Press Release - Friday, 26 June 2020
SOVAPE publish the first comprehensive document in France on vaping and smoking cessation during pregnancy
Smoking and pregnancy: should we really discourage vaping, at the risk of smoking?
In France more than half of pregnant women are unsuccessful in quitting smoking during their pregnancy. Faced with this major public health issue, SOVAPE have reviewed studies and scientific advice on the use of vaping as a tool to help quit smoking.
Difficult to stay the course among pregnant women
In conversation with INFO VAPE, a support group that is in daily contact with pregnant women, SOVAPE have noted recurring concerns about vaping. Those who smoke are discouraged from using vaping as an aid to quitting smoking, and those that have managed to quit by vaping are stigmatized, made to feel guilty, and “summoned” to stop vaping.
These “interventions” carried out by those around them, but also by doctors, midwives, obstetricians and gynaecologists, frequently lead to continued smoking or a relapsed to smoking. Why rule out one of the most effective smoking cessation tools available, when more than half (54.2%) of pregnant women who smoke are unsuccessful in their attempt to quit smoking by more traditional methods, according to data from Santé Publique France?
A document published today by SOVAPE, titled “Pregnancy and Vaping”, examines this issue. It is specifically intended for those women as well as their families and medical teams.
A review of studies available in 2020
In developing the document, SOVAPE has taken existing scientific literature, studies, and professional advice into account. As the inherent dangers of smoking are well established, adherence to precautionary principle clearly calls for the encouragement of pregnant women to stop smoking, which must include vaping.
A recent Cochrane review highlighted the influence of health professionals in attempts to stop smoking by pregnant women. When choosing nicotine substitutes and/or vaping, a significant psychological burden is placed on them. Discouraging the use of vaping, or even recommending its cessation, lessens the chances of successful cessation and can increases the risk of relapse for women who vape exclusively. The pressure exerted respects neither her freedom of choice nor the principle of "first do no harm".
A dangerous recommendation of the French National College of Gynaecologists and Obstetricians (CNGOF)
While carrying out our research SOVAPE discovered a CNGOF opinion piece published in January 2020. The document is of high quality when addressing the harms of tobacco, but it is problematic in that there is a lack of consideration of the available studies on vaping, and no differentiation is made between vaping products and tobacco products such as shisha and heated tobacco.
By recommending that women who have already stopped smoking by vaping should quit, the CNGOF contravenes the precautionary principle. This misguided recommendation greatly increases the risk of relapse to smoking, and in the opinion of SOVAPE, presents a clear danger to women and their children.
SOVAPE sent a letter to the CNGOF and its partners
SOVAPE sent a detailed letter to the CNGOF, as well as to the SFT (co-editor of the opinion), to Santé Publique France (patronage) and to all the organisations that co-signed the opinion piece. The consequences of making recommendations based on incomplete evidence is an increased potential for harm, as it could prolong smoking or cause relapse to smoking in women that had previously quit by using vaping. Considering the body of evidence, studies and expert opinion on this subject that have been neglected in the writing of the opinion piece, a re-examination of this piece is necessary. For the moment, one and a half months after this letter was sent, no organisation has responded.
Link to INFO VAPE [link]
French version of this press release [link]
Full publication of SOVAPE "Vape and pregnancy" [link]
Advice from Dr. Marion Adler, tobacco specialist in smoking cessation assistance for pregnant women at Clamart Hospital since 2001 [link]
Advice from Dr. William Lowenstein, President of SOS-Addiction [link]
ETHRA is delighted to publish this English translation of an article by Frank Baeyens, professor of psychology at the KU Leuven in Belgium and ETHRA scientific partner. This translation is for the French version, published in DH:
"Le gouvernement belge fait une grosse erreur en considérant que la cigarette électronique est aussi nocive que la cigarette classique"
A shorter Flemish version was published in HLN (paywalled): “KU Leuven-professor over anti-tabaksdag: "Cordon sanitair rond nicotine helpt volksgezondheid niet vooruit. Overheid moet e-sigaret actief promoten”
The Belgian government's huge mistake
For several years now the number of smokers appears not to have decreased in Belgium. The current anti-tobacco policy does not seem to be accelerating the trend. If the Belgian government really wants to reduce the number of smokers quickly it must dare to embrace a wider strategy, one which includes tobacco and nicotine products. Simply discouraging smokers is not enough, because the most inveterate smokers do not respond positively. To get smokers to change their minds the government must dare to actively promote attractive alternatives that are less harmful to health, and even dare to promote electronic cigarettes. Keeping a cordon sanitaire around the consumption of nicotine in any form does not advance public health. On this World No Tobacco Day let's focus on the main objective, which is to help people quit smoking, rather than making it an anti-tobacco day.
