The World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) is an international treaty that aims to reduce the demand and supply of tobacco. It entered into force in February 2005, and as of 2023, there are 183 Parties to the treaty.¹

Article 3 of the WHO FCTC establishes that “the objective of this Convention and its protocols is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke”.²

What is the endgame?

The tobacco ‘endgame’ is the concept of moving beyond a focus on tobacco control, towards implementing policies and strategies that could phase out tobacco products entirely.³ According to Cancer Research UK, among others, this would require systemic changes, including:

“initiatives designed to change/eliminate permanently the structural, political and social dynamics that sustain the tobacco epidemic, in order to achieve within a specific time an endpoint for the tobacco epidemic.” ⁴⁵

This could involve the reduction of prevalence of smoking to – or very close to – zero.

Policy Options

Research conducted into potential endgame strategies has identified plausible new policies for reducing smoking to minimal levels. These include:

• A tobacco-free generation policy, which precludes the sale and supply of tobacco to individuals born after a certain year⁶⁷
• A ‘sinking-lid’ strategy, which involves establishing steadily decreasing quotas on the sales or imports of tobacco products⁶⁷⁸
• Substantially reducing the number of tobacco product retailers, which could include restricting retailer density, location, type, or licensing, or restricting tobacco sales to government run outlets⁶⁷⁹¹⁰
• Mandating low-nicotine levels in tobacco products⁶¹¹
• Banning the sale of one or more tobacco products¹⁰⁶
• Shifting control of the supply and distribution of tobacco products away from tobacco companies³¹²

Implementation of endgame policies

National goals and policies

The first countries to propose tobacco endgame goals, and start developing legislation to achieve these targets, were Finland,¹³¹⁴ New Zealand,¹⁵ Ireland,¹⁶ Scotland,¹⁷ Sweden¹⁸ Canada,¹⁹²⁰ and Malaysia.²¹ Other countries that have more recently adopted endgame goals include the Netherlands,²²²³ Australia,²⁴ and the UK.²⁵ Typically, the goal is to have a smoking prevalence of less than 5% of the population.

As of 2023, the Campaign for Tobacco Free Kids (CTFK) policy database shows that 13 countries have banned the sale of waterpipe tobacco products, and 19 countries have banned the sale of smokeless tobacco products.²⁶ A review carried out in 2020 showed that 40 countries had active or pending flavoured tobacco product policies that ranged from banning flavoured tobacco, to banning flavour descriptors and images on packaging.¹⁰²⁷ No countries have yet implemented mandatory denicotinisation, substantial retailer reductions or the sinking lid strategy at a national level.

In 2010, Bhutan was the first country to ban the sale, manufacture and distribution of tobacco products.²⁸ However, the legislation was reversed in 2021 due to concerns that increased tobacco smuggling could result in cross-border transmission of COVID-19.²⁸

Subnational policies

Several US cities have also implemented endgame strategies. Brookline, Massachusetts introduced a generational tobacco ban in 2021 which prohibited the sale of tobacco products and e-cigarettes to anyone born after 1 January 2000.²⁹³⁰ Despite litigation brought by retailers in Brookline, which argued that the policy was pre-empted by state law, the Massachusetts Supreme Judicial Court upheld the generational ban in 2024.³¹ Some cities in California have prohibited the sale of tobacco and nicotine products within their jurisdictions,³² and others have restricted the number or types of retailers permitted to sell tobacco products.³³

In 2016, Balanga City in the Philippines banned the sale and use of all tobacco and nicotine products to those born after 1 January 2000. It also expanded the coverage of an existing smoking ban in the city’s University Town to cover a wider radius. However, both measures were overturned in 2018 after the tobacco industry pursued litigation.³⁴³⁵

Tobacco industry interference

As of 2023, Malaysia, New Zealand and the UK are the only countries that have announced plans to adopt a generational endgame policy. New Zealand also proposed introducing mandated denicotinisation and substantial retailer reduction.

Tobacco industry interference to prevent, delay or undermine the legislation has been observed in each of these countries, and is detailed below.

