On April 24 last year, in the White House Briefing Room, President Donald J. Trump, a man with no scientific or medical qualifications to his name, mused aloud on the (unsurprisingly, highly dangerous) idea of injecting bleach as a treatment for COVID-19. A side camera showed the face of White House Coronavirus Response Coordinator Dr. Deborah Birx as she listened. As Trump continued (“supposing we hit the body with a tremendous… whether it’s ultraviolet or just very powerful light…”), she did not contradict him, later citing her military training as the reason for her silence.

Watching it back, you can’t fail to notice her face proceeding through a series of barely imperceptible muscle movements before coming to rest in a glazed, faraway look that conveys both a personal existential crisis and awareness of a whole new problem to solve.

There’s nothing quite like a pandemic to highlight that politics and science—and politicians and scientists—don’t always see eye to eye. This tension has had real-world consequences for all of us over the last 18 months and will continue to affect our lives as we edge our way out of the first phase of the crisis.

Throughout COVID-19, a second, more familiar pandemic has continued. 

COVID-19 has so far killed an estimated 3.75 million people around the world. Politicians have had to strike a perilous balance between the immediate need to protect life and prevent health care systems from being overwhelmed on the one hand, and the need to mitigate economic damage and protect civil liberties on the other. The World Health Organization has taken up its expected leadership role coordinating the global response and—while not without its critics—has been focused on reducing COVID’s devastating impact and hastening vaccine rollout to low- and middle-income countries.

But throughout COVID-19, a second, more familiar pandemic has continued. In 2019, almost 8 million people died from smoking-related diseases. The WHO predicts a billion lives lost to smoking by 2100; with 80 percent of smokers living in low- and middle-income countries, the biggest burden of death and disease falls on those nations least able to offer effective health care to their citizens.

And yet, despite the evidence that harm reduction works, despite its implementation in the WHO’s response to HIV and substance use, and despite the Framework Convention on Tobacco Control naming harm reduction as one of three key strategies, the WHO—and consequently much of the world’s public health establishment—remains implacably opposed to harm reduction in response to tobacco use. They present lower-risk ways to consume nicotine—such as vapes, heat-not-burn products and forms of smokeless tobacco like snus—not as a golden opportunity for smokers to improve their health, but as a potent new threat.

At the eighth annual Global Forum on Nicotine—streaming free online from the UK this week—parallels between the politicization of COVID and that of nicotine science will be under discussion.

Keynote speaker Fiona Patten, leader of Australia’s Reason Party and an MP in the Parliament of Victoria, has firsthand experience of trying to strike that difficult balance for constituents amid COVID-19. Determined that lessons should be learned from the first wave, she chaired an influential parliamentary inquiry into the Victorian government’s contact tracing system and testing regime. Drawing on this experience and her long commitment to harm reduction of all kinds, Patten’s speech will directly address the fractious relationship between science and politics. 

Which Science—And Which Scientists?

Politicians of all stripes and nationalities have been heard uttering variations on the phrase “guided by the science” during the COVID response. And in a public health crisis—whether caused by a novel coronavirus, or by smoking— surely listening to science and scientists is a rational plan.

But it’s never that simple. The science of COVID-19, just like that of tobacco and nicotine, is not a coherent body of work. It is constantly being revised, developed, added to. Scientists find new evidence, change their minds, disagree with one another—and they should do these things, otherwise there can be no progress. And just as importantly, scientists—like other fallible human beings—make mistakes. Scientists hold biases. And so do the politicians and policymakers who interpret their advice.

With COVID-19 and with tobacco and nicotine science, much depends on which science and which scientists are involved.

Public health and tobacco control is a field currently engaged in a major ideological battle over the future of nicotine use. Valuable research is variously contested, disputed, blacklisted or rubbished. Flawed research can be lauded regardless, or retracted too late. Opposing sides of the tobacco harm reduction debate are rarely able to find common ground, despite the supposedly shared goal of ending smoking-related death and disease.

