October 29, 2024 jaotcadmin

6th Newsletter of the Joint Action on Tobacco Control 2 project

6th Newsletter JATC2 Final Meeting Highlights: A Call for Stronger Tobacco Control Measures

Brussels, 12-13 September 2024 – The 2nd Joint Action on Tobacco Control project (JATC2) concluded its final meeting in Brussels, bringing together partners, the Commission, and key stakeholders to discuss the progress made and challenges ahead in protecting public health in Europe.

During a busy two-day event, JATC2 partners, EU MS representatives, and key stakeholders in tobacco control exchanged views both online and physically and discussed current
challenges, potential success stories, and novel solutions to address the tobacco epidemic in Europe.

The meeting was opened by colleagues from the Danish Ministry of Health, who highlighted initiatives to support a tobacco-free society and knowledge-sharing of best practices across the EU. The WHO Regional Office Europe echoed these sentiments, emphasizing the need for continued action despite current positive outcomes. WHO
Europe noted that the emergence of novel tobacco products, particularly among young people, presented an additional challenge requiring a strategic and vigilant approach.

HaDEA officers subsequently provided insights into the JATC2 project, outlining its key achievements and the ongoing monitoring efforts. The JATC2 team thanked HaDEA, especially its project officer, Marc VandenBroek, for his continuous support and close monitoring of the actions!

The welcoming remarks concluded with the opening comments by DG SANTE, which highlighted JATC2’s instrumental role in advancing tobacco control at the EU level. “The exchange of information, sharing of best practices, and enforcement of legislation has contributed to this overall effort,” noted Dr Marianne Takki, DG SANTE.

Overall, the welcoming remarks at the event underscored the significant strides made in tobacco control efforts across Europe and were a precursor of the presentations to follow and the work performed.

The first presentation of the day was from the JATC2 coordinator and WP1 leader, Frances O’Donovan who provided an overview of the JATC2 activities and size. Launched in October 2021, JATC2 attracted 21 partners and over 170 participants and was structured around nine work packages, including five action-oriented packages and four support packages.

“JATC2 has been instrumental in providing recommendations to align with the TPD, updating the Council recommendation on smoke-free environments, and supporting the implementation of the Framework Convention on Tobacco Control (FCTC),” noted the project coordinator, Frances O’Donovan.

The first keynote presentation of the session was by Dr. Armando Peruga (ICO) to provide the introduction and baseline information on Smoke and Aerosol Free Environments (SAFE) and Tobacco Advertising, Promotion, and Sponsorship (TAPS).

Dr Peruga highlighted that Secondhand Aerosol (SHA) from electronic cigarettes (ENDS) can increase pollutants like PM, VOCs, and air nicotine, potentially leading to increased health risks. Furthermore, he noted that the evidence indicates that while 50% of countries have banned ENDS use in hospitality venues and public transport, policy adoption remains inconsistent across EU MS. Dr Peruga also noted that compliance with TAPS bans has also been uneven, with significant differences between countries.
He concluded that while comprehensive bans on both ENDS and TAPS are highly effective in reducing tobacco-related harm, only a third of countries have adopted comprehensive bans, and even fewer have implemented true TAPS bans – indicating a gap that needs to be covered at the EU level.

Catalan Institute of Oncology (ICO) experts (Dolors Carnicer-Pont, Anna Mar LÓpez Luque) led the discussion from WP8 on how they developed the process to identify best practices for Smoke and Aerosol Free Environments (SAFE). Within WP8, through expert consultations and online questionnaires, 37 practices were identified, covering indoor, outdoor, and hospitality settings. These practices were primarily implemented at national and city levels.

WP8 also explored the challenging barriers and opportunities for expanding SAFE policies across the EU, especially in light of the upcoming council recommendations on smoke-free environments. Barriers included tobacco industry lobbying and government inaction, while opportunities included expanding SAFE policies to outdoor areas in Europe, promoting public support for SAFE areas, and strengthening enforcement and compliance.

Regarding Tobacco Advertising, Promotion, and Sponsorship (TAPS), WP8 identified 24 TAPS areas and suggested ways to overcome loopholes, such as enhanced enforcement and enhancing collaboration between EU MS. WP8 also emphasized the need for harmonized TAPS regulations at the EU level, comprehensive TAPS bans, public education, and prevention of cross-border TAPS activities. WP8 further noted that TAPS bans should be applied to various channels and products toaddress the evolving tobacco landscape.

