Participants of the Morven Dialogue that was held in November 2018 identified 10 Core Principles that aim to guide ongoing and future discussions for the development and implementation of effective policies and objectives on harm reduction. We outline the position of the Foundation for a Smoke-Free World (herein referred to as “The Foundation”) on each Core Principle of the report that was re-released this month.

1. Definitions and Terminologies: Develop Clear and Useful Definitions and Terminologies to Adapt to a Changing EnvironmentThe Foundation seeks to better define the various tobacco/nicotine products, and to effectively communicate the risks and harm levels associated with the use of various products in a truthful and accurate manner, as supported by scientific evidence. Our Global Trends in Nicotine report lays the groundwork for the Foundation’s work and research program as the environment changes, particularly as the tobacco industry undergoes a transformation. We will be using definitions and terminologies in agreement with study reports, findings from the poll that we commissioned in 2017 and the ongoing 2019 poll, statutory definition, and regulatory consistency. The definitions and terminologies used will be understandable by consumers, patients, the general public, and other stakeholders; and understandable for purposes of statutory definition, regulatory consistency, and relevance.
2. Smoking Replacement Products (SRPs): Recognize, Understand, and Act on the Significant Differences Between Combustible and Non-Combustible ProductsCognizant of the significant differences between combustible tobacco products and non-combustible nicotine alternative products (referred to as “SRPs” in the Dialogue report), we are funding studies to characterize various products in terms of their chemical composition, genotoxicity, and mutagenicity. While SRPs is the term used in the Dialogue report, at this stage, we refer to non-combustible products as tobacco harm reduction products or safer nicotine products, as they present lower health risks relative to combustible tobacco products.
3. Regulatory Oversight: Develop a Consistent, Science-Based, Consumer Friendly, and Incentive-Based Regulatory FrameworkWe support proportionate regulation of various products relative to the harm associated with them and based on a continuum of risk, acknowledging that combustible tobacco products are associated with maximal risk, as supported by scientific evidence. We also support regulations that take into consideration the needs of smokers who wish to reduce their risk. Findings of research that is funded by the Foundation could inform regulatory actions of policy makers. We support strict regulation to prevent marketing, advertising, sales, and use of all tobacco products—combustible and non-combustible—to youth and teens.
4. Research and Science: Encourage Transparent, Collaborative Research of the Highest Integrity to Reduce Consumer Health RisksThe Foundation issues several grants based on proposals to conduct cohort studies, preclinical research, and clinical trials. The Foundation has established an independent advisory committee for work related to Health, Science, & Technology (HST). We also ensure oversight and review of grant applications and grantee selections. Research is funded in accordance with Cohen et al.’s criteria and in alignment with the Cochrane mission. All research will be conducted independently of the Foundation or any third party. Findings of the research of our grantees will provide answers to consumers, physicians, regulators, and other stakeholders about effective smoking cessation tools and non-combustible nicotine delivery systems, their risks and relative risks, their potential benefits, and perception of risks and benefits. We also aim to strengthen research capacities in low- and middle-income countries. Research studies will comprise vulnerable populations such as smokers with chronic obstructive pulmonary disorder, mental diseases, diabetes, and cardiovascular disease. The Foundation is also establishing a consortium for its grantees across all institutions to promote scientific discussions among them, and enable them to share their data and collaborate with each other. The Foundation and its grantees will provide gold open access to publications that communicate all research findings in an unbiased manner.
5. Innovation and Technology: Encourage and Incentivize Lower Risk ProductsThe Foundation aims to work collaboratively with the private and public sectors to fund innovativepreclinical research and clinical research and trials that will focus on several research projects. The Foundation plans to launch initiatives to accelerate science-based innovation of lower risk products, relative to combustible tobacco, in low- and middle-income countries. The following innovation and technology research projects are currently funded by the Foundation: biomarkers of exposure and epigenetic markers of smoking behavior; biomarkers of future harm in smokers; and product characterization to assess the chemical composition. The Foundation will also characterize smokers and identify tailored approaches of smoking cessation and tobacco harm reduction to meet smokers’ needs and desires. The Foundation also believes that now is the right time for industry innovation, as unprecedented and innovative technologies are reducing the health risks associated with nicotine delivery compared with those of emissions found only in combustible tobacco.
6. Monitoring, Evaluation, and Accountability: Balance Regulatory Incentives and Fast-Tracking for Lower Risk Products With Rigorous OversightWe agree with the content of this core principle and align ourselves with the need for regulatory oversight of all tobacco, nicotine, and alternative lower risk products. Regulatory oversight is paramount, especially to curb youth use of all these products. The Foundation aims to evaluate industry progress, and assess actions taken that undermine progress toward a smoke-free world, in the form of the Tobacco Transformation Index. The Tobacco Transformation Index will annually evaluate 15 of the largest tobacco companies in the world, as the tobacco industry and nicotine ecosystem undergo a technological disruption.
7. Consumers and the General Public: Involve Those Impacted by Decisions in Developing a Communication and Regulatory FrameworkThe Foundation will be educating the public and consumers, health care professionals, policy makers, regulators, media, and other stakeholders about the risks and relative risks of tobacco, nicotine, and alternative products, and the potential benefits they may offer in terms of reduction in tobacco-associated morbidity and mortality. We commissioned a survey of consumers in 2017 on smoking and are following up with another poll in several countries this year. The 2019 poll aims to gain more insight on the current landscape of smoking behaviors, awareness, consumption, and perceptions of various tobacco products and alternative nicotine delivery systems based on cultural, socioeconomic, and tobacco use by country. Additionally, we support the International Network of Nicotine Consumer Organisations (INNCO) in their efforts as advocates for tobacco harm reduction and their outreach to consumers and the general public in a scientifically accurate manner.
8. Nicotine: Communicate Truthful and Accurate Information About the Risks, Relative Risks, and Possible Benefits About the Use of NicotineThe Foundation’s aim is to communicate information accurately and effectively regarding various tobacco and nicotine products, their risks and relative risks, and to correct misperceptions that nicotine directly causes cancer and premature death, as it does not. To this end, we are supporting the development of a robust digital platform that will (1) continuously monitor the risk perceptions by consumers and key opinion leaders (including health care professionals, researchers, regulators, and policy makers) of nicotine within various delivery systems; (2) outline the direction and major outputs of nicotine-related scientific research; and (3) share updates on how that research may lead to patents and business applications.
9. Tobacco Agriculture: Involve Agriculture Stakeholders in Developing a Communication and Regulatory FrameworkWhile we support the four points outlined in this core principle in the report – which focus on understanding how growing and producing tobacco plays a critical role in tobacco harm reduction – the Foundation’s work goes beyond these points. The Foundation’s Agricultural Transformation Initiative (with initial focus in Malawi) is well advanced and seeks to assist tobacco farmers, particularly smallholder famers, and their communities, diversify their economies. Our work in the agricultural sector will better prepare farmers for a future that sees a decrease in tobacco demand, while strengthening their countries’ economies and lessening their dependence on tobacco.
10. Engagement and Dialogue: Encourage Ongoing Civil Dialogue With Broad Stakeholder InvolvementThe Foundation seeks to engage with various stakeholders, from public health organizations to researcher to consumers, and many more. We have had dialogues with experts at meetings such as the Society for Research on Nicotine and Tobacco (SRNT) and the Global Forum on Nicotine (GFN), as well as the Global Tobacco and Nicotine Forum (GTNF). We will continue to seek engagement and dialogue with more experts and stakeholders, regardless of the opposition we face in the process.