explicitly prohibitionist approach where we're banning entire classes of products for sale. And so that became a big part of my focus as a writer. And so since I'm here talking about the US, I thought I'd start with just a little bit of context on how the US is approaching this from a place that was always fairly laissez faire about most tobacco. But now, just in the past decade and a half, we've banned all flavored cigarettes other than menthol. Nearly all e-cigarettes in the United States are sold illicitly. The law is very clear on this, that if an e-cigarette does not have a marketing order from the FDA, it's illegal in the United States. And in the decade that the FDA has been regulating these products, they've managed to approve 45, if you're grading on a generous curve. And if you know the American market, you know we have tens of thousands of e-cigarettes. So almost all of them are illegal. We have six states that have banned most flavored e-cigarettes, if not all. The one exception is Utah allowed menthol. Two of those are two of the biggest in the U.S., California and New York. All flavored e-cigarettes banned across the board. Notably, in most of these jurisdictions, menthol cigarettes are perfectly legal. So often we are banning the wrong products, even if you are generally okay with this prohibitionist approach. Looking at local, we have 400 municipalities and counties and local governments that have banned flavored e-cigarettes. And we now have 22 towns that have enacted generational tobacco bans where anyone born after a certain year was forbidden from ever buying e-cigarettes. in the US, nicotine products across the board. England recently is doing this with just combustible tobacco. But in the United States, it will be all nicotine products. And we have several small towns that are banning all tobacco nicotine sales entirely, usually with a small exception for premium cigars, which I find very funny in Beverly Hills. So looking at this in a historic context, I don't think we should be surprised. Anytime there's been really big innovations in tobacco, the response has usually been to ban the products. If you go all the way back to the introduction of tobacco to Europe, one of Columbus' crewmen, Rodrigo de Jerez, came back to Spain with the first cigars, and the Spanish Inquisition jailed him for seven years for doing so. Many parts of Europe tried to ban tobacco. When cigarettes were first popularized in the US around the turn of the century, even though America was very accepting of tobacco and saying it's cigar or chewing tobacco, 15 states had once prohibited all cigarettes over a period of about 30 years, and eventually all of those were repealed. And so now we're in a similar stage of disruption, where we have all these new products that we all know about, like snus and nicotine patches and e-cigs. So I don't think it's surprising that we're dealing with prohibition. And I think there are real parallels to the American experiment with alcohol, namely the most obvious one being the creation of a massive illicit market. And we've seen this on a national level with almost all e-cigarettes being sold illicitly in states that have stricter bans like Massachusetts. We see even bigger illicit markets, and we see police activity related to it, which I think is one of the interesting things to talk about, where we actually now have police staking out vape shops to find someone selling flavored e-cigarettes. And actually, this past year, we had the first person that I was able to find in the US sentenced to six months in prison for selling flavored e-cigarettes in Massachusetts. But I want to end on a hopeful note. Prohibition was eventually repealed and is not remembered fondly today. So I'll leave my opening remark with that.
18:42 - 19:31
[Reem Ibrahim]
Here's to hoping that a lot of the prohibition policies that we see today do end up getting repealed and we don't just continue down this slippery slope of, well, the solution to all of our problems is obviously this government restriction or ban. I will say, when I moved to the US about five months ago, I thought the UK is a... very unfree country. People are getting arrested for their tweets. And now I'm able to go to America when it's free. And there were two things I noticed immediately. One, I couldn't drink outside. These open container laws, I couldn't go for a pint and then just sit on the street steps and have a... No, that's ridiculous. And the second thing was when I moved to DC, no flavoured nicotine pouches I walked in, I said, you know, do you have menthol? And he said, no, nothing, nothing, no flavor, which I thought was a tragedy. Let's move on to Juan.
19:34 - 24:55
[Juan José Cirión Lee]
Thank you. It's working? Thank you. I'm the author of a book called The Concept of Harm Reduction and Human Rights, thanks to one of the KAC scholarships. As a lawyer, We all lawyers try to be as precise as possible because that's the way we work. And I've been fighting all the prohibitions in Mexico with all the injunctions possible. We're losing, as you can see. But let me try to read my statement because my English is kind of lousy and I don't want to miss any precise concept. So, when we discuss the social impact of prohibition, we must begin by recognizing the serious blow it represents to human rights. Democratic states have a fundamental duty to respect the human rights of their citizens. Only those actions that are absolutely necessary and where it has been clearly and undeniably proven that they harm the interest of others in the community should be prohibited. Everything else must remain within a framework that protects individual freedoms. The bans and even severe restrictions imposed on alternative nicotine products lack any solid basis in respect for human rights. Individual liberties should be prioritized at all times, especially when the consequences of those actions primarily affect only the person making the decision. We have heard countless arguments in favor of restricting or banning alternative nicotine products, that we are protecting public health, keeping temptation. Sorry. We've heard a lot of reasons for the prohibitions. We are protecting public health, keeping temptation away from minors, and saving money in public health budgets. What we really hear is we must implement genuine prevention policies We must prioritize individual freedoms and act accordingly, and we must properly inform young people so they understand the real risks associated with consuming any substance, whether food-related or recreational. This approach reveals the failure of public health policies, not only in emerging countries, but also in nations that consider themselves advanced. In Mexico, the total ban on the commercialization of vaping devices lacks any scientific basis and stems instead from a purely ideological position. The constitutional reform promoted by the former president appears to have a rather dark backstory. It is widely believed that the initiative gained personal momentum after his then-minor son was recorded vaping inside the presidential office, turning the push for the prohibition into something resembling a personal crusade against vaping. However, recent events have made the true picture even clearer to the international community. A sitting governor has been prosecuted in a United States court for his links to organized crime, something that the Mexicans have known for a long time. There is a clear and direct connection between organized crime and certain Mexican politicians. As a result of the ban, Mexico's three million vapers have been forced into the black market controlled by drug cartels to obtain their devices. The criminal penalties ranging from two to eight years in prison for the commercialization of vaping products have driven away those who once tried to build a legal and regulated business. Instead, the entire industry has been handed over to the cartels. These organizations, often protected by corrupt authorities, now offer users not only vapors, but also all kinds of illicit substances. After all, the penalty for selling a vape is lower than the one that they would receive for trafficking marijuana, cocaine, heroin, or fentanyl. This policy will not reduce the number of vapers, but it will strip users of any certainty about what they are actually consuming and will deliver more resources and power to organize crime. In the end, the one who always loses is the user, especially those who quit with these technologies. We have a very bad scenario in Mexico.
