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Fiona Patten: The final session, look at you all. Thank you. You are the stayers. You are the last ones to leave the party. And I like those people. We're the ones still there when they start putting up the chairs, putting the vacuum cleaners out, not serving you at the bar anymore, but good on you for staying. And I think this is going to be a really interesting final session, because it is kind of a bit of a wrap-up of what we've all heard and learned over the last three or four days. And to be honest, it's a lot. I did a quick count. So there was over 26 presentations and workshops, 78 presenters. Interestingly, over a quarter of them were medical doctors, which I thought was interesting this time. And I don't know whether this is a record for GFN, but 82 countries have been represented here over the last four days. So that's really terrific. And we've got a nice broad range of people up here representing, well, Weirdly, Australia is overrepresented on this session, but ... Sucko. That's in Australian. Again, thank you all, and I'd just like to briefly introduce the panel. To my direct right, we have Joe Thompson, who's with Imperial, and he's in their Science and Regulatory Affairs Department. He's the director of that. I know that he also has an interest in cannabis.

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Joe Thompson: Is that right? I sit on the safety board of a Canadian cannabis company.

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Fiona Patten: Great. We can talk about that later. And 23 years' experience in the science of nicotine-containing products. Next is John Fell. And John, I wanted to make some joke about a smoking gun with you. You're working with the Article 36, which is a charity organisation that looks at scrutinising the development and use of weapons, but that's not why you're here. You have been following the developments of the tobacco and nicotine industries for over 30 years, looks from an equity research analyst perspective, also looking at the investments around this area. and you've also received, been currently doing a project with funding from the Foundation for a Smoke-Free World. We have Joel Sawa, who is a, I don't know that it's in his words, but in our words, a tobacco harm reduction crusader in Uganda. He's really been at the forefront of getting people to have a better understanding of what THR is in Uganda and the broader African region. He's been doing that for four years. A past recipient of one of the scholars from GAC and a board member of the Campaign for Safer Alternatives So, it shows the sort of work that the scholarship program does and to have someone like Joel here joining us today. Also, if anyone is travelling to that part of the world, he runs safari tours. So, just a quick plug for you there, Joel. And to my far left, my friend and colleague in Australia, Colin Mendelsohn. who is a medical practitioner, has been a warrior in tobacco harm reduction in Australia. And as many of you will have heard and read, we are facing a significant force against tobacco harm reduction in Australia. Colin's been working in this area of smoking cessation for over 40 years. He ran a terrific workshop, which I hope some of you were able to attend, on the first day of this. He's a member of the expert advisory group on the Royal Australian College of General Practitioners, and he has been making some headway in tobacco harm reduction in that area, but as I'm sure he will tell you, it has been slow. So I thought the way we would go with this last session is the panellists up here will provide a bit of a reflection on the last three or four, on the last few days of the conference, but also recognising the theme of the conference, which is tobacco harm reduction in the next decade. So they'll all sort of give their reflections and thoughts and takeaways about the issues that will be facing us both now and in the coming decade. And then, rather than opening it up to questions, although you are welcome to ask questions if you still have some after four days, but more importantly, I think I'd really love to hear from some of the people who haven't spoken at the conference, and I'd love to hear their reflections on the forum and on where they think we are going in the next decade. So I'm really, rather than saying that's a comment, not a question, I'm actually welcoming comments, brief comments, as we kind of wind up this really wonderful GFN. So, Colin Singh, as you were last, you're going first. So, Colin, if you'd like to start us off.

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Colin Mendelsohn: Yes, look, I'd like to start by disagreeing with you, Fiona. Is that why you've turned the microphone off? Is this on? It's on. Okay, good. Fiona said earlier, in Australia, we're leading the way on what not to do regarding vaping, and she apologised for that. Well, I take a very different view. I'm very proud of our willingness to lay our lives down as the placebo arm of a randomised controlled trial, sacrificing ourselves in the sake of public health and humanity, and I think we'll achieve great results as a result of that, and Australia should be very proud for taking this. Someone had to do it, and we've made that sacrifice.

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Fiona Patten: Okay, I stand corrected there, Colin, thank you. Yes, thank you.

