Tuesday 7th December 2021 Seminars

09:00 - 09:30

Pre Summit Interview

An exclusive interview between investigative reporter Marc Gunther and Dr Colin Mendelsohn, discussing the story and message behind Dr Mendelsohn’s new book “Stop Smoking, Start Vaping - The Healthy Truth about Vaping".  This new book aims to dispel the myths about vaping and outlines the evidence in an easy-to-read and authoritative manner with over 400 scientific references. It also provides step-by-step advice on how to make the switch from smoking tobacco, and why vaping is controversial.

"Stop Smoking, Start Vaping" will publish on 29 November

Dr Colin Mendelsohn is one of Australia's leading experts on smoking and vaping and the Founding Chairman of the Australian Tobacco Harm Reduction Association charity (ATHRA) and is a member of the committee that develops the RACGP national smoking cessation guidelines.  He was a Conjoint Associate Professor in the School of Public Health and Community Medicine at the University of New South Wales, Sydney.

Marc Gunther is a veteran journalist, speaker and writer who reported on business and sustainability for many years. Since 2015, he has been writing about foundations, nonprofits, psychedelics, animal welfare, global poverty and many other things on his blog, Nonprofit Chronicles and at Medium.  His criteria for investigation includes  (1) Is it important? (2) Is it being covered well by others, i.e., do I have something to contribute? (3) Can my coverage in some way, big or small, make a difference?"

Speakers

10:00 - 10:10

Welcome from the Chair

Chair

  • Prof Ann McNeill Professor of Tobacco Addiction - Institute of Psychiatry, Psychology & Neuroscience,, Kings College London
10:10 - 10:25

OPENING KEYNOTE: What will success look like?

The  public health tobacco goal is to prevent early death and disease caused by burnt tobacco products, especially cigarettes. The WHO Framework Convention on Tobacco Control  (FCTC), which came into force 15 years ago, is central to this endeavour. A first step is for all countries to ensure the effective and equitable implementation of the FCTC, as summarised by the MPOWER interventions. However, this alone is insufficient. Even where these interventions have been fully applied such as in New Zealand and Australia, smoking rates are falling only slowly and most of the progress has occurred in privileged sections of society further marginalising the most vulnerable. The second step is for all countries to embrace tobacco harm reduction (THR) alongside traditional approaches. Innovations in the delivery of nicotine such as e-cigarettes and heat not burn products offer an opportunity to accelerate THR progress. Sweden, with the widespread use of snus and now the lowest rate of smoking in the world, provides proof of the value of THR. Regrettably, the widespread adoption of THR is facing many impediments, notably from WHO and well-funded advocacy groups guided by poor quality science. Success will involve: full implementation in all countries of all available interventions, including THR, with WHO providing evidence-based technical leadership and facilitating dialogue rather than encouraging prohibition of less harmful products. The short-term  measure of success will be for all countries to match the successes of the best performing countries and achieve a very low adult prevalence (<5%) of cigarette smoking by 2040.

Speaker

  • Prof Robert Beaglehole Emeritus Professor - University of Auckland, New Zealand & Chair ASH - Action for Smokefree 2025, NZ
10:25 - 10:40

Depolarizing E-Cigarette Research: The need for epistemic humility

Science is a social activity embedded within a complex research ecosystem, and conducted by highly-trained individuals who are nevertheless human. There are therefore external and internal factors – incentives and cognitive biases – that can shape the behaviour of scientists, the questions they ask, the methods they use, the analytical choices they make, and the conclusions they draw. The factors may be particularly important in research areas where there is considerable uncertainty, and where personal values may come into play. Understanding the nature and impact of these factors, and developing frameworks for arriving at consensus, will be important if we are to make genuinely evidence-based policy recommendations.

Speaker

  • Professor Marcus Munafò Professor of Biological Psychology and MRC Investigator - School of Psychological Science, University of Bristol
10:40 - 10:55

Do e-cigarettes help people quit smoking? A plea to focus on the evidence

Cochrane is a global non-profit, known for producing unbiased and high-quality reviews of healthcare evidence. The Cochrane review of e-cigarettes for smoking cessation was first published in 2014 and has been updated four times since then. Every update brings more evidence showing that e-cigarettes can help people quit smoking, but disagreements persist on interpretation of this evidence base. Perceptions of uncertainty regarding the effectiveness of e-cigarettes for smoking cessation can have wide reaching consequences.

