Introduction and background on INNCO
Formed in June 2016, INNCO is the collective voice for the most influential nicotine consumer organisations operating in eleven countries around the world: organisations which each recognise that there are safer ways to enjoy nicotine consumption than tobacco smoking.
There are currently estimated to be over 20.5 million consumers1 who have made an individual choice to switch to what they recognize is a significantly safer choice to combustible tobacco, including e-cigarettes, snus and other novel products.
INNCO aims to represent the views of consumers in promoting safer use of nicotine and to advocate for effective and proportionate regulation of safer nicotine products and their use. Representation includes engagement with international health, regulatory and public health organisations, to ensure that consumers are effectively and equally represented as stakeholders.
INNCO seeks to achieve this through promoting credible science and research into safer nicotine use by increasing global awareness and understanding of the risk reducing and life-saving potential of new technologies.
We seek to ensure, regionally and internationally:
- The recognition of the relative safety of smoke free nicotine products.
- That there should be no bans on the sale, supply, possession and use of safer forms of smokeless tobacco (e.g. snus), vaping products and E-Liquid containing nicotine, and where currently illegal they should be made legal.
- The need to avoid disproportionate regulation on the manufacture, distribution and any (overly) restrictive consumer access to these products
- The taxation of lower risk nicotine products as consumer goods, with no tobacco duties or excises applied;
- That any restrictions on use in public areas and work spaces are justified on the basis of verifiable evidence
- Any decisions made to restrict or limit the use of alternative nicotine products in private premises should be left to individual owners/managers.
It is imperative that the WHO CoP do not directly or covertly seek to legitimize, condone or overlook state imposed regulations which impose iniquitous prohibitions or deny access to safer alternative nicotine products.
Disingenuous direction from The WHO FCTC poses a global threat to public health
The WHO report 'Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)' (FCTC/COP/7/11) to be discussed at the COP meeting, in Delhi, in November states:
‘If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement.’ 2
INNCO welcomes this broad recognition of the potential for safer nicotine products to save lives and generally improve the public health, but our welcome is tempered by the overall negative tone of the report.
We see that the evidence referenced in the report as being highly selective and supporting a heavily regulated approach to new non-combustible nicotine products. Regulatory options proposed by the WHO3 are designed to restrict awareness, access and use of these products.
INNCO is concerned at the negative and dismissive responses given to large groups of experts in fields of nicotine, tobacco research and addiction. In particular, the extensive research undertaken to assess the relative risk of non-combustible products by Public Health England4and the Royal College of Physicians in the UK5. Their considered opinion, based on credible evidence, assessed the risks as being no more than 5% (and probably less) than that posed by the continued use of inhaling smoke.
The WHO FCTC CoP7 delegates may wish to be reminded that it was the distinguished Royal College of Physicians who first alerted the world to the link between smoking and lung cancer in 1962 [Smoking and Health]6. Their ominous correlation was met with global indifference and inaction which cost lives.
The WHO and the FCTC have made significant progress in combating the dangers of combustible tobacco, but are in grave danger of repeating the same mistake by selectively disregarding the RCP’s superior assessment of the relative safety of E-Cigarettes and snus5.
Evidence of the transformative health effects of switching from smoking to safer nicotine products can be found in the testimonies of those who have experienced major improvements in many aspects of their lives. The rapid growth in the use of alternative products and new technologies has created a consumer-driven health revolution.
This revolution has the capacity not only to deliver major health gains for individuals, but also to make a significant contribution to the overall public health, at no cost to the public purse. Given these considerations, we find it inconceivable that the WHO can seek to make decisions on recommendations for regulation without any regard to the experience of consumers, i.e. the key stakeholders .
The science supporting the efficacy of safer nicotine is compelling and the WHO must give due regard paid to their testimonies and experience which support this.
INNCO believes that safer nicotine products should be categorized as consumer goods and not be subjected to additional taxation. Indeed, we would urge discussion about the appropriateness of including these products within the compass of the FCTC altogether.
The rationale for high taxation of combustible cigarettes is to deter smokers from using them. There should be no price deterrence imposed upon safer alternatives to smoking'. We believe that any approaches to taxation should encourage smokers to switch to a safer product and punitive taxation on E-Cigarettes sends out a negative message. It represents a failure to support the core aim of FCTC i.e. ‘To reduce consumption of tobacco products and prevent disease’.
There is no conclusive evidence of a ‘gateway effect’ of new products, leading people, (particularly young people) into smoking. On the contrary, they offer a gateway OUT of smoking. Recent evidence from the longest running ‘Smoking Toolkit Study’ in the UK shows decreases in smoking rates concomitant with uptake of vaping.8 The Smoking Toolkit Study is specifically designed to inform Tobacco Control, both in the UK and internationally, and has been acknowledged as a reliable model.9
INNCO argues for a proportionate approach to any restrictions on use of products – particularly vaping products – in public and work spaces. Guidance issued in the UK, by Public Health England10, addresses many of the concerns raised about this and could be used to construct pragmatic, sensitive policies and practices, with due respect to the needs and requirements of all concerned.