Malaysia

Proposed legislation

In 2022, Malaysia proposed the ‘Control of Tobacco Products and Smoking Bill 2022’ which aimed to phase out tobacco products and e-cigarettes by introducing a generational endgame policy, prohibiting their use and sale to everyone born on or after 1 January 2007.³⁶

However, when the latest version of the bill was tabled in 2023, the generational ban clause was omitted for all products.³⁷

Interference from industry and associated organisations

Prior to the bill being tabled, several organisations lobbied against the inclusion of e-cigarettes in the generational endgame policy.³⁸³⁹⁴⁰ One of these organisations, the Malaysian Vapers Alliance (MVA), is a member of the World Vapers’ Alliance,⁴¹ which has received funding from the Consumer Choice Center and BAT. The MVA urged the government to exclude e-cigarettes from the generational ban, and stated that it had conducted a survey of 5000 adult vape users, 96.6% of which did not agree with the ban.⁴²

When the generational endgame clause was removed from the bill, Malaysia’s former health minister stated that this was due to strong lobbying from tobacco companies.³⁷ According to local advocates the bill had seen an “unprecedented level of industry interference, some of which have been done in clear violation of the WHO Framework Convention on Tobacco Control”.⁴³

It is not clear what actions were taken by the tobacco industry to oppose the bill, however industry interference in government activities in Malaysia is high, and has continued to rise in recent years.⁴⁴⁴⁵

New Zealand

Proposed legislation

In December 2022, as part of its ‘Smokefree Aotearoa 2025 Action Plan’,⁴⁶ New Zealand passed the ‘Smokefree Environments and Regulated Products’ Amendment Act’ into law, which would have implemented several tobacco endgame policies.⁴⁷ The legislation included three key approaches: a ban on tobacco products being sold to anyone born on or after 1 January 2009, a significant reduction in the amount of nicotine permitted in tobacco products (an 0.8mg/g nicotine limit, compared to 15-16mg/g present in full strength cigarettes), and a huge reduction in the number of retailers allowed to sell tobacco products across the country (from 6000 to 600).⁴⁷⁴⁸

The legislation was due to be implemented progressively starting with the reduction in retailer numbers from July 2024, however in November 2023, as part of an agreement between parties forming a new coalition government, it was announced that all three endgame proposals would be repealed. The new finance minister stated that the additional tobacco tax revenues resulting from repealing the smokefree legislation would be used to finance tax cuts promised during the election campaign.⁴⁹⁵⁰ The repeal was later confirmed in February 2024.⁵¹ It was reported that health officials had urged the coalition government to maintain elements of the bill and suggested compromises such as introducing a purchase age of 25, however the Associate Health Minister, Casey Costello, rejected this.⁵²

In February 2024, public health experts published a briefing pointing to channels of potential tobacco industry influence on the new coalition government.⁵³ The briefing highlighted past connections between coalition politicians and tobacco companies or industry linked organisations, and noted that the arguments used by the coalition government against tobacco endgame policies aligned with those used by tobacco companies.⁵³⁵⁴ It also called for all government members to declare any past and current industry connections.⁵³⁵⁵

Interference from industry and associated organisations

In 2021, following the release of the Smokefree Aotearoa 2025 Action Plan, Imperial Brands, BAT and JTI all submitted responses to the government consultation opposing the major endgame policies.⁵⁶ Industry linked organisations and individuals also submitted responses opposing the legislation. These included submissions from Centre for Research Excellence: Indigenous Sovereignty and Smoking (COREISS),⁵⁷ which is funded by the Foundation for a Smoke Free World, and The New Zealand Initiative,⁵⁸ a think tank whose members include BAT and Imperial Brands.⁵⁹

In June 2021, BAT reportedly facilitated a protest amongst convenience store owners to contest the proposed tobacco product restrictions.⁶⁰ BAT supplied the dairy owners with postcards which opposed the measures, including the comment “If nicotine is slashed, filters banned and price goes up, many people will go to the black market – these will badly hurt my business, increase risk of robbery to personal safety and could force store to close.” Thousands of these postcards were reportedly delivered to the New Zealand Parliament.⁶⁰

In August 2023, the ‘Save our Stores’ campaign, another seemingly grassroots initiative supported by convenience store owners,⁶¹ called for users to sign a petition urging the government to repeal the latest Smokefree 2025 laws. The campaign website stated that it was “supported by” BAT New Zealand and Imperial Brands New Zealand. The campaign website argued that “A ban on normal strength cigarettes will just mean the illicit trade in tobacco products will boom and be controlled by criminal networks”. It also stated that the legislation would destroy small businesses, and that taking away the tax revenue raised by tobacco sales would “hurt families who are already struggling to make ends meet”.⁶² These narratives were repeated in a series of Facebook adverts published as part of the campaign between August and November 2023, with one advert also stating “tobacco taxes pay for 35,000 police officers”.⁶³

This kind of astroturfing is a well-documented industry tactic.

