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Clive Bates: I've got Jess and Paddy are going to be helping out. So if you think I'm ignoring you or something, just signal to them. They're there to spot people in the audience. If you're going to speak, make sure you've got a microphone and make sure you say who you are and where you're from, okay? It's just polite to the rest of the audience that they know where you're coming from, okay? The session itself, the big conversation, this is an experimental session, so it could all go horribly, horribly wrong. I hope not. But essentially, it depends on you, the audience, rather than us here on this stage. Okay? The idea is that we look back to all the way back to 2011 or before if you want to, and we try to work out what's happened and why. And we're doing that with a view to understanding What is the dynamics in this field that we're working in? What causes success, causes failure? What explains the behavior of particular actors? Or what explain, why does WHO do what it does? That kind of thing. So I want to try and get the collective wisdom of this audience distill it into some kind of highly refined fuel, and then at some point play it back to you. That's the idea of the session. So we're going to be broadly two sections. The first section is going to be a little walk down memory lane. And essentially, we're going to play a bunch of short video clips. And I mean short, like a, you know, 30 seconds to a minute and a half. One from each of the years from 2011 through to 2023, okay? And at each point, I'm going to ask if anybody's got anything to add or any insights. I might put some questions based on what we're seeing on screen. But then, what we want to do is take from that, and this is where we're going to get into maximum sort of discussion phase, so this is the second part of this session, is I want to kind of get a thematic approach to what's happened over the last 15 years or so. What are the policy gambits that we're seeing? What justifies them? What arguments are used? We know everybody uses youth as an argument. What else? And what's our equivalent of that argument? What's our response to that argument? Why is the science such a mess? I mean, I'm not even going to have an argument about whether it is a mess. It is a mess, but why? What's driving that? Why is there such sort of indifference to the science? Not universally, but certainly in the mainstream. Then I want to look at advocacy. What makes successful pro-vape consumer advocacy? And what's the nature of the advocacy coming from the anti-vaping, anti-nicotine people? And then the industry, okay? There's some huge industries involved, the tobacco industry, pharmaceutical industry, the vape industry. What's our take on that? And where should we go with understanding the industry and what role should the industry play? And then finally, where are we heading? Where is all of this ultimately heading? If we had a clearer If we had a clearer insight into the end state that we're aiming for, maybe we'd find the path towards it a bit easier to follow. So how do we see the world of nicotine in, say, 15 or 20 years? So that's basically just my introduction to the session today. I'm going to come to, I want, the session depends on audience participation, which means you sticking up your hand and saying something interesting, insightful, informative, even funny, if you're so inclined, to move the session along, okay? I have strong views on all of these things, as you probably know, but I don't want this to be the big monologue, I want this to be the big conversation, and that means you have to get involved. And if we're slacking a bit, I might come to people, whether they like it or not, so have something in mind, just in case I do that. OK, let's go back now. Let's start with the videos and the video clips and take ourselves back to 2011 and one of the first meetings that was ever held on tobacco harm reduction. Video, please.

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Video: Loudly and clearly this week with three common messages. Harm reduction works, harm reduction saves lives, and that the human rights violations committed in the name of drug control or the control of sex work must end, along with the criminalization frameworks that drive these abuses.

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Clive Bates: So a great articulation of harm reduction. Does anybody want to say a few words about the origins of tobacco harm reduction and the movement for tobacco harm reduction? Any thoughts on that? Was anyone involved in the campaign to overturn the UK's MHRA intention to medicalize e-cigarettes back in 2010? Martin. The mic down here, please.

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Martin Cullip: I wasn't directly involved in it, but I was writing on the subject of vaping as early as then. I was writing on vaping as early as then, and I was struck by the passion of the consumers who managed to generate, I think it was over a thousand responses to that consultation. And it's important to realize that they had three options in that consultation. Option one was to ban vaping within 21 days. And as they said, that was their preferred option. And it's quite significant now that that was the MHRA who was doing that consultation, trying to ban vaping, and now MHRA regulates vaping probably better than any regulator in the rest of the world.

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Clive Bates: Yeah. I think, at least in my awareness, that was one of the very first shows of consumer strength, okay? 2010, nobody in the public health community saw this coming. They all All of them, even those that are now very pro-vaping and pro-harm reduction, wanted these products regulated as medicines and taken off the market, either within three weeks or within a year. And a thousand people ended up writing in opposition to that, so that was a very first At the same time, slightly earlier, maybe another kind of equivalent thing, using the more American way of doing these things, was the Sotera decision in the United States, in which the FDA wanted to define vapes as medicines and were defeated in court. So rather than a consultation, it was litigation, which is, as you know, the American way. But it had the same effect. It stopped a preemptive move to medicalization. OK, next one, please. It's about the EU.

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Video: As a member of the European Parliament, I often come across silly, ludicrous EU laws. Mostly I come across proposed EU legislation that seems to be a stranger to common sense. Proposed legislation that makes you wonder who is really pushing for it. An example of this is the EU e-cigarette ban. Users of the electronic cigarettes who have contacted me in their thousands about the EU cigarette ban. The EU's review of the Tobacco Products Directive is aimed at making smoking in all its forms less attractive to young people in order to discourage them from taking it up. The draft EU Tobacco Directive, in its wisdom, seeks to ban electronic cigarettes. This community, also known as vapours, have contacted me because they desperately do not want to see their electronic cigarettes disappear.

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Clive Bates: OK, so that's 2012. Can we also see the 2013 video as well, please? Because that's a similar thing. Because that campaign went on for two years.

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Video: We can go to any store, buy cigarettes we want to make sure these things stay available in every shop throughout Europe not just in pharmacies and not just in a one-size-fits-all manner because one size as we know does not fit all. There is a vote this afternoon on the European Tobacco Products Directive, which will profoundly influence the future of e-cigarettes in Europe. They're still all to play for. So we're all here. We had a great time. We came on the train from London, on what I call the Brussels Vapor train. And we're meeting here with MEPs. And we really hope this will help to swing some of the votes. against this proposal for what I call the medicalization of e-cigarettes.

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Clive Bates: That's me celebrating on the October the 8th after the momentous vote. Okay, so anybody want to reflect on what happened there in the EU back in 2012-13? Anybody old enough to remember that? Anyone involved in it? What were the ingredients of success? Charlie. I remember the day of the vote. Say you are and stand up.

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Charles Hamshaw-Thomas: Charles Hamshaw-Thomas. I remember the day of the vote, you came up to me and you said they've thrown in the advertising. Was it the advertising ban at the very last minute? But the other limits were sort of acceptable. And then an MEP said to us, don't worry about that, we'll change it later.

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Clive Bates: I was right, wasn't I? Yeah, Jerry, in the back, please. Thank you.

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Gerry Stimson: I'd forgotten I'd gave that interview. I was having a bit of a laugh watching myself then, So much older then, I'm younger than that now. But it was, a number of things were important to think. Firstly, that demonstration was incredibly, incredibly polite. You know, we were advised that you really need to lay down in the street and, you know, the fishermen would dump the fish outside of the, you know, European Parliament and so on. So it was really polite. It was also kind of a start of a learning curve for vapor activism. And I think what struck me at the time was that this was very organic. It wasn't really organized. It was a real spontaneous rising up, contacting MEPs, using Twitter. And, you know, there were no groups really organizing this protest. I mean, they come later, and I think that's going to be very important about the development of organized consumer advocacy. But it was really like a spontaneous thing, you know, this is important to us, and we don't want it taken away from us.

