A leading Italian physician has weighed in on South Africa’s Control of Tobacco Products and Electronic Delivery Systems Bill, calling on parliament to adopt science-based tobacco harm reduction policies.
Prof Riccardo Polosa, who leads the Centre of Excellence for Harm Reduction at the University of Catania and has more than two decades of experience in smoking cessation, told the parliamentary portfolio committee on health on Friday that policymakers should seriously consider “evidence-based tobacco harm reduction strategies”.
“Triangulation of systematic reviews and real-world evidence shows that e-cigarettes help smokers quit. The Cochrane Library, the highest level of evidence, concludes that people are more likely to stop smoking using nicotine e-cigarettes than with nicotine replacement therapy such as patches and gums.”
In his presentation, Polosa pointed to real-world data from nearly a million people in the US, explaining that the smoking trend line has decreased sharply while vaping has increased. He said this suggested that the more vaping uptake there is, the more smoking is replaced.
This, he said, had contributed to the “near eradication” of smoking among US high school and college students.
“Quitting smoking is not easy, but combustion-free nicotine products reduce toxic emissions and exposure, making it very likely that they lead to reduced harm.”
He cited what he called a large international replication study.
“Smoking cigarettes kills about 75% of the cells in cultures, but tobacco harm reduction devices show little effect. In some cases, cells are even growing. These products are about 80% less toxic than tobacco cigarettes and about 99% less genotoxic.”
Polosa used Sweden as an example to further his support for harm reduction. “Sweden, where snus, a non-combustible nicotine product, is widely used, has the lowest long-term mortality and cardiovascular disease rates in Europe. This shows the potential of combustion-free nicotine to reduce health risks at population level,” he said.
Polosa said clinical data also revealed rapid health improvements after switching. “Just 48 to 72 hours after quitting smoking, people report getting their sense of taste and smell back. In studies, former smokers who switched to e-cigarettes showed restored mucociliary clearance times equal to never-smokers.”
“Among patients with chronic obstructive pulmonary disease (COPD), 85% reported improvement of respiratory symptoms after switching to e-cigarettes. Our five-year follow-up showed reduced cigarette consumption, better lung function, fewer respiratory infections, and improved quality of life,” said Polosa.
People deserve accurate information on their risks and benefits to make informed choices. The government should integrate harm reduction into its public health strategy to save lives
— Prof Riccardo Polosa
Addressing concerns about vaping in never-smokers, Polosa assured the committee: “In a 3.5-year study of people who vape but have never smoked, we observed no long-term health concerns.”
He offered to support South Africa with science-driven guidance for effective tobacco policy reforms.
“Prevention alone is not enough. Changing tobacco harm reduction tools could help people quit smoking. Non-combustible products are unlikely to create significant health concerns under normal use. People deserve accurate information on their risks and benefits to make informed choices. The government should integrate harm reduction into its public health strategy to save lives.”
South African adjunct professor and independent healthcare consultant Prof Praneet Valodia told the committee that the combustion of tobacco produces between 6,000 and 7,000 chemicals.
“Among these, about 100 are harmful or potentially harmful. Non-combustible nicotine-containing products produce no combustion and 60% to 99% fewer harmful chemicals. This is based on an independent evaluation by the US Food and Drug Administration, a leading authority in tobacco and medicines regulation. Nicotine levels are the same but nicotine is not the harmful substance. It’s the other chemicals, nitrosamines and polycyclic aromatic hydrocarbons which cause disease.”
“The science is clear: combustible cigarettes and non-combustible nicotine products are not the same, and pretending they are undermines public health.
“Switching to non-combustible alternatives significantly reduces harm — we're talking about 60%-99% fewer harmful chemicals. I’ve independently assessed the evidence using the same rigorous standards applied to clinical trials, and the data is overwhelming.
“We need a smarter regulatory framework, one that differentiates based on risk, supports smokers with safer options, and stops ignoring the science. Continuing down the current path is not just flawed, it’s dangerous.”
TimesLIVE
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