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IQOS at risk: the European Commission’s plan to ban heated tobacco, such as IQOS, will likely cause an increase in cigarette smoking.
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Stella Kyriakides, European commissioner for health and food safety.
When the European Parliament formally recognized tobacco harm reduction (THR) as a public health strategy earlier this year, it seemed like European regulators were beginning to follow scientific facts relating to tobacco. Now, in what seems like a one-step-forward-two-steps-backward situation, the European Commission (EC) plans to ban flavored heated tobacco products (HTPs) in all EU member states.
THR promotes the use of less harmful alternatives to combustible cigarettes such as e-cigarettes, heated tobacco, and snus to help reduce smoking prevalence. In February, the European Parliament adopted – by an overwhelming margin of 652 votes in favor of and 15 against with 27 abstentions – a report by the Special Committee on Beating Cancer (BECA) which introduced for the first time a THR perspective at the EU level. The BECA report also called on EC to follow up on the scientific evaluations of the health risks related to e-cigarettes, HTPs, and novel tobacco products, as well as the assessment of the risks of using these products compared to consuming other tobacco products, and the establishment at European level of a list of substances contained in, and emitted by, these products.
But now, following an EC report on HTPs released in June which revealed a more than 2,000% rise in HTP sales (from 924 million units in 2018 to 19.7 billion in 2020), it seems EC went into panic mode and is going to prohibit the sale of flavored HTPs.
“By removing flavored heated tobacco from the market we are taking yet another step towards realizing our vision under Europe’s Beating Cancer Plan to create a “tobacco-free generation” with less than 5% of the population using tobacco by 2040,” said Stella Kyriakides, commissioner for health and food safety. “We want to make smoking as unattractive as possible to protect the health of our citizens and save lives. Stronger actions to reduce tobacco consumption, stricter enforcement, and keeping pace with new developments to address the endless flow of new products entering the market - particularly important to protect younger people – is key for this. Prevention will always be better than cure.”
The proposal will enter into force 20 days after the publication in the Official Journal. Member states will have eight months to transpose the ban into their national law and after the additional three months of transition, the provisions will start to apply.
If reducing smoking prevalence is the goal here, banning HTPs, even just the flavored kind, seems counterintuitive. In 2020, the US Food and Drug Administration (FDA) authorized the marketing of Philip Morris International’s IQOS, an HTP, as a modified risk tobacco product.
“Data submitted by the company shows that marketing these particular products with the authorized information could help addicted adult smokers transition away from combusted cigarettes and reduce their exposure to harmful chemicals, but only if they completely switch,” said Mitch Zeller, then-director of FDA’s Center for Tobacco Products. In Japan, the largest market for HTPs, the introduction of HTPs into the market led to a 34% drop in cigarette sales, according to a 2020 paper by Frost & Sullivan in col-laboration with PMI, Tobacco Harm Reduction and Novel Nicotine and Tobacco Products: Evidence from the Japanese Market.
“The commercial availability of HTPs in Japan is associated with a significant drop in conventional cigarette sales, well ahead of the previous rate of decline,” said Mark Dougan, Frost & Sullivan’s consulting director, healthcare. Moreover, even after heated tobacco products became available, sales of all tobacco products [heated tobacco products and conventional cigarettes] continued to fall. Although there is mixed evidence, data from the 2019 National Health Survey indicates that 76% of consumers who use heated tobacco do so exclusively. Only 24% of HTPs users maintain dual-use.
An American Cancer Society research study in 2020, Effect of IQOS Introduction on Cigarette Sales: Evidence of Decline and Replacement, had similar results, finding that cigarette sales began to substantially decline at the time of the introduction of IQOS in each of the 11 Japanese regions. A recent study in the Cochrane Library, Heated Tobacco Products for Smoking Cessation and Reducing Smoking Prevalence, reviewed data from 11 studies and over 2,600 people and found that people who switched from cigarettes to HTPs had lower levels of exposure to harmful chemicals than those who kept on smoking.
These are but a few examples that show the impact HTPs have on smoking prevalence, health effects, and consumer preference. EC’s decision to ban flavored HTPs will take away a viable alternative for European smokers looking to switch to a lower-risk tobacco product. With one less alternative available to them, smokers very likely would turn back to combustible cigarettes, the very tobacco product EC seeks to eradicate.