Something remarkable is happening in Japan; combustible cigarette use is disappearing. And, with the right policies in place, this collapse in deadly cigarette use can happen in every country.
Japan Tobacco International’s third-quarter results for 2021 showed that domestic sales of cigarettes in Japan had fallen by 8.2 percent during the previous year, which followed an 8.9 percent decline in the preceding quarter.
A foretaste of this phenomenon was seen in 2018, with the Financial Times reporting that Philip Morris’ heated tobacco product, IQOS, was laying waste to cigarette sales in Japan. According to the report, “shipments of traditional cigarettes” declined by more than 7 percent in 2018, which had followed an 11.5 percent decline in the first quarter of 2017. Meanwhile, shipments of “heated units” increased from 1.2 billion to 6.4 billion during the period. In fact, during the quarter, nearly 9 percent of Philip Morris’ global revenue was from reduced-risk products.
In all, reported volumes of cigarettes sold in Japan have now declined 42 percent compared to 2016 when heated tobacco products went mainstream in the Japanese market. It is an unprecedented collapse in cigarette sales. This level of destruction of smoking rates has never been experienced anywhere in the world.
Interestingly, heated tobacco products are likely to be the cause of such reductions in cigarette usage. An American Cancer Society research study in 2020 concluded that heated tobacco products “likely reduced cigarette sales in Japan.” Another 2020 study published in the International Journal of Environmental Research and Public Health came to a similar conclusion, stating that “the accelerated decline in cigarette-only sales since 2016 corresponds to the introduction and growth in the sales of heated tobacco products.”
This isn’t an isolated phenomenon. In Sweden and Norway, snus — an extremely low-risk product comprising pasteurized tobacco sold loose or in small pouches to deliver non-combustible nicotine through the gum — has led to dramatic declines in smoking prevalence. And, wherever e-cigarettes are widely available as a consumer product, the outcome has been the same.
Furthermore, there is emerging evidence that the harm-reduction potential of these products could be starting to translate into real world effects. Investigations into recent Japanese population medical data have shown a significant downward trend in hospitalizations attributable to chronic obstructive pulmonary disease and ischemic heart disease from 2017 onward, which correlates closely with the proliferation of heated tobacco products.
Neighboring South Korea has also seen its traditional cigarette industry losing customers at an unprecedented rate after the introduction of heated tobacco and is observing similar health trends. A 2021 study by the Seoul National University College of Medicine found that compared to smoking, switching to reduced-risk products — which, in South Korea is almost exclusively heated tobacco — was associated with 23 percent lower risk of developing cardiovascular disease.
Authorities in the United States also appear to recognize the potential health benefits of low-risk products. In July 2020, the Food and Drug Administration authorized Philip Morris’ IQOS as a modified risk tobacco product, meaning “the product will or is expected to benefit the health of the population as a whole.” FDA has also conferred MRTP status on eight snus smokeless tobacco products based on the same criteria.
Governments and organizations interested in health should be trying to understand successful products selected by the public and mirror or even improve on them. Harm-reduction products are offering a perfect alignment of business, economic and public health goals without the state having to do anything but allow industry to get on with selling them to adult smokers. With so many products now offering huge reductions in harm from smoking and consumers making purchases themselves without costing taxpayers a dime, there is nothing to dislike.
The only caveat is that these dramatic declines in smoking and positive health trends are happening with many health bodies seeking to oppose reduced-risk products in Japan rather than facilitating them. One can only wonder at how much greater beneficial public health outcomes could be achieved if the Japanese authorities actively encouraged these products rather than attempting to obstruct them.
Policymakers worldwide would do well to recognize how new technology in nicotine delivery can help smokers move away from harmful cigarettes and formulate policies that incentivize access to the potential health benefits of innovative non-combustible products.