Experts Expose Risks, Industry Tactics Behind Heated Tobacco Products; WHO Calls For Ban on Flavored Puffs
Newsletter Edition #277 [The Files In-Depth]
Hi,
Twenty years after the WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force, there are new frontiers in this fight.
The heated tobacco products is nearly US$ 50 billion globally and is expected to grow at a steady pace every year in the medium term. Further, addiction in youth is fueled by flavors.
WHO has called for a ban on flavored products, even as there are efforts to expand the markets for these products. Scholars and activists are consistently working on understanding and exposing such tactics underlying this kind of a market expansion strategy.
In our story today, Peter Dibia, a Nigeria-based communications expert with an understanding of tobacco policies discusses some of the features of the heated tobacco products market informed by recent efforts by activists. Dibia is also a part of our annual Geneva Health Files fellowship program.
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I. STORY OF THE WEEK
Experts Expose Risks, Industry Tactics Behind Heated Tobacco Products; WHO Calls For Ban on Flavored Puffs
By Peter Dibia & Priti Patnaik
As the global use of Heated Tobacco Products (HTPs) accelerates, a panel of international public health experts convened by STOP, a tobacco industry watchdog, recently presented new evidence debunking claims of harm reduction and cessation linked to these products.
In a briefing, researchers and advocates from the United Kingdom, the Philippines, and Ukraine shed light on the health risks, regulatory gaps, and deceptive lobbying strategies associated with HTPs, particularly those marketed by tobacco giant Philip Morris International (PMI).
The session on “Big Tobacco vs The Evidence: What We Really Know About Heated Tobacco Products,” coincided with the release of a new brief by STOP and a supporting academic paper from the University of Bath’s Tobacco Control Research Group.
According to industry estimates, the global heated tobacco products market size was valued at US$ 49.14 billion in 2024 and is projected to grow at a CAGR of 63.2% from 2025 to 2030. “The major factors driving the market growth include steadily decreasing sales of conventional cigarettes globally and a growth in demand for tobacco products that present lower health risks”, reports say.
Demystifying Heated Tobacco Products
At the STOP briefing, experts warned that misleading marketing and inadequate regulatory frameworks are allowing these addictive products to thrive under a façade of scientific legitimacy.
Sophie Braznell, a researcher at the University of Bath, explained the nature and mechanism of HTPs.
“Heated Tobacco Products differ fundamentally from e-cigarettes,” Braznell explained. “They heat actual tobacco leaf to release a nicotine-containing aerosol. In contrast, e-cigarettes vaporise a liquid. But the narrative that HTPs are safer or help people quit is not only misleading, it is unsupported by independent science,” she said.
She further noted that the uptake of HTPs is most pronounced in Japan but is expanding rapidly in other regions due to aggressive promotion and rebranding as reduced-risk alternatives.
In reviewing the current body of evidence, Braznell outlined a striking pattern: most clinical trials related to HTPs were sponsored or conducted by the tobacco industry itself.
“Out of the 49 trials we analysed, 39 had a high risk of bias,” she revealed. “The research was plagued by selective reporting, short durations often five days or fewer and testing under artificial conditions. This undermines the validity of any health benefit claims.”
While some studies indicated marginal improvements in certain biomarkers when compared to cigarette use, Braznell warned against drawing optimistic conclusions. “The effects are inconsistent. Some biomarkers improve slightly; others worsen. It is a misleading binary to say these products are ‘better’ or ‘safe.’ The truth is far more complex and worrying.”
Atty. Sophia San Luis, Executive Director of Imagine Law in the Philippines, described a familiar but alarming scenario: Big Tobacco’s close ties to power and youth-centric marketing.
“The tobacco industry has significant political access in the Philippines,” she said. “There was even an HTP product launch hosted in the presidential palace. That is how embedded the industry is.”
She pointed to IQOS, the leading HTP brand in the country, and its sophisticated campaigns targeting younger demographics featuring influencer-driven referral programmes, VIP events, and even musical concerts.
“We filed a complaint against IQOS’s marketing practices after they announced a Steve Aoki concert linked to product promotion. Thankfully, it was cancelled by the Department of Trade and Industry. But this shows the lengths they will go to attract a new generation of users.”
