Is it time to rename World No Tobacco Day to World No Cigarette Day?

Dr. Edward Makgotlho, PhD

Every year, as World No Tobacco Day comes around, I find myself debating colleagues: is the idea that all forms of tobacco should be removed, still relevant, or is it an outdated approach to tobacco control that requires re-consideration?

Does the fact that certain smokeless tobacco and nicotine products offer substantial harm reduction¹ opportunities, not make the name and essence of this well-intentioned initiative outdated?

Perhaps, instead, it is time to rename it to ‘World No Cigarette Day’, to better reflect a nuanced approach to tobacco control.

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Tobacco harm reduction offers substantial potential benefits: switching smokers who would otherwise continue to smoke to reduced risk¹ alternatives is an opportunity not historically seen in public health.

Modern technology has created a range of smokeless tobacco and nicotine products that pose a potentially lower risk¹ to adult smokers than continuing to smoke traditional cigarettes.

Understanding combustion as the root problem

The root cause of most tobacco-related health issues is combustion – specifically, exposing tobacco to temperatures exceeding 950°C ².

Long-term studies have shown that exposure to harmful chemicals present in cigarette smoke increases the risk of smoking-related diseases³.

When the World Health Organisation’s (WHO’s) Framework Convention on Tobacco Control was first ratified in 2005⁴, BAT was investing substantial time and resources into researching methods to make cigarettes less harmful.

Unfortunately, this research did not yield the desired results.

Despite extensive effort, it proved impossible to produce a cigarette that didn’t expose consumers to harmful chemicals associated with significant health risks⁵.

However, this experience led to a crucial insight: eliminating the burning process was essential for creating truly reduced-risk products.

Two decades later, technology has transformed the industry: BAT today has a range of smokeless products, including oral tobacco products (such as snus), heated tobacco products, vapour products and nicotine pouches.

Recognising combustion as the main causal factor³ in smoking-related disease risk also means we can reconsider nicotine.

For years, people have incorrectly associated nicotine risks with cigarette risks, and consequently many stakeholders across public health, regulatory bodies, academia and the general public have misconceptions about nicotine’s risk profile.

Let me be clear: nicotine is not carcinogenic⁶.

Leading global health authorities widely accept that the harmful chemicals created by tobacco combustion (not nicotine) are the primary cause of smoking-related diseases³̛ ⁷.

Global evidence for harm reduction strategies

Smokeless products do not burn tobacco and produce significantly fewer toxicants than those in cigarette smoke⁸.

Countries embracing these products, like Japan, New Zealand, Sweden, the UK, and the US, have witnessed substantial declines in smoking prevalence⁹.

In fact, Sweden and New Zealand are now approaching the WHO’s definition of smokefree – when less than 5% of the population are smokers.

Long-term data from Sweden provides compelling evidence that tobacco harm reduction is effective. Over three decades, many Swedes have switched from smoking to using snus.

Despite their tobacco use per capita being similar to the EU average, Sweden reports the lowest smoking prevalence in the EU at 5.4% and the lowest health outcomes for lung, trachea, bronchus, and oral cavity cancers in the EU¹⁰.

Scientists have modelled that 3.5 million lives could be saved across the EU over the next 10 years if the EU achieved the same tobacco-related health outcomes as Sweden¹¹.

Implementing harm reduction in South Africa

When harmful behaviours cannot be eliminated, providing less harmful alternatives delivers significant population benefits.

I believe that South Africa’s National Strategic Plan for the Prevention and Control of Non-Communicable Diseases should adopt a dual approach to tackling tobacco’s health burden.

Firstly, it should ensure that adult smokers who would otherwise continue smoking have appropriate access to reduced risk¹ products.

Secondly, it should advocate for robust protections to prevent underage access and consumption.

BAT recently published ‘BAT’s Commitment to Responsible Vaping Products’, which outlines the company’s industry-leading standards in vapour product development.

Among our core commitments is preventing underage access through age verification and safety features, while maintaining strict standards ensuring devices, flavours, packaging and marketing are designed for adults.

