Big Question 1 - What is Tobacco Harm Reduction?

The history of THR

Efforts to reduce the risk of harm from combusted tobacco products date back to the 1950s. The concept of Tobacco Harm Reduction was first articulated by Professor Michael J. Russell, who advocated for the reduction of tar in cigarettes while maintaining levels of nicotine, as “[p]eople smoke for nicotine but they die from the tar.”^[3]

In 2001 the U.S. Institute of Medicine (IoM) - a governmental advisory body now called the National Academy of Science, Engineering and Medicine (NASEM) - outlined the principles behind THR in a publication called Clearing the Smoke. The IoM defined THR as: “decreasing total morbidity and mortality, without completely eliminating tobacco and nicotine use.”^[1]

The leading public health benefits of THR were realised in Sweden, where smoking has been largely replaced by Oral Tobacco Products for the last 70 years, which has resulted in the lowest smoking rates in Europe (5.6% relative to the EU average of 23% in 2023) and as a result has the lowest incidence of lung cancer mortality in Europe (29.1 deaths in 100,000 people relative to the EU average of 66.7 deaths in 100,000 people).^[4]

THR today

It is now widely acknowledged that the cause of most of the serious health risks associated with conventional cigarettes is the exposure to toxicants in the smoke produced when tobacco is burned – and not the nicotine.^[5,6] There exist today four global categories of Reduced-Risk^*† Products (RRPs): Heated Products, Vapour Products, Oral Tobacco Products and Oral Nicotine Pouches. Organisations such as Public Health England^** (PHE) are clear that vaping is likely to be much less risky than smoking traditional cigarettes when used as a complete substitute for continued cigarette smoking.^[7] Similarly, Balfour et al. stated that: “vaping can benefit public health, given substantial evidence supporting the potential of vaping to reduce smoking’s [death] toll.”^[8]

Today, it is estimated that there are more than 115 million Smokeless Product adult consumers, with around 10 million^[9] adult consumers using Oral Nicotine Pouches, 40 million^[10] using Heated Products, and 65 million^[11] using the largest category, Vapour Products.

Our role in THR

Our role is to develop and market responsibly innovative products that support THR, propose solutions to address underage access to tobacco and nicotine products, and engage with regulators and policy makers to facilitate THR.

The U.S. Food and Drug Administration^[12] and other leading public health scientists^[13] have considered the role of THR and its potential benefit to society, as they believe that the risk of underage use of Smokeless Products must be balanced against the substantial THR benefit offered by these products.

In 2019, the Greek ‘Ministry of Health’^*** established a mechanism (Law 4715/2020) for the communication of risk related messages subject to a strict procedure of scientific assessment led by a specialised Committee.^[14] Through this mechanism claims relating to a reduction in “[t]he concentration of chemical substances with known toxicity […] compared to conventional smoking.” were issued for Heated Products glo (BAT) and IQOS (Philip Morris International [PMI]).^[15,16] These claims further emphasise that regulatory bodies are recognising the importance of informing adult smokers, who choose to continue to smoke, about alternative products that can benefit THR.

Figure 2 summarises our role in Tobacco Harm Reduction and how we will focus on both encouraging adult smokers who would otherwise continue to smoke towards exclusive use of Smokeless Products instead of cigarettes, and preventing the access of these products by the underaged.