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Colin Mendelsohn: And we've made it very clear in Australia that bans don't work. I mean, we all know bans don't work and prohibition and harsh restrictions don't work. And we have a huge black market and criminal gangs and huge issues with enforcement and youth vaping. I mean, how much more information do we need to be clear about this being the wrong approach? We're all aware of it, unfortunately. The very much closed off political leaders Fianna accepted are unwilling to open the door to that information. I just wanted to say a little bit about evidence, because it was talked about a lot by a number of different people. And Sarah said we must have evidence for scientific credibility, and we must. And we do have the evidence. And John Oystein said we have enough evidence. And I really agree with him. From a practical point of view, we can always have more evidence. And we need more evidence. There's always little points yet to make. But we have enough evidence. And one of the reasons we need more continuing research is, as Roberto said, there's so much bad science around. And unfortunately, it gets weaponised and used against us. And we have to have replication studies. And we have to have more scientists analysing that junk data. which is weaponised by the media and the publishers and doesn't reflect the real situation on the ground. But the problem is that we don't get a chance to debate the evidence, and this is another issue that's come up repeatedly in the conference, it's very true in Australia, that the people who oppose vaping, it's almost a religious cult, as someone said, they've made up their minds, this is the evidence, and they refuse to debate us, and we find this in Australia. We've repeatedly invited Simon Chapman to debate us. It's much safer to have a rant on a radio program with a journalist who can't address the clearly mistaken arguments that he uses, not to mention any names, and hello, Simon, he's probably watching, but we would love to have the opportunity to address and debate the issues politely, respectfully, we don't get the opportunity, and that's true in so many other countries. And on that issue, too, the science in Australia is often censored by medical journals. We've had significant problems with the Medical Journal of Australia, the Australian New Zealand Journal of Public Health. We recently had a letter published after eight revisions in the Medical Journal of Australia. Another article which I wrote to the Journal of Public Health, they initially refused to even look at it until we sent in a letter signed by experts saying, you can't just not look at it, you've got to consider this. So they said, okay, we'll publish it. Then they said they were going to retract it three months later because of a spurious conflict of interest. I'm just bringing these examples up to show you what we're up against and how the forces are lined up against us, the journals and the media in Australia. But as Moira said, ultimately the evidence will prevail. And I really believe that. I mean, there's only so long I think they can hold out. And I do think that if we persist, eventually, you know, it's just untenable. to be able to say that we don't have the evidence. And from the natural experiment in Australia, I think that we have very good evidence as our smoking rates have not declined for the last five years. Have not declined for the last five years. Whereas in New Zealand, they fell by 33% in two years from 2020 when they legalised vaping. I mean, this is as good an evidence base as you can get, I think. And Mara has said, and Alex Wylak's always saying, things change. History's always changing. We just did a tour of Europe, parts of Europe, and it's always one civilisation after another. Things that you think are locked in will never change. Things change. And, you know, with harm reduction, disruptive technologies, they're always resisted. They always change. It will happen. Hopefully we'll live long enough. Just in terms of the next 10 years, yeah, I agree with some of the other speakers that I think this is a political issue. And I don't think we're going to win this on the evidence. And I think there'll be a point where there's a critical mass of vapours and we're seeing the number of vapours building up. There has to be pressure on the politicians and I think that's where we're going to make the change. And if you work it out in Australia, we have hundreds of vapours in each electorate, and politicians are concerned about getting re-elected more than anything else. The problem is we need to get the vapours motivated. Now, I was very inspired by the stories about the UK, those early vapours who turned the corner for the direction vaping was taking. In Australia, unfortunately, our vapours have not been motivated, and part of that's been because it's been illegal to vape. They're afraid to stick their heads up because of all the risks. But I really think we've just formed a VAPERS association, only just now. We had one several years ago which sort of fell apart. And I'm hoping with that organisation and getting VAPERS to visit their MPs, and we're constantly encouraging them, I personally think that's the way forward. And I think somebody else said that in the meeting. And we need to educate the general public as well because they also drive the debate. But I think the debate is being driven more than anything else by the youth vaping moral panic. And I think we need to actively address that. Because in my opinion, vaping is actually protective to youth. I mean, I know that's a terribly controversial thing to say, and I've never said it outside this room, although it's probably already being repeated online. But the fact is that vaping is diverting young people away from smoking. And it's protecting their parents from dying. And I think if you look at it overall, I think it's very clear that vaping's a good thing for young people. I'm not saying young people should start vaping. Okay, let me just put that out there first. But really, when you look at the overall impact, I think vaping's been good for young people. And please don't quote me on that. So I'm not sure when we'll be able to say that. Look, that's probably the main points I wanted to make, so I'll stop there, thank you.

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Fiona Patten: Thanks, Colin, and I think it goes from that reflection that Alex Wodak has said to me a number of times, that things that can't go on forever, don't. And I think that kind of captures some of those points that you were making. I meant to mention Alex. Joel, as coming from, and I think this has been the wonderful thing about this conference this time, is that we have heard from so many different countries, So I'd love to hear your reflections.