Experience shows that excessive product restrictions or outright prohibitions fail to prevent adult consumers from accessing products.

Instead, such policies typically fuel underground economies and illicit markets.

We estimate that up to 80% of vapes sold across several markets exist outside the regulated system.

A path forward

Tobacco harm reduction offers one of the most significant public health opportunities for South Africa today.

With thoughtful, balanced regulations, I believe that tobacco control and harm reduction strategies can complement each other to reduce the projected health impacts associated with cigarette smoking.

A sensible regulatory framework would classify alternative products according to their lower risk profile and clearly separate them from cigarettes⁹̛ ¹².

This would ensure smokers can access smokeless products and accurate information regarding their risks compared to smoking, enabling those who would not otherwise quit, to make informed choices.

Equally crucial are high product standards and effective barriers to prevent underage access.

Reducing cigarette-related health impacts undoubtedly serves everyone’s interests, but tackling such an important societal issue therefore requires open dialogue, transparent scientific research, and multi-stakeholder collaboration.

Dr. Edward Makgotlho, PhD, is the Head of Scientific Affairs at BAT Sub-Saharan Africa. He holds a PhD in science, specialising in infection and immunology.

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REFERENCES

1. Based on the weight of evidence and assuming a complete switch from cigarette smoking. These products are not risk-free and are addictive.
2. Baker, R.R. A review of pyrolysis studies to unravel reaction steps in burning tobacco. Journal of Analytical & Applied Pyrolysis, 1987, 11: 555–573. Available: https://doi.org/10.1016/0165-2370(87)85054-4
3. IARC Working Group. The evaluation of carcinogenic risks to humans, tobacco smoke & involuntary smoking (No. 83). World Health Organization & International Agency for Research on Cancer, 2004. Available: https://www.ncbi.nlm.nih.gov/books/NBK316407
4. World Health Organization (WHO). Framework Convention on Tobacco Control. Available: https://www.who.int/europe/teams/tobacco/who-framework-convention-on-tobacco-control-(who-fctc)
5. Shepperd, C.J. et al. Changes in levels of biomarkers of exposure and biological effect in a controlled study of smokers switched from conventional cigarettes to reduced-toxicant-prototype cigarettes. Regulatory Toxicology & Pharmacology, 2015, 72 (2): 273–291. Available: https://doi.org/10.1016/j.yrtph.2015.04.016
6. World Health Organization & International Agency for Research on Cancer. IARC monographs on the identification of carcinogenic hazards to humans. Available: https://monographs.iarc.who.int/agents-classified-by-the-iarc
7. UK National Health Service (NHS). Vaping myths and the facts. Available: https://www.nhs.uk/better-health/quit-smoking/vaping-to-quit-smoking/vaping-myths-and-the-facts
8. BAT. ΕΠΙΣΤΗΜΟΝΙΚΗ ΑΠΟΦΑΣΗ ΓΙΑ ΤΟ glo™ neo classic tobacco [translation: Scientific decision on glo™ neo classic tobacco]. 2023. Available: https://www.discoverglo.gr/blog/post/glo-neo-classic-tobacco
9. Health & Food Safety. Special Eurobarometer: Attitudes of Europeans towards tobacco and electronic cigarettes. 2021. European Commission. Available: https://europa.eu/eurobarometer/surveys/detail/2240
10. Farsalinos, K. et al. No smoke, less harm. Smoke Free Sweden. 2024. Available: https://smokefreesweden.org/No%20Smoke%20Less%20Harm.pdf
11. Human, D. et al. Saving lives like Sweden. Smoke Free Sweden. 2023. Available: https://smokefreesweden.org/wp-content/themes/smokefreesweden/assets/pdf/reports/Report_SAVING%20LIVES%20LIKE%20SWEDEN.pdf
12. US Food & Drug Administration. FDA grants first-ever modified risk orders to eight smokeless tobacco products. 2019. Available: https://www.fda.gov/news-events/press-announcements/fdagrants-first-ever-modified-risk-orders-eight-smokeless-tobaccoproducts