More people using snus and e-cigarettes - despite growing opposition

The number of smokers switching from cigarettes to other nicotine products is increasing. At the same time, the political climate for harm reduction has hardened around the world. According to Harry Shapiro, author of the report "Burning Issues: Global State of Tobacco Harm Reduction 2020"

Sweden currently has one of the lowest levels of cigarette consumption in the world. Between 5 and 7 per cent of the country's population smokes. The use of e-cigarettes is also low: two per cent of the population vejpar, half of them daily. At the same time, Swedes use as much nicotine as the European average.

"Some commentators argue that the low number of smokers is due to men taking more parental leave and thus quitting smoking. But this is obviously not the whole explanation", says Mr Perez. Harry Shapiro, journalist and writer, who on behalf of the organisation Knowledge Action Changecompiled the report 'Burning Issues: Global State of Tobacco Harm reduction - 2020'.

Snus has an impact on public health

Harry Shapiro, and several other international experts, see the explanation in the use of snus. Up to 20 per cent of Swedish men use snus. A large proportion of snus users are also ex-smokers. How many is unclear, but between 25 per cent and 80 per cent are figures that are being bandied about in the debate..

'In other countries, where snus is not available, it is different. Certainly the availability of e-cigarettes has made a big difference. But in Sweden, snus is established and ingrained in the culture, it has a different effect on public health," he says.

Smoking is the world's biggest health issue

The report is the second of its kind and summarises the tobacco harm reduction (THR) phenomenon from a global perspective.

"Reducing harm from smoking is one of the world's biggest concerns. And while harm reduction products such as e-cigarettes have been on the market for over a decade, progress is slow. But progress is being made," says Harry Shapiro to Vejpkollen.

100 smokers on a vejpare

Today, more than 98 million people use various products to reduce the harm from their nicotine use. 70 per cent of these use e-cigarettes, the rest heat-not-burn products, snus, nicotine pouches and the like. This is an increase compared to 2018, when the first report was published.

"From a public health perspective, this is a success. But we have 1.1 billion smokers in the world. There are 100 smokers for every vejper. Even though the forecast two years ago said there would be fewer, there are still very few." says Harry Shapiro.

"Dismissing e-cigarettes is stupid"

E-cigarettes have risen and fallen in popularity over the ten years they have been on the market, in line with scientific findings and political fluctuations.

"Science supports vejpning as an injury reduction tool. It's clear, clinically proven. But it has become a question of something else. The debate is tipping over when the only argument needed to restrict e-cigarettes is that the products are part of a conspiracy by tobacco companies to attract new customers," said Mr Perez. Harry Shapiro.

Compare with greener cars

According to Harry Shapiro, it is perfectly understandable not to trust tobacco companies. But to dismiss harm-reduced products simply because of the companies' interests is borderline stupid, he says. At least from a public health perspective.

"It's as if we wouldn't see the environmental benefits of electric and hybrid cars from Toyota, just because the company has made a lot of money from petrol cars in the past. Public health must be based on science, not moralistic attitudes towards nicotine, as is the case with both snus and e-cigarettes."

Moral panic and e-cigarettes

An example of moral panic, fuelled by anything but science, was last year's outbreak of EVALI; a disease caused by illegal e-juices with cannabis. It triggered a series of bans and restrictions on e-cigarettes around the world. And this despite the fact that EVALI was actually a completely different product. But the US is like a beacon to the world, says Harry Shapiro. For better or worse.

"If states in the US ban flavours in e-juice, which are so important for making e-cigarettes effective for smoking cessation, it will be difficult for us in the rest of the world to convince our politicians not to do the same. This is especially true in the developing world, where smoking is most prevalent and the need for change is greatest." says Harry Shapiro.

Success for tobacco harm reduction in the US

At the same time, the US FDA decided during the year that both the heat-not-burn product "IQOS" and Swedish snusmay be marketed as "less harmful tobacco products" in the country. And even though regular e-cigarettes (which don't even contain tobacco) are still awaiting the same treatment, it sparks hope for the future of harm reduction, says Harry Shapiro.

"The FDA reviewed and accepted the research, even though in these cases it comes from the tobacco companies. The price tag was also huge. But what's happening in the US is spreading, and from a public health perspective, it's good news."

Researchers must be made aware of responsibilities

Public health authorities should do everything in their power to reduce smoking, says Harry Shapiro. Even if it means that smokers maintain their nicotine use by other means. The authorities in his native UK, Public Health England, already did so in 2016 when, with the support of the country's prestigious Royal College of Physicians, they found that e-cigarettes with nicotine reduce the risk of harm to a smoker by 95%.

"Those of us fighting for this rely on researchers remaining aware of their responsibilities and continuing to produce good and robust studies. At the same time, political commitment is needed. It took 100 years for cannabis to become accepted and partially legal in some US states. And it was ultimately costumed activists in the White House that made it possible, not banners in the city"

Sweden a good example

He believes that snus in Sweden is an example of how harm reduction is becoming part of society. 'Swedish culture plays a role, but also widespread use that has existed for a long time.

"Even if e-cigarettes are regulated more strictly than they are today, smokers will find them. The interest in quitting smoking remains and when a good alternative is available, consumers will lead the way. In the end, there will be so many users, that politicians must take into account and understand how important it is for public health. And for smokers" says Harry Shapiro.

"Burning Issues - Global state of tobacco harm reduction 2020"

CAN - Tobacco habits in Sweden - ecigarettes

Harm reduction journal - snus and smoking cessation

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