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Clive Bates: I think, if I could just build on that briefly, Gerry, I think the authenticity of that and the way vapors express themselves about what it meant to them really cut through with the politicians, I think, so that's perhaps a lesson there. Anybody else want to comment on the, we're gonna come back to all this, because I want to get the more thematic stuff later. Oh yeah, sorry, go on, yeah. Just, Garrett, just get the mic.

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Garrett McGovern: The one thing that strikes me about watching those videos there is I think we were further down the road 10 years ago than we are now. I think we've regressed. In that time there has been a whole anti-vaping kind of idea that maybe people who seem less informed now maybe weren't informed at all then and sometimes in a way you have more influence than people who know nothing at all than people who think they know everything. And it's just amazing to see the sort of enthusiasm there and I think Jerry put it very well and he said it was actually done very peacefully, very quietly and you know what we achieve but it just goes to show you that It's user advocacy that will win the day here, absolutely, and we need more of that.

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Clive Bates: Thank you.

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Martin Cawley: Martin Cawley from Scotland. Just one point, and it maybe just takes a different twist, Clive, but I remember around that time, it was a time when I stopped smoking, and I used e-cigarettes for a period to help me stop smoking. And the availability was so difficult and I remember driving around trying to find places where I could buy e-cigarettes. So, very different from today where you can access products much more readily. So, just a different twist.

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Clive Bates: Very big difference, yeah. I think, sorry, yeah.

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James Arnold: James. Hi, James Arnold from PMI. What struck me on the UK and Brussels was Consumers moved, but they didn't change MHRA's mind. They didn't change DG Senko's mind. By gathering together, they got the attention of politicians who were elected by giving them a win. And if the narrative has changed, maybe it's because politicians don't see a win.

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Clive Bates: I think that's a really important observation. I'm not going to apologize for those of you who weren't there at the time, because it's actually really interesting. The forces that were lined up against the consumers at the time were massive. So there was a consensus in the European Commission that these products should be, when the MEP said banned, what she meant was regulated as medicines, which would have amounted to the same thing. But there was a consensus in the European Commission that they should be regulated as medicines. The European Council, which is all the member states, 28 at the time, was that they should be regulated as medicines. The Special Committee of the European Parliament that had been put in to report on it, and the Rapporteur, all said they should be regulated as medicines. The Brussels lobbying machine, all regulated as medicines. All the health agencies all around Europe, all regulated as medicines. Yet, the consumers won a massive battle in 2013 precisely because they appealed to elected representatives, and they appealed to them in a way that was incredibly authentic. They didn't come at them with odds ratios, with charts, with toxicology assessments. They said, this works for me, and I'm telling you my story. And I think that's what cut through in the parliament and then rolled all of those others aside. And it was an epic victory given the asymmetry. I think unfortunately the opposition, to Garrett's point here, the opposition has kind of wised up and become much more sophisticated since then and it'll be a much harder ride next time round. Okay, any more, does anyone, I can't see, there's a hand down there. You're in the landing lights, Alex.

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Alex Wodak: Alex Wodak, Australia. I wonder if I could put an alternative perspective to what you're covering in the sense that resistance to new mood-altering drugs is almost universal and is almost always very intense. Indeed, the introduction of cigarettes was fiercely resisted, and so too is the introduction of new harm reduction interventions, almost always fiercely resisted. especially if they are about pleasurable activities, in other words, sex and drugs. These are usually, especially the new drug harm reduction interventions, and after all that's what we're talking about with tobacco harm reduction, is following the same path as happened with the introduction of methadone, the introduction of needle syringe programs, of injecting rooms and so on. So I think what we're seeing is just the same pattern being repeated yet again.

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Clive Bates: No, I think so. Anyone else on? All right, let's move on, because we've got plenty of time to come back to the thematic side of this. Let's go to 2014 video, please.

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Video: Smoking for nicotine products really should not be seen as a problem. They're not part of the problem. They're really part of the solution to smoking. My name's Sarah Jakes. I was a smoker for probably 35 years, having tried just about everything to give up. Eventually decided that I didn't want to give up. I bought an e-cigarette and then I basically accidentally switched. I didn't intend to. I'm here at the Global Nicotine Forum really to meet with other European papers to see what we can do about regulation, how we can influence regulation, how we can work together to achieve the common goal. I'm Delon Human, I'm a physician and I am at the conference because I have seen the potential of e-cigarettes to help those people who want to quit but can't. And frankly I was getting so tired of asking patients to quit and not having an option or an alternative to offer them. So I've been watching e-cigarettes over the last two years and I've been astounded that even the most ardent smokers managed to stop or at least substitute the cigarette use by using e-cigarettes.

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Clive Bates: Okay, so 2014, the first gathering of GFN, one of the first, I mean, I think there'd been vape meets well before that. That was a thing that was already in play, and I'd love to hear from anyone who's been involved in them and the extent they generated advocacy or other sort of political activity. But you start to see a movement coming together here with interest from, sort of belated interest from kind of public health, we'll see Kevin Fenton in a minute, and vapors together, seeing that there's a potentially huge solution to a problem here. Could we just play, let's just play the next one, because they're 2015, and then we'll just reflect a bit on that.

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Video: So this is not about non-smokers taking up e-cigarettes at all. And in fact, the data suggests that it's very, very unusual for people who have not smoked to take up e-cigarettes, in part because it's not very addictive. It's not a fun thing to do. But this is far more about smokers and how we help smokers to reduce the harm from smoking, from moving to a product which is very toxic to something which is significantly less harmful as part of their journey to quit and to quit for good. So what we're saying is, you know, Smoking Cessation Services provides a range of tools to help people who want to quit. But we recognize that consumers are making that choice today. They're seeking and they're purchasing e-cigarettes. We want to ensure that they're using the best available tools through Smoking Cessation Services to help them to quit for good. Remember, the key here is how do you weigh the risks of people smoking and the known harms that that creates from the benefits of promoting a method which is significantly less harmful and ensuring that people are using it as a quit aid. And what we have to ensure is that as we are promoting the use of e-cigarettes to help people to reduce their harm, we're equally focusing on limiting the use of e-cigarettes by people who are not smoking at all. And that's why legislation to prevent the sale to minors or the purchasing of e-cigarettes by minors is so important because it provides that context to protect young people from taking up e-cigarettes.

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Clive Bates: Excellent. So I think what's happening here is you see some, I think, quite inspiring people in public health capturing, catching up with, not capturing, catching up with the tacit knowledge of vapers and consumers who have learned by doing that this actually works. And so there's people like Kevin Fenton and others, you know, and there were many of them present at the first GFN, and they then form a group within public health, and that accounts for a big split in public health because not everyone followed that path. So I think we see around 2014-15 a split emerging in public health into the pro and anti tobacco harm reduction, pro and anti vaping, and actually GFN in some ways encouraged that along. But I would like to hear from anybody in the audience about their reflections on the first two or three GFNs, whether it was different to how it is now. I'd love to know, because I've never been to one, what role, if any, vape meets played? What role? Or was that all about technology and everything? So let's have a few comments from people who are involved at the back there.