UK

Proposed legislation

In October 2023, the UK Prime Minister announced plans to introduce a generational endgame policy. The new legislation would prohibit the sale of tobacco products to anyone born after 1 January 2009. All tobacco products, cigarette papers, waterpipe tobacco and herbal smoking products were included in the proposal.²⁵⁶⁴ Later that month, the Westminster government opened a four nations consultation on the tobacco endgame policy, as well as on potential measures to curb the rise in youth e-cigarette use.⁶⁵

The consultation closed on 6 December 2023.⁶⁶ In response to the submissions, the Westminster government confirmed its plans to introduce a generational tobacco ban, ban disposable e-cigarettes and bring forward new powers which would allow the government to restrict e-cigarette flavours, packaging and retail display.⁶⁷ The Scottish and Welsh governments stated that they would also be introducing the new legislation.⁶⁸⁶⁹

Interference from industry and associated organisations

After the generational policy was announced, tobacco control researchers outlined arguments that they anticipated the industry would use to in an attempt prevent or undermine the UK legislation, based on previously used tactics. These included invoking libertarianism and arguments around personal freedom; claiming that the policy would be unworkable and impossible to police; and that it would have unintended consequences, such as increasing cigarette smuggling.⁷⁰

In December 2023, there were reports that the tobacco industry was lobbying the government to increase the age of smoking to 21, instead of introducing the new generational endgame legislation.⁷¹ An industry source quoted by The i newspaper stated that the generational ban was “unenforceable, and the inevitability of such a ban leading to a black market run by dangerous criminal gangs, there’s a large number of libertarian Tory MPs that do not like the idea the government is limiting people’s free choice…if the Prime Minister does cancel the plan, then [the industry] won’t object to him raising the smoking age to 21”.⁷¹ The illicit tobacco trade has often been used by tobacco companies to promote key misleading narratives that advance their own business goals.  See also Arguments and Language.

The i also revealed that the tobacco industry had been “inundating MPs with lobbying material in a bid to persuade them to oppose the changes”. It also reported that a letter was sent to MPs, seemingly from constituents, but in fact drafted by employees of tobacco companies, which called the generational ban “ridiculous” and “impractical, illiberal and untested”.⁷¹ Andrea Leadsom MP, Parliamentary Under Secretary of State in the Department of Health and Social Care, warned that the industry was working behind the scenes to block the policy.⁷²

Tobacco company lobbying

Tobacco companies lobbied the UK Department of Health and Social Care (DHSC) directly, using many of the same arguments, although only Philip Morris International (PMI) went as far as to issue a legal threat.

In November 2023, PMI sent a pre-action protocol (PAP) letter to the DHSC.⁷³⁷⁴ The PAP letter argued that the consultation was predetermined and that it failed to give adequate reasons regarding the inclusion of heated tobacco products (HTPs). It also argued that  the consultation period was not long enough did not allow the submission of sufficient additional evidence.⁷³ In a preliminary response (December 2023), the government stated that it was already possible for organisations to upload supporting documents, but to make this clearer, this instruction had been added to the consultation landing page.⁷⁵

The government’s full response a week later stated that the legal challenge was “misguided and wholly without merit” and would be “an unjustified attempt to delay or derail important legislative change”.⁷⁶ With regard to HTPs, it stated that some of PMI’s claims were “highly subjective and lack supporting independent evidence”. The response concluded that:

“The Government does not intend to enter into any negotiations with the tobacco industry…and will not as you propose “discuss, on an urgent basis, the potential removal of HTP from the scope of the proposed legislation”…the proposed claim has no merit and your client is urged to reconsider its intention to pursue the claim”.⁷⁶

The Telegraph newspaper reported that PMI later withdrew the threat, stating “We notified the government of procedural flaws in the consultation process. They subsequently amended the consultation procedure to allow substantive responses and answered other enquiries. As such, we withdrew the claim on 15^th January”.⁷⁴ PMI told the newspaper  that it agreed with the UK’s smoke-free 2030 plans, but did “not believe that reduced-risk smoke-free products—including heated tobacco—should be included alongside combustible cigarettes in any potential legislation”.⁷⁴ In December 2023, PMI reportedly held roundtable events with UK MPs in to lobby for its heated tobacco products (HTPs) to be exempt from future smoking bans.⁷¹

In November 2023, a law firm acting on behalf of British American Tobacco (BAT) contacted the DHSC, arguing that  the proposals would “materially impact the rights of our clients and others”. It also argued that there was not enough information “regarding the impacts and costs and benefits of the proposals to permit intelligent consideration”, and – as had PMI – stated that consultation period was not long enough, and did not allow the submission of sufficient supporting evidence.⁷⁷ BAT were reported to be sponsoring a roundtable due to be hosted by MP Graham Brady on behalf of the Centre for Policy Studies in December 2023 to “discuss the Government’s smokefree ambitions, what policies could support the goal, and what a Conservative approach to public health should look like.”⁷¹⁷⁸ BAT stated that the proposed legislation would be difficult to enforce, and risked creating a new category of “under-age adults”.⁷⁹ It also published briefing in response to the consultation, which outlined its stance on e-cigarette restrictions.⁸⁰

