2025 Session 1 Seminars

Public health organizations, both governmental and non-profit, have extraordinarily important roles disseminating - to the public, influencers, healthcare providers, policy makers and others – the most accurate, science-driven information to improve public health. Providing the most accurate and thorough information is an exceptional challenge because the scientific consensus is not always clear. At the same time, this challenge could also be influenced by a variety of other factors, including distrust of companies (nicotine, tobacco and perhaps any company), conscious or unconscious bias regarding harm reduction, the perceived need to meet funder requirements, etc. This presentation will discuss examples and challenges related to accurate dissemination of information by public health organizations and begin to explore ways to improve responsible dissemination of harm reduction information.

New Zealand has some of the most liberal vaping laws in the world, and the rapid rise in vape use has correlated with unprecedented declines in smoking since 2018. Overall nicotine use is up, but the way New Zealander’s use it have transformed. Less than 6.9% of adults now smoke daily. New Zealand has a goal to be smokefree by the end of 2025, meaning less than 5% adult daily smoking. The rapid declines in smoking in recent years mean we have surpassed this goal for young people, the least deprived and will likely achieve it for women and European New Zealanders. Youth smoking is almost a thing of the past, and rates of decline have been especially rapid for Māori.

A change in government saw New Zealand abandon laws to denicotinise cigarettes, ban most combustible sales and mandate a smokefree generation.  Instead, the new government is favouring a harm reduction approach, increasing access to non-combusted nicotine.

This talk will examine progress to date,  whether harm reduction is a feasible endgame strategy for smoking in New Zealand, and whether it can overcome political tensions, outrage and headlines about youth vaping, and a growing public health movement against nicotine and addiction.

Health professionals in the UK and New Zealand are engaging with non-therapeutic products for therapeutic purposes. High-quality independent reviews find high certainty evidence that vapes are as effective for smoking cessation as the most effective pharmacotherapies, with similarly low rates of adverse events, but with greater user acceptability. Unlike other approaches, they do not require high levels of motivation. Indeed, smokers who vape daily have much higher rates of smoking cessation regardless of intention to quit. Consequently, “swap to stop” programmes - programmes that provide priority groups of smokers directly with approved devices - offer a unique opportunity, especially for the most disadvantaged and dependent smokers.

However, the factors that drive use among adult smokers - affordability, accessibility and appeal - also drive use among youth and so are the growing target of public health policies. Around the world, many jurisdictions are adopting policies intended to “stop the start”, reducing uptake among youth.

When these policies also  “stop the swap”, they can undermine smoking cessation and increase smoking and its harms. Like it or not, policy makers must recognise and manage these trade-offs or risk worsening health outcomes and inequalities.

Evidence has consistently supported that e-cigarettes are an effective tool to help adults stop smoking and are substantially less harmful than continuing to smoke.  Yet clinicians and patients alike are often skeptical and adverse to recommending or trying e-cigarettes.  Two distinct barriers are contributing to this stalemate.  First, there is a misperception of absolute and relative risks between e-cigarettes and combustible tobacco products.  Second, because no e-cigarette has received, or is likely to receive,  a medicinal approval under the “safe and effective” standard, these are not a type of traditional quit smoking product that clinicians are accustomed to recommending. Although a handful of products have been approved as "appropriate for the protection of public health" under the existing PMTA process, there is little education to differentiate these products from a much larger unregulated market which offers considerably more choice (specifically on flavors, which has proved important in trials), but would be next to impossible for medical clinicians to recommend.  Recognizing the urgent need for clinicians to support patients in their efforts to quit smoking, the question becomes whether and how to integrate non-medicinal e-cigarettes into the tobacco treatment toolkit and what regulatory pathway can be found to instil confidence for clinicians and patients alike, including safety, accessibility and acceptability.

FDA’s comprehensive plan for the regulation of tobacco and nicotine was announced in 2017 during the first Trump Administration. Events in 2018 overtook efforts to implement that plan. Former Commissioner Gottlieb’s resignation in 2019 was the final nail in the coffin of the 2017 plan. Do the critical components of the 2017 plan stand the test of time? If so, can the plan be resurrected by the Trump Administration in 2025? To what degree would such efforts be undermined by the behavior of the current Administration and the ongoing dispute in U.S. tobacco control and public health circles regarding the application of harm reduction principles to regulatory policy? Retired CTP Center Director Mitch Zeller will attempt to address these simple issues. Let’s see if he can pull it off.

Nicotine, Tobacco & Government Policy

• Has the communication of scientific evidence confused the public
• Can regulation of a consumer nicotine market satisfy tobacco control, or is prohibition of anything other than a medically licensed product the only acceptable option for some.
• Is a medically licensed e-cigarette possible or likely?
• If people use a non-medicinal e-cigarette to stop or replace smoking, is this “therapeutic” or “recreational” use?