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Attendee: So, around like 2013, 2014, you start having pretty significant vape meets and conferences where, you know, you could have hundreds of people. You had growing strength of advocacy groups such as Sephata, CASA. There was a growing presence of lobbying and vape shops were numbering in the thousands. So you had a lot of people who had been using products and they became evangelists and they wanted to provide them to other people in the community. So it was really becoming a huge grassroots sort of effort that you saw throughout the country.

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Clive Bates: Any other views on that? Okay, hang on. Just wait a second for the mic and then say who you are.

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Anton Israel: Hi, Dr. Anton Israel. I want to discuss for one second what you just talked about, the splitting within public health post-2015. We've seen that much later. But the point I want to raise is the fact that any splinter channel that arises from public health is immediately squashed, at least in Israel, by the mainstream public health, those who would go down the Bloomberg pathway, for example. And I think that from that standpoint, it's very disturbing because it means that there's no real pluralism in regards to different independent thought.

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Clive Bates: Yeah, I agree with that. Maria, do you have something you might want to say about this? Thanks.

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Marewa Glover: Hi, Marewa Glover, New Zealand. I just want to acknowledge the role of Twitter in terms of a technology. I think my first GFN I came to was 2015. I didn't even know about it. The many, many consumers were using Twitter at that stage, as were GFN, to advocate, to share information, to educate people. And down in little New Zealand, I was tweeting, and there were a number of us tweeting, and I want to acknowledge Donna Darville from Australia, They were picking up my tweets, probably because we were on the same timeline, and she said to me, are you going to GFN? I'm like, what's that? And it was like, hold the line, caller. And she got in touch with Gerry and Paddy, and I was invited to the 2015. Twitter has been incredibly important. as a communication platform, YouTube as well, and I just, you know, many people have said, oh, all you do is spend all your time on Twitter. I'm like, don't you knock it. It's really paid off, and if you're not on Twitter, there's a huge community of consumers there, and they back you, and anyone attacks you, and they pile on to defend. They are just so active. All this disinformation on Twitter at the moment There is a vapor there is an advocate no tweet goes unanswered. Thank you.

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Ondrej Koumal: So I stepped out of the Bermuda Triangle Ondrej Kumal, I feel being here almost 10 years ago with the first GFN or the first GFNs, I feel despite the battles that you mentioned in the EU and elsewhere, I felt people were a little bit more open-minded at that time. I felt a lot of true scientific intellectual curiosity. I want to learn more. I want to learn. I represent industry. I'm from Philip Morris. I want to learn about your science, what you guys are doing. So I felt really much more open-mindedness. And I think we've regressed. So I don't see the same open-mindedness and curiosity today. I think people made up their mind, I guess, a few years ago. And that's where they're stuck until now.

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Clive Bates: I think that's right, and I think it's the point that was made about Israel, is that there's like a divergence formed in public health and the science and academic community, and if you like, the professional public health community. Put that in quotes. And actually, that divide got very aggressive. It got very abusive, in my opinion. And it started to excommunicate people for coming to the wrong conferences and believing the wrong things. And we saw the emergence of an almost McCarthyite approach to this. in which that sort of brief window of curiosity that you mentioned, Andre, I think was kind of extinguished, really. People went from being open-minded and thinking and wanting to learn more to wanting to take a position and then harden it by, you know, choosing the science that fit their priors. So I think that was an interesting point. Jeannie. Microphone, please, down here. That's it. It's interesting. I don't know if you're going to say this, but I think that also reflects the evolution of the FCTC.

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Jeannie Cameron: Yes, I'm Jeannie Cameron from JCRC. I think one of the things we, if you can go back even further to 2001 to 2003 during the negotiations of the FCTC, which I actually sat through, and you think and you remember that there are 193 governments there who put harm reduction into the FCTC. So you had that was always put in there and never taken out. It's a consensus of agreement. So you had harm reduction strategies being put forward and included in there by those governments. So I think you can go back further. We didn't know what those harm reduction strategies were at that time, but they put that in there and that was done by governments. So it has gone backwards.

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Clive Bates: Yeah, I think so. I'm not sure, I was also involved at the time and I'm not sure what was meant by that. I think they had in mind the pharmaceutical, the idea that there would be harm reduction indications for NRT products was sort of left in there. But yes, I definitely think, and I think the way WHO has dealt with this, it mirrors the wider public health. It was sort of initially, They were sort of hostile and then opened briefly, maybe around 2014, 15, and now they're very much slammed shut on one side of the argument. So yeah, but you're right, it's been going on for a long time. Does anybody else want to comment on this? Anyone? Yeah, Harry. Down here, please. Stand up.

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Harry Shapiro: Stand up, Harry, Harry Shapiro. I just wondered whether this kind of, this split and this hardening of attitudes from, you know, maybe 2013, 14, 15, was as a result of an increasing involvement in the major tobacco companies in buying into the small vaping companies and then developing their own products and so on. And that became the narrative. the narrative for opponents became, oh, well, there you go. Here they go again. And that, I think, is where that kind of Red Sea divide has probably come from.

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Clive Bates: Yeah, I am sure that is a factor and made all the advocacy more difficult because the tobacco companies brought their reputational baggage into the room and that allowed... The question is, was it a real concern about the tobacco companies or was it a useful argument? If you look at where WHO is now, almost everything they say is essentially about them fighting the tobacco industry. It's almost as if that gives them the legitimacy and purpose. And some tobacco control advocates would say tobacco harm reduction is just the nicotine maintenance strategy of big tobacco being played out. So that has entered the debate. The question is whether that's a material argument, in other words, there's some truth in it, or it's an expedient argument used by people who are opposed to this for other reasons but use that argument because it works. I err towards the second explanation myself. Any thoughts? We have an online question. Okay, go. Grab the mic.

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Jessica Harding: Lamir: do you think social media has been key in helping knowledge and science being brought to the world stage, or has it been a hindrance?

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Clive Bates: Let me, there's a, Marewa made a very strong pitch for Twitter, but let me make a devil's advocate argument about that, is that The alternative view is that it consumes a lot of time and energy within a relatively small bubble of people who are engaged in, quotes, online activism. But does that ever reach the outside world and have any effect? That's the counter proposition. Where do people stand on that? Are people spending too much time, not enough time, the right amount of time in social media compared to non-social media advocacy? Views, please. Hello?

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Ondrej Koumal: This is me, Andre, again. I just have a view or... I wanted to mention what I tend to use as the best example to explain the divide. And I use a slide by Deborah Arnott from about a decade ago or so, where she has on the slide the three traditional pillars of tobacco control, objectives of tobacco control, number one. Reduce or eliminate death and disease. Number two, reduce or eliminate nicotine addiction. Number three, destroy the tobacco industry. These were the traditional mutually reinforcing objectives of tobacco control. With a harm reduction product or a harm reduction product produced by tobacco industry, Clearly, this kind of creates some conflict between these three objectives, right? And I think that the views of where people stand, I guess, are maybe driven by which objective they see as the number one objective in this context.