Imperial Brands and the Tobacco Manufacturers’ Association also reportedly engaged with MPs and government officials regarding the proposals, with a spokesperson for Imperial Brands stating “We understand the Government’s desire for new tobacco control measures, because of the health risks associated with smoking. But, like any prohibition, the proposal to ban the legal sale of cigarettes over time threatens significant unintended consequences.”⁷¹

In December 2023, Imperial also wrote to the DHSC, arguing that the consultation was “materially deficient and unfair in several important respects”. As with PMI and BAT, Imperial stated that the consultation period was not long enough, and did not allow the submission of sufficient supporting evidence. It also argued that the evidence base for the proposal should be shared.⁸¹ Imperial published a summary of its response to the government consultation. It said it opposed the generational ban, as it would be “unworkable and unenforceable, and would see an explosion of illicit trade in tobacco”. It also argued that it would not reduce smoking rates.⁸² Imperial’s UK head of corporate and legal affairs stated in the retail press in January 2024 that it was having “direct conversations with government” and talking to MPs “to make them aware of illicit trade that is already a problem in their constituencies” including highlighting “loss of revenue for the average retailer”. Imperial also stated that it did not support e-cigarette restrictions including plain packaging, device standardisation, or flavour bans.⁸³

In November 2023, Japan Tobacco International (JTI) carried out a survey of 1000 convenience retailers in the UK, and reported concerns that a smoking ban would harm business, increase illicit trade, make ID checks more complicated for retailer staff and impact staff training around underage sales.⁸⁴⁸⁵ A JTI feature in Talking Retail, ‘The Generational Ban: Explained’, described the ban as “an experimental policy not supported by evidence”, and encouraged retailers to respond to the government consultation.⁸⁶

Lobbying by industry-linked organisations

The Institute of Economic Affairs, a British think tank with a history of tobacco industry funding, published a briefing paper in November 2023 titled ‘Prohibition 2.0: Critiquing the Generational Tobacco Ban’.⁸⁷ The report echoed the industry narrative that a smoking ban would drive illicit trade and “bolster criminal gangs”. It also stated that a ban would “lead to a grey market in sales between friends” and that it “infantilises one cohort of adults, discriminates on the basis of age and raises issues of intergenerational unfairness.”⁸⁷ The report disregarded figures published in a review commissioned by the UK’s Department of Health in 2022 relating to the cost of smoking to the NHS, and stated “The reality is that smokers pay far more in tobacco duty than they cost the state in healthcare, while nonsmokers cost the state more, on average, in both healthcare and social security payments”.⁸⁷ Action on Smoking and Health (ASH) published an analysis in December 2023 which found that smoking costs England £49.2 billion each year in lost productivity and service costs, plus an additional £25.9 billion lost quality adjusted life years due to premature death from smoking – far outweighing the money brought in from tobacco taxes.⁸⁸

The Consumer Choice Center (CCC), a US lobby group with a history of tobacco industry funding and links to the Atlas Network, launched a campaign titled ‘No2Prohibition’ which urged the public to contact their MP to oppose the new legislation.⁸⁹ The campaign used the argument that the legislation would result in an increase in illicit trade and stated “Discriminating against adult consumers, depending on what year they were born, is unheard of and would set a dangerous precedent for future regulations. What’s next? Alcohol? Sugar? Fat? We can only imagine”.⁸⁹ The campaign included a series of social media adverts centred on messages of freedom of choice and prohibition.⁹⁰ These ads were removed by Meta as they did not include verified “paid for by” disclaimers.⁹⁰

Forest, a British based Smokers’ rights group with a history of tobacco industry funding, stated that it had urged the government not to introduce a generational ban, ahead of the government consultation deadline in December 2023. It also commissioned a consultancy to carry out a survey, which it states found that “58% of respondents think that if a person can vote, drive a car, buy alcohol, or possess a credit card at 18, they should also be allowed to purchase tobacco”.⁹¹

The Association of Convenience Stores (ACS) is an organisation that represents local stores in the UK. Its “Premier Club” members include BAT, JTI, PMI, Imperial Brands and JUUL.⁹² ACS stated in December that it had responded to the government consultation, and in its submission “set out a number of concerns about the practical implications of the [generational endgame] policy”. It also stated that it did not support a ban on disposable e-cigarettes.⁹³

The Scottish Grocers Federation (SGF), a trade association for convenience stores with tobacco company members, published an article opposing several possible new retail regulations, which included the generational tobacco policy and restrictions on the sale and visibility of e-cigarettes, stating that it would harm retail businesses.⁹⁴ Regarding the disposable e-cigarette ban, the SGF Chief Executive warned against “unintended consequences such as an increase in illicit trade” and said that it would “engage with both governments to ensure the best outcome for retailers and their communities”.⁹⁵ SGF also protested its exclusion from the government’s response to the consultation, due to SGF’s connections with the tobacco industry.⁹⁶

