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Photo by Sagar Patil on Unsplash

 

 

 

 

 

 

 

 

Photo by Sagar Patil on Unsplash

It was just a year ago when we launched European Tobacco Harm Reduction Advocates yet we have achieved much in that time.

ETHRA is powered by 22 European consumer groups, all dedicated to defending the rights for adults to use safer nicotine products, all signed up to ETHRA’s core principles. Working as a consortium of equal partners, we pool our expertise, our dedication, and our passion, and it has led to spectacular results. Our grouping is a voice for our partners who arrange their own revenue and who give their time to ETHRA for free, as we run it collectively and without funding.

Together we have aimed to amplify the Tobacco Harm Reduction (THR) consumer voice in Europe and highlight our commonalities while still celebrating our differences. We are very honoured to be supported in this endeavour by our Scientific Partners, all experts in the tobacco harm reduction field.

Our first year has exceeded our expectations.

 

Highlights of ETHRA’s first year

We gained recognition as stakeholders in the TPD review and participated fully in the stakeholder questionnaire process. As a result we produced notes on the subsequent stakeholder interview as a way of contributing an insightful consumer critique of this EU directive which has so much influence over our right to choose, use and enjoy safer alternatives to smoking.

We follow the TPD developments very closely and shine a spotlight on the opaque but critically important review process. Check out our TPD review article for a rundown of what is going into the TPD evaluation. A recent development is that the SCHEER preliminary Opinion has just been published and there is a public consultation which runs for 4 weeks. We will soon publish an article with guidance on how to respond to that. The Opinion is appallingly biased against THR and we simply cannot afford to ignore it.

We published the ETHRA manifesto with the tag #SayYesToTHR in May declaring the rights of safer nicotine users in Europe and on behalf of 27 million consumers. The manifesto was translated into our 16 partner languages - all available for download on our website.

We write to governments and submit to consultations, most recently to explain to the Dutch government why plain packaging for safer products is such a terrible idea.

We regularly publish news articles, to bring national issues to the attention of an international audience. Our most recent is a translation of Sovape’s shocking findings that 75% of French people do not know that vaping is less harmful than smoking. Accurate risk perceptions are fundamental to THR - if consumers do not know that reduced products are safer they will not want to use them. We also recently wrote about Europe’s Beating Cancer plan, urging for the initiative to embrace tobacco harm reduction and so empower smokers to take control of their own health. We submitted to the Cancer Plan public consultation earlier this year.

We sounded the alarm about the proposed flavour bans in Denmark and the Netherlands and galvanised consumers to act.  Flavours have emerged as a key battleground; expect many similar fights in the future.

At the height of the COVID restrictions we highlighted just how vulnerable access to safer alternatives to smoking is - people could buy combustible cigarettes everywhere but access to safer alternatives were heavily restricted, or even denied. This must change.

 

And the future?

We do not intend to relax after our successful first year, but instead to build on it. ETHRA’s Europe wide survey into consumer behaviour is coming soon. The survey will gather the opinions of those affected by possible changes in regulations to reduced risk nicotine products in the European Union. Help us celebrate our birthday by doing the survey and sharing it in your circles.

If you are in a grass roots THR consumer group based in Europe and support ETHRA’s principles, we would love to hear from you. So please get in touch if you are interested in partnering with us.

Follow our Twitter account and Facebook page, where we channel articles and opinion from all over Europe and beyond.

To finish, we would like to take this opportunity to give a huge thank you to everyone who has supported us and helped to make our first year such a successful one. Let’s make year 2 even better.

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sovape logoPress Release - Thursday, 24 September 2020

BVA-SOVAPE 2020 vape and nicotine survey

 

The results of the new BVA-SOVAPE survey show that most French people still have false perceptions of the risks of vaping and nicotine. This is detrimental to public health and, because there has been no public information campaign to redress it, has not changed since 2019. Sovape, public health experts, addiction experts and smoking cessation experts are sounding the alarm.

How many smokers are discouraged from quitting because of false beliefs about effective alternatives? The French population’s state of misinformation about vaping and nicotine, as revealed by the BVA survey commissioned by the SOVAPE association, is very worrisome. Only 8% of respondents know that vaping massively reduces the risks compared to smoking. 78% mistakenly believe that nicotine is carcinogenic.

This perception of risk, which is contrary to reality, is a brake on people using vaping and nicotine substitution to stop smoking. In the absence of an adequate information campaign by authorities, the situation has not changed significantly since the previous BVA-SOVAPE survey in 2019.

