18C.7 Key Australian and international position statements on heated tobacco products

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Last updated: March 2018          Suggested citation: Greenhalgh, EM. 18C. Heated tobacco (‘heat-not-burn’) products. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18c-non-combustible-cigarettes/18c-7-key-australian-and-international-position-statements

As heated tobacco products are relatively new, relatively few organisations have released official position statements on their use and regulation. Those major agencies that have issued information or expressed concerns regarding their risk to individual and public health have advocated caution, as outlined below.

18C.7.1 Australian agencies

The Australian Government Department of Health, in its enquiry into e-cigarettes, has stated that “There are concerns about the marketing and use of heat not burn tobacco products, because of the limited evidence on their ability to reduce the risk associated with conventional tobacco products and the risks they may pose to population health, such as their potential to disrupt the decline in tobacco use in Australia. The most reliable epidemiological evidence shows that the best way to avoid tobacco-related premature death and disease is to prevent exposure or to cease the use of tobacco products entirely. There is no safe level of tobacco consumption”.¹

18C.7.2 Global agencies 

The World Health Organization, in its heat-not-burn (HNB) information sheet, states that “All forms of tobacco use are harmful, including HNB tobacco products. Tobacco is inherently toxic and contains carcinogens even in its natural form. Therefore, HNB tobacco products should be subject to policy and regulatory measures applied to all other tobacco products, in line with the WHO Framework Convention on Tobacco Control (WHO FCTC).²

The International Union Against Tuberculosis and Lung Disease’s position statement on heat-not-burn (HNB) products concludes:

 

1. The potential benefits and risks from HNB tobacco products to the public health remain undetermined but early independent research indicates that the tobacco companies are understating the risks. The Union recommends that governments apply the precautionary principle to the regulation of HNB tobacco products. Countries should wait for independent assessment of the health effects of HNB tobacco products and not simply take industry assertions at face value before allowing the sale of these products. 
2. Governments should ban indoor HNB use because the aerosol released from HNB tobacco products contain many of the harmful constituents found in cigarette smoke. There are likely health risks from being exposed to second-hand aerosol of HNB tobacco products. 
3. Advertising, promotion, and sponsorship activities of HNB tobacco products should be banned as they have the potential to glamorize cigarette smoking. Children and adult non-smokers are at the risk of being led into nicotine addiction and subsequently smoking cigarettes or using other tobacco products. 
4. HNB tobacco products should be incorporated in the regular monitoring framework of tobacco use in the country. 
5. In countries where HNB tobacco products are already available, governments should also prohibit claims that these products assist in smoking cessation until independent evidence at both individual and population levels is available that this claim is accurate. The potential of HNB tobacco products to reduce willingness to quit smoking and the impact of dual use with cigarettes should also be independently assessed. 
6. Tobacco industry should not be involved in the discussions of HNB tobacco products policies or any other tobacco control policies. Such involvement is a violation of the WHO FCTC Article 5.3 and its Guidelines.³

18C.7.3 Overseas agencies

Public Health England, in its latest evidence review, concluded that “…it is currently not clear whether heated tobacco products provide any advantage as an additional potential harm reduction product. Depending on emerging evidence on their relative risk to combustible tobacco and e-cigarettes, regulatory levers such as taxation and accessibility restrictions should be applied to favour the least harmful options alongside continued efforts to encourage and support complete cessation of tobacco use”.⁴

The French Alliance Against Tobacco’s position statement concludes that: independent data on heated tobacco is insufficient; heated tobacco must be subject to the rules on smoked tobacco products;  and heated tobacco is more of a problem than a solution for tobacco control.⁵

References 

1. Department of Health, Standing Committee on Health, Aged Care and sport - inquiry into the use and marketing of electronic cigarettes and personal vaporisers in Australia. Australian Government; 2017. Available from: https://www.aph.gov.au/DocumentStore.ashx?id=4f4d5093-5468-40c0-b573-986692900aad&subId=512734.

2. World Health Organization. Heated tobacco products (HTPs) information sheet. 2017. Available from: http://www.who.int/tobacco/publications/prod_regulation/heated-tobacco-products/en/

3. International Union Against Tuberculosis and Lung Disease. The Union's position on heat-not-burn (hnb) tobacco products. 2017. Available from: https://www.theunion.org/what-we-do/publications/official/body/Heat-not-burn-Union-Position-Statement-Final.pdf

4. Ruprecht AA, De Marco C, Saffari A, Pozzi P, Mazza R, et al. Environmental pollution and emission factors of electronic cigarettes, heat-not-burn tobacco products, and conventional cigarettes. Aerosol Science and Technology, 2017; 51(6):674–84. Available from: https://doi.org/10.1080/02786826.2017.1300231

5. French Alliance Against Tobacco. Heat not burn tobacco & related products. 2017. Available from: http://ensp.org/2017/11/24/position-paper-heat-not-burn-tobacco-related-products/