By Tiffany Kary
Corrected April 21, 2020, 6:43 PM EDT
- Groups backed by cigarette maker, Juul dispute health warnings
- FDA says vaping has unknown effects on risks of the virus
New York City Mayor Bill de Blasio pointed a finger at the vaping industry last month as he discussed a 22-year-old New Yorker who’d been hospitalized with Covid-19. “We do think the fact that he is a vaper is affecting this situation,” de Blasio said.
The suggestion that vaping and cigarettes can worsen the risks from the new coronavirus has put nicotine purveyors in the spotlight. Groups indirectly funded by Philip Morris International, maker of Marlboros and electronic nicotine devices, and vape firm Juul Labs Inc. are pushing back. Their messages contradict public-health experts’ warnings that smoking puts people at higher risk for severe cases of Covid-19 and that vaping’s effect is unknown but potentially harmful too.
Two days after de Blasio’s statement, The Global State of Tobacco Harm Reduction, a group that maps e-cigarette use around the world, dismissed “unfounded rumors” about connections between vaping and coronavirus — and the “limited available evidence” linking it to smoking. A website called Consumer Advocates for Smoke-Free Alternatives Association published an article by Roberto Sussman and Carmen Escrig saying the “pandemic provides fertile ground for spreading misinformation on vaping.” The posts were among nine instances reviewed by Bloomberg.
Such spin can take a dangerous toll, not just on public health but now on the global economy as well, said Michél Legendre, a campaign director at the nonprofit Corporate Accountability, a frequent critic of Philip Morris and other large companies.
“We’re in the middle of a pandemic where information and time is at a premium,” Legendre said. “Having doctors and public officials have to sort through this mess of misinformation is time that most people around the world cannot afford.”
The coronavirus debate comes as companies approach a regulatory deadline to show the Food and Drug Administration that their e-cigarette products have a public-health benefit, a step that will allow the firms to keep selling them in the U.S. A judge has said he intends to extend the May deadline because of the virus.
Public-health officials and research scientists acknowledge that study of the coronavirus is still in its infancy. So is vaping, at least compared to smoking. But many say that existing evidence from diseases like tuberculosis, bronchitis and pneumonia is strong enough for them to make recommendations to the public. Anything that makes the lungs less healthy, they say, will weaken your chances against a deadly respiratory disease like Covid-19.
The FDA says smoking can result in “worse outcomes” for people with Covid-19 because it increases the risk of respiratory infections, for instance, and e-cigarette use can expose the lungs to toxic chemicals, with unknown effects for people who get the virus. The Cleveland Clinic has said “aldehydes and other components in vaping liquids can impair the immune function of cells found in the airway and lungs.” And the Canadian Pediatric Association says vaping or smoking, including cannabis, may put young people at increased risk of severe coronavirus infection.
Many messages dismissing links between the virus and vaping or smoking came from authors, scientists or publications that have received indirect funding from companies that sell cigarettes or vape devices. Often the funding behind these messages is indirect and traces back to Philip Morris International’s non-profit Foundation for a Smoke Free World, or FSFW.
While Philip Morris is best known for Marlboro cigarettes, it has said for years that it wants to move smokers to “reduced risk” products, such as its IQOS, a heat-not-burn device that already has FDA authorization, or Mesh, a vape device. Philip Morris’s sister company, Altria Group Inc., sells IQOS in the U.S. and has a stake in Juul. Asked about any links between its products and susceptibility to the virus, Philip Morris deferred to public-health bodies.
“People should continue to be guided by the advice and recommendations of their governmental health authorities and medical professionals on these complex health questions,” Philip Morris spokesman Corey Henry said in an email. The company isn’t aware of any scientific studies about smoke-free alternatives and Covid-19, he said. Altria said it’s making no claims about the relative risks of IQOS. Juul declined to comment on whether vaping carries less of a risk factor for coronavirus than smoking.
When asked about messages from groups funded by its foundation, Philip Morris said the FSFW makes its own decisions and that the $160 million the company gave to the non-profit in 2018 and 2019 had no strings attached. Derek Yach, founder of FSFW, said the groups his organization funds have their own views and that the foundation is “agnostic to the results of the research” it supports. He said he thinks it’s too soon to determine how vaping might affect coronavirus infections but he expects data will eventually show smoking does affect the severity of the disease.
Groups funded by FSFW also acknowledge that data is sparse, but reiterate a common message: Vaping is a better choice than cigarettes when it comes to concerns about the health effects of the coronavirus. Both Global State, which slammed the “unfounded rumors” tying vaping and Covid-19, and Consumer Advocates, which published the article decrying “misinformation” on the topic, received money from the foundation in 2018.
The two authors of the Consumer Advocates article, Sussman and Escrig, are affiliated with separate institutions that are members of INNCO, a group that received grants in 2018 from the FSFW with the mandate to help nicotine consumer organizations, and which has lobbied the World Health Organization on their behalf. INNCO’s members are all “independent and autonomous,” said president Julie Woessner.
Sussman, a director at ProVapeo Mexico, said INNCO has not given it funding or any other form of support such as services. Escrig, who’s listed as the international coordinator for a group called Medical Organizations Supporting Vaping and E-cigarettes, said the group “has never received financing or support of any kind” from INNCO.
The messages cited the work of a scientist, Konstantinos Farsalinos. The day after de Blasio’s comments in New York were reported, Farsalinos’s blog in Greece slammed the mayor, contending there’s “zero evidence on how e-cigarette use affects coronavirus infectivity and disease progression.” Farsalinos, a researcher at two universities in Greece and one in Saudi Arabia, belittled the original data out of China that led to the theory smoking helps the disease progress, calling it “too weak” because of the low number of smokers studied.
