The US has just been added to a list of 44 countries allowing the use of IQOS, an electric heat-not-burn tobacco system that has now become the first of its kind to qualify for sale in the States. However, as more countries embrace the device, the situation in Malta remains unchanged.
In just two years, 7.3 million adult smokers have chosen to switch from combustible cigarettes to heat-not-burn tobacco products, and this latest decision by the US’ Food and Drug Administration (FDA) will now make the device available to the approximately 40 million American adult smokers.
“This decision by the FDA is a historic milestone,” said André Calantzopoulos, CEO of Philip Morris International (the company behind IQOS). “All of us at PMI are determined to replace cigarettes with smoke-free alternatives that combine sophisticated technology and intensive scientific validation. Furthermore, Phillip Morris fully supports the stringent marketing guidelines and requirements as laid down by the FDA.”
Apart from the US, 19 EU countries allow the widespread use of IQOS… but the device is still prohibited in Malta
Despite the high number of smokers on the island, IQOS is prohibited under a general ban of smokeless tobacco products.
Smokeless tobacco was totally banned in Malta in 1988, later reconfirmed in 2016 by Legal Notice 67. According to the law, smokeless tobacco is defined as “a tobacco product not involving a combustion process, including chewing tobacco, nasal tobacco and tobacco for oral use”.
Last year, ahead of World No Tobacco Day (31st May), tobacco companies in Malta lobbied the government to regulate heat-not-burn technology, claiming it could reduce the public health consequences of smoking since the products do not required combustion for nicotine deliver. The Health Ministry seems to however disagree with this point.
“Tobacco products consumed in a process not involving combustion (such as smokeless tobacco products) are relatively new developments and research on their health effects is limited and related to emissions rather than long-term health effects,” a Health Ministry spokesperson had told Lovin Malta last year.
“In Malta, in spite of existing tobacco control efforts to help them quit or not to start, thousands of Maltese people continue to smoke who could benefit from this approach.”
“The government in Malta, in contrast to virtually all other countries in the EU, is not allowing these smoke-free products for current adult smokers,” Philip Morris International had said in an official response to the situation on the islands. “We believe that by working together with the government to responsibly permit these better alternatives on the market, we can help address one of the largest public health challenges: to make Malta smoke-free.”
A local online petition has seen hundreds of people sign in an effort to make IQOS available in Malta
“Smokers in Malta are looking for less harmful alternatives to cigarettes,” says Charles Saliba, who started the Change.org petition aimed at the country’s Health Ministry.
At the time of writing, the petition, which simply reads Make IQOS available in Malta, has 780 supporters, with signees saying everything from “it’s definitely a healthier way of smoking when one cannot quit the habit” to calling the current ban nonsensical.
The Health Ministry has warned of these possible harmful effects regarding smokeless tobacco products:
1. These products contain nicotine as a major constituent and are addictive. Nicotine can have adverse effects during pregnancy and may contribute to cardiovascular disease. Although nicotine itself is not a carcinogen, it may function as a “tumour promoter”. Nicotine also seems involved in fundamental aspects of the biology of malignant diseases, as well as of neurodegeneration.
2. Users may be exposed to toxins different from cigarettes.
3. Due to the addictive nature of the products, cessation is difficult, as it is for smoking tobacco.
4. Tobacco manufacturers encourage use of smokeless products by smokers on occasions when they are not permitted to smoke. Promoting smokeless products may encourage individuals to adopt smokeless tobacco use in addition to continuing smoking.
5. Youth are especially vulnerable to trying new innovative experiences. Furthermore, smokeless tobacco use is more socially acceptable than smoking and it is usually easy to practice without detection.
6. Use of smokeless tobacco has been reported to increase the chances of subsequent initiation of smoking i.e. persons who experiment with them often develop a pattern of regular daily use and over time, many users increase amounts they consume.
7. Smokeless tobacco is allowed to have characterising flavour and may therefore facilitate initiation of tobacco consumption, especially in young people. Flavouring is an effective tactic introduced by the tobacco industry to attract new and retain existing smokers. A study by Kowitt SD et al lured cigarettes were perceived to be less harmful, more appealing, and looked like “candy sticks”.
8. Consumption of such products, especially if promoted with smoking cessation claims, undermine the positive developments that have taken place in reducing smoking. They may especially undermine efforts to ‘De-normalise’ tobacco use.