 

75% of French people do not know that vaping is less harmful than smoking.

According to a new survey conducted in early September 2020 by BVA (see the report on Sovape website):

    • Only 8% of French people know that vaping is much less risky than smoking (compared to 7% in 2019 - 1%);
    • Only 23% think that it is a little or much less risky (versus 25% in 2019 + 2%);
    • 58% think that vaping is as much or more risky as smoking (vs. 59% in 2019 - 1%);
    • And 18% say they don’t know (versus 15% in 2019 - 3%).

Overall, 75% of French people are still mistaken about the risks of vaping compared to smoking.

Professor Gérard DUBOIS, member of the National Academy of Medicine, comments: “That less than one in ten French people know that vaping is much less dangerous than smoking, that nearly 2 in 3 French people think that vaping is as dangerous as smoking, and that 3 in 4 French people are mistaken is the disastrous result of criminal misinformation regarding the leading preventable cause of death in the world. (…) Vaping is one of the means to fight against the leading preventable cause of death: smoking. It is understandable that huge financial interests are dismayed to note that despite their efforts, smoking prevalence is falling in France. There is no doubt that if smokers, who for the most part want to stop smoking, knew exactly what is what, the effects would be even more spectacular. These are therefore avoidable deaths that are happening, and this is why misinformation is criminal in this area.”

Jean-Pierre COUTERON, Spokesperson for the Addiction Federation, contextualises: “At a time when so many of our fellow citizens are weakened by the economic and social crisis which is added to the Covid health crisis, not giving them the right information about the help that vaping can bring and not encouraging registration in self-support groups is a serious mistake - in terms of public health as much as in terms of harm reduction.”

 

No change in nicotine misperceived as a carcinogen

According to the new BVA-SOVAPE survey, 78% of French people believe that nicotine is carcinogenic (-2% compared to 2019).

However, nicotine is not a proven carcinogen for humans. “It is important that appropriate information is given to legitimise the use of nicotine, the primary active ingredient in replacement substitutes for smoking cessation," said Antoine Deutsch, from the French National Cancer Institute (INCa), at the October 2019 Vape Summit1. Unfortunately, this essential message remains unheard, due to a lack of media coverage.

Professor Benoit VALLET, from the School of Public Affairs SciencesPo Paris, declares: “This ‘erroneous perception’ amongst the French, the existence of which is reinforced this year, now not only merits strong investments in prevention messages from our national agency, but also research efforts in the human and social sciences to better understand this lack of knowledge and how it is maintained. Has the “tobacco and addictions” health insurance Fund already addressed this serious issue?”

 

Disinformation: a Detrimental Evil to Public Health

More than 96% of unassisted quit attempts fail. Nicotine substitution doubles the chances of success. Vaping doubles the chances compared to pharmaceutical substitutes. The combination of these aids with peer-support group follow-up can further double these odds, according to SOVAPE’s survey conducted during Tobacco-Free Month 20172. A 38% success rate of cessation at five months was measured in the follow-up of participants in the self-help group for smoking cessation with vaping on Facebook, now called INFO-VAPE3. Participants in the group are almost ten times more successful than those attempting to quit without help.

In the field, the demonisation of nicotine is detrimental to the work of helping people to quit smoking.

Doctor Valentine DELAUNAY says: “While giving smoking-cessation guidance to people who have already tried to quit smoking several times, I find that these people are still as uninformed as ever. They don’t know that smoking with a nicotine patch is possible, that vaping is a safe and validated tool for quitting, that it can be safely combined with nicotine substitutes (NRT). Only a large scale and repeated, coherent information campaign delivering these few key messages can reassure and inform French smokers.”

Professor Jean-François ETTER, from the Faculty of Medicine of the University of Geneva, estimates: “These misperceptions have public health consequences: because of this, fewer smokers are giving up cigarettes and switching to lower-risk products. Correcting these misperceptions will require a long-term effort, which will include informing the public and professionals (health professionals, journalists, policy makers, etc.), training health professionals in particular, and allocating the necessary resources.”

 

Restoring the Truth: An Emergency and an Ethical Necessity

Nearly 75,000 people die from smoking-related diseases in France every year. Offering appropriate information to smokers to give them a chance to quit is an ethical necessity. Independent vaping professionals are banned from “advertising and propaganda” and cannot counterbalance smear campaigns. It is therefore up to the competent authorities to assume their responsibility in this matter.

