SFP Position Paper on Heated Tobacco Products

 

I. Summary

• Heated tobacco products (HTPs) are tobacco products that were first launched in 2014 and are heavily promoted by tobacco companies. Studies on the health impacts of HTPs are scarce, and they are primarily funded by tobacco companies.
• According to the World Health Organization, there is insufficient evidence to support the claim that these products are less harmful than traditional cigarettes, and further independent studies will need to be conducted to support any claims of reduced risk or harm.
• The use of heated tobacco products has increased sharply in the EU. Between 2018 and 2020, sales of heated cigarettes skyrocketed from 924 million to 19.7 billion, an increase of more than 2 000 %, according to a report published by the Commission.^[1] in June 2022.
• PTCs remain toxic tobacco products and should never be promoted as smoking cessation tools.
• PTCs target smokers, former smokers, and never smokers in order to keep tobacco product sales high. A major concern is the effects of marketing these products, particularly on youth.^[2]An aggressive advertising campaign, combined with the existence of a wide variety of aromas, high-tech design, the perception of reduced harmfulness and the ease of obtaining and consuming these products, makes them increasingly attractive to young people, who are thus encouraged to adopt them, although they are not without risk.
• Under the Framework Convention on Tobacco Control (FCTC), COP 8 recognized in 2018 that PTCs were tobacco products subject to the provisions of the FCTC.^[3].
• The European Commission has adopted Delegated Directive (EU) 2022/2100^[4], which removes certain exemptions for heated tobacco products and regulates these products in a manner similar to cigarettes and rolling tobacco.
• We welcome the Commission's delegated directive and stress that PTCs are tobacco products that should be regulated in the same way as cigarettes, which means applying the same tax rate, the same ban on advertising and promotion, the same labelling requirements and the same ban on flavours or consumption in public places.

 

II. Key facts and evidence on PTCs

• Definition

A heated tobacco product is a smoking tobacco product. It is heated to produce an emission containing nicotine and other chemicals, which is then inhaled by users.

• What are the most popular heated tobacco products?

Heated tobacco products include: IQOS, manufactured by Philip Morris International (PMI), Glo, manufactured by British American Tobacco (BAT), Ploom TECH, produced by Japan Tobacco International (JTI), lil by KT&G, Mok, by China Tobacco, and Pulse, by Imperial Brands. The first PTC launched was IQOS, in December 2014^[5].

• What do we know so far?

PTCs are tobacco products that contain tobacco, nicotine, and non-tobacco additives such as humectants and flavorings.[6]. The tobacco in PTCs is heated by a device, producing aerosols containing nicotine, toxic chemicals and carcinogens also found in cigarette smoke and harmful to health.

Studies on the health impacts of PTCs are rare, and they are largely funded by tobacco companies. Dautzenberg noted that no independent studies have shown that heated tobacco products are less harmful than traditional cigarettes.^[7]The U.S. Centers for Disease Control and Prevention (CDC) says more studies are needed to understand the short- and long-term health effects of heated tobacco products.^[8]. "In addition, funding of studies by tobacco companies remains problematic [...]"^[9].

According to the World Health Organization, there is insufficient evidence to support the claim that these products are less harmful than traditional cigarettes, and further independent studies will need to be conducted to support any claims of reduced risk or harm.^[10].

• Are PTCs widespread?

The use of heated tobacco products has increased sharply in the EU. Between 2018 and 2020, sales of heated cigarettes skyrocketed from 924 million to 19.7 billion, an increase of more than 2,000 %, according to a report published by the Commission[11] in June 2022. The data presented by the Commission confirmed that the volume of sales of heated tobacco products at retail level increased by a percentage of more than 10 % in more than five Member States over the defined period from 2018 to 2020^[12].

• Are PTCs useful for smoking cessation?

Cochrane conducted a review of studies on heated tobacco and smoking cessation and "found no studies reporting the effectiveness of heated tobacco for smoking cessation." The organization concluded that "while the included studies required smokers to switch completely to PTCs or to attempt to abstain from smoking, none reported smoking cessation outcomes. The effectiveness of heated tobacco for smoking cessation therefore remains uncertain."^[13].