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Joel Sawa: Thank you so much, Fiona. My discussion will be along my experience for starters in my country also in relation to the region and also what this GFN represents in the same. The GFN this year represents what THR has evolved or morphed into over the past few years. And for me, I was very interested on a discussion that was hosted by Will Godfrey. One of the discussions, rather. The discussion was about the global perspective of THR. And one of the things that came out clearly was that there's a lot to be done in terms of the regions. the various challenges that advocacy is facing. One thing which was clear to me like I mentioned earlier when we were talking is that it comes to show that some of the challenges we're experiencing globally are similar somewhat. So region by region, challenges maybe along policy, the public health challenges that are revolving around combustibles. So they're not too different really. The dynamics may be different. You might find that maybe down in Africa our biggest limitations may be funding in particular ways here and there, but then again, in other places, the challenge might not necessarily be funding, okay, the degree varies, yes, but then again, in some areas, you might find the issue is the uptake of the legislators, so to speak. In my country, particularly, safer nicotine alternatives are banned entirely. There's a blanket ban that was passed in 2015 that renders it illegal to distribute, to sell, to promote electronic cigarettes and any other form of safer nicotine alternative. Now, what we do down there is we do more of education, because as we all know, THR in itself is an intellectual concept. It raises discussion, it raises debate. So like it was said earlier in the last session, indeed what is missing in many points is the aspect of debate. So if that is impeded, not too much knowledge is able to be disseminated. Yeah, and we first, there's a lot of hostility, I notice, around the discussion of safer nicotine products. This is not limited to one region alone, this is general, okay? We find that tobacco control is very well, like it was said in the last session by Konstantinos, Tobacco control is not disorganized. They're not the wild west, so to speak. They are homogeneous, they are very well planned out, their tactic is very clear, they are out to limit how far THR can go, or even so, kill it in totality if possible. So what are we going to do as the fraternity behind tobacco harm reduction? How are we going to address this? It's a question I asked, actually, in one of the sessions. I'd asked a similar question. The question was, how are we, as a tobacco harm reduction, going to evolve? Rather, how are we going to transition with the changes that are coming over time? because we see that governments and tobacco control are eagerly coming up with new tactics day and night. When you think you have one end covered, they have a new approach to how to pull you down. So how then are we ourselves going to counter this as well? Because it means we should be adaptive and progressive as well. In relation to the changes that keep coming, working day and night to see how best we can counter this. And I also do agree that it is, tobacco harm reduction in itself is political, has political addresses, and this is not cheap as well. So this comes to cover the aspect of funding on a general level because tobacco control is a well-organized machine that is well-oiled, financially, so to speak. I do not know how we will get, how this finances will be accessed, I can't point a finger, but I think we need to come up with ways and mechanisms that are able to ensure that we're able to get funds that are able to push projects, push discussions around the same, around tobacco harm reduction, so to speak. And also, I think we need more of this forum, but in a localized sense. We've been having meetings back, I'm sure across the continent, several countries, because some of the scholars, some were not present, have held meetings in their countries by support of the program, the scholarship program. They've had stakeholder meetings and the like, and these discussions have yielded quite a bit of result, because you see, you're able to gather I would like to start by saying thank you to all of you for being here. Thank you very much. I would like to start by saying thank you to all of you. most parts of Africa, where I come from, it is still mysterious. It's still not well understood. So the challenge is up to us to keep on demystifying this concept every other time. So when you have more localized fora, there will be more engagement, more understanding, more education, and like, yes. Okay. In this sense, I believe that advocacy is very much needed. We cannot undermine the place of advocacy together with every other area that covers THR because THR is rather wide. There is the advocacy, there's the involvement of the experts, the involvement of the academicians and all the like, the media and all that. But then again, there needs to be, I think advocacy also needs to be The various advocates around the globe need to put in more effort to make sure that their people, the consumers, are reached out. There needs to be more consumer-centered advocacy. We actually deal with the people who are affected. I appreciate intellectual discussions, but I think if you actually go down and you engage the person who's really, really directly affected, the results can change or alter a thinking of somebody, one or the other. And it's only then are you able to come in and advise the policymakers, because then you've talked to the people who are using and the people who are affected. I'm looking forward to in the next decade, what do I foresee or what are my expectations? Just a minute. I see a time where we'll have more involvement of the doctors, the medical fraternity, where clinicians will be, where there will be more dialogue, more science advanced. Sorry, just a minute. where there will be more, where doctors will, where clinical, where doctors will be able to deal with patients from a more informed point of view, where safer nicotine alternatives will be presented as a form of remedy without necessarily having to, without the struggle that there is right now. It will, where some of, where the electronic cigarettes, snus, and the like can be easily accepted, as well as nicotine replacement therapies There would be a form of secession that would be endorsed in many places. I don't know. I'd like to see a time where the WHO is able to come to the table and be involved in these discussions, having meetings where consumers are present and actually engaging in their own problems so that we can have more consumer-oriented policies. But I also foresee a time where there will be more There are going to be more campaigns, more campaigns, nothing for us without us. There will be more campaigns towards that. It will be the voice of the consumers much, much more so than it has previously been.

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Fiona Patten: Thank you. Thanks, Joel. And I think it goes back to what you said right at the beginning, that everything that you've said is something that everyone in this room has in common, that voice, the lack of voice for the consumer, the lack of education in every area. And I think in Uganda, I'm no doubt, given the politics there, It is difficult to speak against a government like that. And I certainly have been reading with horror some of the stuff that's happening with the LGBTI community in Uganda. And so more power to your arm. John.