Ill-conceived regulations result in unintended consequences.
It is the responsibility of the WHO to scrutinise and evaluate documentation without bias, and that their methodology is transparent, as is their decision making process. If due regard is not given to the development of regulatory frameworks and requirements, a situation will be created where the only players able to afford the costs of compliance will be large companies and principally large tobacco companies. This is already in danger of happening in the US under the FDA Deeming Regulations.
Ignoring these consequences is surely not the intention of FCTC, given its aim:-
‘to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.’11
In terms of reducing levels of smoking and the consequences for health, there is now a genuine opportunity to develop new approaches, with the potential to transform the landscape. A key to this is to place harm reduction, one of the pillars of FCTC12, at the centre of policy and promote safer use of nicotine as a way to achieve this.
Currently, the process of policy analysis, review and suggestions to signatory’s leans towards absolute proof of “safety”, however when being “safe” becomes “punitive” - it ignores the fundamental founding principle of the World Health Organisation to “...work side by side with governments and other partners to ensure the highest attainable level of health for all people.”13 which the WHO applies to EVERY other public health harm reduction option except for Vaping Products and snus.
There needs to be a move away from fear of “disruptive technologies” by the WHO and its associates. We would point out that at one time, seat belts, airbags and reverse cameras in vehicles were also considered in a negative light, but are now standard options on all new motor vehicles. From a health perspective, robotic surgery, Teflon mesh and immunotherapy were also considered disruptive technologies and are now considered “cutting edge” methods of conserving and protecting health. We believe vaping and associated non-combustible products will prove to be no different. As such, these options need to be given the same consideration and regulatory treatment as any other harm reduction and harm prevention methods.
FCTC CoP Inclusion and Transparency
In its operating practices and policies – particularly with regard to the exclusion of consumers from policy decision making process – FCTC is out of step with established practice amongst other UN bodies. Examples where effective engagement of stakeholder groups has helped develop effective policy and practical responses include the engagement of, by the United Nations, people living with HIV/AIDS, IV users, climate change activists and organisations, all of whom have been included at the centre of CoPs and their equivalents.
'Involving communities’ is a key part of WHO's mission, as set out for example in The Ottawa Charter for Health Promotion.
‘To acknowledge people as the main health resource…and to accept the community as the essential voice in matters of its health, living conditions and well-being.’
WHO - OTTAWA CHARTER FOR HEALTH PROMOTION 1986
INNCO seeks to be consulted by the WHO FCTC, EU TPD and other associated bodies and to participate in discussions relating to the regulation of non-combustible products. There needs to be a commitment to transparency, an open door to participation and a parallel process of consensus within the engagement process.
As a legitimate expert stakeholder we play an active and important role in representing and communicating the views of nicotine consumers across the world – 20.5 million consumers have a right to be heard. "NOTHING ABOUT US WITHOUT US!”
On the 20th of September, Public Health England reported that the number of smokers in England had fallen to its lowest level, with just 16.9% of adults smoking. Smoking prevalence has declined continuously and dramatically over the past 50 years by about two-thirds. In 1974, over 50% of men in Britain were smokers; that had fallen to just 19.1% in England in 2015. Similarly, just over 40% of women smoked: Last year it was only 14.9%. There is no doubt amongst alternative nicotine consumers that the increasing and widespread use of e-cigarettes has significantly contributed to the reduction of smoking rates. 14 Across the globe, wherever alternative nicotine products are freely accessible and not subject to disproportionate regulation, a similar pattern is emerging.
The WHO has a moral duty to acknowledge evidence which highlight the significant reduction in harm afforded by smokeless technologies (including snus). They should do so without prejudice, pressure or fear. Failure to do so will not only put people’s lives and health at IMMEDIATE risk, but also diminish the credibility of the organisation.
It is the WHO’s FCTC delegates responsibility at the forthcoming CoP7 to be fully aware of emerging public health trends and technologies and to recognise their benefits in order make an informed decision regarding the best practice for public health. Forty years ago Professor Michael Russell observed that “ people smoke for the nicotine but they die from the tar”. Back then it wasn’t possible to have one without the other. Now it is - unless that choice is taken away.
Judy E Gibson
Steering Group Coordinator
on behalf the INNCO Steering Group and our international member organisations
INNCO accepts no funding from any commercial interests including smokeless nicotine product manufacturers and distributors nor from tobacco companies. We have no competing interests and, specifically, no conflicts with respect to Article 5.3 of the FCTC.
 http://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1 (para 28-32)
 Article 3 FCTC, adopted November 2004
 http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf (Article 1d)