The World Health Organization has concluded that PTCs "do not help smokers quit smoking"^[14]. PTCs remain toxic (tobacco) products and should never be presented as smoking cessation tools.

• Do PTCs only target smokers?

PTCs target smokers, former smokers and people who have never smoked[15] in order to keep tobacco sales high. In Italy, 45 % of IQOS users are people who have never smoked[16].

One of the main concerns is the effects of marketing these products, particularly on young people.[17]An aggressive advertising campaign, combined with the existence of a wide variety of aromas, high-tech design, the perception of reduced harmfulness and the ease of obtaining and consuming these products, makes them increasingly attractive to young people, who are thus encouraged to adopt them, although they are not without risk.[18].

 

III. Recommendations on the regulation of PTCs

Under the Framework Convention on Tobacco Control (FCTC), COP 8 recognized in 2018 that PTCs were tobacco products subject to the provisions of the FCTC.^[19].

Under Union law, PTCs are currently notified and marketed in accordance with the provisions of Article 18 of Directive 2014/40/EU on tobacco products.[20] (hereinafter the “TPD”). As regards the sale, presentation and manufacture of these products within the EU, the relevant provisions of the TPD apply and should be implemented[21]. This includes the prohibition on giving false impressions as provided for in Article 13, including any suggestion that a particular tobacco product is less harmful than others.

In 2022, the European Commission adopted Delegated Directive (EU) 2022/2100 amending Directive 2014/40/EU of the European Parliament and of the Council on tobacco products ^[22]. This directive removes certain exemptions for heated tobacco products and regulates these products in a similar way to cigarettes and rolling tobacco. This withdrawal was decided following the increase in consumption of these products across EU Member States, as described in a Commission report.[23]. This proposal would extend to heated tobacco the ban on tobacco products containing a characterising flavour (which currently applies to cigarettes and rolling tobacco). The Commission's delegated directive also includes the obligation to display on the packaging of heated tobacco a warning in the form of a clear illustration, in addition to the health warning message in the form of text.

We welcome the Commission's delegated directive and underline that PTCs are tobacco products that should be regulated in the same way as cigarettes, which means applying the same tax rate to them[24], the same ban on advertising and promotion, the same labeling requirements, and the same ban on flavors and consumption in public places.

 