Opening the discussions on WP7 on the health impact and regulatory implications of e-cigarettes and novel products, Dr. Filippos Filippidis, representing the ERS Tobacco Control Committee, brought forward thought-provoking points on the role of e-cigarettes and heated tobacco products (HTPs) in the EU tobacco product landscape. He highlighted the diverse user groups, including novel product users, dual users, and former smokers, and the importance of understanding the relative size of these population subgroups and the associated health risks of e-cigarettes and HTPs.

Leading WP7, RIVM (National Institute for Public Health and the Environment, Netherlands) experts (Anne Havermans, Charlotte Pauwels) brought forward their harmonized findings on the breadth of information within the EU-CEG dataset with regard to e-cigarettes and HTPs. The data revealed a wide range of products at the EU level, with menthol noted as the most frequently used ingredient.

RIVM highlighted the importance of comparing products across EU MS to gain valuable market insights and the need for a routine assessment of ingredient data so as to understand trends, ensure regulatory compliance, and identify potential toxic ingredients. Key recommendations included stricter enforcement, automated validation checks at the EU-CEG level, clearer guidelines for submitters, and automated ingredient data validation.

WP7 also presented their extensive work on the factors contributing to the attractiveness, addictiveness, and toxicity of novel tobacco products and e-cigarettes. Towards this point, product- related factors like sensory properties and flavors, as well as situational factors like accessibility, marketing, and social networks, were identified as key parameters. To further mitigate risks, WP7 suggested strengthening the enforcement of TPD flavor bans and potentially establishing limits on harmful substances.

WP7 also presented work on reporting adverse events at the EU level. The WP7 findings highlighted the need for a centralized system to collect reports of adverse health incidents related to novel tobacco products at the EU level. While some EU MS have recorded such incidents, data collection and analysis vary significantly across EU MS,
making comparisons challenging. Overall, WP7 recommended implementing a mandatory EU-centralized reporting system with comprehensive case documentation to improve data quality and facilitate analysis and mapping of cases.

The evaluation of project implementation is crucial for assessing progress, improving future strategies, and ensuring accountability and transparency to stakeholders; hence, the next presentation was on project evaluation through WP3. Presented by AGES (Irina Gebetsberger-Hartleitner, Christine Weber), an overview of the activities for internal monitoring was presented, including how the project was assessed internally at multiple time points. Overall, the general key findings indicated a strong appreciation for the JATC2, which was perceived to have high value and a significant community benefit, which strengthened cooperation, communication, and knowledge
exchange across EU MS. These positive results stressed the need for ongoing dissemination, and sustainability mechanisms so as to ensure that the project’s endpoints reach their full potential. Moreover, AGES concluded that the desire for project continuation was emphasized across the JATC2 partners and network.

Day 2 started with a thought-provoking presentation by Prof Luke Clancy on Tobacco Product Regulation, who noted that “Out of the box solutions and new technologies are needed to combat the tobacco epidemic.” Prof Clancy indicates the similarities and differences between how the public and policymakers perceived the COVID-19 pandemic and how they perceive the tobacco epidemic, noting that there are lessons we can learn from how the pandemic was mitigated, which are parallelisms with how we can combat tobacco control, via different pathways, including via product regulation.

Subsequently, colleagues from the Danish Safety Technology Authority (DSTA) (Marie Østergaard Hejselbæk, Monika Margrethe) provided an overview of the activities performed within the context of WP6 so as to improve tobacco product regulation through cross-EU MS collaboration. During the implementation of Work Package 6 (WP6), there were notable advancements in fostering better communication channels, refining problem-solving techniques, and streamlining the integration of solutions across the European Union Member States (EU MS) via both the creation of a CIRCABC repository and also through knowledge hub meetings. These developments played a pivotal role in directly furthering the primary objective of the JATC2 project, which is to enhance cross- EU collaboration. Notably the CIRCABC database includes both sections specific to products but also a forum for posing questions and discussions with other EU MS policymakers.

Dr. Reinskje Talhout provided the next Keynote presentation on tobacco product regulation, stressing the complexity of the topic, the breadth of products, and the role of ingredients, composition, and flavors on tobacco product attractiveness. Dr. Talhout stressed the importance of using the information available to best fuel public health policies, setting the stage for the next presentation of WP5.

The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) (Benoît Labarbe, Enrico Davoli) provided an overview of the work performed in WP5, with a specific focus on how to maximize the wealth of data that is available through EU-CEG. ANSES brought forward a descriptive overview of the EU-CEG data set and the WP5 activities, including work on the different open-source software tools and procedures that can be used to assess and analyze EU-CEG data at the EU MS level through the provision of how-to guides, a process that allows even EU MS with limited capacity to assess and interpret EU CEG data. Subsequently, Istituto di Ricerche Farmacologiche Mario Negri (IRFMN) presented an overview of the work performed to harmonize EU MS laboratory work with work performed at a global scale, including also the activities to create aprotocol for the laboratory assessment of ingredients that can be applied by both EU and WHO laboratories.