Speaker

  • Dr Jamie Hartmann-Boyce Managing Editor, Cochrane Tobacco Addiction Group & Senior Research Fellow - University of Oxford
10:55 - 11:10

The need to unbias the application of competing interest principles in e-cigarette research

Every researcher can be potentially motivated by factors other than an objective search for truth. The clinical research community has addressed some of these factors by requiring declarations of competing interests. These mostly focus on financial links with companies that may stand to gain or lose from findings or views being presented. The rules are important but, like most rules, they need to be applied diligently and fairly if they are not to do more harm than good. In the field of e-cigarette research, this presentation will argue that unfair application of the rules is leading to significant bias. On the one hand, acceptance by researchers of research products from e-cigarette companies with no financial gain to researchers is judged by opponents of e-cigarettes as grounds for disregarding findings and heaping opprobrium on the researchers concerned. On the other hand acceptance of career-enhancing grants from organisations that are strongly opposed to e-cigarettes does not appear to be regarded as an issue. In this way, competing interest principles are arguably being weaponised in what some regard as a war on tobacco users rather than a war on tobacco. The application of competing interest principles needs to be scrutinised by the scientific and public health community to achieve balance

Speaker

11:10 - 11:25

AM BREAK

11:25 - 11:40

Could e-cigarettes contribute to harm reduction for children as well as adults?

Current policy approaches to e-cigarette regulation in the USA give primacy to the need to protect children from addiction over fostering increased adult smoking cessation.  But, as well as failing to maximise the potential public health gain from adult use of new nicotine delivery products, the focus on minimizing children’s use of e-cigarettes might itself be a net contributor to harm at the population level, by inadvertently favouring the incumbent cigarette and hampering the transition to genuinely reduced risk alternatives.

This talk will give data from the Youth Risk Behavior Survey, conducted on a national sample of high school students in the USA, on risk behaviours in a number of domains, including drug use, violence, sexual behaviour, psychological wellbeing, and school attendance and performance.  Current use of e-cigarettes and cigarettes are both associated with the whole range of problem behaviours, with the association being stronger for cigarettes than for e-cigarettes.  Causal pathways between different behaviours cannot be identified, but the occurrence of any one behaviour tends to be positively associated with all of the others, lending support to the notion of shared vulnerability factors, the so-called common liability hypothesis.   On this model, the rise in popularity of e-cigarettes to overtake cigarettes among youth is better understood as product substitution, rather than as a concerning new risk for enticing otherwise innocent youth into cigarette use and nicotine addiction.

The talk will also update information from the National Youth Tobacco Survey on nicotine dependence in youth e-cigarette and cigarette users.  It remains the case that indicators of dependence are highest in those who smoke cigarettes, and considerably lower in e-cigarette users.  In 2020 only 254,000 (2.3%) of otherwise tobacco-naïve high school students used e-cigarettes on 20 or more days in the past month.   The estimated overall population burden of nicotine dependence in youth has decreased between 2012 and 2020.

Speaker

  • Prof Martin Jarvis Emeritus Professor of Health Psychology, Department of Behavioural Science & Health - University College London
11:40 - 12:10

Panel discussion and live Q&A

Is scientific evidence underpinning the THR dialogue or is ideological opposition influencing the debate?

 

 

Chair

  • Prof Ann McNeill Professor of Tobacco Addiction - Institute of Psychiatry, Psychology & Neuroscience,, Kings College London

Speakers

  • Prof Robert Beaglehole Emeritus Professor - University of Auckland, New Zealand & Chair ASH - Action for Smokefree 2025, NZ
  • Professor Marcus Munafò Professor of Biological Psychology and MRC Investigator - School of Psychological Science, University of Bristol
  • Professor Robert West Professor Emeritus of Health Psychology - University College London
  • Dr Jamie Hartmann-Boyce Managing Editor, Cochrane Tobacco Addiction Group & Senior Research Fellow - University of Oxford
  • Prof Martin Jarvis Emeritus Professor of Health Psychology, Department of Behavioural Science & Health - University College London
12:10 - 12:50

LUNCH

12:50 - 12:55

Introduction from the Chair

Chair

12:55 - 13:10

Is there a place for low-risk nicotine ‘alternatives’ on the market when smoking is about to disappear?

In some countries, like Norway and Sweden, the level of smoking has reached a minimum – in particular among young adults below the age of 25 where the prevalence of smoking is approximately 2%. Availability to snus in combination with a robust infrastructure for tobacco control are the main reasons. In these markets snus has displaced cigarettes and ever-smokers has made up the majority among snus users. When smoking is about to be eradicated, the largest reservoir of potential snus users – the smokers - will decrease. As a consequence, the future prevalence of snus users will probably decline. However, the decimation of smokers will subsequently also change the user configuration of snus. Never smokers will eventually make up the majority, and – if large enough - tip the net effect on public health effect from positive to negative. In such a situation, the harm reduction function of snus - and e-cigarettes – will be reduced. Still, availability to these products may deter tobacco prone youth in future generations from taking up cigarettes – provided that hunger for nicotine will exist in future generations. I will present the recent trends on tobacco use in Norway and discuss how the new situation will challenge the narrative of THR.