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 [1] European Commission, “REPORT FROM THE COMMISSION establishing a significant development in the situation for heated tobacco products in accordance with Directive 2014/40/EU”, 15 June 2022 https://eur-lex.europa.eu/legal-content/FR/TXT/HTML/?uri=CELEX:52022DC0279[2] Karma McKelvey, Lucy Popova, Minji Kim, Benjamin W Chaffee, Maya Vijayaraghavan, Pamela Ling and Bonnie Halpern-Felsher, “Heated tobacco products likely appeal to adolescents and young adults”, September 17, 2018, https://tobaccocontrol.bmj.com/content/27/Suppl_1/s41[3] WHO, FCTC/COP8(22), “New and emerging tobacco products”, 6 October 2018, https://fctc.who.int/fr/publications/m/item/fctc-cop8(22)-novel-and-emerging-tobacco-products[4] European Commission, “Delegated Directive (EU) 2022/2100 on the withdrawal of certain exemptions for heated tobacco products”, 3 November 2022 https://health.ec.europa.eu/publications/commission-delegated-directive-eu-20222100-withdrawal-certain-exemptions-respect-heated-tobacco_en[5] Tobacco Free Kids, “Heated tobacco products.” Definitions and global market. Factsheet”, October 2020. https://www.tobaccofreekids.org/assets/global/pdfs/en/HTP_definition_en.pdf[6] World Health Organization, “Fact Sheet on Heated Tobacco Products, 2^e edition», March 2020, https://www.who.int/fr/publications/i/item/WHO-HEP-HPR-2020.2[7] Dautzenberg B, Dautzenberg MD, « Heated tobacco: systematic review of the literature [Systematic analysis of the scientific literature on heated tobacco] ». Revue des Maladies Respiratoires. 2019 Jan;36(1):82-103. French. DOI: 10.1016/j.rmr.2018.10.010. Epub 2018 Nov 11. PMID: 30429092. https://www.rev-mal-respir.com/article/1272644[8] Centers for Disease Control and Prevention, “Heated tobacco products,” 2020. https://www.cdc.gov/tobacco/basic_information/heated-tobacco-products/pdfs/heated-tobacco-products_h.pdf[9] McNeill A ea, “Evidence review of e-cigarettes and heated tobacco products 2018 A report commissioned by Public Health England”, London, 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf[10] World Health Organization, “Fact Sheet on Heated Tobacco Products,” March 2020, https://www.who.int/fr/publications/i/item/WHO-HEP-HPR-2020.2[11] European Commission, “REPORT FROM THE COMMISSION establishing a significant development in the situation for heated tobacco products in accordance with Directive 2014/40/EU”, 15 June 2022, https://eur-lex.europa.eu/legal-content/FR/TXT/HTML/?uri=CELEX:52022DC0279[12] European Commission, “REPORT FROM THE COMMISSION establishing a significant development in the situation for heated tobacco products in accordance with Directive 2014/40/EU”, 15 June 2022, https://eur-lex.europa.eu/legal-content/FR/TXT/HTML/?uri=CELEX:52022DC0279[13] Tatton-Birch H ea, Heated tobacco products for smoking cessation and reducing smoking prevalence, Cochrane Reviews, January 6, 2022, https://doi.org/10.1002/14651858.CD013790.pub2[14] World Health Organization, Heated Tobacco Products Fact Sheet, March 2020, https://www.who.int/fr/publications/i/item/WHO-HEP-HPR-2020.2[15] Gallus S. ea, The role of novel (tobacco) Products on tobacco control in Italy, Int J Environ Res Public Health. 2021 Feb; 18(4): 1895. Published online February 16, 2016. DOI: 10.3390/ijerph18041895[16] Liu and others, Heat-Not-Burn Tobacco Products Are Getting Hot in Italy, J Epidemiol 2018;28(5):274-275.[17] Karma McKelvey, Lucy Popova, Minji Kim, Benjamin W Chaffee, Maya Vijayaraghavan, Pamela Ling and Bonnie Halpern-Felsher, “Heated tobacco products likely appeal to adolescents and young adults”, September 17, 2018, https://tobaccocontrol.bmj.com/content/27/Suppl_1/s41[18] Aldcroft A, Branch-Hollis A, Phillips T, ea, BMJ Public Health: a new public health journal from BMJ, BMJ Public Health 2023;1:e000008, DOi: 10.1136/bmjph-2023-000008. https://tobaccocontrol.bmj.com/content/27/Suppl_1/s41[19] Conference of the Parties to the WHO Framework Convention on Tobacco Control, eighth session, decision FCTC/COP8(22), New and emerging tobacco products, https://fctc.who.int/fr/publications/m/item/fctc-cop8(22)-novel-and-emerging-tobacco-products[20] DIRECTIVE 2014/40/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 3 April 2014 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco and related products, and repealing Directive 2001/37/EC, 3 April 2014,https://eur-lex.europa.eu/legal-content/FR/TXT/PDF/?uri=CELEX:32014L0040[21] European Parliament, Parliamentary question, 'Answer given by Mr Andriukaitis on behalf of the Commission', 9 January 2017 https://www.europarl.europa.eu/doceo/document/P-8-2016-009191-ASW_FR.html?redirect%20-%20def1[22] COMMISSION DELEGATED DIRECTIVE (EU) 2022/2100 of 29 June 2022 amending Directive 2014/40/EU of the European Parliament and of the Council as regards the withdrawal of certain exemptions for heated tobacco products. https://eur-lex.europa.eu/legal-content/FR/TXT/PDF/?uri=CELEX:32022L2100&from=FR[23] European Commission, “REPORT FROM THE COMMISSION establishing a significant development in the situation for heated tobacco products in accordance with Directive 2014/40/EU”, 15 June 2022, https://eur-lex.europa.eu/legal-content/FR/TXT/HTML/?uri=CELEX:52022DC0279[24] SFP position paper on the revision of Directive 2011/64/EU on tobacco taxation, https://www.smokefreepartnership.eu/our-policy-work/position-papers-briefings-reports/sfp-position-paper-tobacco-taxes