arlier this year we looked at tobacco harm reduction and observed that smoking still causes

8m deaths a year . Why had there been so many false starts on finding safer ways to use nicotine ? Despite brilliant innovations and the launch of safer products – thanks to consumer-driven breakthroughs in tobacco harm reduction ( THR ) – we learned about inertia in public health , varying resistance through global politics , conflicts within the tobacco industry , and confusion surrounding tobacco control organisations , who resisted the notion that safer nicotine products could be used recreationally ( DDN , February 2023 ).

So when DDN was invited to the tenth Global Forum on Nicotine ( GFN ), it seemed like an interesting opportunity to see key players in active debate . As the event ’ s co-founder Paddy Costall

said , ‘ Ours is the only conference in the smoking , tobacco and nicotine arena that welcomes all the players involved in tobacco harm reduction – consumers , regulators , parliamentarians , manufacturers and scientists – with no bans on who can attend or who can speak .’

A SENSE OF OPTIMISM The event was born from a sense of optimism , said cofounder Prof Gerry Stimson . ‘ We thought we were on the cusp of a breakthrough , and that with safer nicotine products , millions of premature deaths from smoking could be avoided . If played right , we felt sure that harm reduction for tobacco could be a huge individual and public health success .’ The last ten years had been a challenge , with regulators , parliamentarians and legislators changing the pace of progress . But he still remained confident that ‘ it ’ s not a matter of whether

tobacco harm reduction will happen , but when ’.

Fifty ‘ thought leaders ’ from the field were invited to speak .

They looked at the milestones of the last ten years , assessed a complex political , regulatory and scientific environment , and debated the challenges of the future . The flavour of the event was energetic and respectful , and characterised by a willingness to listen . Despite the great divide between countries that were being constrained by poor policy and regulatory obstacles and those buoyed by a wave of progress and consumer interest , there was a sense that sharing the science could translate into helpful take-home messages . There were bound to be more questions than answers . A session called ‘ The Big THR Conversation ’, chaired by UK public health expert Clive Bates , asked : How can the last decade influence and inform the next ?’

‘ Nicotine doesn ’ t cause cancer and when we make people realise this then we can discuss lower levels of harm of the products .’

What are the dynamics ? What causes success or failure ? Why does the World Health Organization ( WHO ) do what it does ? Why is the science a mess ? Why is there such indifference to that ? What role should the industry play ? How do we see the world of nicotine in 15-20 years ?

ENTRENCHED POSITIONS As delegates from different countries gave their thoughts , we heard about narratives