24:55 - 25:48
[Reem Ibrahim]
Thank you very much, Juan. That's very fascinating. Thank you. Amazing. So we are going to open up to a panel discussion, and then we will hear from all of you wonderful people. My first question is for Carissa, because we talk about Sweden as the beacon, the world leader of tobacco harm reduction. They have allowed adults to choose safer and healthier products like snus, like nicotine pouches, and it has resulted in them actually achieving what the World Health Organization claim they want, which is an adult smoking population of less than 5%. Now, I believe that this year it was that Sweden actually achieved it. Can you tell me a bit about what happened in 2016 when nicotine pouches were introduced to the market and women, namely, started using them and what happened to the smoking rate with them?
25:50 - 28:05
[Carissa Düring]
I think this is a very nice example of how different products reach different kind of groups. Because we've had tobacco snus in Sweden for a long time, and it was mainly men who used it and consumed it. Not very many women used that. Instead, they turned into smoking. So women were smoking in a higher extent than males, and males were using tobacco snus. And then what happened is that nicotine pouches was innovated and they were presented to the market. And within a few years, this made young adults and women start to quit smoking. They started to put down their cigarettes and pick up the nicotine pouch instead I am one of these people that I started out smoking then the nicotine pouches came I took one and then I never smoked again so it kind of changed the whole scene in Sweden and this is what has been driving us to reach smoke free status and I think that's important to remember because when we talk about Different groups of society, they don't use tobacco and nicotine equally. There are groups that use it more. There are other groups that use it less. It's some groups that have it easier to quit. And usually the most exposed are the ones that are already suffering from poverty or illnesses or low socioeconomic status. In general, and when we are thinking about how do we get our smoking rates down, we need to make sure that we find alternatives that works for all of these different groups. Now women in Sweden is a quite big group, but one group that we have not really managed to get yet, for example, is older women. they are still smoking to a much larger extent. So a lot of policy, I think, must also come from this perspective, that there is not a solution that fits all, and we need to realize that different groups have different abilities to put down the cigarette.
28:07 - 28:46
[Reem Ibrahim]
I think the reason why that is such an important lesson and the reason why Sweden is such an interesting example for the rest of the world to look to is that when you're looking at the two genders and having a higher smoking rate amongst women than men is quite a rarity for a lot of countries. And the fact that you see this disparity and then a new product enters the market and those younger consumers, those younger female consumers immediately take it up and the smoking rate literally plummets is I think it's a miracle and it's something that we absolutely should celebrate. And it's something that the rest of the world ought to look to as a brilliant example as well. Do you want to come back?
28:47 - 29:00
[Carissa Düring]
I think it is also a very good example that people want to quit. When they are given the alternative that they want or need, they will quit and they will do so very rapidly.
29:01 - 29:25
[Reem Ibrahim]
I think that's absolutely right. Let's turn to South Africa, a country which has not afforded that particular choice. And actually, the disparity in the pricing system, I think, is really interesting. Assanda, can you talk a little bit about what the sort of social impact of this COVID era ban actually was and the impact, particularly on South African communities and what that actually looked like on the ground?
29:26 - 31:45
[Asanda Gcoyi]
Sure, I think the one thing that we really feeling right now, I mean, I've been a part of a group that has been involved in the regulatory space of this particular bill for quite some time. And what you're seeing is that in many communities that you go to, issues of tobacco harm reduction don't resonate at all because it's so far removed from their reality in the sense that it's something they can't even think they would ever afford when you look at the price of illicit tobacco. So those are things that are really heartbreaking in the sense that policy makers are not making any attempts to close this gap. because one would think that any proposal they come with, one will deal with the rampant illicit trade, because you cannot reintroduce more stringent regulations when you have rates of illicit trade as high as 70%. And what those rates of illicit trade have meant is that legal formal businesses unfortunately have had to let go of people because the guys that are in the illicit side of things are not contributing to the fiscus government is suffering. So it's a mess. The consequences are just so dire that to an ordinary person, it seems like a straightforward thing of advocate for tobacco harm reduction, get people to use these products. In a perfect world, that's what you'd want to do. The reality on the ground is, unfortunately, decisions are taken from a point of what can I afford? As an ordinary person living in a township, what can I afford? And I can afford a pack of cigarettes that are illicit, that you don't know what's in those products. So the consequence of that burn is really felt to this day, and I suspect unless something drastic happens in dealing with, at the core, the illicit market, unfortunately this is going to be the case for many more years to come.
31:46 - 32:19
[Reem Ibrahim]
That's really interesting. Can you tell me a bit about the normalization of the illicit market? The idea that culturally and socially, when you make it so difficult to access these safer products, they're too expensive, especially for so many communities in South Africa. And at the same time, illegal tobacco is so cheap and so widely accessible suddenly it becomes normal to go to criminals for your everyday products. Can you talk a bit about what culturally that has meant in South Africa?
32:20 - 34:07
[Asanda Gcoyi]
That has taken, I mean, it has taken a lot of us aback because you have ordinary South Africans who are partaking in illicit business, and it's not by choice. And what I mean by that is that if you live in certain areas and you are a secondary seller, for example, of, say, a disposable vape or even cigarettes, you will buy a product that will give you the most in terms of margin. It's that simple, you know. And unfortunately, those are the products that are illicit. So it's not frowned upon in many communities for even shops to be selling illicit cigarettes. That's normal. And I think only once the law enforcement or government take a stand and say that is... not acceptable, then will you start seeing some action. But an interesting point that I'd like to add is that even during parliament public hearings in various communities, so you have parliament members going into various areas to get people's views as they work on this bill, you have groupings of organized, informal resellers of illicit products that are advocating against stringent rules because they're saying, if you do A, B, C, D, it means I can't sell my illicit tobacco. And they have a voice. That's how normal it has become, unfortunately. And like I said, unless there is a will from regulators and law enforcement, it's not going to change.