The World Vapers Alliance (WVA), which has links to BAT, criticised the generational smoking ban. It argued that the UK should instead be “doubling down on its harm reduction strategy”.⁹⁷ WVA also urged the public to respond to the government consultation to oppose e-cigarette flavour restrictions, the disposable e-cigarette ban and inclusion of heated tobacco products in the generational smoking ban.⁹⁸ After the consultation closed, WVA published a press release which urged the government to reconsider its stance on banning disposable e-cigarettes.⁹⁹

The UK Vaping Industry Association (UKVIA) published a press release opposing the e-cigarette regulations, stating “the tobacco industry and illicit markets will be the only winners from bans on disposables and flavoured vapes”.¹⁰⁰ (UKVIA stated in September 2023 that all of its tobacco company memberships had ended. For details see the UKVIA page).

Relevant Links

• Sunset Plans: Progress on Tobacco Endgame Around the World, ASH (US) website
• Tobacco endgames, ASH Scotland website

TobaccoTactics Resources

• Tobacco Industry Tactics
• Illicit tobacco trade
• Price and Tax
• Menthol and Flavoured Tobacco

Tobacco Control Research Group (TCRG) Research

Sunak’s smoke-free generation: spare a thought for the tobacco industry, G. Hartwell, A.B. Gilmore, M.C.I . van Schalkwyk, M. McKee, BMJ, 2023; 383 :p2922 doi:10.1136/bmj.p2922

References

The post Tobacco Industry Interference with Endgame Policies appeared first on TobaccoTactics.

Meanwhile the range of products available continues to grow. TobaccoTactics focuses mainly on the products in which the large transnational tobacco companies (TTCs) have developed an interest since the early 2000s. We refer to them collectively as ‘newer nicotine and tobacco products’.

There is an ongoing scientific and policy debate about the role of these products in tobacco control, and whether they can help reduce the harms of tobacco. This page explores the concepts and issues around the topic and links to relevant pages on TobaccoTactics, research by the Tobacco Control Research Group (TCRG), and resources for further reading.

What is Harm Reduction?

The concept of harm reduction, first used in relation to illicit drugs, refers to policies and programmes which aim to reduce the harm from addictive behaviours for individuals, and the community and society in which they live.^106107108109 Harm reduction recognises that, while the preferred goal is abstinence, this is not always achievable. Helping people change to less harmful alternatives may be a more effective approach.¹⁰⁷¹⁰⁸ It therefore primarily aims to reduce drug-related harm rather than drug use.¹⁰⁹

Tobacco Harm Reduction

The concept of tobacco harm reduction (THR) refers to reducing the levels of disease (morbidity) and death (mortality) from tobacco use among smokers. While eliminating exposure to nicotine altogether would result in the greatest reduction of harm, THR recognises that this is not always achievable, and users may not always be able or willing to quit. So THR advocates, as its primary goal, that users switch to using nicotine in its less harmful forms.

People smoke primarily because they are addicted to nicotine, but it is the other toxins in tobacco smoke that cause most of the harm. Nicotine can be obtained from a range of products, which vary in their level of harm and addictiveness. This “spectrum of harm” ranges from conventional smoked tobacco (cigarettes) at the top, to medicinal nicotine (nicotine replacement therapy, or NRT) at the bottom.¹¹⁰¹¹¹

It is hard to determine the exact position of other products in this spectrum, especially their long-term effects on health. With a longer history of use in Scandinavia and the US, there has been research into the relative harms of snus for a number of years. It would generally be placed at the lower end of the spectrum.¹¹²

More recently there has been considerable research around the potential role of e-cigarettes, and some evidence that they might help individual smokers quit cigarettes. However,  they are not harm free and there are concerns around youth uptake and dual use with with new and conventional tobacco products.^{113114115116117118}

The research around newer heated tobacco products (HTPs) is much less developed.^115119120 While there is some independent evidence of reduced exposure to harmful chemicals from these products, there is currently no independent evidence that HTPs are less harmful than cigarettes, in terms of reduced disease or mortality. There is also no reliable evidence that they help people stop smoking cigarettes. The UK Cochrane review, published in January 2022, found that to date all randomised control trials (RCTs) assessing safety had been funded by tobacco companies. Of the eleven trials eight were “at unclear risk of bias and three at high risk.”¹²¹ The reviewers concluded that: “Independently funded research on the effectiveness and safety of HTPs is needed.”¹²¹

For individual smokers, quitting entirely is the best option for reducing harm. If smokers are not able to quit, the risk of disease from tobacco use can be reduced by switching completely to a genuinely less harmful product. Continuing to smoke cigarettes alongside other tobacco or nicotine products would not lead to the same health benefits.