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Jonathan Fell: Thanks Fiona. I'm going to run through my four kind of I guess highlight themes from the last few days. Actually starting with Before I got here, I watched the video that Clive Bates put up, and I thought, there's a really interesting line in there, he said, which is, if you ask an academic about nicotine use, you get a stupid answer. It's just about people getting hooked by nasty companies, which is not the answer you get from the people who smoke. And I think, for me, there's still some cognitive dissonance in this field, if that's the right term. and maybe at this conference as well. Consumers aren't helpless victims very often. They've got agency, they're making choices about pleasure. But the tobacco industry is still basically seen as evil. And if people don't believe that, they at least don't challenge that concept very often. We've got still a very cartoon view of the tobacco industry globally. It's very US-centric and it misses a lot of the complexities about how the industry actually developed I remember in one of the sessions, I think it was Cozy said, it would help THR if tobacco companies would sell their combustible business. I think there was a colorful phrase, it's hard to put reformed pedophiles in charge of the kindergarten. And lots of people here I'm sure wish the tobacco industry would go away, but it's not going to. They don't have any choice but to get involved in tobacco harm reduction, and that is increasingly being driven by investors. And as you mentioned, Fiona, I'm doing this project for the foundation to see if there are ways of stepping that engagement of investors up, ramping it up. Second thing I want to talk about or has really stood out for me is that discussion about does nicotine have benefits. I thought that session from Paul Newhouse this morning was fantastic. Literally mind boggling. And I also like that line that Garrett McGovern said yesterday, you know, let's get nicotine out of jail and see what the benefits are. And you can regard that maybe as a distraction from what tobacco harm reduction is about, but I reckon that if you do start to rehabilitate nicotine, that will be helpful. It will help counter the misinformation that even lots of the medical profession have about that, you know, villain nicotine being the major problem. And then we also can maybe have a more nuanced debate about addiction, you know, about whether nicotine as opposed to smoking really does fit the classic definition of, you know, addiction being something that brings additional real adverse consequences with it. I think, Joel, you've sort of hinted at this or mentioned it in your bit as well. Third thing is that the tobacco harm reduction debate isn't just about vaping, although that obviously tends to dominate discussions, especially in the media. Now, I used to think pouches were not a product for me, but thanks to Thomas and Cecilia, I've had a go at this week and rather enjoyed them, so maybe it is a product I like. And then we've heard quite a lot about medicinal products as well. And, you know, whether people like it or not, I'm sure we are going to get some medicinal nicotine products coming onto the market or a wider range of them. And I understand the concerns that people have about that. But again, I think it will be helpful in the end. You know, the more products there are out there for people to choose from, the more channels they're available in, the better and the quicker, you know, the smoking habit can be reduced. And then finally, I'm an optimist, rose-tinted spectacles, and so what has stood out for me is also progress despite adversity. How many users in the world were there of safer nicotine products 10 years ago? Maybe 10, 20 million? The great work that Harry has done in the global state of tobacco harm reduction, I think they estimated 112 million in 2021, despite what we all know has been a massively challenging environment and a difficult environment to make the case for THR. So there's progress. Not enough, obviously, but I do believe that number is going to keep growing. And even in the US, despite the shitshow there, that the data from Altria's consumer track is still showing that the number of vapors is growing steadily, you know, year after year, at least in the last four or five years. I've really enjoyed hearing a bit of perspective from places I don't know that much about, frankly. South America, you were with me there in the Central Asia presentation. You know, the optimism that's coming out of some parts of Asia. Yeah, there were loads of difficulties, loads of regulatory barriers, the personal attacks, some terrible behavior by tobacco harm reduction opponents. But the cat, for me, is out of the bag now and I don't think you're gonna be able to stop consumers finding this stuff out for themselves and getting hold of the products one way or another. And to mix metaphors, the train has left the station as well when it comes to the big tobacco companies knowing they've got to transform and there isn't any going back.

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Fiona Patten: Thank you, John, and I think you're absolutely right. Even in Australia, where we have some of the more draconian laws and quite awful legislators and regulators on this, we've seen a steady increase in consumers and we're now over a million people in Australia are now using safer nicotine products. So thank you for ending on such an optimistic note. Joe.

