Hong Kong remains opposed to new alternatives to reduce smoking after U.S. approval.

HPicture By https://rebcenter-moscow.ru/ (Own work) CC BY-SA 4.0 via Wikimedia Commons

U.S. regulators now allow the sale of heat-not-burn tobacco products, but Hong Kong is sticking to its zero-tolerance approach to the new alternatives to smoking and opposition remains strong.

IQOS, developed by tobacco giant Philip Morris International (PMI), is an electronic device that heats tobacco-filled sticks wrapped in paper to generate a smoke-free aerosol that contains nicotine. PMI says it is the first electrically heated tobacco product to qualify for sale in the U.S.

Banning innovation

In February, the Hong Kong government imposed a complete ban on e-cigarettes – with penalties of six months in jail of fines of HK$50,000 for the importation, production, sales, distribution or promotion of alternative smoking products. Singapore and Thailand have already prohibited such products.

The U.S. has taken a different approach.

“The agency determined that authorizing these products for the U.S. market is appropriate for the protection of the public health because… the products produce fewer or lower levels of some toxins than combustible cigarettes,” says the U.S. Food and Drug Administration (FDA).

From a rigorous science-based review, the regulator found that carbon monoxide exposure from IQOS aerosol is comparable to environmental exposure. At the same time, levels of acrolein and formaldehyde are 89 – 95 percent and 66 – 91 percent lower than in traditional cigarettes.

But the FDA approval of IQOS does not mean it is safe, noted Mitch Zeller, director of the FDA’s Center for Tobacco Products. Rather, the review ensures that marketing IQOS is “appropriate for the protection of the public health”.

Permitted, regulated

The marketing greenlight, however, comes with requirements on how IQOS can be marketed to adults.

PMI must notify the FDA of its labeling, advertising and marketing plans, including information about specific adult target audiences for IQOS. It also needs to plan how to restrict youth access and limit youth exposure to the labeling, advertising, marketing and promotion of IQOS.

The FDA also is requiring all package labels and advertisements for these products to include a warning about the addictiveness of nicotine, in addition to other warnings required for cigarettes, to prevent consumer misperceptions about the relative addiction risk of using IQOS compared to combusted cigarettes.

“The order sets out clear commericalisation guidelines, including marketing requirements that maximize the opportunity for adults to switch from cigarettes, while minimizing unintended use. We fully support this objective,” says PMI’s CEO Andre Calantzopoulos.

Strong opposition in Hong Kong

It is not immediately clear if the move by the U.S. will shake things up in Hong Kong, where government officials and medical groups have strongly opposed any smoking alternatives.

“The medical community all along supports a total ban and opposes mere regulation of new tobacco products including electronic cigarettes and heat-not-burn tobacco products,” says the Hong Kong Academy of Medicine.

David Lam, vice president of Hong Kong Medical Association, called the new smoking products “evil”. He added that making them available on the market would be another mistake after traditional cigarettes were made accessible.

“These products are being marketed as trendy products to attract youngsters who don’t already smoke,” says Mr Antonio Cho-shing Kwong, chairman of the Hong Kong Council on Smoking and Health.

Medical communities worldwide are divided on the risks of e-cigarettes.

The Royal College of Physicians in the U.K. claimed in 2016 that “concerns about e-cigarettes helping to recruit a new generation of tobacco smokers through a gateway effect are, at least to date, unfounded.”