34:08 - 35:08
[Reem Ibrahim]
Thank you. I think that's really interesting because it's definitely happening in other places where the illicit market may not be as enormous as it is in South Africa. But this normalization where law-abiding citizens, people that, generally speaking, do not break the law, will start breaking the law. And all of a sudden, it is normal for them to break the law. And culturally, that obviously means that there are so many other consequences. You get your tobacco products in the same place that you get your cocaine. all of a sudden it becomes extraordinarily normal to break the law. Jacob, could you speak to a little bit about that? So, you know, in the US, there have been enormous unintended consequences to tobacco control policies and to prohibition. Can you talk a little bit about the sort of So that social impact, what does it actually look like in many American communities? Of course, we know that smoking rates are far higher in areas like the Rust Belt, in sort of poorer communities. What has this actually meant for people on the ground?
35:09 - 36:24
[Jacob Grier]
Yeah, I think in the US, as much as we talk about the many, many bans we have, whether it's at the federal level or at state level, the one thing we have going for us is that they're very ineffective. And so we've insulated ourselves from the worst unintended consequences so far. We have almost all vapes in the United States technically being illegal. But there's so little enforcement on that that we don't have the criminal gang issue yet that we see in Australia, for example, where you've had almost 200 arsons gangs going with turf wars for these products, our market is still peaceful for the most part. We have a lot of lost tax revenue in certain states that have banned flavored vapes. On a more concrete level, the best studies that I've seen that have looked at the impact of passing these flavor bans on e-cigarettes is that they have found that they reach their goal of somewhat reducing demand for e-cigarettes. That does go down. But the cost of that is that this is substituted with combustible cigarettes. And so what we see happening is that more people end up smoking than otherwise would be because of these bans. And I think everyone in this room can figure out the math on how that's going to work out from a public health perspective, that this is a very bad substitute.
36:25 - 37:23
[Reem Ibrahim]
It's also interesting, I think, because of tobacco taxes. In Chicago, I believe it's the highest tobacco taxes in the United States. But of course, the United States, each state has no border. You can cross between them very, very easily without any restrictions. And so if you are in Chicago and you are paying an enormous amount of money for legal tobacco, of course, it then means that you end up just... getting your friend from the neighboring state to go and bring it over for you or indeed buying it elsewhere. I think in California, where the taxes are also pretty high, there have been some studies that actually looked at, when you're looking at the packets of tobacco in the rubbish bins, or the trash cans, and looking at exactly where they come from, the majority of them don't even come from California. They come from other states or from not even the US. They come from foreign countries. So do you think there has also been this normalization of, well, it might not be legal here, but I can just get it elsewhere?
37:23 - 38:56
[Jacob Grier]
I think there absolutely has been. And to be honest, I don't even know the extent to which so many people who are buying flavored e-cigarettes even know that they're getting them illicitly because it's just so easy. So I'm actually not clear on that. I know I talked to one friend in San Francisco when their flavor ban passed, and she just knew. I go to this shop, and they're all under the counter, and you ask for the speakeasy menu, and you can get the list of all the flavored e-cigarettes you can buy. So there's some awareness of it. If I could add to this, I think even if we don't see it in the policies like this, the real pernicious cost is the ignorance about the relative risk of these different products. And I'm astonished all the time when I talk to people who have no idea that e-cigarettes are a lower risk profile than combustible cigarettes. And sometimes it's nonsmokers, sometimes it's people who smoke. But the fact that the policymakers in the US and a lot of nonprofits and public health leaders are pushing for these bans sends the very clear message that these must be just as bad as smoking. And so I think that that indirect way of suppressing demand and of people who don't have the time to do research, look at studies, they should be getting this from a better source. And in the United States right now, we really don't have it on any side. We're very polarized. On the left, it's very hostile for our own unique history reasons to tobacco harm reduction. And on the right, you have no credibility. We used to have some credibility, but now we have people like Donald Trump and R.F. Kennedy Jr., and those are not who I want to be the face of tobacco harm reduction.
38:57 - 39:04
[Reem Ibrahim]
Just to push back on that ever so slightly, RFK Jr. has been relatively supportive of tobacco harm reduction.
39:04 - 39:08
[Jacob Grier]
Yes, that's what I'm saying, and I think that's not to our benefit in the long run.
39:08 - 39:35
[Reem Ibrahim]
People don't trust him. Juan, from a human rights perspective, I think this is a really interesting angle here because we're talking about what it means to be a human being and to have bodily autonomy and to have the ability to make decisions for yourself and the right to choose better health pathways. Can you tell me what that actually looks like from a human rights law perspective?
39:36 - 43:03
[Juan José Cirión Lee]
Well, it's been recognized since the 18th century that we have freedom to choose whatever we want. The problem is, in this case, the prohibitions have the problem that two concepts has been said in this panel. First is perception. The problem of prohibition is that maybe you can get the products, but the perception is that if they are prohibited, it's because of something. It doesn't matter what. In Mexico, we hear very incredible things about the prohibition of vapings. I was telling to the audience in a panel in the morning that One of the deputies in Mexico said that vaping caused, how do you say that? I will remember the word. Something very stupid. Promiscuity. Vaping caused promiscuity. You know, in the TV, so the people hear that and they say, well, maybe it's a joke, but they think that something is happening. It doesn't matter for the second concept, that is law enforcement, that in Mexico, there is no law enforcement. From every 100 crimes, just one is known by the authorities. And from 100 known by the authorities, only one gets a sentence from a judge. So if you see, the law enforcement is very low in Mexico. What is happening with the prohibition right now in Mexico is that you can find vapes everywhere. The difference between before and now is that before, some people try with injunctions to sell them legally. Right now, because you can go to jail for selling vapes, they are out of the market. So the only people who are selling vapes is the crime, the cartels in Mexico. And there's another thing. There are cartels selling vapes on the streets. They are very easily found, and they are very cheap. It didn't impact the price. But what is happening right now is that if you are from one cartel protected by the people from the government, nothing is going to happen to you. But if you are not linked with the government, maybe they will try to catch you. At this time, Just one person has been caught by the authorities for selling vapes. And they made a raid. They took 10 million pieces of vaping products. They just arrested one guy. And they said that they arrested him not for selling vaping, but for having drugs and weapons. So this is the way it's working in Mexico. There is a prohibition. At the level of constitution, there's a restriction. But at the end, you can find vapes everywhere. All of them, right now, sell by organized crime.