Setting the stage for an overview of how the JATC2 results were disseminated, Dr. Allen Gallagher from the University of Bath provided an intriguing opening with regards to how the tobacco industry influences public opinion, including norm shaping, redefining issues, controlling data and the use of front groups to promote their agenda.

WP2 dissemination activities were presented by Dr. Angeliki Lambrou from the National Public Health Organization, Greece. WP2 employed a comprehensive dissemination strategy to ensure that progress and news reached stakeholders across the EU. This included regular newsletters, social media campaigns, targeted webinars, and participation in relevant conferences. Additionally, JATC2 leveraged its online website to share resources, publications, and success stories of the JATC2 actions. By utilizing these channels, the project effectively communicated its achievements, raised awareness of tobacco control issues, and supported collaboration among stakeholders across the EU.

The importance of Cross EU Collaboration was stressed by the next Keynote speaker, Cornel Radu-Loghin from the European Network on Smoking and Tobacco Prevention (ENSP). ENSP noted that cross-EU collaboration through networks and civil society plays a crucial role in addressing tobacco control and driving positive change across Europe. By fostering collaboration and information sharing among stakeholders, including non-governmental organizations, advocacy groups, grassroots movements, cross-EU networks, and civil society initiatives, we can effectively amplify the impact of EU MS efforts, such as those performed under the JATC2 project.

Sustainability is a key consideration in EU-funded projects as it ensures that the benefits of the project endure over time, and with the above in mind, Istituto Superiore di Sanità (ISS), on behalf of WP4 (Renata Solimini, Maurice Mulcahy), presented an overview of how JATC2 activities can continue after the project has concluded and how the JATC2 results also feed into Europe’s Beating Cancer Plan. WP4 noted that seven webinars were performed, and to facilitate the exchange of knowledge and to identify best practices related to the Tobacco Products Directive and the Tobacco Advertising Directive, guidance documents were prepared. These guidelines included important aspects
such as how to identify best practices, how to treat nicotine dependence, how to counteract the tobacco industry, and how to ensure the sustainability of tobacco control initiatives.

Importantly, WP4 also developed a sustainability roadmap to ensure sustainability for tobacco control at the EU level, continued EU-CEG development, and continued communication through knowledge hubs as also steps to ensure smoke and aerosol-free environments, especially in light of the breadth of tobacco products on the EU market.

As the final introductory on Endgame strategies, Laurent Huber from Action on Smoking and Health (ASH) US provided an overview of what steps could be taken to promote the Endgame strategy globally, “It has a due date. It will vary, but it is not someday” noted Laurent Huber as Endgame strategies operationalize the vision to end the death and disease caused by tobacco. An overview of jurisdictions with Endgame strategies in place was presented, including how the EU can take a lead in tobacco Endgame, as it has also led many other tobacco control activities.

WP9 provided subsequently an overview of the WP9 activities that were performed to identify tobacco endgame strategies, to explore best practices and to develop an effective and comprehensive endgame strategy within JATC2. Within a busy three year period WP9 noted that through a triangulation of multiple data sources policy briefs, reports, manuscripts and a tobacco endgame toolkit was created.

Intended for different target groups such as regulators, policymakers, researchers, and civil society organizations interested in the concept and different country approaches. WP9 noted that while developed for the European context, its contents may be beneficial in other regions as it provides information on multiple topics, including tobacco endgame goals and measures in Europe, feasible policy options, case studies, and potential best practices, key considerations and common myths as 6th
also useful sources of information (incl. WP9 reports, articles, and webinar recordings).

After two busy days, the JATC2 closing session performed a wrap-up by the keynote speakers who synthesized the key take-home messages as noted by the different JATC2 WPs. Prof Constantine Vardavas, representing JATC1, noted the importance of the continuation of tobacco control activities in the EU through JATC1 and now JATC2, with a forward-looking spirit towards new joint actions. Overall, the participants agreed that the primary objectives of the JATC2 were to foster collaboration between EU MS and the European Commission and to support the harmonization of the TPD, objectives that were successfully met.

Finally after 36 months of work, and 2 very busy meeting days, the JATC2 coordinator, concluded that focused on assessing current directives, developing tobacco endgame strategies, strengthening the tobacco regulation community, regulating novel tobacco products, and promoting data sharing and the expansion of smoke-free environments the JATC2 project has been invaluable in advancing tobacco control efforts across the EU.