by Shane Eubank June 14, 2020
The Global Forum on Nicotine 2020 just wrapped, their first forum to be held virtually in light of the pandemic. The theme of GFN20 was Nicotine: science, ethics, and human rights. Participants were spoiled for choice with the incredible lineup of speakers and engaging question and area periods. If you did not attend the live event, you can find recordings of the full event here.
Clive Bates, former Director of Action on Smoking and Health (ASH) in the UK and now Director of the Counterfactual, kicked off the forum with a discussion titled What’s Gone Wrong? While many of us connected with the tobacco harm reduction field might well have been preparing our own mental lists of ‘what’s gone wrong’, Clive Bates chose to begin his eight point address with ‘what’s gone right.’
“... this is a story of innovation: improvements in battery technology allowed sufficient volumes of liquid to be aerosolized- carrying nicotine, carrying flavours- to create an attractive, popular alternative to cigarettes without the products of combustion and a fraction of the risk to the users. Should be unequivocal good news, should be seen as a great breakthrough, it’s taken off massively, if everyone got behind it cigarettes would be obsolete within, um, you know within a generation. We’d have won the war against the epidemic of smoking related disease.” You can hear the enthusiasm in Bates’ voice.
If we pause here for a moment (and I recommend it, it’s nice to remember the pure excitement of the early days) this should be one of the most exciting technological advances in recent history. “...if everyone got behind it cigarettes would be obsolete ... within a generation. We’d have won the war against the epidemic of smoking related disease.” What an incredible feat that would be.
Smoking related deaths are estimated to total around eight million in 2020. The CDC states that, “If smoking continues at the current rate among U.S. youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.” That is incredibly stark. If anyone wonders why producers continue to spend massive amounts of money further innovating in a market so directly under attack, why small business owners fight to stay open when it would be easier to move on, why advocates wake up ready to do battle every day that they can- this is why. They’ve not lost focus on what's at stake.
And Bates draws attention to this distinction in his third point: the change of mission over time. Referring back to his time as director of ASH he notes, “... our overriding concern was people dying in agony of cancer, living in misery with COPD, people dropping dead with heart attacks, heart failure, and so on.” Bates goes on to relate the new mission of tobacco control as a “war on drugs and the drug in question is nicotine and the battleground is with the youth and that is a material change from where we were in the past.”
While we’re not always conscious of it, we (those of us involved in advocacy efforts) are fighting a separate battle from our anti- counterparts. We keep trying to return the focus to the lives of people who smoke, to their inherent worth and autonomy and right to access safer products. They (the anti crowd) are increasingly focused on nicotine rather than smoking and on youth instead of on smokers. They are, as evidenced by legislation being enacted around the world, succeeding in framing the issue as a ‘nicotine and youth’ problem. A problem, Clive Bates points out, with considerably lesser stakes in the material world than the issue of smoking related harms.
Bates describes that legislation as, “some of the worst policy written, ever. There has been a failure to do what good policy makers should do which is to consider impacts, do proper impact assessments, look at and scrutinize for unintended consequences. The unintended consequences in the harm reduction area are always to do with more smoking and those involve much greater harms than the reduction in relatively minor risks that the regulation is usually intended to address.”
Conversely, the primary thing that keeps people going in the tobacco harm reduction field is the very clear-eyed goal of providing and protecting options for smokers that very well may save their health and improve the quality of their lives. We’re a diverse lot but we have that in common. And passion, which is good because it’s needed with what we’re up against.
In his seventh point, Bates addresses the all important issue of money. “... we have seen incredibly wealthy benefactors, like Bloomberg coming in with his foundation, funding a model of the problem, exclusively- primarily anyway, focused on the idea that harm reduction products are essentially a tobacco industry conspiracy designed to, you know, hook youth and subvert fifty years of tobacco control. This is absolute nonsense, this is a completely flawed view of the world. They’re coming up with ridiculous policy prescriptions all the time but that money is huge and it’s everywhere. It’s in Vital Strategies, it’s propping up the World Bank, the WHO, it’s funding huge activist groups, a massive international network of activists and it’s deeply damaging, it’s unaccountable, largely unchallenged, even buying up media coverage. It’s disgraceful and it’s largely unscrutinized.”
Bates closes as he began, on a hopeful note. He commends the efforts of advocates and advocate groups worldwide- their tenacity, resilience, and persistence. What he would like to see going forward is greater organization and networking between advocates and groups the world over. GFN20 is a wonderful example of that and his hope is that thousands of people are/were able to participate in this, its first online forum. He’s right- on this and every point. The battle is ongoing and will be for the foreseeable future and collaboration and support are critical.
I highly recommend watching the speech in full here. And if you'd like to read more from Clive Bates click through to his website where, among other great articles, you'll find the full transcript of Louise Ross' speech from GFN20.
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