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Joe Thompson: Thank you. The challenge to say something that's not already been said. I'm going to start with something you certainly would have heard before. The problem is always leadership. The solution is always leadership. This is my first GFN. I've not been here before. And the sessions I've sat in, the conversations I've had with so many of you, many of those things I've wholeheartedly agreed with. And the remainder has made me stop, think, listen, and try and understand. And on a personal note, I thank you for that challenge. What I see is leadership. In each of your fields, the stakeholders that you represent is leadership. And I commend you for that and encourage you in that, despite what you might think of me, despite my affiliation with a multinational tobacco company. And I leave here with optimism. And my optimism starts in Australia. I am optimistic. And I'm optimistic for two reasons. For one, that I think you alluded to at the beginning, which is showing the world how not to do it. And what will be important is how that story is told. The second is one of the consequences, which was the rise of illicit trade. Now, I'm not optimistic about illicit trade. Please don't misunderstand or misrepresent me. But it reminds us of the consumer and ultimately the consumer will choose. And what's happening there is because of consumer choice. And in a session I forget which day it was now, one day blurs into the next, but that Clive ran, reflecting back on the last 10 years, and reminded us of the consumer advocacy with MEPs in preventing licensing of vaping products at that time. And as a tobacco company, it reminds us that the consumer comes first and ensuring that we have reduced risk products that meet their needs. Ultimately, they'll choose. We can have products with great science behind them, but if it doesn't meet the needs of consumers, they won't choose them. So that's our challenge, Imperial's challenge. And I've heard frustration. I've heard frustration from different groups, from low and middle income countries at the pace, the speed of making those products available. And I don't believe it's for the big multinationals to solve on their own, but I do believe they have a role. And that, for me, is to take that back and look at those barriers and look at what our role is in addressing the barriers and the opportunities for making reduced risk products, making that consumer choice available. The other reasons for being optimistic, regulation. We heard a phenomenal case study from the Philippines around how a regulatory framework has been involved in some of the challenges to get there that has at the heart of it harm reduction. I also heard last week and was confirmed by someone made a comment, I forget again which day, that it's changing in Thailand with respect to vaping. So there are reasons to be optimistic. The European Tobacco Product Directive is under review. That'll be three. I think in 10 years' time, we'll be hurtling towards four. And there's reason to be optimistic about that, too. We are seeing, on the one hand, a risk, a risk of further prohibition. On the other, we are seeing member states that wish to take regulation into their own hand, which might lead to greater prohibition or might lead to more freedom under that directive and therefore the opportunity for someone to take leadership. Because what is needed is a country somewhere to develop that framework for harm reduction, for these products, starting with not how do we regulate the product, but how do we help the consumer? There are a billion smokers on a billion different journeys. And that framework needs to be robust. It needs to be able to be repeatable. It needs product standards that are not a barrier to entry, but product standards that guarantee safety, quality, efficacy. And it needs enforcement. Enforcement to protect youth through youth access prevention, which is a societal issue. The other reason for optimism is the science. There is a lot of good quality science demonstrating reduced risk potential of products. And if we fast forward 10 years, what will be layered on top of that is a beginning of data that shows the public health benefit of those products. We're seeing a bit already, we've heard this week in terms of the UK, and its approach to vaping and how it's regulating vaping and the freedom for consumers and the consequence of smoking incidents falling. But we will have data in 10 years' time beyond population health modelling, which is what we currently do. So I think there is reason for optimism. Our part in that, we are starting what we term actual use studies, whereby we are tracking smokers in three countries, UK and France in vaping and the Czech Republic on heated tobacco, with no intention to quit smoking. And we are tracking them on using those reduced risk products to look at what's their experience over time. Does it help them cut down smoking? Does it help them quit? What works? What doesn't? And using that data to tell us two things. One, to demonstrate harm reduction in practice in a country, and the other is to provide information on barriers and drivers to further help us develop products that are going to meet their needs. So I do think that there are reasons for optimism. It's important that we continue, no matter how difficult it is to publish, but to publish science and have that peer-reviewed and open to scrutiny and debated. And that is part of our role, industry's role, imperial's role, in correcting one of the biggest barriers to harm reduction, which is a misinformation on nicotine. I don't think that's something that imperial or the multinationals can solve, because we won't be listened to, but we do have a role in that. And I'll perhaps finish with this, because I'm reminded of an old proverb. And it's, well, how do you take the optimism and realize that so it doesn't become unrealized hope, hope that's failed? And for me, if the vine, the promise of new wine is harm reduction, we have to continue to beware the foxes that ruin the vine. And I'll stop there.

00:40:44 --> 00:45:40

Fiona Patten: Thank you. That was beautifully poetic to finish that on. And I concur, obviously, with all of your contributions. And I certainly, in thinking of this, and as someone who's been involved in harm reduction for decades, it's now I'm leaving here thinking about the allies that we need to bring back into the room. So it is the harm reduction the harm reduction community that's out there fighting for safer sex use, that's fighting for needle and syringe programs, but those people have not been in the room on tobacco harm reduction and I think that's a great opportunity to bring them in. I think also touching on the equity issues that have been raised and the fact that it's our most vulnerable and disadvantaged communities, it's some of our developing countries and communities that need probably the most assistance and probably have the most need for tobacco harm reduction. So how do we engage with the communities that are working with those communities? So how do we work with the people working with our disadvantaged and vulnerable communities in our countries and in the areas that we live? You know, it's been, The hate and the anger that was mentioned in the previous session coming from the tobacco control activists in some ways does, and I think Nancy pointed this out, it feels like the dinosaur's last roar and that we're really, they are sort of yelling at the clouds and making themselves miserable as well as probably making us miserable. It's been remarkable how none of that anger seems to have presented itself at this conference. There has been great optimism at this conference. There has been a great desire for conciliation and, in some cases, reconciliation at this conference. And I think that puts us in very good stead to go forward, because we're going forward in an optimistic way. We're going forward with science on our side, as difficult as it is for scientists. And I know, and Alex Wodok mentioned it to me during one of the breaks, if you are a young researcher, to be looking at tobacco, to be looking at nicotine is difficult, and it is still difficult, but it's happening, and people are doing it. I think I've always been nervous about the involvement of the industry, and having come to GFNs over the years, I've really come to the quite right conclusion that the industry has to be part of the solution. And we say that when we're talking about climate change, when we're talking about a whole bunch of other issues, we say, well, the coal industry has got to be part of the solution. Industry has to be, because you have the resources and, you know, it's your consumers that we're talking about. And I think, finally, and I think the most important point that we have heard throughout this is the voice of the consumer and the need for the voice of the consumer to be at the centre. if our tobacco control regulators could look at the problem of trying to save people's lives as quickly as possible and prevent people from dying as quickly as possible, rather than trying to kill the tobacco industry, which seems to be the focus, and listen to the consumers, as we've all said, then we will progress in the next 10 years, and I have no doubt we will. And again, going back to what you just said, Joel, by the leadership that has been shown by all of the presenters that we've seen at this forum and over the last four days. So thank you to all of the panellists. Please feel free to ask the panellists questions. Great, in one minute or a few seconds. The other thing that I, as I mentioned at the start, I'm really interested to hear from people who haven't spoken at the conference, and I'd love to hear your own personal reflections. If this has been your first GFN, how have you found it? You know, what takeaways are you leaving Warsaw with? But to start this off, gentleman in the back.