Reducing Harm at Population Level

Although there is no single definition of harm reduction, it is generally acknowledged that it needs to reduce harm not only for the individual user but for the community and society in which they live.¹²²¹²³ In tobacco harm reduction, therefore, it is necessary to consider the impacts on the whole population rather than just those who currently smoke.¹²⁴

A product might enable some smokers to quit or reduce their risk of disease. But if it still increases population level of harm, it cannot be considered as harm-reducing; for example if a large numbers of non-smokers took up the use of tobacco products; continued to smoke rather than quit; or continued to smoke cigarettes and use other products at the same time (dual or poly/multi use).^{125126127128129}

Although individual smokers who switch fully to less harmful products can reduce their health risks, that does not mean that the introduction of one or more newer products in a country will lead to reduced harm at a population level.^130131132133 This would depend on which products are available, whether they enable smokers to quit, and if they are genuinely lower risk than combustibles. It also depends on how they are used. If they are primarily taken up by smokers to quit, or by those who would otherwise have started smoking, this would help reduce overall levels of smoking and therefore reduce harm in the population. However, if they are taken up by people who have not used the products before (sometimes called “nicotine naïve” consumers), including children, this could lead to an increase in smoking, and increase harm.^{134135136137138139}

A summary of these issues is provided by the National Academies of Sciences.¹¹⁷

Particular concerns about the potential for population benefit have been expressed by healthcare professionals, policy makers and tobacco control advocates low and middle-income countries (LMICs).^140141142

The impact at population (or country) level also depends on other inter-related factors, including:

• the strength and enforcement of regulation controlling the product itself (e.g. its nicotine content and formulation as well as its price, promotion and availability)
• the behaviour of the companies selling tobacco and newer products: for example whether and how they market to youth, or circumvent regulation, such as smoke-free policies
• the strength and enforcement of tobacco control regulation more generally (i.e. FCTC measures)
• the degree of tobacco company interference, and the ability to counter it

Overall, quitting smoking entirely remains the best option both for individual smokers and from a public health perspective.

• For up to date information on tobacco regulation, see the Tobacco Control Laws website, published by the Campaign for Tobacco Free Kids (CTFK).
• Information on the regulation of specific products can be found on the pages linked below.
• For information on tobacco companies’ interference in tobacco control, see the Global Tobacco Industry Interference Index.

The Role of the Tobacco Industry

Tobacco harm reduction has become controversial and, some feel, divisive in public health, in particular where the debate has focussed on the potential role for other nicotine and tobacco products such as e-cigarettes and snus.^112143144145

• See the list of TobaccoTactics Resources below for links to pages on the various products made and sold by tobacco companies.

One of the reasons harm reduction is a sensitive topic is that it can involve engagement with the tobacco industry, which has a history of manipulating public debate and health policy.

A History of Misinformation and Manipulation

In the 1960s and 1970s, public health scientists and officials in the US and UK encouraged smokers to switch to low-tar and low-nicotine cigarette brands.  They had been persuaded by an apparent commitment by tobacco companies to develop a “less hazardous cigarette”.¹⁴⁶¹⁴⁷ However, the tobacco industry concealed its own research which showed that these modified products would lead to ‘compensatory’ smoking behaviours (such as inhaling more strongly or taking more frequent puffs) and not in fact reduce the harms of smoking.^146148149

In the 1990s harm reduction claims were also made for early ‘heat not burn’ tobacco products, although these were not commercially successful at the time.¹⁴⁸

Historians of public health have warned that, given the tobacco industry’s past misleading use of harm reduction claims to further its commercial and policy goals, THR strategies need to be approached with care and be supported by robust scientific evidence.^149150151152

The Industry’s Real Motive

In one word: profit. While tobacco companies continue to sell and promote their conventional products, global cigarette sales are decreasing.¹⁵³

Tobacco companies have invested in, developed and promoted newer nicotine and tobacco products in the hope that this will prevent smokers from quitting entirely and attract new users. Ultimately, the aim is to offset the diminishing profits from conventional tobacco products. However, the main driver for tobacco company growth is still cigarettes; and this is likely to continue to be the case for the foreseeable future.^143153154

Evidence shows that the tobacco industry has never been genuinely interested in reducing harm. Its activities are primarily designed to serve its commercial objectives, in a variety of ways:

• by claiming a commitment to harm reduction, and attempt to improve its reputation. This can be seen as an attempt to “‘renormalise’ an industry that wants to be seen as a responsible business with a legitimate product”.^143153154155
• by using newer products as tools to initiate dialogue with scientists, public health experts, politicians and policy makers, re-framing the industry as ‘part of the solution’ rather than being responsible for the problem. It continues to try to re-enter the policy arena from which it has increasingly, and successfully, been excluded (see below), to gain a ‘seat at the table’.¹⁵³¹⁵⁴
• by attempting to weaken and undermine tobacco control regulations. Nearly a decade after the promotion of snus as a dual use product, tobacco companies are following the same strategy. British American Tobacco (BAT) has referred to the “additive opportunity” of newer products ; a way to gain both new nicotine users and give smokers “new consumption moments”, including in restaurants and other places where smoking is banned.¹⁴³¹⁵⁶ Philip Morris International (PMI) has promoted “IQOS friendly places” including hotels, clubs and other public spaces, where people can use HTPs despite smoking bans.¹⁵⁷ The tobacco industry’s fundamental conflict of interest should prevent it from influencing the regulation of newer products.
• as a tactic to divide the public health community.^150153158

Research shows that the industry uses different public narratives in its investor-facing and public-facing materials, which serve to mislead and distract from the harms of its products.¹⁵⁹¹⁶⁰ Companies emphasise individual factors like consumer choice, and downplay the addictiveness of their products, and both individual and population level harms.¹⁵⁹¹⁶⁰ Large transnational companies:

“seek to normalize their role in public discussions of health policy, to cast themselves as instrumental in the redress of tobacco-related inequalities and shift responsibility for the continuation of tobacco-product use onto individual consumers.” ¹⁶⁰

Meanwhile conventional cigarettes remain key to tobacco companies’ business models.

The main barrier to achieving public health benefits from harm reduction approaches is the behaviour of the tobacco industry. There is a fundamental conflict of interest between tobacco companies’ interests and public health. This is enshrined in the World Health Organization’s (WHO) Framework Convention for Tobacco Control (FCTC).  FCTC Article 5.3 requires the exclusion of the tobacco industry and its front groups from policy making. As the tobacco industry manipulates debates over harm reduction for policy advantage, Article 5.3 applies to those producers of newer products who are part of the tobacco industry, and the third party organisations lobbying on its behalf.¹⁵³¹⁵⁴

Industry-Funded Research

The tobacco industry attempts to influence the scientific debates around newer products and harm reduction. Research into these products and their impacts, at both individual and population level, is essential. The tobacco industry has a clear vested interest in showing that their products are safe, but it has a  history of manipulating the science around cigarettes.^161162163 It has also done this via third parties.¹⁶⁴¹⁶⁵

Evidence is beginning to emerge indicating that we should also be concerned about the industry’s newer products science,¹⁶⁶¹⁶⁷ particularly its heavy involvement in heated tobacco product science.^115119120166

Researchers from the Center for Tobacco Control Research at UCSF found that articles funded by the tobacco industry favoured harm reduction, while non-industry-funded articles, were “evenly divided in stance”.¹⁶⁸ They also found a lack of empirical research, with more of the debate conducted in ‘opinion pieces’.¹⁶⁹

A number of scientists influencing the debate on harm reduction or newer products are funded by the tobacco industry. Examples on TobaccoTactics include:

• Jed E. Rose is director of the Center for Smoking Cessation Research (CSCR) at Duke University in the USA, an institution with a long history of tobacco money. He is the inventor of the nicotine patch, and a nicotine aerosol technology. The Center, his research and his career are closely interlinked with the tobacco industry, more specifically Philip Morris (Philip Morris International, and previously Philip Morris USA which is now Altria owned).  The story on Duke University and the Tobacco Industry shows Philip Morris actively promoting the nicotine patch as a quitting strategy, with the research funded by the company and with the endorsement of scientists involved.
• Brad Rodu is a Professor of Medicine at the University of Louisville, whose work is funded by unrestricted grants from Swedish Match, Reynolds American, Altria and British American Tobacco.
• Carl V Phillips was hired by U.S. Smokeless Tobacco Company as an expert witness to deny any causal association between Smokeless Tobacco and oral- or tongue cancer.
• Riccardo Polosa is an Italian scientist who conducted a clinical trial for e-cigarettes and was also involved in marketing them as a cessation therapy. The page E-cigarettes: Mixing Research and Marketing details how his institute was founded with Philip Morris money.
• The Foundation for a Smoke-Free World (FSFW) funds research and advocacy around newer products products – while being fully-funded by Philip Morris International. Many of FSFW’s grantees , and researchers in its Centers of Excellence, are active in harm reduction advocacy.

It has been argued that the best way to ensure independent science in this area is through a tax on tobacco companies.¹⁷⁰ Until that happens, care must be taken when interpreting research funded directly – or indirectly – by the tobacco industry.