43:04 - 44:04
[Reem Ibrahim]
I do think that we have two choices when we're talking about public health in this way. Either nicotine products are provided by a taxed and regulated private sector, or they are provided by criminal gangs. There is no third option in which they're provided by nobody because demand exists. If demand exists and the private sector is not legally allowed to provide and meet that demand, demand will be met elsewhere. And ultimately, as we know, criminals are opportunists. If they see the opportunity to make money, they will. And if these products are not being, the demand is not being met by the private sector, the legal sector, they will exist in the black market. I would like to open it up to all of you wonderful people. You can ask your questions. Can I get a show of hands for who actually has a question? Okay. All right. We'll start with you. And I believe we have a microphone. We do have a microphone. Yes. Tell us your name and ask your question.
44:04 - 46:18
[Sundramoorthy Pathmanathan]
Hi. Good afternoon to all. My name is Moorthy. Hi. Hi, I'm from Malaysia and I am an academician and an expert in the field of criminology. A lot of my training comes from the United States. I spent many years there before. Anyways, the issue that I want to address here, prohibition itself is inherently evil. The topic today, because I know I can't give a lecture here, being an academician, I'm used to, prohibition and public health. But there's also the impact on the criminal justice system. It's not only on public health. Because in Malaysia, for example, drug use is a crime. unlike many countries, democratic countries in the world. You'll go to prison if you're a repeat drug user in Malaysia. Initially, you get treated, et cetera, but you're a repeat offender, you'll end up. Prisons, bottom line, we must acknowledge worldwide, whether it's in England, Australia, Japan, or wherever, are breeding grounds for crime. We sent thousands of Malaysians into prison because of drug use. Eventually, in Malaysia, the regulators, the policymakers are planning to prohibit vaping. You're going to find it all over in the black market, each and every one. The black market will thrive. And when the black market thrives, on the other hand, is the impact on the users. People will still buy. I've been hearing things about buying illegal cigarettes, et cetera. Illicit cigarettes, not illegal cigarettes. So we're going to unnecessarily label, in the Malaysian case, because no two nations is alike, but we're going to label many more thousands as criminals because we are punitive in nature in Malaysia. We still have the death sentence. The point I'm trying to tell you is that the prohibition goes beyond public health. It has an impact on society and the criminal justice system at large. Thank you. Just wanted to share that thought.
46:18 - 46:24
[Reem Ibrahim]
Thank you. Juan, do you have anything to respond to that specifically to do with the criminal justice system and the impact of prohibition?
46:26 - 47:55
[Juan José Cirión Lee]
What I said before is that human rights have to be respected for all the authorities, for all the governments, especially the democratic ones. What I heard from Malaysia sounds very terrible. But what I mean is it's very important that we are always thinking about harm reduction as one of the primary policies, but we have to think before human rights. Human rights are the first step to make authorities know that even if these things were more harmful than the combustible cigarettes, we have the right to choose. The information is very important, The government should give correct information. As I told you, in Mexico, that's not happening. And the problem with that is the perception. The thing you are addressing right now is very bad, because first, the government is not respecting human rights. And second, they don't have the correct information to know how to deal with this situation. If they are going to make criminals from one day to another, that would be terrible. The only country that I know that have been happening is in China, but I think that we should fight against this because we have to use human rights at the first sight.
47:56 - 49:06
[Jacob Grier]
Jacob? Yeah, I wanted to add to that as well. Like you said, prohibition comes across as a very ugly word. And so even advocates of prohibition tend to avoid it. To give one example, in the United States, Robert Proctor is someone who has argued for a very long time for the prohibition of cigarettes and pretty much every form of nicotine. And he goes into his book about how he doesn't think prohibition is the right term. We should think of this as abolition. And he tries to reframe the entire thing as a freeing people from the dependency on nicotine. So this term is toxic. And the other thing I'd add is people try to dodge it even when they're enacting it. And a great example is Massachusetts. where the flavor ban was pitched as, this is just a regulation, it's not a criminal law, and so no one will be prosecuted for selling flavored e-cigarettes. But the way this actually works in practice is that by pushing these flavored e-cigarettes to the illicit market, anyone selling them is also not paying the excise tax. and not paying an excise tax on tobacco products is a felony punishable by up to five years in prison. And this is true in just about every state in the United States. So even when these laws are pitched as being mere regulation, we immediately switch into this criminal justice problem right away.
49:07 - 50:13
[Reem Ibrahim]
And of course, we're looking at France, who just about a month ago have completely banned nicotine pouches. They've offended some of the Swedes, I think, by saying they are these awful Nordic products. Of course. Yes. I think that... Yes, and I think that the corruption argument is fascinating when we're looking at all governments, because, I mean, I am a libertarian, so I tend to point out the fact that the majority of governments, all governments, tend to have an element of corruption, but also... The idea that these particular industries or these particular cartels for example in Mexico have that relationship with the government and therefore they don't get prosecuted for doing something that is already illegal. And this happens in the private sector in America where a company might lobby the government for special privileges and be afforded those special privileges and that is not seen as corruption, it is seen as the healthy part of democracy when in reality there's special interest being captured by the state. I think that everybody here on this panel has really quite eloquently described that. Yes, go on, Juan.
