A GLOBAL health expert said the World Health Organization, governments and the tobacco industry should use the opportunity made by the advancement in nicotine delivery technology to reduce up to 4 million deaths from smoking each year.

At the 8th Global Forum on Nicotine on June 18, 2021, Dr. Derek Yach, president of the Foundation for a Smoke-Free World, said the world is experiencing a revolution in nicotine delivery technology, as there are now more than a hundred million people using harm reduction products.

Yach said that to complete the transformation of the industry, a commitment from all parties to prioritize the end of the tobacco epidemic would be needed.

“Industry must commit to ending the sale of combustible cigarettes and act accordingly through their investments. Industry must commit to ending youth nicotine use in all forms and there are many strategies that could be done to achieve that,” he said.

The WHO and governments should commit to revising the Framework Convention, which explicitly builds a risk proportionate regulatory system that doesn’t require major changes to the text, he said.

He said this is possible amid the transformation of the tobacco industry, which gave rise to less harmful nicotine options. “Projections suggest that if these tools were more widely available, we would be able to cut the long-term trends of deaths by maybe between 3 and 4 million, if we acted more vigorously,” Dr. Yach said.

Cliff Douglas agreed, acknowledging the need for a genuine and clearly demonstrable commitment by industry to ending combustible tobacco use.

“I agree with Derek and many leading scientific researchers and colleagues that more engagement with industry is needed. And science produced by industry should not be summarily dismissed or canceled, but rather given due consideration under careful peer review with full disclosure of conflicts of interest,” Douglas said.

Dr. Yach shared his insights as a speaker, with tobacco policy expert Cliff Douglas as the responder, in the Michael Russell keynote titled “Why has the WHO FCTC failed to reduce adult smoking and its health impact?”

Dr. Yach noted the evolution of the tobacco industry from one that denied the damage caused by smoking on health in 1954 to its “pharmaceuticalization” today, supported by research and science.

He said that despite such changes made possible by investment in innovation, policy has lost touch with science. “Industry has created tools that have the potential to create one of the most profound public health shifts in history,” he noted.

“The present technological revolution demands an accompanying ideological revolution. Currently, many in tobacco control are skeptical, even hostile towards the contributions of industry. The origins of this hostility are not terribly difficult to identify… For generations, the tobacco industry has created products that have killed millions of people,” Dr. Yach said.

“A notable offense, if you may remember, came in 1954, when a group of tobacco companies published a Frank statement to cigarette smokers. This appeared in 400 American newspapers that claimed that there was a lack of scientific consensus on the damages of smoking,” he said.

“This is what tobacco science meant during the second half of the 20th century—a series of schemes to devise, distract and confuse smokers regarding the deadly consequences of using combustible tobacco. But no amount of PR of observation could hide the devastation caused by the tobacco in the long-term,” said Dr. Yach.

He said that in the 1990s, as part of the U.S. Master Settlement Agreement between American tobacco companies and attorneys general from 46 states, the industry was forced to disband the so-called research groups. “The settlement marked the beginning of a new era in the treatment of industry and endeavors at funds, including, and especially research,” he said.

Dr. Yach said that throughout the 1990s and into the new millennium, anti-industry attitudes and policies became the default. In 2005, the World Health Organization codified this stance in the Framework Convention on Tobacco Control.

“Today, this assumed conflict is often justified as justification for a hostile attack and attitude toward the industry,” said Dr. Yach. He noted that over the past two decades, thoughtful and justified action against industry evolved into perfunctory bands, boycotts and attacks.

He, however, noted that some tobacco executives and companies recognized the public’s desire for safer nicotine options and began prioritizing research on harm reduction.

“A few companies made a bet that investment in harm reduction will pay out in the long run. This was a shrewd business decision and incidentally, it’s proving to be an excellent contribution to science and health. Though the transition to safer products remains incomplete, many tobacco companies have diverted resources away from combustibles and towards reduced risk portfolios,” he said.

Dr. Yach said this gave rise to companies that are responding to consumers demand for nicotine products that are not deadly.

“In many respects, the nicotine industry now functions in a manner, some say like pharmaceutical industry. To be sure they’re self-interested and profit driven. At the same time, they are leaders in scientific innovation and essential to actually address massive health crisis,” he said.

Dr. Yach said the other public health experts described the phenomenon as the tobacco industry’s actual and perceived transition into pharmaceutical-like industry through the manufacture and sale of non-combustible tobacco and nicotine products for smoking cessation or long-term nicotine maintenance.

He said these companies are completing exhaustive studies to meet the scientific standards and rigor set by major regulatory bodies including the Food and Drug Administration. “To satisfy the FDA’s strict rules of evidence, tobacco and e-cigarette companies have conducted extensive peer review research and have disseminated these findings by a monograph report,” he said.

Dr. Yach said, however, that to complete the transformation of the industry, a new Frank statement is needed, including a commitment from all parties to prioritize the end of the tobacco epidemic.

“All of the above is feasible,” he said. “From a scientific perspective, a lot of the hard work has already been done. What remains, then, is a bigger challenge—which is challenging and changing cultural and political attitudes.”

The 8th Global Forum on Nicotine was held in Liverpool and online on June 17 and 18, 2021 under the theme “the Future for Nicotine”. It addressed some of the concerns prompted by recent reviews and reports that will have an impact in different parts of the world, as well as implications for discussions at the postponed FCTC COP 9 meeting, later this year.