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Clive Bates: All right, that is a good answer to a question I didn't ask. You're welcome. It's a really important point, and I think we should come back to that in its own right and have a bit more discussion about it. What you are trying to do here, are you improving welfare, reducing disease, reducing smoking, reducing tobacco, reducing nicotine, dealing with the tobacco industry, dealing with the welfare of non-users? All of these things lead you in different directions that were largely aligned when the dominant product was cigarettes. You could just say all of the above, and you can't really say that now. But let's, can we just hold that thought and come back to it? I was actually asking about social media, and if anybody's got any views on whether social media activism, we've got one down here, and then Jerry, and... Garrett. Yeah, oh, Garrett, yeah.

00:36:42 --> 00:37:53

Alexandro Lucian: Hello, Alexandro Lucian from Brazil. I started blogging about vaping in 2015 because I quit smoking because of vaping. And I often see myself like the conspiracy theorist. Because all the doctors in Brazil, all the major associations tell people that vaping is as harmful as cigarettes. And I am the crazy guy with just a blog and a YouTube channel saying things like high tobacco induction and vaping is bad. far less harmful, and sometimes I find myself talking to the same people, a small audience, a very niche audience, that agrees with me, are informed consumers, people that also quit smoking, buy cigarettes, that buy e-cigarettes. But it's difficult to pop the bubble and to talk to people outside this small community. So social media helps, but doesn't solve the problem. But it's better to do something as small as it is, as opposed to not doing anything.

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Clive Bates: OK. Jerry, you were going to say something about this.

00:38:00 --> 00:38:32

Gerry Stimson: Yes, clearly Twitter can be an echo chamber, but really it's around 2014, 2015, it gave vapers a chance to engage with so-called experts. So you could actually make your views known to people with whom you disagreed, and those people actually were pretty rattled by the rise of vaping because their expertise was criticized by people on Twitter. Never before could that happen, because you'd have to go to a conference to get your view across to a public health grandee, but now you could make your views known globally, and they didn't like it.

00:38:32 --> 00:39:34

Clive Bates: It's fascinating. Around that time, there were some very enormously self-important people who encountered, and I'm thinking of Martin McKee and Mike Dorb and these sort of people who encountered, for want of a better word, real people for the first time ever. and were amazed that real people weren't deferential to them and didn't just agree with everything they said. And I think that's one of the powerful things. I personally think consumers and vapers own the space on social media. If you look at the way Campaign for Tobacco-Free Kids or the World Health Organization engages, they don't have much space that isn't immediately and quite rigorously and usually politely criticized fairly firmly. And I think that's quite an interesting dynamic that they've never really experienced before. Let's have that one there.

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Miguel Okumura: Hi, I'm Miguel Okumura, also from Brazil. I would like to add that I recognize the strength of social media to vaping activism, but at the same time, Our projects keep going through shadow bands on social media, and our reach is very limited. And we who create the content, we actually don't know why our content do not get to the people. So this is like, it makes it harder to pop the bubble, like Alexander says.

00:40:16 --> 00:40:37

Clive Bates: I think that's an interesting point. You rarely see a vaping or harm reduction post that gets more than, say, 100 or so retweets. It's a very small number considering there's 80 odd million people. So, yeah. Okay. There was a couple down here. John and then in the distance.

00:40:42 --> 00:41:26

John Oyston: Hi, John Oyston from Canada. Twitter, I find, my Twitter audience is talking to the echo chamber, but that's actually remarkably useful, because from Twitter, I've got a lot of people who have given me links to articles that I might never have seen, or they're distributed images that are useful and helpful. So I have found Twitter's been useful from that point of view. What's more interesting is I have a Facebook page, which is mostly family vacations and things that's growing in my garden and family stuff. And every now and again, I post stuff about vaping there. And that's fascinating, because one of my friends said, oh, I thought someone had hacked into your account, because there was a doctor saying good things about vaping. So I think that is actually perhaps one of the more useful things I do on social media.

00:41:26 --> 00:41:29

Clive Bates: The next one, 2016. We need to speed up a bit. 2016, the empire strikes back. Please.

00:41:41 --> 00:42:08

Video: A bipartisan congressional act entrusted the FDA, Food and Drug Administration, to regulate the manufacturing, distribution, and marketing of tobacco products in order to protect public health. With that authority, today we are taking a significant step to do just that. We're protecting our nation's children and teenagers and helping adults get the information they need to make informed decisions about tobacco and nicotine use.

00:42:11 --> 00:42:46

Clive Bates: Okay, so that's a very strong, it turns out, I mean, whatever the rhetoric, a very strong intervention there from FDA, which introduced this appropriate for the protection of public health standard, which when you plays out, looks a little bit like medical, a medical standard of evidence, but more complicated, because it requires a population test. Any thoughts on FDA? Just briefly, because this could be an enormously long subject, but yeah, over there. Stand up.

00:42:49 --> 00:43:27

Simon Bauer: Hi, Simon Bauer from Germany. We saw something similar everywhere in the world after that, because for politicians it was a very new issue. We had vaping a few years, but it was quite new for politicians, they didn't see it before. And we saw the same in the EU and everywhere in the world. So it's very easy to say it's something similar and we have rules and it's a very short way to get it done. And I think that's where all started to see it as the same from there and that was the starting point for many following problems.

00:43:28 --> 00:44:01

Clive Bates: I think it's quite interesting, again, so there was a lag in public health awareness and understanding, and then I think that led to a policy snapback in a lot of places where you start to see the public health advocates getting under the skin of the regulators like FDA and their equivalents in other countries, definitely. All right, oh yeah, down there, please. Yeah, Roberto, please, briefly.

00:44:01 --> 00:44:38

Roberto Sussman: It's very important to compare the way the FDA has regulated or has treated IQOS and the way they have addressed vapor products. Because the IQOS, I have gone into the details in the IQOS regulation. And it is good. I think it passes. And it is important because it's an important backup of a harm reduction product. But in the case of rape, I think it's important to compare these two cases.

00:44:38 --> 00:44:53

Clive Bates: Okay. I agree. All right. Anybody else? I'm going to go on to the next one then. the formation of the, we got it, 2017, formation of the Foundation for Smoke-Free World.

00:45:02 --> 00:45:53

Video: Well, I'd spent my life really focused very strongly on tobacco control. Initially here in South Africa, where some of the early legislation we did with then Minister Nkwazazana Zuma. And then at the World Health Organization, where I led and played a key role in the development of a worldwide treaty. There's been huge success over the decades, particularly in putting in place better taxes, banning advertising and so on, but we still have a billion smokers in the world. And I felt that we needed to make a lot faster progress on reaching out and working with smokers, not just on having them quit, but getting them to understand that a wide range of new products out there, from e-cigarettes and others, would also help them reduce their risk considerably and eventually hopefully help them quit.

00:45:53 --> 00:46:29

Clive Bates: Okay, I don't think there's anyone from the Foundation here, but if there is and you want to say something, please do. The interesting thing here is that that was set up with money from Philip Morris to pursue a mission, which was to end smoking within a generation, which I think probably most people would think would be quite a good thing, if that could be done. Yet it encountered incredible hostility and opposition. Why? Anybody, any views on that? Let's go to Jeannie first, briefly.

