Session 4:Tobacco control and regulation Seminars

The EU Tobacco Products Directive was a milestone in tobacco control, covering everything from tracking and tracing of tobacco products to banning flavours in cigarettes, large pictorial health warnings on cigarette packs to regulation of e-cigarettes. But the in the years since the TPD came into force in May 2016 it has become clear that a review of the regulations is needed, particularly with respect to e-cigarettes and novel nicotine products. There are loopholes in the legislation which are being exploited by the tobacco industry. The evidence is growing that e-cigarettes can help smokers who can’t or don’t want to quit using nicotine, to stop smoking and stay quit, thereby significantly improving their health and wellbeing. This is a major public health benefit which needs to be sustained. However, just as crucially all novel nicotine products need to be regulated to minimise the risk of youth uptake. This presentation sets out ideas for how the regulations should be revised in the light of these two objectives.

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THE WHO FCTC and the associated MPOWER package of interventions provide a comprehensive approach to tobacco control including, at least in theory, tobacco harm reduction. Implementation of these interventions has been limited particularly for the most effective measures such as excise tax increases and comprehensive bans on advertising and sponsorship. Even in countries which have fully implemented WHO’s recommendations marked failures in tobacco control are evident. For example, in New Zealand which has for three decades been progressively implementing WHO recommendations, inequalities in cigarette smoking rates have not been reduced and adult daily cigarette smoking rates are 13%. The enormous potential of tobacco harm reduction has not been realized. In part, this is because of divisions within the tobacco control community and fears of youth vaping. New Zealand vaping legislation was passed in August 2020 and, despite several limitations, has the potential to accelerate progress toward New Zealand’s ambitious, but achievable, Smokefree 2025 goal with <5% of adults smoking cigarettes a daily. The New Zealand experience provides lessons for countries at all stages in their efforts to reduce the dreadful burden of death and disease caused by cigarette smoking, especially the need for evidence-based tobacco harm reduction strategies.

Several countries have proposed 'smokefree targets', including New Zealand and Ireland, which set their goals for 2025. They are certain to fail.  England has recently made a commitment "to make smoked tobacco obsolete by 2030". Someone now has to fill in the blanks: what should be done to bring this about? Imagine if everyone involved was paid by results and their livelihoods depended on meeting the goal. Imagine too that they had permission to take heretical measures? What would they do? Maybe a grand masterstroke like a cigarette prohibition or an aggressive reduced-nicotine rule?  Or maybe something smarter than that? This presentation takes a look at the playbook.

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As the U.S. election is underway and we wait to hear if there is a new Administration / Congressional leadership, this session will explore the material implications for tobacco control and public health policies that would result. With election results for both branches of government likely to remain in flux for weeks, there is one political truth that holds to be self evident regardless of electoral outcome: Democrats in all levels of government routinely turn to the Campaign for Tobacco-Free Kids and Bloomberg Philanthropies for guidance on how to approach tobacco policy issues. These two non-profits are held in high regard as deeply trusted partners by virtually all Democrats, and actively encourage policymakers to advance universal flavor bans, increased taxes, and nicotine caps in all tobacco products. This means that wherever we find Democrats in power, we need to contemplate these suite of policies as real possibilities; whether that’s in the White House, Congress, state legislatures, or state administrations.

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Implementation of the PMTA deadline, and continuing regulatory pressure in areas of policy such as flavours and youth access to vaping products have been discussed widely in the media and resulted in a huge amount of regulatory change in the US. But what implications does all this have on regulation in other global markets, including Europe where discussions are about to start on a revision of the Tobacco Products Directive? And how has the market reacted to the changing legal landscape? As we look ahead to a new market environment where other reduced risk products are being offered to consumers such as heated tobacco and nicotine pouches, how does the changing market for combustible alternatives affect development of policy and regulation in this area?