Speaker

13:10 - 13:25

The tobacco control climate in Germany

The prevalence of tobacco smoking in Germany is still at a very high level (nearly 30%), and the use of alternative nicotine delivery systems (ANDS) has been increasing in the population. The World Health Organisation (WHO) recommends monitoring the use of tobacco and ANDS on a national level to support implementation of the WHO Framework Convention on Tobacco Control and reduce tobacco-related harm. The DEBRA study (German Study on Tobacco Use) addresses this recommendation by tracking key variables of patterns and trends in the use of tobacco and ANDS in Germany. Furthermore, the study collects data on relevant associated factors, such as socioeconomic background, alcohol consumption, and mental health.  This session will explore attitudes towards e-cigarettes by medical/public health organisations and the evidence- and consensus-based view towards harm reduction according to the recently updated German clinical guidelines for treating tobacco. It will provide contextual data on the use of tobacco and ANDS and provide a future outlook, including the strategy for a smoke-free Germany 2040.

Speaker

  • Prof Daniel Kotz Professor in addiction research and clinical epidemiology, Institute of General Practice - Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany
13:25 - 13:40

Reconsidering the meaning of tobacco harm reduction

Definitions of THR have evolved since the late 70s and more recently includes targeting people who cannot or don’t want to quit nicotine. Those who cannot or do not want to quit nicotine tends to be people with mental health and substance use problems, but also those in routine and manual occupations, those living in social housing and in certain geographical locations.  There are several challenges and opportunities relating to THR and this presentation will highlight a few of these, such as the need to reconsider how we measure THR, how we incorporate and prioritise what outcomes matter most to people who smoke or vape. The discourse around THR needs to evolve and expand rather than be constricted or silenced.

Speaker

  • Dr Debbie Robson RMN, PhD Senior Lecturer in Tobacco Harm Reduction - National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
13:40 - 13:55

Australia doubles down on its e-cigarette sales ban

Australia is one of the only English-speaking, high-income countries that has banned the sale of e-cigarettes as consumer products. Until 1 October 2021, smokers could legally import nicotine for personal use with prescription. Most smokers imported nicotine illegally because very few doctors were prepared to prescribe nicotine. The use of e-cigarettes increased among Australian smokers and adolescents despite the sales ban prompting a tougher enforcement of the sales ban. Since 1 October 2021 smokers who import nicotine without a script may face up to a $200,000 fine and imprisonment. This policy has been justified by giving an absolute priority to protecting youth from a ‘vaping epidemic’ that has supposedly occurred. I make some predictions about how the policy may work and what its likely effects will be on Australian vapers and smokers who want to use e-cigarettes to quit smoking.

Speaker

  • Prof Wayne Hall Professor Emeritus, National Centre for Youth Substance Use Research - The University of Queensland
13:55 - 14:10

The new tobacco wars

What hostile and supportive forces are bearing on the transitions to low-risk alternatives to smoking? Are we about to squander the opportunity to avoid millions of premature deaths and cases of disease through a dogmatic refusal to embrace innovation and harm reduction? Or will the fundamentals of risk and personal agency and autonomy ultimately prevail?  An epic battle is underway between the Public Health establishment and the public's health. How will it play out?

Speaker

14:10 - 14:45

Panel discussion and live Q&A

Does tobacco harm reduction (THR) compliment or undermine core tobacco control principles?

Chair

Speakers

  • Dr Karl E. Lund Senior Researcher - Norwegian Institute of Public Health
  • Prof Daniel Kotz Professor in addiction research and clinical epidemiology, Institute of General Practice - Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany
  • Prof Wayne Hall Professor Emeritus, National Centre for Youth Substance Use Research - The University of Queensland
  • Dr Debbie Robson RMN, PhD Senior Lecturer in Tobacco Harm Reduction - National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
  • Clive Bates Director - Counterfactual Consulting Ltd
14:45 - 15:00

PM BREAK

15:00 - 15:05

Introduction from the Chair

Chair

  • Martin Dockrell Tobacco Control Programme Lead - Office of Health Improvement & Disparities (OHID)
15:05 - 15:20

MHRA Regulatory Update

The MHRA is the competent authority for a notification scheme for e-cigarettes and refill containers in Great Britain and Northern Ireland and is responsible for implementing the majority of provisions under Part 6 of the Tobacco and related Products Regulations (TRPR) and the Tobacco Products and Nicotine Inhaling Products (Amendment) (EU Exit) Regulations 2020.  The TRPR introduced rules which ensure i) minimum standards for the safety and quality of all e-cigarettes and refill containers (otherwise known as e-liquids) ii) that information is provided to consumers so that they can make informed choices and iii) an environment that protects children from starting to use these.  This session will present recent data and insight in to what the MHRA does and how they do it.  Specifically focussing on: I) Post Brexit E-cigarette notification systems, requirements and challenges in the UK  II) Overview of E-cigarette Yellow card data 2016-2021  III) Disposable E-cigarettes products and compliance with UK notification requirements  IV)  Supporting enforcement in a multi-agency framework.