Professor Antoine FLAHAUT, Director of the Institute of Global Health at the University of Geneva (Switzerland) says: “It seems to me that it is the primary responsibility of governments to recognise the harm reduction potential associated with the consumption of safer nicotine products and to promote them effectively to cigarette smokers. That 75% of French people still believe that the electronic-cigarette is no less harmful than the cigarette is a level of misinformation that is highly detrimental to the health of smokers. The learned societies, Santé Publique France, and the Ministry in charge of health should take up this issue, so that this trend is quickly reversed and so that the vast majority of French people understand that the consumption of safer nicotine products is infinitely less dangerous to health than smoked tobacco, because it is the tars and carbon monoxide (CO) produced by the combustion of tobacco that cause the cancers and cardiovascular diseases induced by smoking.”

However, since SOVAPE sounded the alarm in October 2019, no adequate information campaign has been undertaken on the subject. The Covid-19 epidemic has certainly created an exceptional situation, however, these circumstances should not aggravate the situation by abandoning other health issues, especially the main preventable cause of disease which is smoking. There is an urgent need to set the record straight and give smokers every chance to stop.

Jacques LE HOUEZEC, scientist, smoking cessation expert and trainer, concludes: “It is the burning that kills, not nicotine, and not even tobacco itself. Burning any plant produces the same toxins as burning a cigarette (tars, carbon monoxide, fine solid particles and oxidising gases). Instead of properly informing smokers about these simple and verified facts, anti-smoking campaigns have always wrongly blamed nicotine. The result is there to see, and it seems to me that it is even worse than it was a few years ago. The misinformation about vaping has undoubtedly and unduly reinforced fears for smokers and non-smokers alike. It is essential that correct and honest information be given to the population concerning nicotine and the tobacco harm reduction in general.”

 

Find Sovape’s full press release, all the reactions and BVA’s survey report at [access]

 

Sources 

(1) Videos from 3e Vape Summit, in French and in English [access]

(2) Report in french about vaping group during Mois Sans Tabac 2017 [access]

(3)INFO-VAPE website  [access]
     INFO-VAPE Facebook group [access]

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ETHRA has made a submission to the Netherlands Ministry of Health, Wellbeing and Sports’ public plain packaging consultation, which ended last Friday. The purpose of the draft legislation is to “set requirements by ministerial regulation for the standard packaging of cigars and electronic vapor goods.” If enacted the legislation will see plain packaging requirements, which are currently applied to combustible tobacco products, also applied to products which are far less risky to health, such as vaping products.

The rationale for the proposed legislation is the usual “think of the children” rhetoric, stating the need to protect young people from smoking. This is despite youth smoking rates continuing to fall in The Netherlands. Predictably, no thought has been given to the plight of smokers who could greatly benefit from switching to vaping products. Nor has consideration been given to the consequences of misleading smokers by requiring safer products to have plain packaging – and so implying that safer nicotine products are as harmful to health as combustible products.

This gross miscommunication of the relative risks of vaping compared to smoking will cause more smoking. If accepted, this legislation will set a dangerous precedent that could spread to the rest of the EU and so it should be strongly resisted.

 

ETHRA’s submission to verhittingsapparaten en standaardverpakkingen e-sigaretten en sigaren

Thank you for the opportunity to comment on these proposals. Our contribution outlines why applying neutral packaging to safer alternatives to smoking would be detrimental to Dutch public health.

First, a quick note about who we are: European Tobacco Harm Reduction Advocates (ETHRA)1 is a group of 22 consumer associations in 16 European countries, representing approximately 27 million consumers across Europe2 and supported by scientific experts in the field of tobacco control or nicotine research. We are mostly ex-smokers who have used safer nicotine products, such as vapes and snus, to quit smoking and to remain smoke free. We are very proud to represent Dutch consumers too, as Acvoda3 is one of our consumer group partners. ETHRA is not funded by the tobacco or vaping industry, in fact we are not funded at all as our grouping is a voice for our partners who arrange their own revenue and who give their time to ETHRA for free. Our mission is to give consumers of safer nicotine products a voice and to ensure that the full harm reduction potential of safer nicotine products is not hindered by inappropriate regulation.

We feel that the reasoning for these proposals4 as applied to safer alternatives to smoking are not underpinned by science.