50:14 - 50:42
[Juan José Cirión Lee]
And the worst part in Mexico is that they terminated with a competition from one day to the other. All the people who are trying to sell legally with injunctions cannot sell when the law came. And only the cartels are selling right now. So there was a lot of competition between semi-legal sellers and the cartels. And right now, they have the monopoly to sell them.
50:43 - 50:45
[Reem Ibrahim]
Other questions? Yes, here in the front.
50:51 - 51:55
[Fiona Patten]
Thank you. Fiona Patten from Australia. Hi. Hi. Thank you. I feel less bad hearing how bad other countries are. But in Australia, we had a news report that our Bureau of Statistics has now announced has now calculated that over 80% of all tobacco and nicotine products are sold illicitly. So I'm wondering whether anyone thinks... We'd heard from Alex Wodak saying that we've reached a tipping point and to be optimistic. Is there a tipping point when... In the market, that means that the government does respond. I mean, they've downgraded their excises in Australia, obviously. And when we talk about 80% of illicit products, it's 99.9% of vape products or non-combustible nicotine products are illicit. Do you think there is a tipping point when the governments do go, OK, we've actually got to do something different?
51:55 - 52:07
[Reem Ibrahim]
Do you mind explaining a little bit about what actually happened in Australia? I mean, it was basically when people started dying from these firebombings that the Australian government said, well, maybe we should do something about this.
52:07 - 53:31
[Fiona Patten]
Oh, I wish that was the case, Leanne. I wish that was the case. In fact, they just doubled down. So in Victoria, in Melbourne, in my hometown, we've had over 200 firebombs. Yes, people have died and people not involved in the market have died. But that has not stopped their fervour for closing this down. I mean, of course, you know, when you point out to the police that every single one of those 1.5 million vapours are walking down the streets, are breaking the law and should be arrested, the police obviously do not enforce that. But... They're trying to enforce the ban on vapes. They're trying to enforce cracking down on illicit tobacco. But it is so ubiquitous now. And when it's 80% of the market... You know, enforcement, you can't address that. You just, it just doesn't work. Law enforcement cannot do it. Prohibition or abolition, as they might like to call it, cannot do that. And I'm wondering, you know, I'm posing that question to the panel. Do you think there is a point when governments go, okay, it's now owned by the criminals, we should actually try and return it back to the licensed operators, for example?
53:32 - 56:04
[Juan José Cirión Lee]
First, I would say that we think that Australia is the sandbox of prohibitions in the first world country and Mexico in the third world countries. We are the sandbox, so yeah. So what we've seen, what is happening in Australia is a bit different from what is going to happen in countries like Mexico because At the end, in Australia, they try to make law enforcement. In Mexico, we don't. So something is going to be very different. We've seen what is happening in Australia. We all know that we don't want that in our countries. But we can go to a different level, like in Mexico, with the way we are parting with the cartels. So I don't know what is going to happen. The way the Constitution in Mexico was changed is not a prohibition itself. Even the media has been trying to say that in Mexico we have a prohibition at the constitutional level. If you see the way the law was written, it doesn't say prohibition. The prohibition is not in the Constitution in Mexico. It's in the general health law. So we can try to change that if we make a different kind of interpretation to the constitution law and then change the way we are doing the general health law. That's what we are trying to do right now. I have 17 injunctions against the prohibition. Strangely, we don't have any resolution yet, even though they should be done two months ago, but we will see what is going to happen. At the end, as an activist, we should try to fight all the prohibitions the way we can. As a lawyer, I do it in court, and we will see what is going to happen at the end. You know that in Mexico we have a problem. Half of the judges were elected with with instructions by the government, and the other half are afraid of the government. So it's going to be difficult, but at the end, we will see what the judges said about the way they are interpreting the constitution.
56:05 - 56:09
[Reem Ibrahim]
Asanda, can we hear from you on this idea? Do you think that there is this tipping point?
56:09 - 57:59
[Asanda Gcoyi]
Before I get to that, an interesting point. We had an Australian pro-prohibition professor present to our parliament advocating for prohibition. So yeah, and they took it very seriously. On our end, I think it is not about the illicit reaching a particular point that has gathered interest or rather a response from our authorities, but it is the... the ever-increasing lawlessness that we see in South Africa just generally. So we've got, I mean, our crime rates have gone up, you know, drugs, et cetera. And we found that, so we've got a, we always have commissions. We've got a commission that is investigating the criminal justice system, police, et cetera. that at the root of all of these issues is the illicit syndicate and illicit trade. So not just illicit tobacco but all sorts of different products. So that has necessitated a position from the presidency to say we need to look at illicit trade broadly and see what we can do to tackle it. But particular focus on tobacco and these other products, and that is purely based on what recently happened with one of the tobacco companies having had to close its factory because of the high rates of illicit. That obviously speaks to unemployment, etc. But it isn't a direct response of saying it is too high, therefore we need to do something. It's other issues that have forced that conversation.
57:59 - 58:20
[Reem Ibrahim]
And Carissa, just on the flip side of that, do you think that there has been a tipping point in Sweden where the evidence is just so overwhelming, there is no way the prohibitionists could even gain a foothold? I mean, is it that it has just been so successful that there is that tipping point from the flip side, or do you think it's something else?
58:22 - 60:00
[Carissa Düring]
This is quite difficult because the prohibitionists in Sweden, they are very strong and they are closing their eyes towards the evidence. But of course, it is getting harder and harder for them to make their argument. the more evidence that we gather over time, the less they have to say. And they are kind of start to make things up and like do weird things with the statistics so it will prove their point. And I don't think we are really like in culturally in a tipping point because I believe that still most people in charge and a lot of politicians are still very, well, maybe not that they want to ban schizo nicotine pouches, that would never work, that they want to severely restrict it. But I think we are going in that direction with time and also with the younger generation who grew up with nicotine pouches as they gain influence as well in Sweden. And I think when it comes to like will you abolish prohibition or not? I think this is a very important thing, because over time, the evidence will just continue to gather. It will gather in New Zealand, in Sweden, in other countries that will continue and follow. And eventually, that amount of evidence will be so large that its social effects will be, and the costs will be too high, and there are too much evidence in contrary of prohibition that they will have to let it go eventually.
