WHO expert warned that vapers produce a new generation of nicotine addicts

Adriana Blanco Marquizo

“The business of the tobacco industry is not cigarettes, it is nicotine”the doctor warned Adriana Blanco Marquizohead of the Secretariat of the WHO Framework Convention on Tobacco Control (FCTC) since 2020, and warned that vapers -or electronic cigarettes or, according to their more scientific name, electronic nicotine delivery systems- are generating a new generation of addicts to this drug that “has effects on brain development, especially in young people.”

Adriana Blanco Marquizo, a Uruguayan doctor in charge of the Secretariat in Geneva that oversees the implementation of the international treaty approved in 2003 and ratified by more than 180 countries to fight against tobacco use, spoke with infobae about the tobacco epidemic and He repudiated that tobacco companies now use their vapers to introduce young people to a new way of consuming nicotine and want to “convince” that these products are less harmful than conventional cigarettes. “The tobacco company does not care about public health, it cares, like most industries, about its economic profits,” he remarked.

The doctor also referred to the new campaign of the World Health Organization that calls on all governments to change tobacco crops for other plantations and said that he hopes that Brazil – the third largest tobacco grower in the world, after China and India, with more than 355,000 hectares dedicated to it – strengthen its initiatives to combat smoking. “The change of government there is probably going to reorient the policies,” he estimated.

In addition, he pointed out that it generates “a lot of expectation” that Argentina is considering the ratification of the FCTC because “it really is better to be in the discussions than to be out of them”, because it is among the three largest tobacco growers in the Americas and because it needs to adopt these land conversion measures to achieve a less environmental impact, to improve the conditions of the people who work those crops and to maintain fertile land for food and not to grow tobacco.

-The next May 31 will be celebrated, as every year since 1987, the World Day Without Tobacco. How is the campaign that the WHO will present on that date to promote the fight against smoking?

-This year’s initiative is focused on changing the cultivation of tobacco for other crops. The idea is “let’s grow food, not tobacco” and what it seeks is to face two problems: food insecurity, which unfortunately has increased with the pandemic and various world crises that are being seen, and the problem of tobacco cultivation, which it is very harmful to the environment and also keeps growers in a regime of poverty and health risks that we really want to change.

-What are your proposals to seek this change?

-Basically they are calling on governments to think about how to support growers in this change of crops and how to end all policies that tend to encourage tobacco cultivation. Many countries still have subsidies for tobacco growing, which is not what we are looking for at the moment.

-In the Latin American region, do you observe that there are nations that would be more willing to achieve these reforms?

-Among the countries that have tobacco crops, which are not too many in the Americas region, I could highlight Brazil, which has already taken measures in this regard and is home to one of our knowledge centers that is going to be awarded in the upcoming World No Tobacco Day for promoting economically sustainable livelihoods for growers and protecting the environment. In Brazil, there is already a history of reconversion of tobacco growers to other crops, so I suppose that now they are going to try to resume this topic that had started a while ago. Argentina is also a major grower and is not yet a party to the WHO convention, but I know there is a bill in Congress now considering ratification.

-In Brazil there was a change of government this year, do you think this will help to significantly change the process there?

-Precisely in these days I had an interview with the Minister of Health of Brazil in the environment of the World Health Assembly and she expressed her total support to continue with everything that has to do with tobacco control measures. Brazil has been a pioneer in this matter, even in the negotiations of the agreement, and I believe that, yes, the change of government will probably reorient policies in favor of tobacco control.

-During the government of Jair Bolsonaro were there setbacks in this matter?

-I couldn’t say if there were setbacks, but for now there was a less active participation, let’s say, from the country. But I think that now some of the measures will be resumed.

File photo: A car drives past a tobacco plantation on land that the Xokleng indigenous people claim as their territory in Vitor Meireles, Santa Catarina state, Brazil, in August 2021 (REUTERS/Amanda Perobelli)
File photo: A car drives past a tobacco plantation on land that the Xokleng indigenous people claim as their territory in Vitor Meireles, Santa Catarina state, Brazil, in August 2021 (REUTERS/Amanda Perobelli) (AMANDA PEROBELLI/ )

-In November of this year, two important events will be held in Panama: the tenth session of the Conference of the Parties to the FCTC and the third session of the Meeting of the Parties to the Protocol to Eliminate Illicit Trade in Tobacco Products. Could you anticipate what topics will be discussed there?