With COVID-19 and with tobacco and nicotine science, much depends on which science and which scientists are involved. As Professor Paul Cairney of the University of Stirling has noted, what the phrase “guided by the science” meant in the UK COVID-response was “guided by our scientists.” The UK government relied heavily on evidence from a select group of scientists on its Scientific Advisory Group for Emergencies (SAGE), to the exclusion of many other sources.

Cairney also observes, tellingly, that “the minister-adviser relationship is conditional on […] the willingness of advisers to follow the ‘rules of the game’ within a wider political and policymaking context.” Toeing the line and abiding by certain “formal and informal rules” is important.

This is echoed by Professor Alex Stevens of the University of Kent, in an analysis of his experience in another fraught area of public policy making, the response to illicit drug use. Stevens resigned last year from the UK government’s Advisory Council on the Misuse of Drugs, after expert candidates considered appointable by the Council’s members were deemed unsuitable by the UK Home Office. Twitter feeds had been trawled and posts critical of ministers or policy—including on unrelated issues—were eventually unearthed as the reason that they had been considered unfit to hold advisory roles. These were individuals who did not “play the game.”

Cliff Douglas called for an end to the ”internecine warfare” on tobacco harm reduction—which he argues is costing millions of adult smokers their health and lives.

Toeing the line can be important within the scientific establishment, too, and perhaps nowhere is this more damaging than in the field of nicotine science. Eminent US tobacco control expert (and GFN speaker) Cliff Douglas recently called for an end to the ”internecine warfare” on tobacco harm reduction—which he argues is costing millions of adult smokers their health and ultimately their lives.

At the conference on Thursday, Robyn Gougelet and Clive Bates will co-host a panel on orthodoxy, challenges and dissent in science and discuss how progress could be made. Presentations from panelists Michelle Minton (“Nicotine: the new front of America’s war on drugs?”), Roberto Sussman (“How do physics and other disciplines compare to tobacco and nicotine science?’), Brad Rodu (“How institutional funding in the US works against tobacco harm reduction”) and Konstantinos Farsalinos (forthcoming) are available to watch online in advance, with the live session given over to discussion and questions from delegates.    

Who Else Needs a Seat At The Table?

In his critique of expert groups on drugs, Alex Stevens noted the routine exclusion of people “who have themselves experienced harms or pleasures from drugs.”

The concept of “nothing about us without us” is central to GFN, where many of the speakers and delegates are nicotine consumers. As such, the event provides policymakers and scientists with the invaluable opportunity to hear directly from some of the 98 million people worldwide who have already quit smoking by switching to safer nicotine products. And it gives people who use nicotine the opportunity to ask questions of those in a position to make changes.

GFN is also proud to be visiting Liverpool this year. It’s not only the birthplace of the Beatles, but is known in England as “the home of harm reduction,” thanks to the pioneering work of the Mersey Health Region in the response to issues around illicit drugs in the 1980s.

The day-to-day actions we take to reduce our risk of COVID-19 infection or transmission—mask-wearing, hand hygiene, social distancing—are all harm reduction measures. Governments around the world have, sometimes belatedly, listened to the evidence in seeking the best ways to reduce death and disease from COVID-19. Let’s hope that they will soon do the same for smoking. 

Photograph by Robert Hoge via Flickr/Creative Commons 2.0

Register to join the Global Forum on Nicotine online for free on Thursday 17 and Friday 18 June; the conference will be streamed using a TV-style format, with commentary and short films shown in breaks between sessions. All content will be available to watch again for free after the event. Follow @GFNicotine #GFN21

Filter is an official media partner of GFN21, which is organized by KAC Communications. KAC Communications’ sister company, Knowledge-Action-Change, has separately provided restricted grants and donations to The Influence Foundation, which operates Filter, for projects unrelated to the conference. Filter’s Editorial Independence Policy applies.

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