00:46:32 --> 00:46:44

Jeannie Cameron: It's very simple. It was launched at a tobacco industry event.

00:46:44 --> 00:47:04

Anton Israel: I think it was simply competing on funds if you want to look at the success rate of various organizations. A lot of times you look at how much funding do they have to actually take on board more and more aspects of what they're doing. And I think that this was a direct challenge on those who are ATOs or other groups that are very similar minded.

00:47:04 --> 00:47:11

Clive Bates: Okay. Any other thoughts? Yeah. Hang on, one there.

00:47:11 --> 00:48:09

Andrew Manson: Here, here. Oh, sorry. Hi, it's Andrew Manson from the UK. I think it's very important throughout this process to understand that the progress we've made so far is because this has been consumer driven. It's not been driven by the industry, it's not been driven by public health. And consumers need to be treated with respect. I don't just mean the vaping community, but I mean smokers. And putting messages to say that smoking needs to be reduced to zero and treating smokers as if they're either ill or weak or easily influenced by the tobacco industry is frankly unhelpful. We need to listen and talk to smokers, and we need to make products that meet their needs better than cigarettes do. And then the consumer movement will continue.

00:48:09 --> 00:48:28

Clive Bates: All right. So that's a sort of industry perspective is that the job is not to be too much of an activist. It's just to make good products that people can buy and use and make money from doing that. That's not a bad way of looking at it. Anyone else? In that case, I'm going to move on. If we could have the next two, because they're kind of related, 2018 and then 2019.

00:48:51 --> 00:49:23

Video: Reports say that actually many people are no longer using it as a weaning step away from cigarette smoking. They do a bit of cigarette, they also do a bit of e-cigarette. if they are already smokers of cigarettes. There are some who are probably getting into the habit because it seems cool.

00:49:23 --> 00:49:56

Clive Bates: All right, so India, 100 million smokers, bans all the safer products. Snus, so prohibition's not a new thing. Snus has been banned since the early 90s in the European Union, with the exception of Sweden, where it's reduce smoking to the lowest level in the world. Prohibition, there's a strong prohibition reflex in this world. Where is that coming from? What's behind that? Why do people do that?

00:50:01 --> 00:53:08

Bengt Wiberg: I'm Bengt Wiberg from Sweden, founder of the EU4Snus movement with members from more than 100 nations. Thank you for bringing up 2018, because I was there on the photo at the European Court of Justice together with Tobacco Harm Reduction Friends, Uwe Hille from Germany and Atta Khan-Befritz from NNA Sweden. What happened there in the court made me decide that the ban on snus is 100% political. Nothing was considered about, I think, about 100,000 pages of scientific evidence, the evidence of the Swedish experience with the lowest smoking rate in Europe and probably the first country that will reach the WHO and EU goal of 5% smokers daily. I tell you two arguments that came from EU lawyers. One EU lawyer said snus has nothing to do at all with the fact that Swedish males have stopped smoking. It has to do with paternity leave. Another EU lawyer said, snooze has nothing to do with Swedish men quit smoking, it has to do with Swedish men's healthy living style. Forgetting why the women who I think are equally healthy living style. I'd like to finish with sort of a helicopter perspective, because if anyone here, anyone on the planet Google the question, does nicotine in itself cause cancer? You will find the reply, thanks to Google, from FDA saying, no, it doesn't, and many other organizations. So, basic problem is not vaping is the best golden bullet or snus is or nicotine pouches is. We have to start from the very top. When people realize that nicotine in itself does not cause cancer, then we can discuss the lower levels of harm between the products. And what I'm very proud of with EU First News is that since 2018, when Magazines write about tobacco harm reduction. Snooze is also mentioned. There is not one single golden bullet. Thank you.

00:53:09 --> 00:54:02

Clive Bates: Thank you, and by the way, well done for all your work on this. It's been magnificent. But I think these prohibitions do illustrate a kind of mode of operation of HIN. There's no evidence behind any of these things. When you read the work of people who are advocating prohibition, like the union advocates prohibition of vaping and heated tobacco products in every LMIC in the world, that's 80% of smokers. At no point do they discuss unintended consequences, trade-offs, the actual evidence that supports prohibition. Sure, there isn't any. And so on and so on. It's not, as you rightly say, Ben, it's not a scientific or policy analysis. It's something quite different. Norbert, and then Jim. Nice short one, Norbert, please.

00:54:06 --> 00:54:45

Norbert Schmidt: Norbert Zillatron-Schmidt, from Germany, Consumers Organization. And I wanted to know why snus is banned in Europe. And I asked on the Tobacco Control Conference. And the answer I got was, well, we have more than enough tobacco products. We don't need this one. We can ban it. As it wasn't popular, we can ban it. It's really... What is the reasoning for banning snooze in Europe?

00:54:45 --> 00:55:26

Clive Bates: It's a really interesting point, why it stays banned. It was originally banned on the back of a youth moral panic, you know, around school bandits. And that set everybody off and they got a ban. And there's an incredible resistance to unwinding anything. because it looks as though they're going weak on the industry or they're going weak on tobacco or something. So that's where I think the political pressure comes. They don't want to look as though they're reversing something on this and look as though they're going soft on something, even though it would have enormous public health benefits. Jim. And then one down here.

00:55:26 --> 00:55:51

James Arnold: Hi, Jim Arnold, still from PMI. Stand up. Stand up and be breathing. And I shall stand, sir. I think bans happen because they make a really nice political headline, and I think they happen because there isn't another nice political headline on the other side. That's not a headline that's based on science or industry submissions or HPHCs. I think there needs to be an equally important, countervailing, politically popular headline.

00:55:52 --> 00:56:07

Clive Bates: I think you can dramatise a ban or a prohibition. You know, it's why there's a narrative about the ban on disposables. It makes the politicians involved look as though they have potency and control and everything, which, of course, they don't in reality. Now, as a... Down here.

00:56:07 --> 00:56:46

Fiona Patten: You're right in the light, so... Thanks, Clive. Fiona Patten from Australia. And as a former Member of Parliament, I think the simple answer to why we use prohibition is it's easy. It's much harder to regulate. It's much harder to develop legislation to regulate. And we're seeing this whether it's medicinal cannabis or we're seeing this whether it's adult use of cannabis. So, from a politician's perspective, a prohibition and a ban is a much easier sell. It makes a much easier headline, but it is actually technically and legislatively much easier as well.

00:56:48 --> 00:57:05

Clive Bates: Yeah, no, I agree with that. Of course, it's not easy to do, but it's easy to legislate. It doesn't actually work, you know, it's obviously. But, you know, enforcing a ban is immensely difficult, as you know. Okay, I am, sorry, let's, yeah, go on. Down here.