San Luis concluded with a stark reminder: “HTPs are not marketed for harm reduction. They are marketed for market expansion.”
Importantly, the World Health Organization (WHO) has also raised significant concerns about Heated Tobacco Products. WHO maintains that there is currently no evidence to demonstrate that HTPs are less harmful than conventional cigarettes. In its public health guidance, WHO advises that all forms of tobacco use including HTPs pose health risks and urges governments to regulate them as tobacco products, applying the same strict controls and taxation measures.
“Claims of reduced harm must be viewed critically,” WHO has stated “The absence of smoke does not mean the absence of harm.” (Also see: WHO and tobacco control partners urge countries not to partner or work with the tobacco industry)
The WHO Framework Convention on Tobacco Control (FCTC) explicitly warns countries against partnerships with the tobacco industry and recommends strong regulatory action to limit the proliferation of new tobacco and nicotine products.
In fact, Articles 9 and 10 of the FCTC give governments the legal basis to regulate the contents and disclosures related to HTPs, ensuring that any product entering the market must meet rigorous safety standards and cannot be marketed deceptively. The FCTC also empowers countries to restrict or ban misleading claims of reduced risk when there is insufficient independent evidence.
Dmytro Kupyra, Executive Director of the Advocacy Center “Life” in Ukraine, provided a gripping case study on how industry lobbying reversed progressive public health policies.
“In 2020, we succeeded in raising the excise tax on HTPs to match that of traditional cigarettes,” he said. “This resulted in a significant increase in public revenue proof that taxation works.”
However, he noted, that success was short-lived. In 2024, the Ukrainian Ministry of Finance, under pressure from tobacco-funded economists, proposed a 75% tax cut for HTPs.
“This preferential tax will cost Ukraine an estimated $500 million in revenue over four years,” Kupyra said. “More importantly, it is a public health disaster. Lower taxes mean wider access and higher consumption. That means more deaths.”
Kupyra warned that the industry’s influence is not just economic but existential. “They are willing to trade lives for profit, and they are finding government allies to help them do it.”
Sharing a perspective from the UK, Hazel Cheeseman, Chief Executive of Action on Smoking and Health (ASH UK), dissected PMI’s playbook for establishing HTPs as the next frontier of addiction.
“There is a very deliberate three-part strategy,” she said. “First, market the products as clean and modern. Second, align with government and regulatory agencies to seem like a responsible partner. Third, influence public opinion through corporate social responsibility campaigns and misinformation.”
Cheeseman said PMI is attempting to rebrand itself not only as a seller of ‘safer’ nicotine but also as a public health collaborator, while continuing to lobby against strong regulation.
“There are clear concerns in the UK Government about their marketing approach,” she added. “While PMI claims compliance, what they are doing is exploiting the gaps in regulation, particularly in the online and point-of-sale domains.”
Taken together, the experiences shared from the Philippines, Ukraine, and the United Kingdom reveal a common thread: the tobacco industry, particularly PMI, is replicating a strategy that prioritises profit over truth and health.
“We have seen this movie before with traditional cigarettes,” said Braznell. “Now it is just being rerun with sleek devices, youth-friendly branding, and a lot of misleading science.”
Panelists urged journalists and policymakers to maintain scepticism and insist on independent data when assessing HTPs and other so-called harm-reduction products.
“It is not enough to hear that a product is ‘less harmful,’” said Cheeseman. “We must ask: compared to what? In what context? Over how long? And who funded the research?”
The experts called for stronger global regulations, full transparency in health research, and public education campaigns to expose the truth behind the industry’s latest venture.
“The science must be separated from the spin,” said Kupyra.
“We need governments to tax, regulate, and resist not partner with the tobacco industry,” San Luis added.
With HTPs being positioned as the future of nicotine consumption, the fight for truth, transparency, and public health is far from over. But with unified voices like those heard at this briefing and backed by WHO and the FCTC the world is better equipped to resist Big Tobacco’s relentless rebranding.
Response from Philip Morris International
In response to the STOP briefing and report, Philip Morris International (PMI) issued a detailed rebuttal, calling the findings “biased” and “misleading,” while defending the role of HTPs in smoking harm reduction.