00:45:40 --> 00:47:56

Kgosi Letlape: My name is Kgosi Letlape from South Africa, and I just want to go back to the reference to the comments that I've made, and just give a perspective where they come from. There's a bill that has been presented in my country, which basically criminalizes harm reduction, where effectively parts of the bill say that if you claim that one tobacco product is less harmful than another, or it reduces risks, that would be punishable by 10 years imprisonment and or a fine. So I just want people to understand when I make a plea that there should be separation of combustibles from non-combustibles so that we could begin to fight the fact that effectively, harm reduction is being criminalized in our own country. And it's because of the conflation of saying these things are just as terrible as combustible cigarettes. And harm reduction is a ruse. So I just wonder how the panel thinks you could assist us in that regard. And I'm appealing to the whole house that this bill will be coming up for publication, public comment, and even people from outside the country can comment on that. Because we are on a path that is even far more radical than what you have in Australia or elsewhere, where they are creating an ipso facto ban on reduced risk products with a threat of imprisonment. So the sentences for various offenses range from three months to 20 years. If you smoke near a door or a window, it'll be three months. If you allow somebody to smoke in your own house, outdoor, and you've employed a domestic worker, it's 10 years. So we're having criminalization of smoking and criminalization of harm reduction. How can you assess that?

00:47:56 --> 00:48:08

Fiona Patten: Wow. And you're legalizing cannabis. Yes. Would any of the panellists like to comment on what seems extraordinarily draconian legislation?

00:48:08 --> 00:48:15

Colin Mendelsohn: I wasn't clear. Are they criminalising smoking or vaping?

00:48:15 --> 00:48:51

Kgosi Letlape: Both. What they've done, they've described smoke as anything. So whether it's a combustible cigarette, an e-cigarette, a heat not burn product, They are all the same, so they are being put into the same category. But remember, the target is the new products, because they're going to have difficulty changing legislation for the combustibles. So the trick from public health is to say there's absolutely no difference, and they are going into the issues of the WHO about gateway, about these things being more toxic than cigarettes, et cetera.

00:48:51 --> 00:49:01

Colin Mendelsohn: So they didn't learn from the ban during the COVID period. where they banned cigarette sales, and yet they had this huge underground market, and cigarette sales increased.

00:49:01 --> 00:49:11

Kgosi Letlape: No, they haven't learned from that. As has been said, you know, it's okay to take money from the tobacco industry if you are government, but if you're a citizen, you can't.

00:49:11 --> 00:50:11

Colin Mendelsohn: Yeah. But I mean, the inevitable outcome of this will be an increasing black market. Of course, people will want to continue to smoke, and smokers will want to continue to vape, and they're going to find a way to do it. So, I mean, there are quite a few countries that criminalise, you know, harm reduction products. In Australia, you can go to jail for up to two years for vaping without a prescription. There are fines up to $45,000, fines up to $225,000 for importing without a prescription, and there are a number of other countries which criminalise vaping, but which it's a question of to what extent they try to enforce it. There are a lot of countries like India Many others, which I can't think of right now, but they criminalize, but yet people do it anyway. It's a question of how actively it's enforced. I'm wondering how actively they are going to enforce, because I can't see it working. I mean, this sort of thing never works in the long run.

00:50:11 --> 00:50:39

Kgosi Letlape: I think we might just... I don't smoke, I don't sell cigarettes or anything, but if I go out as a health activist and I go on a radio program, and I say e-cigarettes pose less harm than combustible cigarettes, it'll be a criminal offence and I can go to jail for 10 years. So it's beyond not just the users, it's even about advocating.

00:50:39 --> 00:50:49

Colin Mendelsohn: I think that's also true in many other countries as well, that you can't make that claim. It's certainly true in Australia and I think in the United States.

00:50:49 --> 00:50:51

Fiona Patten: Yes, I'm not sure. John?

00:50:54 --> 00:51:43

Jonathan Fell: to say a couple of things. Sorry, I wasn't meaning to pick on you with my remarks earlier. But for me, you have to tackle that in the end with information and with trusting people to work it out for themselves. I mean, how can you control information like that? How can you stop people in South Africa finally becoming aware, looking on the internet, that they're being lied to, not told the truth? And for me, you tackle that situation with information. And merely specifying who can or can't sell a particular type of product isn't really going to do with that. Look at the US, where there are a lot of vaping companies with no tobacco connections. It doesn't stop them being vilified. So I don't think that's the answer, sadly.