The stated aim of the proposals is to protect young people from smoking and the explanatory note says that use of e-cigarettes by young people is “considerable”. However, the latest Trimbos data does not bear this out and we find it interesting that the explanatory note does not include this data. This, from Jongeren en riskant gedrag5 shows that youth vaping is actually in decline:

“Between 2015 and 2019 there was a decrease in the percentage of young people aged 12 to 16 who have ever used an e-cigarette; from 34% in 2015 to 25% in 2019.”

There is no evidence that vaping is leading young people to smoking, in the Netherlands or elsewhere. In the Netherlands youth smoking rates are low and continue to decline, from 2.1% in 2017 to 1.8% in 20196. In the USA, analysis of the most recent National Youth Tobacco Survey found that frequent use of vaping products was rare among never smokers. US youth smoking continues to drop, falling from 8.1% in 2018 to 5.8% in 20197.

The explanatory note states that e-cigarettes are harmful. This is highly misleading. It has been known for decades that people smoke for the nicotine but die from the tar8. Since the use of safer nicotine products doesn’t involve combustion, there is no tar. In fact, vaping is at least 95% less harmful than smoking9. A recent review10 from the UK’s Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) concluded that smokers who switch completely to vaping will get a substantial health benefit and that there is a considerable reduction in the risk of lung cancer due to lower exposure to harmful compounds.

The explanatory note states that the government does not consider e-cigarettes to be effective for smoking cessation. This is not correct as there is robust evidence showing that vaping leads to quitting smoking11 and smoking prevalence is dropping in countries where safer alternatives to smoking have been widely adopted12. In an analysis of 8 European member states, the Netherlands was found to have the best long-term quitting success rate for smokers using e-cigarettes13.

By seeking to solve a non-existent problem (youth vaping), the proposals fail to take the actual problem (adult smoking) into account. It is adult smokers who will be adversely affected by these measures. Adult smoking prevalence in the Netherlands is high, at 21.7%14. This 21.7% represents a lot of people who could benefit greatly from switching to a less harmful product. Adult smokers should be entitled to take steps to improve their own health but concealing and misrepresenting the safer alternatives will prevent them from doing that. Adult smokers are far more likely to suffer smoking related disease and death than young smokers and their interests should be taken into account. A focus on adult smoking also has benefits for youth, as youth are more likely to smoke if their parents smoke15.

Here we will outline why plain (or neutral) packaging for vaping products will deny adult smokers the right to improve their own health and so will prolong smoking.

Treating safer nicotine products in the same way as harmful combustible cigarettes sends the wrong message that the products are equally as harmful. This discourages people from switching, which results in more smoking. Tragically, the misperception that e-cigarettes are as harmful as combustible tobacco products is growing16 amongst smokers and the proposals in this bill will contribute to that.

E-cigarettes are new products and it is critical that adult smokers can be informed about these innovative products and receive non-misleading information about their risk in relation to combustible tobacco products. E-cigarettes are competing with combustible cigarettes, but it is not a level playing field: everyone already knows what combustible cigarettes are and how to use them.

Access to information about these new products is already restricted, as The Tobacco Products Directive (TPD) prohibits most forms of advertising. So, it is crucial that the product packaging can convey information and that consumers can see this information in order to choose which product to buy. E-cigarettes are much more complicated to use than combustible cigarettes and there are many different types, how can consumers use these safer alternatives without access to information about them? Ideally, smokers should be incentivised to use something which is better for them and it would be a win for public health if accurate evidence-based information could be communicated on product packaging17.

The TPD mandated health warnings which are displayed on vaping products hugely overstate the risks of using e-cigarettes and deter smokers from switching18. These off- putting health warnings will be even more prominent if the neutral packaging proposals are applied.

The justification for applying plain packaging restrictions to combustible cigarettes rests on the harms done by smoke and the high risks to health. There is no such basis for applying the restrictions to products which reduce harm.

As well as being inimical to public health we feel that these measures are unnecessary: there is already a ban on the sale of nicotine products to under 18’s and display bans are also in place.

We appreciate that there are concerns about youth initiation, but these concerns are not borne out by the evidence. The National Prevention Agreement is misusing the precautionary principle19 by seeking to protect youth from an illusory threat at the expense of adult smokers, for whom the harms are very real.