00:57:12 --> 00:58:54

Sidebottom: Hi everyone, Robert Sidebottom representing the United Kingdom Vaping Industry Association. I'm also here as the Managing Director for Arcus Compliance. Now just on this subject of banning disposables, which is a discussion which is currently going on in the UK at the moment, as we're all very aware. Steve Barclay, for example, has just been in the Telegraph today saying that he's interested to learn the lessons from Australia which I think is a there's a number of lessons that could be learned from that I think I'm quite happy to send those to Steve Barkley but just out of interest based on that and this political ease of doing banning we did a Freedom of Information Act request from 11 cities across the UK covering a population of 5.5 million people and we asked the councils to tell us exactly how many prosecutions they'd done for selling illegal vape or youth access. There were just 19 successful prosecutions were made for illicit vape traders across 11 major UK cities between 2021 and 2023. And the sum total of those fines came to less than two and a half thousand pounds. Now, I find that particularly staggering in the face of the media saying, you know, youth epidemic, we must do something about it. And then the UK Parliament turning around and saying, oh, we need to discuss banning disposables. Well, if we ban them and we effectively put a prohibition on them, who's going to enforce that? Because we're not enforcing it now.

00:58:54 --> 00:59:06

Clive Bates: So what's the generalizable insight from that, if there is one? What are you saying there? People talk tough on enforcement, they don't do it or what?

00:59:07 --> 01:00:17

Sidebottom: Well, the CTSI, so the Chartered Institute of Trading Standards, has actually called out for additional support for their offices. The UK VIA has supported that as well. We've put recommendations in place for additional support for trading standards offices, for additional training. and for increased fines. You know, one of my favourite throwaway statements about this is, well, there's two things, really. There's an intrinsic link between the illegal market in the UK and youth access. That's absolutely undeniable. But also, you know, my favourite throwaway comment is that, you know, the greatest deterrent to doing something wrong is a high probability of being caught. And unfortunately, there isn't a high probability of being caught in the UK at the moment, hence why we have this huge youth access issue. It's very clear, and the evidence is very clear from this Freedom of Information information, and the report will be coming out soon, that we need to give our enforcement officers more power to their elbow and the ability to actually put in place what the regulation says at this point.

01:00:18 --> 01:00:36

Clive Bates: All right. Anybody see things differently than that? I want to move on, Charlie, so unless it's on that... Oh, sorry. Okay. Somebody down there. You have to wave your hand or I'll... Okay.

01:00:36 --> 01:01:13

Simon Bauer: You asked for another opinion, but I raised my hand before. Okay. All right. Say something different. The snooze ban is bad and bullshit. We all agree on that. But it becomes even more crazy when you think about, like, white pouches in Germany, they made it even shorter way political, to say it's not tobacco, it's food, so food with nicotine is forbidden. It was so fast, so easy, and so damn bullshit. But you can't even got even shorter than the snooze thing. It's more easy for politicians, because it was a decision, I guess one meeting, and bam, gone.

01:01:14 --> 01:02:10

Clive Bates: So I think from that we can say... There are different ways of delivering a prohibitionist political intent. I mean, one way, the easiest way, is just to write it into law. The Australian way is to say everything, we just make it so difficult to access these things via pharmacies and everything. It's a de facto prohibition. American way at the moment is to say, well, we'll just make these products as unappealing as possible by banning all the flavors. So, I think the thing to take here is, and I think somebody said it in one of the earlier sessions, you have to get to the intent behind the policy, and then you have to tackle that intent, I think, before you engage with the policy itself. Anybody else? I'm going to go on to the next one, because we've got a couple more to do yet. 2020, please.

01:02:12 --> 01:03:07

Video: America has been in the grip of a health scare over e-cigarettes... ...because of a deadly outbreak of what is being called EVALI EVALI is an electronic cigarette... ...with vaping product use associated with lung injury People were complaining of respiratory symptoms... ...really having trouble breathing... ...and in some cases it was fatal Since April 2019... ...60 deaths and over 2,500 hospital cases... ...have been reported in America The American Medical Association and the Centers for Disease Control advised the country's 11 million vapers to quit. Seven states proposed partial or total bans. Some politicians called for a national ban on all e-cigarettes. Yet the health scare isn't down to nicotine-based vaping, but illicit cannabis vaping products.

01:03:09 --> 01:04:03

Clive Bates: All right, so this really introduces probably one of the biggest kind of science and risk communication shocks to hit the vaping world. You could register the effect of the Ivali, things like a seismograph could measure the change in risk perceptions, not just in the United States, but also in Europe and around the world. And Ivali, to this very day, even though it has nothing at all to do with nicotine vaping and cannot have had anything to do with nicotine vaping, continues to reverberate around the world and continues to be used, papers making the case. What's going on there? What was actually happening with Ivali? Any views on that, on how that actually worked out? Yeah, Garrett.

01:04:09 --> 01:04:47

Garrett McGovern: I think it's very interesting that clip because the actual cause of it was mentioned as a sort of a afterthought at the very end the word cannabis was mentioned cannabis oil. And I think really what happened with the Valley was it was another opportunity to down electronic cigarettes and create more lack of confidence, consumer confidence in the product. And really the damage was done, even though the FDA came out with all supports of what it was, the damage was done. Even to this day in Ireland, where I am, when I talk to people, I say, you know, nobody has died from vaping. They throw back a Valley at me, you know, and the public are misled. Thank you.

01:04:49 --> 01:04:53

Clive Bates: And anybody else? Yes. Yeah.

01:04:53 --> 01:04:55

Ondrej Koumal: Danny is it?

01:04:55 --> 01:04:55

Harry Shapiro: Yeah.

01:04:57 --> 01:05:36

Danni Tower: Hello, I'm Danni Tower. I work in Research and Development at BAT. And I just wanted to share a perspective, I think, related to the Avali situation, which is really about the criticality of robust and rigorous product stewardship approaches for all manufacturers, and also regulations that are built around the highest of product standards for consumer product safety. I've been at BAT for just over five years, and for the majority of that time, I've been the lead liquid developer for the vapor category at BAT. And there are many, you know, the reaction to that value crisis did send shockwaves through us all, as you pointed out, Clive.

01:05:36 --> 01:06:17

Clive Bates: But, okay, but if you have high product stewardship standards, and you didn't put any, you know, Vitamin E acetate in BAT's vape products, I assume, because it can't even do that. We still have excellent product stewardship for the most part. It wasn't caused by a failure in the nicotine vaping industry. It was caused by a communications failure somewhere. Now, how do you think product stewardship would have helped there? And what could have been done differently in handling of Ivali, particularly by the companies?

01:06:18 --> 01:06:39

Danni Tower: I'm not so personally aware of the communications failure. My understanding is that the products that were predominantly the cause of the Ivali crisis were illicit products, not legal products. So clearly not being manufactured and controlled with the same product stewardship standards as the regulated part of the industry.

01:06:39 --> 01:06:44

Clive Bates: Okay. Yeah.

01:06:44 --> 01:07:46

Joe Thompson: Thank you. Joe Thompson, Imperial Brands. The failing, for me, you're right, is a communication issue, and it was squarely with CDC. Slow, did not provide clarity, created uncertainty around the safety of vaping products. Those products have been on the market for 10 years. If it was legal products, if it was vaping products, Why now, or why then, and why only the United States? So I think, colleagues in BAT, Imperial, we knew it wasn't legal vaping products. To answer your question in terms of product safety, I think the industry's role was probably not to communicate further on EVALI, no one will believe what we're saying, but there is a role there for product standards, and having better product standards that are mandated in regulation and where that regulation is enforced.

