Big tobacco companies are marketing heated tobacco products (HTP) as a less harmful alternative to cigarettes, but researchers warned this week that there is no evidence to support this or the industry claim that they can help smokers to quit.

HTPs are electronic devices that heat an insert of processed tobacco, often in a stick or pod, to produce an aerosol containing nicotine and other chemicals. The tobacco insert is often flavoured, including with flavours such as bubble gum and lime that appeal to young people.

“There are three key things policymakers and consumers need to know,” said Dr Sophie Braznell, a researcher from the University of Bath who co-authored a brief on HTPs released on Wednesday by STOP, a tobacco industry watchdog.

“First, heated tobacco products cause harmful effects. Second, there is no clear evidence that they are safer or less safe than other tobacco and nicotine products, even cigarettes. Third, available research lacks the independence and quality that might help us draw any conclusions about the impacts of real-world use,” Braznell told a media briefing on Wednesday.

Billion-dollar market

The HTP market is estimated to be worth $36.7 billion and is projected to grow by over 52% between now and 2032, according to market research company Stellar.

“HTPs are available in at least 57 countries across Europe, North and South America, Eurasia, and East Asia. The market for HTPs in Africa and the Middle East is small but growing,” according to Stellar, with Asia Pacific being the fastest-growing region in the market.

HTPs have become more popular than cigarettes in Japan, while sales are surging internationally with promotions at events aimed at youth.

The HTP market leader is Philip Morris International’s (PMI) IQOS, an abbreviation of “I Quit Ordinary Smoking”, while British American Tobacco (which makes Glo) and Japan Tobacco International (Ploom) are the other key players.

HTPs are available in a limited number of African countries, including South Africa, Kenya, Nigeria, Botswana, Zambia, Zimbabwe and Ghana. 

However, the cost of the device is a barrier, acknowledged Frederic de Wilde, PMI’s president for South and Southeast Asia, the Commonwealth of Independent States, the Middle East, and Africa region.

“Africa definitely has a role to play and we are committed to coming up with smoke-free products to offer alternatives to African smokers,” de Wilde told African Business in an interview in late December 2024.

But he said that the current HTPs were “premium devices”, and PMI is “piloting a new simple device that is less expensive and targeted for medium and low price segments”.

Biased clinical trials

Braznell has spent the past five years reviewing clinical trials involving HTPs. She and colleagues found 49 clinical trials on humans, but 34 were linked to the tobacco industry, with one-third linked to Philip Morris International. 

In addition, they were usually run over a very short time – five days or less – and in controlled settings like laboratories, rather than real-world settings.

“Overall, 39 of the trials were judged to have a high risk of bias,” said Braznell, including selective reporting of results. She and colleagues also published their findings on the trials in the BMJ this week.

Aggressive marketing

Sophia San Luis, executive director of Imagine Law, a Philippines-based public interest law group, told the media briefing that big tobacco companies were aggressively marketing their HTPs to young people.

President Ferdinand Marcos has hosted PMI since he assumed office in 2022, and the company has promoted its smoke-free products at events organised by First Lady Liza Araneta Marcos.

Renowned DJ Steve Aoki promotes IQOS products, and there is a ‘limited edition” HTP bearing his name. However, a range of NGOs and community organisations stopped an IQOS-sponsored concert featuring Aoki on the grounds that it violated advertising bans on tobacco products.

Dmytro Kupyra, executive director of “Life,” a Ukrainian NGO working to reduce mortality and morbidity from non-communicable diseases, said his country had increased taxes on HTP six-fold in 2021, which had contained sales. 

However, in 2024, the Ministry of Finance reduced HTP taxes by 25%, after the tobacco companies conducted an intense campaign for taxes to be reduced. This means that Ukraine is no longer aligned with the European Union on taxation.

“For next four year, between 2025 to 2028, Ukraine will lose around $500 million in tobacco excise taxes, and Ukraine will have around 24,000 additional deaths from hamful tobacco use,” said Kupyra, who said that about 15% of young Ukrainians aged 18 to 28 use HTPs thanks to aggressive marketing.

Hazel Cheeseman, CEO of the UK’s Action on Smoking and Health (ASH), said that PMI had a three-pronged strategy to promote HTPs.

“First of all, they want to aggressively secure a share of the nicotine market for their heated tobacco product, and are aggressively marketing them in ways that the UK Government does not believe is in line with the law,” said Cheeseman, whose public health charity set up by the Royal College of Physicians to end the harm caused by tobacco in the UK.

“They’re also seeking to secure a beneficial regulatory environment for their products through their lobbying efforts. But also, they want to be seen as a credible partner by the UK government on the basis that they have this apparently less harmful product,” said Cheeseman.

The UK’s comprehensive advertising restrictions on tobacco products were passed before HTPs existed, so PMI had marketed HTPs more aggressively and openly than they could for cigarettes, said Cheeseman.

When the UK government challenged PMI, they undertook to suspend marketing – but there are  numerous pop-up promotions of IQOS.

Questionable industry claims

“We are often told by the industry that heated tobacco products are a scientifically backed better alternative for adult smokers. But our own research shows us that we should be questioning whether, in fact, they are better for health,” said Braznell.

We’ve brought up questions and concerns about the quality of the available evidence, as well as other research that we’ve done over the last few years, which has shown that the tobacco industry continues to manipulate and misuse science for profit. 

“Work of our colleagues around the world has shown that many heated tobacco product users are not successfully quitting smoking using these products, and in fact, are perpetually continuing to use both heated tobacco products and cigarettes. 

“And lastly, we know that again and again, the tobacco industry is not just marketing heated tobacco products at smokers, but also to non-smokers and children.”

Image Credits: Filter, PMI.