ETHRA is registered on the EU Transparency Register, registration number 354946837243-73

 

Sources

(1) European Tobacco Harm Reduction Advocates [access]

(2) Estimate of 27 million consumers provided by ECigIntelligence/TobaccoIntelligence. The actual figure is likely to be far higher because the data for smokeless tobacco is taken from research (Leon et al 2016) using data gathered in 2010 in only 17 countries

(3) Acvoda. Actief Voor Dampen [access]

(4) Verhittingsapparaten en standaardverpakkingen e-sigaretten en sigaren [access]

(5) Jeugd en riskant gedrag 2019, Trimbos Institute [access]

(6) Jeugd en riskant gedrag 2019, Trimbos Institute [access]

(7) Martin Jarvis, Sarah Jackson, Robert West, Jamie Brown. (2020). Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA? Qeios [access]

(8) Britton J. E-cigarettes and the precautionary principle. BMJ Opinion. 20 Sept 2019 [access]

(9) Public Health England, Evidence review of e-cigarettes and heated tobacco products 2018 A report commissioned by Public Health England, February 2018 [access]

(10) Committee on toxicity of chemicals in food, consumer Products and the environment. Statement on the potential toxicological risks from electronic nicotine. September 2020 [access]

(11) Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019 Feb 14;380(7): NEJMoa1808779 [access]

(12) Interview on Tobacco Products Directive: notes by ETHRA, pps 8-9 Impact of e-cigarettes on smoking cessation [access]

(13) Hummel K, Nagelhout GE, Fong GT, et al. Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis. 2018;16(Suppl 2): A6. doi:10.18332/tid/98912 [access]

(14) Cijfers roken, Trimbos Institute [access]

(15) Leonardi-Bee J, Jere ML, Britton J. Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis. Thorax 2011; 66:847-855 [access]

(16) Public Health England. Vaping in England: 2020 evidence update summary. March 2020 [access]

(17) Communicating the relative health risks of E-cigarettes: An online experimental study exploring the effects of a comparative health message versus the EU nicotine addiction warnings on smokers' and non-smokers' risk perceptions and behavioural intentions [access]

(18) Cox S, Frings D, Ahmed R, Dawkins L. Messages matter: The Tobacco Products Directive nicotine addiction health warning versus an alternative relative risk message on smokers’ willingness to use and purchase an electronic cigarette. Addict Behav Rep. 2018; 8:136-139 [access]

(19) The Counterfactual. Ten perverse intellectual contortions: a guide to the sophistry of anti-vaping activists. Clive Bates. April 2018. [access]

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Europe's Beating Cancer PlanBeating cancer plan2(EBCP) is a key EU initiative put in place to combat cancer, a leading cause of death in the EU, claiming an estimated 1.3 million lives each year. The initiative was launched on February 4th at an event in the European Parliament in Brussels, and includes two public consultations: the roadmap and a public consultation.

The roadmap, running from the 4th of February until the 3rd of March, invited feedback from stakeholders in the form of comment submissions. The public consultation, launched the same day but with a closing date of May 21st, was in the form of a structured questionnaire aimed more towards the general public. Responses to both consultations will be fed into a synopsis report which will be published alongside the draft cancer plan.

Speaking ahead of the launch, Health and Food Safety Commissioner Stella Kyriakides said: “The success of this plan will depend on the engagement of a wide range of actors. I hope that everyone will participate fully in this process and share their invaluable expertise, experience, and insight. We need everyone to contribute and ensure that our Plan is ambitious and far-reaching and has a concrete impact on the lives of our citizens.”

The importance of the project was underlined by the Commission President Ursula von der Leyen referring to the plan in her Political Guidelines for the Next European Commission: “As a physician, I am passionate about health. 40% of us will face cancer at some point in our lives and almost all of us will know the anxiety and grief of a friend or family member diagnosed with cancer. Survival rates are on the up, especially thanks to early detection and screening programmes. But there is a lot more we can do. I will put forward a European plan to fight cancer, to support Member States in improving cancer control and care.”

On September 10th, the Commission held a townhall meeting to provide an update on the findings and key messages of the EBCP to date. Whilst the meeting didn’t go into the finer details of the plan, what did become obvious was that cancer prevention will be a key factor in taking the plan forward in a progressive manner. This was not surprising as the Beating Cancer Plan factsheet states that four out of every ten cases of cancer are preventable, and von der Leyen had included prevention as a key element of the EBCP in her mission letter to Health Commissioner Stella Kyriakides.