-Yes, there are some issues that are already clear on the agenda, such as the work plan for the FCTC Secretariat for the next intersectional period or the discussion of measures that go beyond what the agreement stipulates, which is what you consider your article 2.1. New guidelines on cross-border advertising and the appearance of tobacco use on social networks and digital entertainment media will be discussed. Some other issues of new tobacco products, the exchange of information on illicit products entering countries and the actions we have taken to support the implementation of the protocol will also be discussed.

-The FCTC was approved by the World Health Assembly in 2003, its entry into force took place in February 2005 and it is one of the most endorsed treaties of the United Nations. In these almost two decades of work, what advances have been observed in the fight against smoking?

-In the last report on trends in tobacco use published by the WHO, in 2021, a decrease in the absolute number of smokers was detected for the first time. The decline is not huge, but it has been going down steadily, which is very auspicious. Legislation complying with FCTC mandates has also been passed in many, many countries. The nations that have ratified the agreement cover more than 90% of the population and there is progress in the implementation of many measures, such as smoke-free environment, health warnings on tobacco products or now plain packaging . Some other actions that are very effective are unfortunately not as implemented as the issue of increasing taxes or the complete ban on advertising.

-Switzerland recently announced that it will ban tobacco advertising in the written press, in the cinema, in stadiums and on websites that do not have access control based on age. Do you think that more countries could act in the same way?

-Switzerland’s measure is welcome, especially since it is not part of the agreement yet. And obviously those countries that do not yet have this type of restrictions can follow this example. But there are nations with more comprehensive measures, which have a total ban on advertising in all media plus a ban on all kinds of promotions and sponsorship by the industry. And what is also important is that these advertising bans do not have to be limited to those media that theoretically are only for adults, because we all know that it is very difficult to prevent minors from accessing them, even if they have age controls. And the mere fact of restricting anything to do with tobacco to adults is itself a way to get teenagers excited. Because, well, when you’re a teenager you want to be an adult and it’s really a way of making it attractive, especially since it makes this forbidden, “let’s see if I can come in, let’s see if I can get in here even though I don’t have the age”. So the ideal is what article 13 of the agreement and the guides for the implementation of article 13 ask for, which is a complete, total ban, at all times, in all media, for all audiences of all types of advertising. of tobacco products.

Electronic cigarette
The use of electronic nicotine delivery systems, also known as vapers, has gained popularity among young smokers (RyanJLane/)

-In recent years, consumption among young people has been closely linked to the increase in vapers or electronic cigarettes. What is the risk of expanding this new type of products?

-Specifically the problem is that young people are being introduced to a new form of drug consumption that is nicotine. And I emphasize that, regardless of whether this product is a tobacco derivative or not, it has nicotine.

Nicotine is an addictive drug that has effects on brain development, especially in young people, in addition to its effects on cardiovascular health and other areas of the body. The most serious problem is that the tobacco industry owns many brands of these electronic cigarettes and wants to convince two things. One is the idea that these products are much less harmful than cigarettes, which is still difficult to prove because we do not have as many years of consumption of these products as we have of cigarettes. Science is not yet defined on what the risks are, because although there is less exposure to some substances that are in the cigarette, especially those that have to do with combustion, exposure to fewer substances does not mean that the risk of disease is lower.

The worst thing is that there is a study, which was produced in the United Kingdom, which says that they are 95% less harmful, although in reality there is no scientific basis that says how that number was produced. It was apparently a group of experts that got together and came to a 95% conclusion that is not supported by research that can prove it. Today the WHO, which is the world authority on health, is doing various analyzes of these products and still cannot conclude with certainty that they are less harmful.

And the other idea that the industry wants to make believe is when it says that it is making these products solely to help smokers. That is, he wants to solve a problem that he caused. And the point is that while it says that its target audience is those who want to switch to these products or want to use them to quit smoking, the reality is that the focus of the promotion is on young people. Because you can see that these products are much more attractive to young people than to adults, with different flavors such as pina coladas or colors… There are even places with electronic cigarettes that are practically toys. So there really is a double standard. As has always been with the industry, this is no surprise. The tobacco company does not care about public health, it cares, like most industries, about its economic profits.

-And this industry has not phased out conventional tobacco products either.

-The experience today is that people in general consume both: the new products and also the regular cigarettes. That is the vast majority. Those who fully switch to e-cigarettes are not that many.