00:51:43 --> 00:51:55

Fiona Patten: I think it's certainly something that we all in this room should be sharing and being made aware of. So thank you for alerting us to it. Robert, Mr Wiki.

00:51:55 --> 00:53:18

Richard Prune: Thank you. Richard Prune from Safety Nicotine Wiki. All I wanted to say was I share the promise and I look back on how far we've come And even though this is my first GFN, I've followed everyone since the start. And I just want people to remember the progress we've already made and the positives we've already had, positive effects we've already had on the people who are most important, the consumers of tobacco products, those people that smoke, that don't want to anymore. And we've helped so many of them thus far. We need to keep going. We need to keep getting better. We need to find new ways to reach those people who want to make a positive change in their life. I wonder if the panel would like to comment on that. Thank you.

00:53:18 --> 00:53:41

Fiona Patten: Thank you, Richard. And while they are responding, I want people in the audience to be thinking, I want to hear from people who haven't spoken or this is their first GFN to also put your hand up.

00:53:41 --> 00:54:06

Colin Mendelsohn: I think that's a very positive point to make, Richard, that we have come an enormous way. I mean, look at this conference. A lot of the activity in this field, you get very discouraged but we need to also keep our heads up considering how far we have come and the rate at which change is happening is very reassuring. I can't remember the second part of the question but that's the main thing.

00:54:10 --> 00:54:26

Richard Prune: It was just to keep positive and to look for new ways to actually, as to how we can help people who we haven't actually managed to reach so far.

00:54:26 --> 00:54:53

Joel Sawa: Thanks. I think there's more research going on. There's need for more research. And I foresee that happening, more activity towards enhancing even the technology that is already presently being used. So I think there's a lot to look forward to in terms of in an optimistic sense. Yeah.

00:54:53 --> 00:55:01

Fiona Patten: Great. Does anyone else have some reflections or comments? Yeah, thank you, Charlie.

00:55:09 --> 00:55:37

Charles Hamshaw-Thomas: Charles Hamshaw-Thomas, do you think each of you – Joe, I did like your comments about leadership, but do each of you think there are areas where there needs to be more collaboration between stakeholders? We've heard about environmental waste this week. You've just mentioned product standards, gaps in science. There might be several areas. Do you think there are some of these areas some of the stakeholders could work together on?

00:55:41 --> 00:57:12

Joe Thompson: Yes. I think all of them, to be honest. I don't think any one party, any stakeholder will achieve what needs to be done and realize the hope and the optimism that we have without it. It's got to be through collaboration. It's got to be working with stakeholders who won't always agree and doing that collectively. And that means Yeah, I think, you know, pulling people together that I think the difficulty is with the exception of those that are in the room is that is those that don't want to be in the room. And, you know, learning from some of some of the, well, the analogy with, um, was it Chapman? Simon, thank you. By turning up, you confirm there's something to debate, and I think that's part of the – and therefore they don't engage because it means, well, there's something to solve here when they've already got the answer. That's part of the challenge to overcome, but absolutely, I think in all of these areas, whether it's sustainability, environmental, core harm reduction, regulatory or policy on tobacco harm reduction, yeah, it's leadership, but you need the guiding coalition to make leadership effective.

00:57:12 --> 00:59:11

Jonathan Fell: Thank you. I just meant, well, I'd mentioned a couple of fields. I mean, there are more, my personal hobby horses, I suppose. One is David Sweeney's about data, which I suppose I'm attuned to because of my financial hat as well. But lots of places around the world, if you're trying to work out what the size of the reduced harm tobacco nicotine product market is, it's just very, very difficult. There aren't good figures. It's very difficult, especially in vaping, to know, because it's not excised in a lot of places, how big the market is, what demand is, The demand for cigarettes has been replaced by that. And I think if there were ways for the industry to cooperate better and produce high quality stats on that, it would help lots of people and particularly help make the case for how and why this is working. The other area where, I mean, it's not so much cooperation, but just stop squabbling. I get a bit frustrated or cross when I see companies using a particular kind of favoured regulatory scheme for competitive advantage. I think there were stupid spats about that and it annoys a lot of people. I mean, it must, I'm guessing, really annoy politicians. And in particular, it also really annoys a lot of consumer advocates who see the industry playing games. And I'm just daft, as far as I'm concerned, because one of the problems that the industry has had for ages is that smokers, people who smoke, would never stand up for their habit or their cause. And suddenly, when people switch to become harm reduction advocates, suddenly people are much more ready to speak up and why would you jeopardise the chances of them speaking up on your behalf and helping to drive change?

00:59:11 --> 01:00:06

Fiona Patten: It certainly seems to be a significant side effect of giving up smoking is you become an evangelist. Whether you've given up smoking and not moved to tobacco harm reduction products or you have, we all should need to find that voice, and I think we need to fight the stigma of that in our countries. But, as you say, working together and collaborating, particularly, I think, on data, data really helps regulators and legislators and politicians if they love a number, as does the media. And it's much easier to be able to sell a story with numbers than just a vibe or other information. Does anyone else want to comment on this? Great. To you.