Everybody knows that smoking is bad for your health. Everybody also knows that it is very difficult to stop smoking, partly because of the dependence creating effects of nicotine. There are a multitude of methods for quitting smoking but the new principle of "Tobacco Harm Reduction" (THR) is often a successful strategy. This principle encourages smokers to replace their cigarettes with nicotine products that present a proven low health risk, such as electronic cigarettes, nicotine patches or other nicotine replacement products. The method aims to significantly and quickly reduce the risks associated with the most harmful effects of smoking (such as cancer, cardiovascular disease, lung disease and the psychological damage caused by stigma or discrimination). The rest is less important. The fact that people continue to use nicotine is certainly much less worrying since nicotine is far less harmful in itself.
For THR to become widely adopted, people who want to quit smoking must be able to trust the safety of alternative nicotine products and to see these products as attractive alternatives. It is therefore essential to be able to communicate accurate and balanced information on the relative benefits and risks associated with these products. It is also essential to have an evidence based policy that reflects the differences in risks. Finally, it is up to the informed smokers to weigh the pros and cons and to opt, if they wish, for these alternative products.
Currently, the policy pursued by Belgium is more or less opposed to the principle of THR. The Belgian legislator considers electronic cigarettes and other less harmful alternatives as "similar to tobacco products" and has subjected them to the same strict restrictions, notably with regards to advertising. The latest legislative proposals are also going in this direction since the proposals include plain packaging for vaping products, labelling warnings against potential risks and significant limits on flavours - including proposals to ban all flavours except for tobacco.
Treating tobacco products and less harmful alternatives as the same in legal and political terms is absolutely not a good thing. Firstly, it reinforces the false impression that these two products are equally harmful. Why would a smoker opt for electronic cigarettes if they appear to be as harmful as traditional cigarettes, with no positive effect on their health? Secondly, this type of restrictive policy does not encourage smokers to turn to electronic cigarettes. It is currently impossible to inform smokers about the positive aspects for health through advertising, the product will be made less attractive - according to the plans of some - through bans on attractive flavours and packaging, vapers can only vape in areas provided for that purpose, and no product can be purchased on the internet. The predictable consequence is that smokers will continue to smoke, with all the negative effects that this has on their health.
A THR strategy aims to convince smokers who have failed to quit, or who do not wish to quit any kind of nicotine use, to vape rather than smoke. Many people fear that the over-the-counter sale of electronic cigarettes with various flavours will attract a multitude of young non-smokers who would then become addicted and then opt for the traditional cigarette. However, there is no indication to that effect, neither in Belgium nor in neighbouring countries, and, contrary to the assertions of some, this is not the case in the United States either. Many young people try vaping once or a few times but few choose to vape daily. If some continue it is unfortunate but it is generally because they were already smokers or had smoked before.
We must also dare to ask this: is it such a bad thing if young people start vaping, or continue to vape, if the numbers of young smokers decrease considerably? In countries where vaping is on the rise, we are seeing an accelerated and drastic decline in the number of young people who smoke.
Finally, it would be presumptuous to insist that someone who started smoking after starting vaping did so because the electronic cigarette had pushed them towards traditional tobacco products. The fact is that people who are more likely to vape are also more likely to start smoking traditional cigarettes, regardless of whether they have ever vaped or not.
Policy makers who want to include low-risk nicotine products in tobacco legislation are seeking to prevent a hypothetical or virtual problem. This would not be such a bad thing if it did not hinder the search for a solution to the really big and actual problem: the minimal decline in the percentage of +/- 20% of Belgian smokers and the billion smokers worldwide. I therefore hope that in the future the Health Commission will develop legislation which gives pride of place to the principle of THR in the strategy of discouraging smoking. The methods and strategies of "classic tobacco control" are useful, but their effects come too little and too late for many smokers.
Frank Baeyens is professor of psychology at KU Leuven in Belgium
It has been reported that Germany’s federal drug commissioner is hoping to use her country’s imminent EU Presidency to further obstruct vaping products all over Europe.
Die Welt writes that Daniela Ludwig has identified an opportunity to transfer her distaste for reduced risk products to a wider audience as Germany takes up its six-month Presidency for the second half of 2020.
The 44-year-old politician from Rosenheim also relies on the European Union. Regulation is still different from country to country. From this summer, Germany will take over the EU Council Presidency. “We have the opportunity to talk to the countries about this. I would have already prepared a catalogue for the e-cigarette,” said Ludwig. For example, the rules on taxation or ingredients should be standardized.
The drug commissioner leaves no doubt about her overarching goal. "I want people to get away from the cigarette, whether it's a tobacco cigarette or some other product," said Ludwig.
Ludwig is in favour of both banning advertising of e-cigarettes and taxing liquids in Germany at the same rate as cigarettes, along with strictly restricting flavours, which are a vital attraction to vaping for former smokers.
This is despite a drug and addiction report of the Federal Government presented by Ludwig in 2019 concluding that e-cigarettes are significantly less harmful than smoking, and The Institute of Addiction Research at the University of Applied Sciences in Frankfurt declaring that the potential of e-cigarettes in Germany has been “massively underestimated”.
ETHRA is concerned at the possibility of damaging policies Germany’s Presidency may generate for vapers in EU member states and would hope that it uses its term of office wisely instead of installing naïve and unthinking regulation across the continent.
