Harm reduction holds the key to finally overcoming tobacco
The issue of tobacco harm reduction (THR) is not new in Europe, but now it has received support from an unlikely direction: German dentists. Several doctors associated with the University of Leipzig Medical Center and clinics in Cologne are calling for the integration of tobacco harm reduction strategies into dental care, citing the immediate health benefits that can be derived from stopping the use of combustible tobacco products. One dentist has even begun keeping novel nicotine products in his clinic to show them to patients struggling to kick conventional cigarettes.
This urgent call from dentists – who as medical professionals consider themselves to be “at the front line” of harm reduction efforts – drives home the need for a serious discussion about harm reduction, particularly in light of the fact that weaning millions of people off nicotine entirely is an unrealistic, impractical public health target. In practice, a far more advisable policy would be to empower health professionals to encourage the switch from tobacco to alternative nicotine products like e-cigarettes, which carry far lower risks for the user.
Several studies have already shown that using vaping devices contributes to a decrease in tobacco smoking. In France, 80 percent of vape users have reduced their consumption of cigarettes. A British study of more than 370 users found that vaping helped to substantially reduce individuals’ smoking relapse rate, particularly in those who begin by using a vape pen or tank device. Over in the UK, Public Health England found that more than 50,000 smokers were able to quit in 2017 with the aid of a vaping product. In light of this, calls for a shift in policy would seem like a viable and sustainable public health initiative to implement across Europe.
However, this message is colliding fiercely with the overly dogmatic approaches dominating in the World Health Organisation (WHO) and among many European policymakers. The EU’s Beating Cancer Plan, for example, has been widely criticized for failing to include harm reduction approaches, something of an oversight given it aims to cut the number of smokers by around 90 million.
“[The EU’s plan is] very disappointing and a failure of imagination, innovation, and courage in policy-making,” lamented tobacco harm reduction advocate Clive Bates, the former Director of Action on Smoking and Health in the UK. Several MEPs voiced their criticism as well, suggesting that e-cigarettes and tobacco products should not be treated the same. As Greek MEP Maria Spyraki emphasized, “the goal is to win the war against cancer. One in five patients in the EU suffers from lung cancer, therefore we have to help smokers by giving them the opportunity to gradually quit”.
Such criticism easily extends to the WHO, which, like many policymakers in Brussels, continues to put vaping in the same corner as smoking tobacco, despite overwhelming scientific evidence to the contrary. A recent WHO report even referred to the “dark impact of e-cigarettes”—dangerous fearmongering which risks setting back the fight against smoking. Indeed, WHO communications have routinely propagated a misinformation double-whammy: first, that vaping devices will increase the number of smokers and, second, that e-cigarettes pose an equal or greater risk to public health as combustible tobacco products.
Fortunately, the data speaks for itself. Multiple studies have found that e-cigarettes are dramatically safer than combustible tobacco products, with less than 1% of the carcinogenic emissions of tobacco smoke. A UK government review of all available evidence found that almost all of the 2.6 million British adults using e-cigarettes are current or ex-smokers, and the vast majority of users rely on these devices to help them steer clear of smoking combustible cigarettes.
What the UK review also found, however, was a concerning increase in the number of people that have been misled to believe e-cigarettes are “equally or more harmful” than smoking. In 2013, just eight percent of people were concerned about “electronic tobacco products”. By 2015, this figure had leapt to more than 22 percent. The situation is even worse in continental Europe, where a survey found that a staggering 59% of Europeans incorrectly believe that vaping is just as dangerous or more dangerous than smoking—something which could set Europe back years in its efforts to create a smoke-free generation.
By needlessly sounding the alarm over e-cigarettes, the WHO is effectively blocking the successes of its own anti-smoking policies and missing the bigger story: vaping is a far less risky alternative to consuming combustible tobacco, and the language around this should be adjusted accordingly. This is especially important for the WHO, an organisation which sets global health standards that guide regional and national policy all over the world, including in Brussels.
Not all governments are oblivious to the public health benefits of a harm reduction approach. Last month, the UK’s Department of Health announced that the state-funded National Health Service (NHS) could soon begin offering electronic cigarettes to smokers looking to quit. In stark contrast to the language used by the EU and WHO, the ministry pointed to evidence that these products were “highly effective” in helping individuals quit smoking.
Though the UK has one of the lowest smoking rates in Europe, there are more than six million smokers in the UK, with smoking rates much higher in poorer areas. Unemployed people are nearly twice as likely to smoke and, depending on the region, between 10 to 25 percent of pregnant women are smokers at the time of delivery. In 2019, more than 64,000 people died from smoking-related illnesses.
Across the Channel, the EU is facing a smoking epidemic of even greater proportions. Despite large-scale health policy efforts, smoking was the cause of one-fifth of cancer cases in 2018, and remains the most significant cause of premature death in the region. In this instance, Brussels could benefit from taking a page from London’s book for once.
Image: Vaping by Mike Mozart/Flickr