Smoking is a leading cause of death and disease, yet it is in this area that we have clear evidence that preventative measures can work, through the adoption of safer nicotine products like snus and vaping products. It has been known for decades that people smoke for the nicotine but die from the tar. Since the use of safer nicotine products doesn’t involve combustion, there is no tar. You only have to look at the data from Sweden to see this in effect: not only does Sweden have a smoking prevalence that is almost at ‘smoke free’ status (<5%), Sweden also has the lowest rates of smoking related cancers and cardiovascular disease in Europe. This is largely due to the widespread use of snus, a product that is banned in the rest of the EU.

Equally, vaping has the potential to vastly reduce the burden on health from smoking. One of the key findings of Public Health England’s Evidence Review of e-cigarettes and heated tobacco products 2018 concluded: “the cancer potencies of e-cigarettes were largely under 0.5% of the risk of smoking”. The Royal College of Physicians also advised that smokers should be encouraged to switch to vaping, in their 2016 report, Nicotine Without Smoke.

These obvious solutions to the problem of smoking related cancers were reinforced in many of the submissions tBeating cancer plan1o the roadmap and to the public consultation.  Of the four hundred submissions received for the road map, one in six submissions suggested that tobacco harm reduction (THR) policies should be put in place, such as recommending vaping to smokers. And of the two thousand submissions received for the public consultation, one in five also supported the adoption of tobacco harm reduction policies

One notable contribution came from Dr Konstantinos Farsalinos, who said: “Smoking is the most important, preventable risk factor for cancer. Any strategy to combat cancer should address smoking as a priority. Currently available evidence is compelling in supporting the vastly lower cancer risk of electronic cigarettes compared to tobacco cigarettes, the efficacy of electronic cigarettes as smoking substitutes and the large benefits expected in the health of smokers who switch to electronic cigarette use.”

Another pertinent submission came from Clive Bates who said: “the strategy of tobacco harm reduction is highly promising and has emerged over the last ten years. This means the replacement of cigarettes with low-risk non-combustible nicotine alternative. This strategy is advancing as an innovation-led, consumer-driven response to the harms of smoking that commands significant support in the expert community.”

ETHRA also set out our position on what a successful cancer plan would look like: “Citizens will have access to evidence based information about Tobacco Harm Reduction and access to all Tobacco Harm Reduction products. A key example of this is that there remains a widespread misconception amongst smokers and health professionals that most of the harm of smoking comes from nicotine, which is deterring many smokers from trying safer nicotine products. Giving good information and access to products will reduce smoking related disease and death and will enable many to live longer and in better health.”

The last point made by ETHRA is especially relevant in today’s climate, where safer nicotine products are constantly demonised and where there is a constant bombardment of sensationalist news stories, based on what can only be described as junk science.

Given the volume of contributions and the high quality of supporting evidence calling for the implementation of THR policies to reduce smoking related cancers, together with the fact that the Commission identified prevention as a key area to take action on, it was disappointing that these points were not directly addressed by the panel during the town hall. Questions were put to the panel on three occasions, by participants using the chat feature, asking about THR measures that could massively reduce the burden on health from smoking, but these were not answered by the panel.

However, although these questions were not answered by the panel, other participants in the townhall took the opportunity to give their views on THR, and vaping in particular. One suggested that vaping does not help smokers to quit and cited an in vitro cell study recently presented by the European Respiratory Society, suggesting potential harms from vaping. The second reply referenced the cases of lung injuries in the USA last year, but seemed unaware that they were caused by vaping illicit THC laced with vitamin E acetate, a compound never used in nicotine e-liquids and already banned in the EU.

Fortunately, THR advocates were on hand to correct these misconceptions, pointing out that the evidence for vaping efficacy in smoking cessation is obvious from population based national surveys which record smoking and vaping prevalence, and is also evidenced by the fact that there are millions of vapers across Europe, the majority of whom are ex-smokers. Adding to that the results of a cell study are not comparable to the effects vaping has on whole body systems. The Town Hall meeting was not recorded but the chat conversation will be made a public document.

Tellingly, these messages highlighted perfectly the points raised by ETHRA and other THR advocates: that the dissemination of accurate information about safer nicotine products will be imperative if the EU wants to seriously reduce smoking related harms.

It is apparent that there is strong support for THR measures among academics and citizens. There is a growing body of evidence that clearly shows tobacco harm reduction products help smokers to quit and vastly reduce their exposure to cancer causing chemicals. For Europe’s Beating Cancer Plan to be a success, measures must be put in place that allow smokers to take control of their own health, which must mean championing, not demonising, the use of safer nicotine products.