It should be noted that e-cigarettes have been regarded with suspicion by the German government, which boasts a smoking prevalence rate of 27.5%, exceeding that of states which liberally regulate vaping. Europe does not need to be lectured about e-cigarettes by Germany and the EU would be wrong to bind member states to counterproductive legislation on taxation, flavours and advertising with regard to safer nicotine products.
“It is disappointing that Ms Ludwig wishes to see failed policies from Germany transferred to the EU as a whole”, says Hendrik Broxtermann of ETHRA partner ExRaucher (IG), “Regulation of vaping under the current EU Tobacco Products Directive is not perfect but may just be acceptable. We should be seeking to improve the regulation we have by liberalising in some areas, not imposing more restrictions which can only protect the cigarette trade.
“Taxation of vaping products will deter millions of smokers from trying out safer products; banning or restricting flavours will take away a major factor in the appeal of vaping as a substitute for tobacco smoking; and banning advertising will make vastly safer products invisible to the very people who need to see them in order to facilitate more uptake for the good of Europe’s health.
"What Ms Ludwig should be doing is engaging with the people who use these products instead of pronouncing from an ideological position, while also ignoring her own scientific experts on the subject.”
The EU TPD review presents many threats to beneficial harm reduction options, so ETHRA would urge German vapers to petition their elected representatives to ensure that the German Presidency of the EU is used for good, not as an opportunity to put a halt to products which have led to significant declines in smoking in the EU.
Europe-wide consumer organisation launches manifesto on behalf of millions of former smokers
- European Tobacco Harm Reduction Advocates (ETHRA) – comprised of 21 consumer associations in 16 European countries – today launches a manifesto declaring the rights of safer nicotine users in Europe
- The manifesto is on behalf of 27 million grass roots consumers across Europe who have quit smoking using safer products such as e-cigarettes and snus
- The ETHRA Manifesto calls on policymakers to recognise the benefits of tobacco harm reduction in advance of World No Tobacco Day
DUBLIN, May 26th, 2020: Reduced risk products such as e-cigarettes and snus are providing a gateway out of smoking for millions of Europeans, yet across the continent, consumer access to these products is being denied or is under threat. Today sees the launch of the ETHRA Manifesto, a document written by consumers to promote appropriate regulation of innovative solutions for people who wish to continue using nicotine in far safer forms than smoking tobacco, as well as on behalf of the many smokers who may be able to quit through switching to these products in the future.
Tobacco harm reduction refers to public health and other evidence-based policies, designed to lessen the negative social and/or physical consequences associated with smoking. It endorses the use of novel nicotine products and supports research into their safety and efficacy.
The 21 partners of ETHRA – representing millions of consumers in 16 countries – urge the EU, the WHO, and governments in Europe and beyond to consider these important principles when forming their policies.
Access to harm reduction, including tobacco harm reduction, must be recognised as a human right.
Consumers of safer nicotine products must be recognised as essential stakeholders in discussions of policy.
Regulation for safer nicotine products must reflect the risks relative to the risks from smoking.
Regulators must recognise that having a wide choice of products and flavours is key to the success of safer nicotine products in enabling people to stop smoking.
Regulation must consider the harm to adults when considering bans intended to protect youth.
Tax policy must take into account that high taxation of safer nicotine products increases rates of smoking.
Tobacco harm reduction is facing challenging times in Europe, as the review of the EU Tobacco Products Directive is already underway and the WHO’s Conference of the Parties will be held in the Netherlands next year. Consumers fear that both organisations are seeking to implement policies which would severely damage the progress of safer nicotine products which have had such a dramatic beneficial impact on the lives of millions of Europeans.
ETHRA is concerned that policies towards prohibiting flavours in reduced risk products, restricting publicity of far safer alternatives to combustible tobacco - and many more legislative burdens on smoking substitutes - are being considered by policymakers based on nothing but ill-informed ideology and cherry-picked research.
“Regulators should be aware of the overwhelmingly beneficial effect of reduced risk nicotine products to attract smokers away from lit tobacco” said Rob de Lange of ACVODA, a Dutch consumer association and partner of ETHRA, “Smoking rates in countries which regulate alternative nicotine products sensibly have collapsed, yet consumers are constantly fighting against public health organisations who seem to favour an ill-informed precautionary approach which can only perpetuate smoking and protect the most harmful nicotine delivery system of all, the cigarette”.
Peter Stigaard, of Danish consumer association DADAFO said “Tobacco harm reduction has been an unprecedented success story in enlightened European states, yet the EU and the WHO appear eager to wind back the clock and impose harsh and ill-conceived restrictions on products which are saving lives.”.
Issued on behalf of European Tobacco Harm Reduction Advocates
Note to Editors: ETHRA has been formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation. ETHRA aims to represent the interests of nicotine consumers across Europe and to spread the word into states which are still sceptical about the benefits of harm reduction.
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.
ETHRA manifesto, available in 14 languages
EU attitude towards safer nicotine products is regressive
European Commission compares e-cigarettes to ‘poison’, EURACTIV.com
WHO Q&A on vaping is criticised by scientists
WHO warning on vaping draws harsh response from U.K. researchers, ScienceMag