Speaker

  • Craig Copland E-Cigarette Unit Manager - Vigilance and Risk Management of Medicines - MHRA - The Medicines and Healthcare products Regulatory Agency
15:20 - 15:35

The challenge of e-cigarette enforcement

Weights and Measures Authorities in Great Britain have a duty to enforce the Tobacco and Related Products Regulations 2016 and Local Authorities have a duty to consider a programme of enforcement in relation to the Children and Families Act 2014 (prohibition of sale of nicotine products to under 18s). Trading Standards Officers are therefore in principle responsible for protecting the front line between illegal product and (potentially vulnerable) consumer as well as ensuring a level playing field and fair trading environment. But there are ever decreasing numbers of Trading Standards Officers and at least 250 different pieces of legislation to enforce – so how do the protectors decide who or what to protect? How do they prioritise the greatest threats and risks? This session looks at the current challenges for enforcement and the impact this has on manufacturers, retailers, consumers and children

Speaker

  • Kate Pike Co-ordinator - Trading Standards North West - Member of the Department of Health and Social Care National Tobacco Focus Group
15:35 - 15:50

A stitch in time: safeguarding UK market from youth uptake

While youth use of e-cigarettes remains low in the UK, particularly among those who have never smoked, but it could still be lower and there are straightforward ways in which we can strengthen our existing protections.  Avoiding uptake among young people is an important part of a balanced approach to regulation of e-cigarettes. It ensures that young people are protected from potential of harm while ensuring health professionals and others have confidence in promoting products to the smokers who need them. Current loopholes in our laws, such as the ability to hand out free samples to children, and opportunities to ensure packaging does not exacerbate appeal to young people can sensibly reduce the risk of growing youth uptake and preserve the market for smokers who would benefit from switching.

Speaker

  • Hazel Cheeseman Deputy Chief Executive & Policy Director - ASH (Action on Smoking & Health)
15:50 - 16:05

Balancing regulation to achieve intended consequences

Thoroughly evaluating where the regulatory sweet spots lie requires careful critical thinking if the desired outputs, net of unintended consequences, are to be delivered.  All too often, there is inadequate thought given to explore the potential for unintended consequences of regulation, which at face value aim to focus on consumer harm reduction, but often without the nuances that the real world brings.  In this presentation, I will outline some of the more topical areas of regulatory discussion; from flavour bans, to plain(er) packaging, and to advertising and youth vaping, including the use of retail-based EPOS data. In doing so I hope to give a perspective on where sweeter areas may lie. 

Speaker

  • Marcus Saxton Chairman - Independent British Vape Trade Association (IBVTA)
16:05 - 16:20

Unintended market consequences from the regulation of vape products in the US, and the prospects for future regulation in Europe

The vape category is subject to differing regulation across the world, with many governments becoming more restrictive towards the category in the last few years. It is only recently that we have enough data in this very fragmented sector to show clear correlations between the adoption of a restrictive policy and the market and consumer changes which result. I will present our market data in the US showing clear growth in flavoured disposable vape products and synthetic nicotine which correlate to restrictions imposed on flavoured pod products and an increasingly negative outlook for the PMTA process. In Europe, I will present similar data showing market responses to the restrictions brought in by the Tobacco Products Directive. In addition, I will show some initial output from our second survey of European Parliament MEPs to demonstrate their understanding of and attitude towards new nicotine products in the lead up to being asked to vote on policy which will hugely affect the category in the EU in the years to come.

Speaker

  • Tim Phillips Managing Director - ECigIntelligence/TobaccoIntelligence
16:20 - 16:55

Panel discussion and live Q&A

Has the UK created a perfect template for e-cigarette regulation, will other countries follow?

Chair

  • Martin Dockrell Tobacco Control Programme Lead - Office of Health Improvement & Disparities (OHID)

Speakers

  • Craig Copland E-Cigarette Unit Manager - Vigilance and Risk Management of Medicines - MHRA - The Medicines and Healthcare products Regulatory Agency
  • Kate Pike Co-ordinator - Trading Standards North West - Member of the Department of Health and Social Care National Tobacco Focus Group
  • Hazel Cheeseman Deputy Chief Executive & Policy Director - ASH (Action on Smoking & Health)
  • Marcus Saxton Chairman - Independent British Vape Trade Association (IBVTA)
  • Tim Phillips Managing Director - ECigIntelligence/TobaccoIntelligence