60:02 - 60:06
[Reem Ibrahim]
That's really interesting. Any other questions? Yes, here in the front.
60:11 - 62:15
[Thomas Nahde]
Thank you so much. Thomas Nader from Germany, Imperial Brands. Hi. Well, first of all, let me thank you. It's a great panel. Huge energy on the panel, and I really appreciate that. I have a question to the panel, and that is, do we need to shift the narrative? And I'll give you two examples or questions to that, what I mean by that. Number one, I'm a non-native speaker. If I hear illicit products, That doesn't tell me anything, anything, right? If I hear illegal, it's, well, okay, I understand that. Isn't that those products which I get under the counter? And I'm fine with that. If I hear that that is linked to criminal gangs and that means probably, at least in some countries, right, shipping those products in containers in the one direction and probably weapons, people, drugs in the other direction, that is a whole different story and people need to understand that. That's number one. And the other one is on Sweden, right? And Reem, you make the great point. Sweden is a great example, but if you talk to policymakers in countries like Germany, and we heard about EUTPD today in the morning, if you talk to policymakers and talk about Sweden, it's like, yep, got it, Sweden. Isn't that about snus, which is illegal in all of the other European countries? You need Brexit. You can make your own laws. And then you're like, well, OK, got it. The other example is the UK, and then policymakers say that. well, UK is no longer considered to be a European country or in the EU, right? And then you're starting to struggle, and then you're making the point of, what about talk about Japan? Well, that's on the other side of the world, and you can't really compare populations. I think we need to look into stories like yours, Carissa, with women and nicotine pouches, and I'm wondering if we need to shift the narrative and be stronger on that.
62:16 - 62:16
[Reem Ibrahim]
That's a really great question.
62:17 - 63:08
[Carissa Düring]
Anybody want to pick up on that first? I think that when it comes to what kind of narrative we present, I think there is a lot of benefits in including many of them and many stories, like the story of Sweden, the story of the young woman from Sweden who quit smoking, But also just from a policy perspective, there is the human rights perspective, there is the tax perspective that the governments are losing a lot of money by keeping things illicit. So I think there's a benefit in plurality and doing different kinds of perspectives because it will hit different for different people and different groups. So yeah, that's my take.
63:10 - 64:11
[Jacob Grier]
I can jump in on this a little bit. I talked about this if you were at my talk here last year. A lot of us often skip away from what is actually the most resonant argument that we have on our side. We talk a lot about scientific studies, which we should because it's very important. If we don't have facts on our side, we shouldn't be doing this. But that's boring to a lot of people, and it's hard to understand. We can talk about the relative safety of e-cigarettes versus other things. We can talk about substitution effects if you ban vaping and people turn to smoking. But a lot of this is going to fall on deaf ears. People aren't going to listen. And the most powerful argument that resonates with the most people is that it's nobody's business if a consenting adult wants to do this. And I think we should reframe a lot of these arguments, not skip over the other ones, but also talk about the personal autonomy aspect of this. Because the other side certainly does it. We talked about prohibition being reframed as abolition and how we're freeing people from the scourge of cigarettes. And we can make that same argument about giving people that choice.
64:11 - 66:12
[Reem Ibrahim]
Yeah, I think that's absolutely right. I think we need to be unequivocal about our defence of individual freedoms in public health. And I think that when we're having these conversations about it, and I think you're absolutely right, Jacob, this question of using evidence-based policymaking, the other side, they say facts don't care about your feelings. Feelings don't care about your facts. And actually, a lot of the public health activists will use evidence in that way and pick information information that is potentially also incorrect. The WHO lie all the time. And that doesn't matter. The facts don't matter. The feelings matter. The emotions matter. And so to your question, I think that when it comes to this narrative, as Carissa very eloquently pointed out, the story of women in Sweden having a higher smoking rate than men, and this new product, this new technology coming out, and women, young women, no longer having the long-term health impacts of the carcinogens from combustibles, them having that ability and that freedom to do so. I also think, just from this perspective, that prohibitionism and the sort of push towards anti-industry is a fundamentally anti-capitalist perspective. I think that a lot of these public health academics tend to come at the policy from a, I want to introduce a ban, a restriction, a tax, and no matter what the evidence is, the clear solution here is for politicians to do something. And if you are a politician, you want votes, and for you to be seen to be doing good stuff, i.e., I am saving the children, and all of the mothers vote for you because they're very afraid of their children vaping. So to this point, Carissa, do you think then in a country like Sweden, the moral arguments around individual freedoms have landed? Or do you think it is this evidence scientific based approach that has meant that Sweden has been such a brilliant miracle success?
66:14 - 67:09
[Carissa Düring]
I think the strongest argument here would be the freedom argument. It resonates with a lot of Swedes and we have a great expression which is, don't touch my snooze. And this is like the mentality that we went into the negotiations with the EU about our exemption from the ban. And a lot of Swedes still feel like that. It's like we know that the rest of the Europe, they don't use snus, but we do. And that is our right to use snus. So don't touch our snus. And that resonates very strongly with Swedes. And I think a lot of politicians in Sweden are also aware about this fact that you can't go in and touch this because then Swedes will be like, no, this is not your business. So yeah.
67:11 - 67:33
[Reem Ibrahim]
And that must also extend to tobacco and other products as well. I mean, if you believe in adults being able to choose what they do with their own bodies and their own lives and be able to make their own choices about their own health, then that ought to extend to all products. More questions? No more questions. Oh, here we go. Yes. There is a microphone. Yes. Yes.