01:07:46 --> 01:08:48

Clive Bates: Okay, so these products were all, the products that caused Ivali were mostly unregulated and mostly illicit. So they're outside of that kind of marketplace anyway. So let's just go on, let's move on actually because I think maybe come back to Ivali because I think there's There are some lessons about how well and how long it took the response to happen there. On the blame on CDC, I agree, and I think you can tell that CDC was to blame and it was deliberate because they've done nothing at all since that to correct the misinterpretations that they created. They have done nothing to change the terminology or to put clarity into the information marketplace about what was the actual cause. They're still trying to maintain doubt and ambiguity about it, which means that they were using it tactically, in my view. Let's get the last couple now. 2021.

01:09:06 --> 01:10:58

Video: A message to the Philippine delegation of COP and to all COP delegates. To the Philippine delegate, especially Secretary Locsin, I commend you, sir. I commend you. The fact that you proposed those amendments that are based on science and evidence, it takes a man to stand by his principles and really speak out based on the science, what you've read and what's readily available. And to the other COP delegates, I think for the most part, it's a waste of time and it's a waste of money because the approach was never holistic. Those people Consumer groups like us, which is a big time stakeholder in this particular policy, none of us were invited. So what's the point? I mean, whatever regulation, whatever recommendation the COP will come up with, it will always be half-baked because it never heard us. You never listen to the consumers, the very people who will be affected by this regulation. Well, of course, we've already got the vaping framework. We've already seen vaping being used by people as a tool to stop smoking. And that actually enables us to push ahead with further activity to reduce down smoking because there is an alternative that works very successfully for people in order to stop smoking.

01:11:00 --> 01:12:13

Clive Bates: Right, so the purpose of that, that's three examples of reasons to be cheerful, reasons to be optimistic. That's vapors, consumers, public health advocates making progress, respectively, and Damien Sweeney deserves huge applause for this, in the European Union with the Europe Beating Cancer Plan. amazing work in the Philippines by consumers, but also by the regulators really acting on behalf of Philippines citizens. And then the most amazing results have been achieved in New Zealand, where we've seen Maori smoking, particularly among women, just absolutely plummet as vaping has taken over in that marketplace. And that's because they set up an environment that was conducive to it. So I think it's easy to get kind of filled with doom in these meetings, but I think that's just some flashes of good news. Does anybody want to comment on that or perhaps also add to it?

01:12:19 --> 01:15:59

Heneage Mitchell: Heneage Mitchell from Factasia. Please call me H, also known as Mr. H, and in some quarters, Sir H. It's quite so. Okay, thank you for bringing this bit up because I wanted to make a couple of comments on last year's GFN, but this actually segues exactly into what I wanted to say, which is this. I've been coming to GFN since 2014. I've seen and met and communicated with many consumer advocates here, and I believe that, frankly, the majority of the global consumer advocates throughout the world have at some stage come here to GFN. GFN opened the doors for consumers, and I think it's important to realize that we as consumers are the reason everybody's sitting in this room here, because if we hadn't embraced these products, It wouldn't be an issue. The fact that we have embraced them and encountered all these difficulties has led us, the consumers, to create groups in our respective countries. And all of us work for nothing. All of us get up every day and we go to the grind. We see no progress, no progress, no progress. And it's very, very disheartening. But I encourage all consumers to just take a broader look, as Clive has just done. Where we came into this, 2013, 2012, 2014, we were facing bans all over the place. So the consumers, I mean, a significant percentage of the active consumers representing one billion smokers on the planet are actually sitting here in GFN now. I'm looking at you, I'm sitting with them. These are my friends, I've met them through the advocacy. The advocacy has been difficult, it's been very tiring, very frustrating, and of course advocate blowout has been discussed, I think it was discussed at that particular GFN. The thing is, if you look back at where we were and where we are, those little incremental steps, all those setbacks, all the hardships, all the troubles and the stress that we've put up with, we're here now. You've mentioned the Philippines. I know the reason it got across the line in the Philippines was because of consumer advocacy supported by people in this room, researchers, industry. People who understand it, even some medical people, it turned it there. It's turning in Malaysia. It's turning in Thailand. I guarantee you that it will be legal to vape in Thailand soon. This is because consumer advocates have tirelessly and selflessly and in very small numbers pushed those doors, kicked at them, put their elbows on them. And we've got here now. So why I can see, yes, it's very easy to become negative. It's very easy. We've done an incredible, incredible work. Amazing stuff. And I want to recognize Jerry, wherever he is, and Paddy, because without them, We would not have the platform to have met each other, got our messaging right, and put it out there. And we, I'm not saying me, but the people I'm sitting here with have done an incredible job in their countries, and I take my hats off to you all. So please, whatever difficulties we might run into, we're doing the right thing, and it's working. Thank you all.

01:15:59 --> 01:16:16

Clive Bates: Okay, great, that's good. I think we all share those sentiments. Right, let's get on to the next set of videos, please.

01:16:16 --> 01:16:51

Video: Mexico takes charge on their battle against smoking as they prohibit the sales of vapes and e-cigarettes as a whole. Paul Gachellian will give us the details live. Yes, Paul, go ahead. Mariel, the president of Mexico, Andres Manuel, signed a decree to prohibit the distribution of vapes yesterday on World No Tobacco Day, marking the hallmark on their fight against smoking.

01:16:51 --> 01:16:53

Clive Bates: Vaper activism in Chile.

01:17:37 --> 01:18:55

Video: The new tax, which comes into effect on the 1st of June, will cripple the vaping industry. Now, Moise says that vaping is a healthier alternative to smoking cigarettes, but the new tax will push consumers back to cheaper tobacco products. The National Treasury gazetted a tax on electronic nicotine and non-nicotine devices on the premise that it would curb the growing popularity of vaping and protect consumers from the potential harm that these products pose. So is this about JUUL or is this about vaping? Today's decision on Juul is just about Juul. Every e-cigarette manufacturer in the U.S. was required to submit reams and reams of research and scientific evidence demonstrating to the FDA that their products posed a net benefit to public health. In other words, that the potential benefit to adult cigarette smokers switching to something less harmful outweighed any risks or unintended consequences that these products might create, like attractiveness to young people or other safety issues. So on a case-by-case basis, the FDA has been looking at these products. And today, the FDA said that Juul's application fell short. And therefore, Juul, which represents about a third of all e-cigarettes sold, has to come off the market.

01:18:57 --> 01:19:51

Clive Bates: All right, yeah. So let's just, after a bit of a rebound from the more upbeat perspective we had a few seconds ago, and again, you see Regulatory agencies acting politically, no doubt at all that there was a political basis for that decision on Juul, for example. The Mexico decision, entirely science, policy, economics-free, it's just a big political gesture. And I think one of the things to take away from that is to raise the cost of that. Juul, of course, is challenging that decision in the courts. Because we're getting close to the end, I just want to go jump ahead now to the final segment, and then we'll just round up. So we could have the kind of where are we now thing from 2023.