Another distinction that must be made, which the industry does not make, is that in these new products there are two families that are totally separate. One is electronic cigarettes –or vapers or, with the more scientific name, electronic nicotine delivery systems-, which are not tobacco products because they only have nicotine and do not have anything from the tobacco plant, and in the definition of products Convention tobacco products have to have something from the plant. But the other family is heated tobacco products, like the Phillip Morris IQOS, which are tobacco products because they are small electronic devices where you put a small cigarette with tobacco inside. So those are also tobacco products and they have to be regulated under the rules of the agreement and so far there is no one who says that they are beneficial in any way. And even all that is said to be less risky is said for e-cigarettes, not these, despite the fact that the industry continues to say that they are less risky because they expose you to less things.

-Can you see that the tobacco industry is moving more towards these electronic products than towards conventional cigarettes?

-Currently the vast majority of the market is still dedicated to cigarettes. The industry says it wants to kill them but in fact it is opening new cigarette factories in different countries. That is to say that not only has it not stopped, but it continues to increase and in no country has a date been set to say “from that year on we are not going to produce more conventional cigarettes, we are going to produce only these alternatives”.

And the history of wanting to do something less harmful is long and until now it has never been proven to be true. So I think that as people who work in public health we have to be careful about what things we say to the population, especially when there is an addictive substance involved. Because once all these young people enter, for example now with vapers, there we already have a new generation of nicotine addicts and the industry is not interested in what product it is going to sell. Because even they already said in the 60s that their business is not cigarettes or tobacco, their business is nicotine. The cigarette is a vehicle.

Blanco Marquizo explained that the WHO carried out various studies on vapers and still could not conclude with certainty that they are less harmful than conventional cigarettes.

How do you manage to reduce the number of smokers in the world?

-What we are seeing is that when one puts the necessary measures to make the environment more conducive to health, people react well. Because in general the decision to start smoking is taken in adolescence. It does not happen at 18, 20, 25 years. 80% of people who start smoking do so in adolescence. At a time where theoretically we are not allowed to make many decisions. And the fact that there are opportunities to do promotion, to do marketing to young people, makes young people start. The day that advertising is no longer there will be many fewer young consumers. In fact, after the smoke-free environment measures, when you begin to see that smoking is not a socially acceptable attitude, many people and many young people are not interested, because the problem was all this glamorous smoking environment that was did before. But now that it’s starting to change, many young people have no interest in starting to smoke because they don’t see it as attractive.

I believe that the number of smokers can be reduced to an infinitely lower number than it is now if there is an environment where what is most present is not the cigarette. It is not possible if you find cigarettes around all the cash registers, if you have advertising, if you still have a number of influencers working for the industry on social networks… I believe that with a context of denormalization of cigarette use this will end up falling. Also if the cigarette is expensive; many people quit smoking when it becomes expensive.

And I think that people are going to stop smoking as long as we don’t have an industry that violates all the measures and continues to try to maintain its business. That is unfortunately difficult to handle.

– Do you think that declaring tobacco consumption illegal is an option?

-No, that’s clear. That hasn’t worked anywhere. The issue of only trying to limit the supply side, making the drug illegal or imposing penalties, has not stopped people from using drugs and has generated other problems in society. I do not consider it and the FCTC does not consider the prohibition in any of its articles either. What the agreement considers is the regulation in a way that in the long run will extinguish the consumption of tobacco. In that I am sure that, in the long run, it will become extinct, especially without innovations from the industry that tries to sell these things as a solution. But I don’t think banning is the way to fix the problem.

-Finally, do you notice that any country could make more progress against smoking?

-A piece of news that has generated a lot of expectation in me is that Argentina is considering the ratification of the FCTC, because I think that it is really better to be in the discussions than to be outside of them. And also, due to the growth of the population, it must be understood that tobacco production is not going to fall next year. This is going to take many years and it is going to give time precisely to these conversion measures promoted by World No Tobacco Day to improve the conditions of Argentine growers, for example, or to achieve a lower environmental impact and protect fertile lands for food and not to grow tobacco.

There are many ideas and these are some of the ones that will be discussed at the Conference of the Parties in Panama on how to proceed. There are countries that have almost fully implemented the FCTC and are now thinking of going a little further. Because the agreement is open and that is very clear in its article 2.1, which says that its provisions are the floor and not the ceiling. The points of this international treaty are the minimum that countries are required to implement, but from then on, governments are free to do what they think may be effective to combat tobacco use.

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