01:00:06 --> 01:01:12

Andrew Manson: Okay. Andrew Manson from the UK. Sorry. Andrew Manson from the UK. And it's great to hear the optimism, and I don't want to kind of knock the optimism at all, because I'm an optimist myself. But 10 years ago, there were a billion smokers. Today, there's still a billion smokers. Two parts of this question is, in 10 years' time, do we still expect to see a billion smokers? And more importantly, in terms of making that change, we can put some of that responsibility on adverse tobacco control and this sort of thing. But at the end of the day, a question, particularly for you, Joe, do you really think that the products out there are good enough in terms of affordability and performance. And from an industry point of view, I mean not an imperial point of view, do you see an acceleration and improvement of that over the next 10 years to address those one billion smokers that still want to use cigarettes?

01:01:12 --> 01:03:09

Joe Thompson: Thank you. If in 10 years' time there's still a billion smokers, then harm reduction would have made little progress. My expectation is there won't be a billion smokers and that harm reduction would have made progress and you would have a, I don't know the numbers, a percentage of those that would have quit, a percentage of those that use nicotine-containing products. The products today, I don't think anyone's got the perfect product. Not every product is right for every consumer. So some consumers prefer nicotine pouches, some prefer heated tobacco, because they feel it's less of a compromise from the smoking experience. Some prefer vaping products. I suspect that those three categories will probably be the three categories in 10 years, but I'm just, I'm guessing the same as anyone else could guess. But innovation happens quickly and it happens fast. And it doesn't just happen within the industry, actually a lot of it, particularly for vaping, happens across Europe, across Asia, startups that are constantly innovating to create better products. And that couples with the industry that is seeking to understand consumers what they want, what they need, and it's not as simple as just providing nicotine. There's a whole raft of behavioral and psychological reasons as to why smokers smoke and why they find it hard to switch. But that innovation will accelerate and continue to accelerate over the next decade. That's what I think will happen.

01:03:09 --> 01:03:10

Fiona Patten: Any of the other optimists on the panel?

01:03:12 --> 01:03:40

Colin Mendelsohn: Yeah, I just wanted to make the point that most of the smokers are in the low and middle income countries. And they're the biggest challenge, unfortunately. I mean, we're making progress in the Western countries, in the high income countries, but much less success there. And I think the WHO has a lot to blame, a lot to take a lot of the blame for that. But the progress seems to be very slow there. And that's what worries me in terms of the total numbers that we'd expect to see in the future.

01:03:42 --> 01:04:48

Fiona Patten: And I think Christopher Russell mentioned in the session yesterday about a study that said if we implemented all of the World Health Organization's recommendations and Empower's recommendations, we would reduce smoking by 2030 to, I think it was 750 million smokers. So we can't just do what we're doing. We can't just keep doing what we're doing now. We do need to disrupt and we do need to innovate in this area. Otherwise, we will be stuck with a growing population but the same number of smokers. Are there any other comments, questions? Fantastic. Well, I think this shows a very good conference when no one has left it with a question. So I'm very pleased and I thank you all and I hope, oh, one, yes, please. You may have the last word at the conference, so be careful.

01:04:48 --> 01:04:48

Stefan Mathisson: Yeah, I know.

01:04:49 --> 01:04:50

Fiona Patten: No pressure.

01:04:50 --> 01:06:19

Stefan Mathisson: Yeah. I'm Stefan. I'm from Sweden and I run an online news outlet on vaping and harm reduction. So coming from Sweden, it's interesting to be here. This is my first conference I've been attending online since a couple of years. And even though I write on vaping, I know what's the Swedish kind of way of handling these products and stuff like that. But that's not my question really. Because this one kind of, it's not an elephant in the room, but everyone who has been vaping for a while know where these products come from. They come from China. You know, that's where everything started, really. It had very little to do with big tobacco companies and such things. And that is what I've been kind of missing on this conference. The voice from the manufacturers in China who actually made this happen. I know the tobacco companies and many other companies work with Chinese companies to produce their devices and stuff like that, but I'm kind of missing that voice here. I don't know why that is, but just a feeling I got. You see them around, but yeah. So I don't know if that was a question or if that was just a statement, I'm just, yeah.

01:06:19 --> 01:07:25

Fiona Patten: It's a very interesting reflection and I think that probably is a great segue to the fact that you will have all seen some feedback sheets about the conference, and we'd encourage you, I've been asked to ask you to please fill in those feedback forms, because it helps shape what the conference will look like next time. On that, I think I, you know, personally, and I'm sure on behalf of all of the panellists, I'd like to thank the organisers of this conference and obviously all of the people. But before we welcome to the stage one of the founders, Paddy, to make some final remarks, could I get a round of applause for the final panellists? And that's a round of applause for all of you for sticking it out till after lunch on Saturday. But now if we could please welcome Paddy for possibly the last time on the stage.