He suggested that vaping might be beneficial for coronavirus because a common ingredient in vape liquid, propylene glycol, has antiviral properties. This idea was also quickly picked up by other blogs and tweets.
Farsalinos said he takes no money from companies affiliated with the e-cigarette or tobacco industries: “I have no links with any foundation [including the FSFW] and I do not work for, cooperate with or have any financial or other interest in any industry or commercial entity.” When asked about past disclosures that a group called E-Cigarette Research Advocates Group has funded some of his work, he said in an email exchange that the group is a “non-official (not listed or registered anywhere) group of vapers (not businessmen) who created the website.”
Concerns about vaping’s health effects have increased in just the last year. A spate of vape-related lung illnesses in 2019 that killed 68 people in the U.S. changed the view of how e-cigarettes can affect the respiratory system, said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “If you had asked me a year ago, I would have said combustible tobacco was worse than vaping for this kind of virus,” she said in an interview. Now, in the wake of last year’s lung illnesses, “I don’t think we know.”
Some scientists say that smoking and vaping could also make people more susceptible to infection in the first place. Dr. Stanton Glantz, a professor at the University of California, San Francisco’s Center for Tobacco Control Research and Education, said the cells that line the nose and upper airways are edged with microscopic hair-like tendrils called cilia that can push tiny viruses out. “Smoking destroys cilia,” he said. “So the ability to push this stuff out before it gets to the lungs’ alveoli is ruined if you smoke.”
The messages published by groups funded by Philip Morris or the vape industry portray such ideas as engendering mass panic – all while subtly positioning next-generation products as a better alternative to smoking for coronavirus risk.
On March 10, an online magazine called Filter published an article saying smoking hasn’t definitively been linked to exacerbating Covid-19, but that there could be a benefit to switching to “risk-reduced nicotine products” like vapes. It cited Marewa Glover, a behavioral health scientist in New Zealand, saying that public-health warnings about vaping and the virus are “typical tobacco control exploiting what is a tragic unexpected outbreak.”
Filter disclosed that the article’s author, Michael McGrady, is supported by the Knowledge-Action-Change Tobacco Harm Reduction Scholarship program, which it called an independently administered scholarship funded by a grant from Philip Morris’s FSFW. McGrady, a 23-year-old journalist based in Colorado, said in an interview that his scholarship is for $10,000 and that he chooses the topics of his articles himself.
Glover has her own ties to industry funding. She works for the Centre of Research Excellence: Indigenous Sovereignty and Smoking, an organization focused on reducing tobacco related harm among indigenous peoples. It was granted $978,449 from FSFW in 2018. Glover cited the FSFW’s “complete autonomy” from Philip Morris and the tobacco industry, and said she has never received funding from any vaping or tobacco product company.
Filter Magazine itself is funded by The Influence Foundation, a New York-based nonprofit whose donors have included Philip Morris, Altria Client Services, Reynolds America and Juul Labs Inc. The Influence Foundation’s Editorial Independence Policy grants the editorial team at Filter “full authority over editorial decisions.” Juul said it has “no involvement in the editorial of Filter.”
Some of the messages dismissing vaping or smoking’s connections to the virus also criticize regulators or those who have advocated for tobacco control, including Michael R. Bloomberg. Bloomberg has campaigned and given money in support of a ban on flavored e-cigarettes and tobacco. He is the majority owner of Bloomberg LP, the parent company of Bloomberg News. His charity, Bloomberg Philanthropies, has funded Legendre’s group, Corporate Accountability, most recently in 2018.
At stake in all this are the lives of the estimated 1.1 billion people around the world who smoke, and the 41 million who vape.
So is the financial health of tobacco and vape companies, which could see sales suffer if their products are linked to yet another deadly disease. In early April, a lawsuit from individuals and school districts against Juul Labs and Altria that seeks medical monitoring and damages related to youth vaping was updated to include claims about the coronavirus. If companies are held liable for some costs of the pandemic, it could also give rise to something akin to the 1998 settlement that forced tobacco companies to pay more than $100 billion to U.S. states for costs from diseases like lung cancer.
Whether the warring messages even reach nicotine’s most vulnerable audiences — like the estimated 1 in 5 high school students who vape — remains to be seen. Laura Heaney, the 18-year-old president of Southampton High School’s chapter of Students Against Destructive Decisions, said few of the 30 people she knows who vape even think about what it might mean for the coronavirus. “The ones that do blow it off casually,” she said. “They think, worst case scenario, they will just get the common cold.”
Meanwhile, the messages made with the aid of tobacco and vape money continue to ping their way around the world. Some even ask for donations. “This is an urgent appeal to help people coping with the trail of disease, death and devastation that the coronavirus pandemic is bringing to the world,” says a message on the website of the Center of Excellence for the Acceleration of Harm Reduction in Catania, Italy.
The center received money from Philip Morris’s foundation in 2018. Its director, Riccardo Polosa, has a long history of work for the tobacco industry. Polosa said in an email that the center is independent “no matter the funding source.” In a separate Filter magazine article, he said he ensured vape shops weren’t closed in Italy during the virus lockdown. The idea that you are at higher risk of getting Covid-19 if you smoke or vape, he said in the article, is “just a game that is trying to create a new hysteria.”
(Corrects story originally published on April 17 to clarify the nature of the relationship between INNCO and two of its member organizations, in paragraphs 15 and 16.)
April 17, 2020