Below are some of the key assertions from PMI’s response, published on May 7, 2025:
1. Smoke-free Commitment: PMI says it has invested over $14 billion in smoke-free product development since 2008 and aims to be predominantly smoke-free by 2030.
2. FDA Authorisation: IQOS has been authorised by the US FDA as a Modified Risk Tobacco Product (MRTP), confirming reduced exposure to harmful chemicals compared to cigarettes.
3. Scientific Claims: PMI maintains that IQOS does not produce smoke and generates significantly fewer harmful and potentially harmful compounds (HPHCs).
4. Carbon Monoxide Reduction: Emissions of carbon monoxide from IQOS are said to be reduced by over 99%, prompting the FDA to remove associated warning labels.
5. Youth Marketing Denial: PMI rejects claims that it targets youth, citing age-verification measures and survey data showing low HTP use among adolescents.
6. Dual Use Allegation: The company asserts that 72% of adult IQOS users worldwide have completely switched from cigarettes, contradicting dual-use concerns.
7. Biomarker Evidence: PMI argues that biomarker data show consistent health benefits compared to cigarette use, even in confinement studies.
PMI has also alleged that “STOP and its partners are heavily funded by Bloomberg Philanthropies and are not conducting objective science.”
A STOP spokesperson said: “We encourage everyone to read the STOP brief and decide whether they trust independent science or one of the world's biggest cigarette companies."
WHO Calls Out Flavored Tobacco And Nicotine Products
While the HTP space remains contested, a new front has opened up rapidly. The challenge of flavored products and its appeal to the youth. WHO now wants flavored products banned.
On World No Tobacco Day, on May 31, WHO called on governments to urgently ban all flavours in tobacco and nicotine products, including cigarettes, pouches, hookahs and e-cigarettes, to protect youth from addiction and disease.
In a statement, WHO said, “Flavours like menthol, bubble gum and cotton candy are masking the harshness of tobacco and nicotine products turning toxic products into youth-friendly bait. Flavours not only make it harder to quit but have also been linked to serious lung diseases. Cigarettes, which still kill up to half of their users, also come in flavours or can have flavours added to them.”
“We are watching a generation get hooked on nicotine through gummy bear-flavoured pouches and rainbow-coloured vapes,” said Rüdiger Krech, WHO Director of Health Promotion. “This isn’t innovation, it’s manipulation. And we must stop it.”
In a new publication, WHO describes how flavours and accessories like capsule filters and click-on drops are marketed to bypass regulations and hook new users.
WHO has said that flavors and accessories “can be considered a means to circumvent the intent of flavour bans, as they allow users to experience flavoured tobacco products even when the products themselves comply with flavour regulations. As such accessories are usually sold separately and do not contain tobacco or nicotine, they fall outside the scope of tobacco control legislation.”
Tedros Adhanom Ghebreyesus, Director-General of WHO has called for a ban: “Flavours are fuelling a new wave of addiction, and should be banned”. Without bold action, the global tobacco epidemic, already killing around 8 million people each year, will continue to be driven by addiction dressed up with appealing flavours, Tedros said.
Already, over 50 countries ban flavoured tobacco; more than 40 countries ban e-cigarette sales; 5 specifically ban disposables and 7 ban e-cigarette flavours. Flavour accessories remain largely unregulated, WHO has found. Countries such as Belgium, Denmark, and Lithuania are taking action, and WHO urges others to follow.
See related documents on HTPs
FCTC/COP8(22) Novel and emerging tobacco products [October 2018 Decision]
FCTC/COP/10/9 Challenges posed by and classification of novel and emerging tobacco products [November 2023]
II. PODCAST CORNER
Trailblazers with Garry: a conversation with John-Arne Røttingen
"Trailblazers with Garry" is a new series from Global Health Matters, where host Garry Aslanyan sits down with trailblazers — thinkers, leaders, and influencers shaping the future of global health — for short face-to-face conversations, available in both audio and video formats. It’s a chance to get to know the people behind the work and hear their perspectives on the current global health landscape.
Step inside the Wellcome Trust in London with our next trailblazer, the newly appointed CEO John-Arne Røttingen — former head of CEPI and Norway’s Ambassador for Global Health — traces his leadership journey and vision for the foundation. He explains why bolder citizen-scientist partnerships are crucial to navigating the global-health funding crunch ahead.
Listen here.
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