Implications for Global Tobacco Control

The WHO has published guidelines on newer products and their regulation. An information sheet on HTPs was released in July 2018, recommending that “HTPs should be subject to the same policy and regulatory measures applied to all other tobacco products” in line with the FCTC.¹⁷¹

In March 2019, the Secretariat of the WHO FCTC issued an information note, which compiled all Conference of the Parties (COP) decisions related to e-cigarettes. A few months later, the Secretariat released a statement urging governments to remain vigilant, stating that:

“novel and emerging nicotine and tobacco products…are creating another layer of interference by the tobacco industry and related industries, which is still reported by Parties as the most serious barrier to progress in implementing the WHO FCTC”. ¹⁷² It also reminded Parties of their obligations under Article 5.3 to protect tobacco control policies and activities from all commercial and vested interests.¹⁷²

According to the editor of the journal Tobacco Control, tobacco companies:

“continue to work to interject themselves into activities promoted under the WHO Framework Convention on Tobacco Control (FCTC), particularly criticising Article 5.3, which seeks to protect public health policy-making from their commercial interests, and why their allies seek to pressure and undermine the WHO.”¹⁷³

The global tobacco control priority remains the implementation of comprehensive, evidence-based, well-enforced population level policies. As outlined in the FCTC these aim to reduce the uptake of smoking by young people and prompt smokers to quit. They include policies such as tobacco tax increases, bans on promotion, restrictions on availability, and the implementation of WHO FCTC Article 5.3. Any harm reduction approaches should be implemented as part of a broader strategy, including a comprehensive range of well enforced tobacco control policies.

The Tobacco Control Research Group states that:

“The tobacco industry, and its front groups, should not be treated as legitimate partners in any discussions on tobacco control policies and approaches, including harm reduction, or in research on NNTPs [novel nicotine and tobacco products].”¹⁵⁸

For more information on how the tobacco industry works through its front groups and other allies see the page: Third Party Techniques.

Tobacco Endgame

In some countries (such as New Zealand and Canada) ‘endgame’ approaches to creating a tobacco- and nicotine-free future are increasingly being discussed, for example de-nicotinising tobacco products. Endgame approaches are diverse.¹⁷⁴¹⁷⁵ They may include a role for genuinely reduced risk products to be used as quitting aids and/or alternative products to cigarettes.^176177178179

• For more information see Tobacco Industry Interference with Endgame Policies

TobaccoTactics Resources

The Newer Nicotine and Tobacco Products page gives an overview of transnational tobacco companies’ interests and products, and links to more detailed pages for each company. The page contains a graphic overview of key tobacco company brands.

The following pages give more detail on the product types, and link back to tobacco company product pages:

• E-cigarettes
• Heated Tobacco Products
• Smokeless Tobacco, Snus & related products
  • Cigarette Companies Investing in Snus
  • Snus: EU Ban on Snus Sales
  • Nicotine Pouches
• Nicotine Replacement Therapy;
  • For Philip Morris promoting QuitAssist, a nicotine patch as a quitting strategy, see the page on Duke University and the Tobacco Industry
  • See Kind Consumer for BAT’s early interest in a nicotine inhaler
  • For other products,  see Tobacco Company Investments in Pharmaceutical and NRT Products

See also Product Innovation as a tobacco company strategy.

List of pages in the category Harm Reduction.

Tobacco Industry Product Terminology page – also covers conventional and traditional products.

Read more about Tobacco Industry Tactics

Relevant Links

• Addiction at any cost. Philip Morris International uncovered, STOP, 2020, available from exposetobacco.org
• TCRG statement on novel nicotine and tobacco products

TCRG Research

Identifying misleading corporate narratives: The application of linguistic and qualitative methods to commercial determinants of health research, I. Fitzpatrick , A. Bertscher, A.B. Gilmore, PLOS Global Public Health, 16 November 2022, doi:10.1371/journal.pgph.0000379

Tobacco industry messaging around harm: Narrative framing in PMI and BAT press releases and annual reports 2011 to 2021, I. Fitzpatrick, S. Dance, K. Silver, M. Violini, T.R. Hird, Frontiers in Public Health, 18 October 2022, doi:10.3389/fpubh.2022.958354

Understanding the emergence of the tobacco industry’s use of the term tobacco harm reduction in order to inform public health policy, S. Peeters, A.B. Gilmore, Tobacco Control, 2015;24:182-189

E-cigarettes: threat or opportunity?, A.B. Gilmore, G.E. Hartwell, European Journal of Public Health, 2014, 24(4):532-3. doi:10.1093/eurpub/cku085

For a comprehensive list of all TCRG publications, including TCRG research that evaluates the impact of public health policy, go to the Bath TCRG’s list of publications.

References

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