To: Members of the European Parliament

Brussels, 9^th February 2022

Support amendments for a stronger public health perspective on novel products such as heated tobacco and electronic cigarettes

The European Respiratory Society (ERS) and the European Network for Smoking and Tobacco Prevention (ENSP) recommend you strengthen the Special Committee on Beating Cancer (BECA) report on novel tobacco products and electronic cigarettes. Specifically, we ask you to support the 6 amendments tabled by MEPs Fritzon, Moretti and Casares (on behalf of the S&D Group). They seek to improve the text in line with currently available research, clinical evidence and recommendations of the WHO on new and emerging nicotine and tobacco products.

The joint position of ERS and ENSP on novel products is guided by scientific evidence and the precautionary principle, and such products are not recommended for smoking cessation purposes. Furthermore:

• They are not demonstrably superior to approved medications for smoking cessation (NRT) and are not approved for the treatment of tobacco dependence (with exception of the UK)¹.
• They may increase dual use (e.g. using e-cigarettes and continuing the use of conventional tobacco) which prolongs tobacco exposure².
• Short-term safety data suggest they cause airway reactivity³, but there are recorded cases of serious health consequences including lung injury and acute respiratory failure⁴.
• The long-term health risk of exposure to e-cigarette constituent chemicals is yet unknown⁵.
• Heated tobacco devices have been shown to release cancer causing chemicals⁶.

In order to beat cancer, the ultimate goal must be for current smokers to stop smoking and not to switch to an alternative addictive product. Young people should be free both from any exposure to e-cigarettes, heated tobacco and their aerosols in public and private spaces. Also, from the industry’s and interest groups’ promotion of such products⁷.

We fully support the amendments to Paragraph 7 and 12 and other additions of new recitals and citations, proposed by MEPs Fritzon, Moretti and Casares on behalf of the S&D Group. We encourage you to follow your conscience, rather than party political positions and vote for them.

Yours sincerely,

Prof Jonathan Grigg – Chair of the European Respiratory Society Tobacco Control Committee

Dr Francisco Rodriguez Lozano – President of the European Network for Smoking and Tobacco Prevention

References

1. Hopkinson NS, Bush A, Grigg. J Should e-cigarettes be licensed as medicines? BMJ 2022;376: n2912. https://www.bmj.com/content/376/bmj.n2912
2. ERS Position Paper on Heated Tobacco Products. https://www.ersnet.org/news-and-features/news/ers-position-paper-on-heated-tobacco-products/
3. TackSHS EU Horizon Project Fact Sheet. http://tackshs.eu/wp-content/uploads/2019/10/TackSHS-leaflet_20191023.pdf
4. CDC. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping Products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
5. ENSP 2020 Guidelines for Treating Tobacco Dependence. https://ensp.network/wp-content/uploads/2020/10/guidelines_2020_english_forprint.pdf
6. Auer R, Concha-Lozano N,  Jacot-Sadowski I; et al. Heat-Not-Burn Tobacco Cigarettes Smoke by Any Other Name. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628970
7. Stéphane Horel. Vaping: The real dollars behind fake consumer organisations. https://www.lemonde.fr/societe/article/2021/11/03/vaping-the-real-dollars-behind-fake-consumer-organisations_6100848_3224.html

About ERS: European Respiratory Society (ERS) is an international organisation that brings together physicians, healthcare professionals, scientists and other experts working in respiratory medicine. We are one of the leading medical organisations in the respiratory field, with a growing membership representing over 160 countries. Our mission is to promote lung health and alleviate suffering from disease and drive standards for respiratory medicine globally. Science, education and advocacy are at the core of everything we do.

About ENSP: The European Network for Smoking and Tobacco Prevention (ENSP) is an international membership non-profit organisation, established in 1997. ENSP’s mission is to develop a strategy for co-ordinated action among organisations active in tobacco control in Europe to support the WHO FCTC implementation across Europe and to reduce the prevalence of tobacco use in Europe to less than 5% by 2040. Our vision for the future is to eliminate the health inequalities among European citizens and their suffering caused by ill health and early death due to tobacco-related diseases. We strive to achieve it via projects and activities in the fields of prevention, smoking cessation, and research.