New Report Urges Global Tobacco Harm Reduction


A new report urges regulators to scale up tobacco harm reduction (THR) around the world to help smokers make the switch. Burning Issues: The Global State of Tobacco Harm Reduction 2020 (GSTHR), the recently released second edition of a major biennial report produced by Knowledge-Action-Change, found that smoking-related death and disease disproportionately impact poor and marginalized groups, especially in low- and middle-income countries.

no smoking graphic
Credit: Kevin Phillips

Author Harry Shapiro, coins new terms in the report, calling e-cigarettes “safer nicotine products” (SNP) and EVALI (E-cigarette or Vaping Lung Injury) is now “Vitamin E-Related Lung Injury” (VITERLI).

The report found that there are only nine SNP users for every 100 smokers globally; most live in high-income countries. Overall, 98 million people are estimated to use SNP worldwide. Of those, 68 million are vapers, with the largest vaping populations in the US, China, the Russian Federation, the UK, France, Japan, Germany and Mexico and 20 million are heated tobacco product users—most of whom live in Japan, where cigarette sales have dropped by 32 percent since 2016.

Shapiro also criticizes bad science in the vaping industry, such as studies by discredited researcher Stanton Glantz. GSTHR examines two of his studies that were severely criticized by leading tobacco experts and one study that was retracted. It compares Glantz to Harry Anslinger, the former head of the Federal Bureau of Narcotics who used fear-mongering and moral panics to enact cannabis prohibition.

“SNP is one of the most startling public health success stories of modern times … THR offers a global opportunity for one of the most dramatic public health innovations ever to tackle a non-communicable disease,” Shapiro writes. “In a time of COVID-19 when global health and public finance systems are stretched to breaking point and may not recover for some time, the imperative to drive forward with THR has never been more urgent.”

The report makes several conclusions, including:

  • SNPs have the potential to substantially reduce the global toll of death and disease from smoking, and to effect a global public health revolution.
  • Many US and US-funded organizations have manufactured panics about young people and vaping, about flavors and the outbreak of lung disease, overshadowing the real public health challenge, which is to persuade adult smokers to switch.
  • The increasingly prohibitionist emphasis risks many consequences, including that current smokers may decide not to switch, current users of SNP may go back to smoking, and the growth of unregulated and potentially unsafe products.


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