67:36 - 70:19
[Mark Tyndall]
Yeah, hi, I'm Mark Tyndall from Canada. I think this will come up during the next few days, but when we talk about prohibition and the legal market, often we automatically talk about criminals and these people selling these products are bad people and criminals. From our public health standpoint, the people that are distributing illegal vapes to countries where you can't get them are actually doing a public health service. People who are selling cigarettes for $3 a pack instead of $18 a pack in Canada are doing a public health service for people living in poverty. In some ways, I think we have to recognize that there's a real need for these products, and we, most people in this room, believe that people should have access to safer nicotine products. And often when we talk about Prohibition and illegal gangs, cartels, we have to get rid of that. But for right now, they're the only thing that some countries have. And I think even in their minds, they're profit-driven, but they realize that there's a need and a demand for these products. I don't think that, certainly the people buying them don't consider themselves criminals, and probably some of the people selling them, at least at a street level, don't really think they're criminals. They're really providing a public health service. So I just think with our language when we talk about this, that these people aren't necessarily our public health enemies because they're ultimately getting people access to products that were not able to get them. Dealing with a lot of the success I've had dealing with other drugs in Canada is actually talking to people who are dealing with drugs. And a lot of them are the street level people. And they're sort of important in the whole structure. I learned about the community so much that I would direct my patients to certain places they should get their drugs now because these people are bad and this dealer is really good and he always has really good stuff. So I think we're kind of being a bit duplicitous when we just automatically say if you're not getting them from a legal source, then it's bad because the products are still necessary, there's a demand there, and we need to... make sure that those people aren't criminalized.
70:20 - 70:52
[Reem Ibrahim]
Yeah, and this is something that's really interesting because in countries like Canada, the harm reduction aspect of basically every drug is accepted and people are treated, you know, drug addicts are treated as patients and not as criminals. They are not demonised for being addicted to a particular drug. And yet when it comes to tobacco, that same moral dignity is not given to smokers. And I do think that this fundamentally comes down to the complete demonization of smokers.
70:52 - 71:01
[Mark Tyndall]
Asanda, do you think this is something... You're being really kind about that, so that's really not what happens, but on paper, that's what should happen. Yes, well, indeed.
71:02 - 71:19
[Reem Ibrahim]
Asanda, do you think that this sort of demonization of smokers, you end up having a lot of those people go to the black market, and there is that sort of, again, that sort of negative connotation to somebody that is in the black market, or do you think it's become so normalized that that doesn't matter?
71:20 - 72:38
[Asanda Gcoyi]
I think there is a demonization. I mean, in South Africa, for example, it's like when you're a smoker, you're not a person. I mean, during that time of COVID, one of the ministers actually said if there was a choice between, so if you had two people who had contracted COVID and one of them was a smoker and the other was not a smoker, you would have to treat the one who was not a smoker. So that tells you how deeply entrenched the negative sentiments are towards smokers. You see it in public participation processes, where someone would stand and say, hey, I'm a smoker, my voice counts. Not just from the regulators, but even the public looks at them differently. There's almost that, it's as if people think, knowing what you know about smoking, how dare you, why would you smoke, you know? So I do think that a smoker does, unfortunately, carry a lot more of the burden, and it's unfortunate, but that's been my experience and how we've looked at smoking.
72:42 - 73:26
[Carissa Düring]
I think what you're saying is super interesting. And when you think about these people that are smokers, they are usually already a marginalized group. So those that are denied care, they are the ones that are already marginalized. I mean, a lot of people use nicotine as a stress relief or to deal with anxiety. and people who live very hard lives and deal with a lot of financial stress or work, they don't have a job, those kinds of circumstances would increase the likelihood. So we are marginalizing a group that is already very marginalized.
73:28 - 74:44
[Reem Ibrahim]
There's also the other aspect of this, which is that smokers smoke because they like smoking. And if you give them a product that they also like that is much healthier for them, then that's a fundamentally good thing. Any other questions? No more questions, okay. Well, we are sort of, we've got about 15 minutes left. I do want to give each of our panelists a moment to give us some final remarks. I do think that we've covered so much on this panel so far. And this idea that the prohibition that we're seeing across so many different countries It does make you feel, and I do think that whenever I come to conferences like this, and GFN is brilliant at this, that we are really in a global fight. This is a global fight. Politicians across the entire world are coming at this particular issue, this public health issue, from a pro-government regulation, pro-government restriction angle immediately without any of the evidence in front of them. And so all of us in this room are in the same fight. We are all in the same fight together. We are all here to talk about these ideas and hopefully be able to help one another make changes in our own countries. I'm going to start from the opposite end. So let's start with Juan. You can give your final remarks.
74:45 - 75:08
[Juan José Cirión Lee]
very short one. I think that legal prohibition doesn't change reality. And legal prohibition doesn't go according to the human rights we have. So sometimes, even with the prohibition, we have to do what we have to do to have our human rights intact.
75:09 - 75:11
[Reem Ibrahim]
That would be it. Great. Jacob?
75:12 - 75:13
[Jacob Grier]
Can I go longer than that?
75:13 - 75:14
[Reem Ibrahim]
Of course you can.
75:15 - 76:30
[Jacob Grier]
I had a couple of things that come to mind. One, usually when I give these talks, I always like to recommend a book called Demons by Virginia Barrage, who's an English historian. And the main point of the book is that drugs that have cultural legitimacy are much harder to regulate and ban than ones that don't. And so for most of the 20th century, the big three psychoactive drugs in the West were alcohol, caffeine, and nicotine in the form of tobacco. And they were all very difficult to regulate. We saw prohibition happen and then get repealed. And then we've seen towards the end of the century, the delegitimization of nicotine. And that's enabled a lot of what we're seeing now. A great comparison is alcohol. And you look at all the regulations that have been passed in the United States and around the world in response to youth vaping, which is very hard to find immediate measurable harms from. Like, you can see a lot of long-term risks to think about, but in the short term, Not too bad when you compare it to alcohol, which in the United States, binge drinking among underaged is estimated to kill about 3,500 teenagers a year. And yet, the idea that we would ban flavored alcoholic drinks would get absolutely no traction
76:30 - 77:42
[Reem Ibrahim]
This is the same situation with the United Kingdom. So in the UK, we've completely banned disposable vapes on the basis that it is bad for the environment, of course, the lithium in the batteries from disposable vapes, but we use electric vehicles which have way more lithium in them than the disposable vapes, and so the logic just doesn't add up. But on this point about alcohol, the moral panic around young people vaping despite the fact that according to Ash's own figures, Action on Smoking and Health, double the number of 11 to 17 year olds drink alcohol regularly than vape regularly. But no one is saying we should ban alcohol for everyone just because some people that are already banned from buying a product managed to get their hands on it behind their parents. So this particular argument, this disparity of, well, when it comes to other products, things like alcohol, there is not that immediate response where we are going to be taking away every single adult's right to choose what they do with these products. And yet when it comes to nicotine specifically, there is almost no criticism to a immediate restriction or tax on this.