01:19:53 --> 01:23:14

Video: The Quebec provincial government just announced a ban on flavours in nicotine vaping products. Within only 90 days, all flavoured vapes, except for tobacco flavour, will be illegal in LaBelle province. The decision is devastating news for the 250,000 nicotine vapers who rely on various flavours to stay smoke-free. And for the hundreds of small business owners and the thousands of workers in Quebec's vaping industry, the flavour ban amounts to a death sentence for their businesses. Butler has announced that the government will crack down on vaping to reduce harm among the younger generations. The government is proposing stronger regulation and enforcement of all e-cigarettes, including new controls on their importation, contacts and packaging. Joining us today to discuss this new plan is Dr Colin Mendelsohn, an academic and researcher in tobacco treatment. What are you trying to do this year? First, we intend to hold an event, Tobacco Harm Reduction Forum, within this quarter in South Africa. That's the first one. And we're hoping the second one will be in Nigeria. This time around, we're trying to involve a lot of medical doctors to get them to understand tobacco harm reduction, especially from CDC Africa, and also government doctors who advise the government. believe when doing so they can give them the facts about safer nicotine products and that way we'll move a bit faster than just using advocates on their own. The first thing the policy makers normally do is speak to medical doctors. So if you can get more doctors in Africa involved in tobacco hand production, we can move this a bit faster. Are you happy with the progress that's being made in South Africa or other parts of Africa in terms of tobacco harm reduction and championing the cause? Or do you think we're moving too slowly? Oh, it's too slow. Look at a country like Canada. Just this week, the Ministry of Health came up and endorsed vaping. They look at the evidence and they move faster. We are the only continent where we have smoking rates growing at the fastest rate, but there's really nothing that's going on there in terms of trying to reduce these rates. government handing out free vapes. One million smokers across England are going to be given a free vaping starter kit. That's the kit for almost one in five smokers in England, alongside behavioural support to encourage them to give up tobacco. It's an attempt to end people's pesky smoking habits and get smoking rates in England below 5% by 2030. But charities have warned that swapping cigarettes for vapes is nowhere near sufficient in tackling addiction. local authorities will be invited to join the scheme first, and then it will be rolled out nationally over the next two years. Officials think it will cost around £45 million, funded from the health department's budget. A recent review of the government's targets recommend promoting vaping as an alternative to tobacco, but they did say they're not a silver bullet or totally risk-free. And there are still concerns about its popularity amongst young people, with the government setting up a new squad to crack down on vapes being sold illegally to under-18s.

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Clive Bates: All right. So that's finishing there with a fairly upbeat story in England. Right. We're in the last couple of minutes now. Does anybody want to try and pull any of this together? Anybody want any like overall overview type comments on this? All right. I'm going to put a few out to you. I mean, I think I think what we're seeing on the policy side is essentially It's driven by moral intuitions, by instincts, by moralizing, by ideology, and it's manifesting itself in various forms of prohibition, either medicalization, outright prohibitions, flavor bans, high taxes, and so on. We're also seeing a push to treat these products as if they're no different to cigarettes. In other words, indifference to the huge difference in risks. And alternatively, we need to see a risk-proportionate approach, which we're only seeing in a few places. We're seeing the youth argument really heavily weaponized, and we're seeing a shift in the harms moving away from middle-aged people with cancer and cardiovascular disease and COPD to young people becoming addicted. And that narrative is now playing out very strongly and it's designed and crafted to address the threat, I think, that many of those anti-vaping activists see in the rise of smoke-free products. The science, I think, the scientists we see, we saw with Ivali, has become subordinate to a political agenda, and many of the scientists are producing evidence to order that backs up these moral intuitions about how this is wrong or bad, or the political or funding that sits behind them that says that we must ban or eradicate these. At the same time, The consumer advocacy and the basic economic processes are working in our favor. The vaping products are much better than smoking for you. They deal with a whole range of problems. They provide a drug, nicotine, that people like for whatever reason, and the use of them around the world is steadily rising. It's an unstoppable basic technology and innovation process, a kind of creative destruction. In my view, it's going much more slowly than it should, and it's being held back by the public health community, but nevertheless, it is proceeding and will never stop. Even if all the products become illegal, which I don't think will ever happen, but if it did, it still wouldn't stop. The advocacy that's working is based on the authentic experience of vapors telling their story to a political system that's responsive to users. So that doesn't mean civil servants or bureaucrats. It means people who need to be elected. And it means that the communication of authentic experience is what is carrying the day where victories are won, in my opinion. And you can see that coming through in some of the testimonies. The industry, just a couple of thoughts about that. It's essential that the industry goes through a transformation and it moves its products from combustible to non-combustible. Anyone who I think is opposing that, and many in public health are, are missing a massive opportunity. to see one of the most problematic and difficult industries that we've ever had change into something different and something much less problematic. And I hope everybody, even if you don't like the industry, sees that as an actual essential direction. But the industry, as a caution, brings baggage with it. And I think sometimes we've seen that that is deliberate, that baggage is hauled out of the past and thrown into the present because it works as an argument, not because it's really meaningful anymore. And then the end game, where we're all heading, I think The tobacco harm reduction debate is very useful. It brings a lot of public health people on side, people who want to solve problems, like I want to solve the problem of COPD or cardiovascular disease. I don't want these people getting cancer or strokes. But ultimately, it's not a medical or a health thing. It's a recreational stimulant that people like using in the same way that they like using alcohol or they like using caffeine or other drugs, okay? And ultimately, we'll have to come to terms with that and depend less on the harm reduction argument, particularly as the as the market for cigarettes declines. We will need in the end to make a case that this should be treated in society more like caffeine and alcohol. So I'm sorry to end the big conversation on a short monologue. I just wanted to get to the end in time for us to finish on time and let you go to your next thing. If anybody wants to say one last thing, really burning issue, I'll happily go with that, so I'm not the very last word. There's somebody. Take the chance, take the shot. Briefly though.

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Richard Pruen: Hello, Richard Pruen from the Safer Nicotine Wiki. I would just like to say, it's a little bit cheeky, but I'll go with it.

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Clive Bates: Are you going to say that the Safer Nicotine Wiki is just like the best thing?

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Richard Pruen: No, no, no, no.

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Clive Bates: Because I was going to say that for you.

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Richard Pruen: Okay.

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Clive Bates: It's absolutely brilliant.

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Richard Pruen: Just had one doctor who's put a video up on Safer Nicotine Wiki, and I've built a page around it with very quick, brief information. Even though I don't track page views specifically to the page, that has become the most popular page on the wiki. Can we please have more of that?

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Clive Bates: Okay, look, if you've not heard of this, I really urge you to get involved. It's what I call a citizen science initiative. Richard's a citizen scientist. It's a brilliant resource of all the papers and all the information and all the science you would ever need to be an effective advocate. It's better than almost anything else I can think of as a repository of information. If you want to know about therapeutic uses of nicotine or something, it's the go-to page. Richard and his co-workers, Skip Murray and other people involved, have done an amazing job. It's a great example of citizen and vapor activism. I think it's worth closing on that because it's a great story of people taking the initiative and creating resources that others can use. And if you can contribute, if you can help Richard build that up, please do. Safer Nicotine Wiki, search Google, and you'll find it, and it's brilliant. I think with that, we'll close. Thanks, everyone. Great contributions.