77:42 - 78:07
[Jacob Grier]
Yeah, and I'll pick on Robert Proctor again, because he's a great example. Even the name of his book about this was called Golden Holocaust. So immediately comparing smoking tobacco to the worst evil in modern history, and then trying to reframe prohibition as abolition. And he does the alcohol comparison as well. And he says that prohibition didn't work for alcohol because people enjoy alcohol, but nobody enjoys tobacco. This is just a false desire.
78:07 - 78:09
[Reem Ibrahim]
They're addicted. They have no idea what they're doing with their lives.
78:10 - 79:42
[Jacob Grier]
Yeah, and this book, in fairness, was written, I think, 10 or 15 years ago before we have a lot of the innovations we have today. But he talked about harm reduction. And I don't remember the exact quote, but it was something like, advocating for a safer cigarette is like advocating for safer smallpox or safer terrorism. He's just completely delegitimizing the idea that anyone would use this for any good reason. So the last point I wanted to make, if I can as well, is, Talking about to Fiona's point about like is there a tipping point and this is kind of fatalistic but also optimistic which is that I think a lot of what we're facing now is just boils down to a lot of the people who have influence over tobacco policy have a very 1990s mindset and that's because the in the 1990s harm reduction for tobacco was very much in its infancy pretty much everywhere but Sweden and And we were looking at close to peak smoking deaths in the US, because there's a lag about when people smoke and when they die. So everyone who was smoking in the 60s was dying in the 90s. There was a lot of visibility. Everyone knew people who were dying from smoking-related diseases. And tobacco companies were at peak dishonesty and reprehensible behavior. And so you can understand why anyone coming up in that milieu is going to be very skeptical and very hostile to tobacco harm reduction. And so I think the optimistic note is that one way to win arguments is to just prevent better evidence and have better arguments. But the other way is for people to just age out of this mindset. And Michael Bloomberg is very old, right? This is an optimistic note for us.
79:43 - 79:46
[Reem Ibrahim]
So many pennies that he'll have to spend on prohibitionism.
79:47 - 80:03
[Jacob Grier]
So I think the salience of... this image of tobacco and nicotine is going to fade. And that's going to help us in the long run, whether it's a tipping point based on use or just people facing up to the reality of what the actual risk of these products are compared to what tobacco was in the 20th century.
80:04 - 80:07
[Reem Ibrahim]
I love that optimism. That's fantastic. Asando.
80:07 - 81:00
[Asanda Gcoyi]
I think for me, what's important, and this is something I always say during engagements, that this is not about products. This is about people. This is, at the end of the day, it really is about those 8 million a year smokers that die. And that should be the focus. And I think oftentimes we lose that in the words we choose and how we frame arguments. But at the core, it really is about people and people needing help. And if that means in our advocacy we need to change things around and whatnot, then that's what we need to do. But we have to ensure that everyone has access to these products that can save their lives.
81:01 - 81:10
[Reem Ibrahim]
Absolutely, I completely agree, Carissa. And I also think that ending on Carissa is great because Sweden is a fantastic country that we can all look up to.
81:10 - 82:21
[Carissa Düring]
That's good. I think that I got a bit inspired by the questions that came in now, which provoked a question in me that I will leave with you guys. I use nicotine pouches daily because I'm a consumer. If I go to France, where nicotine pouches are illegal, today I will not be allowed to carry my nicotine pouches with me. That has led to me feeling like I'm never going to visit France again. That's for sure. Until they reverse this. But I have some friends that live in Paris. They are all smokers. So if I went there with like cans, tins of nicotine pouches to give them to my friends in France who are smokers, am I doing something that is right or am I doing something that is wrong?
82:25 - 85:14
[Reem Ibrahim]
It's up to you. Well, you could get up to five years in prison for just that. So, I mean, it's insane when we're thinking about European countries that have now entered into this. And I really enjoy Jacob's optimistic note, this idea that the... disgust around the tobacco industry and their behaviour in the 20th century, perhaps we will begin to forget it historically and begin to realise that actually whoever it is making safer products, we ought to celebrate that and allow adults to make those choices. I also think that, just zooming out for a moment, this extends, this kind of attitude against industry, so to speak, this anti-capitalist idea, extends to so many other areas of policy. Let's look at the environment. The environment is something that has resulted, you know, the climate change idea has resulted in so many regulations and restrictions. And what we have also seen is lots of the campaigners around the environment have argued for many, many new laws being created, many of which have made a lot of people poorer. And here we have a solution with nuclear energy. And those particular people do not want nuclear energy. In fact, the Green Party in the UK have advocated for nuclear energy to be banned. Obesity. A lot of these companies have created fantastic products like GLP-1, semaglutide, which means that people that have spent years of their life obese, they are far more likely to have cardiovascular issues. They are far more likely to be very ill in the long term. And here we have a product that is going to solve that problem. But no, no, no, the anti-obesity campaigners do not want this solution because it didn't come from them. What they want is regulations and restrictions and junk food advertisement bans and taxes on sugar. And when you look at housing, housing being expensive, the solution here is increasing supply. But no, no, no, what the campaigners want is rent controls and restrictions. So this particular attitude against individual choice and against the evidence around how adults are actually able to make those choices for themselves and for their own health, that particular attitude is permeated across all of public policy. And so I think that whilst we are all in this room, we are not alone in the fight for safer nicotine products and the fight for public health being evidence-based. We are also not alone from that perspective globally in every area of policy. So just before I finish up and I give you a couple of housekeeping notes, I think we all ought to come together and think about how important these conferences are because we are actually able to have those conversations with one another and realize, my God, we are not alone.