Meeting Summary - June 8-9, 2021: Scientific Advisory Board on Vaping Products

Virtual Meeting

List of participants

Attendees

• Dr. Steven Hoffman (Chair)
• Dr. Sonia Johnson (Executive Secretary)
• Dr. Carolyn Baglole
• Dr. Judith Bartlett
• Dr. Nicholas Chadi
• Dr. Joanna Cohen
• Dr. Mark Eisenberg
• Dr. Maciej Goniewicz
• Dr. David Hammond
• Dr. Milan Khara
• Dr. Nancy Rigotti

Regrets

• Dr. Ann McNeill

Secretariat

• Dr. Suneil Malik
• Dr. Trevor Mischki
• Dr. Christine Czoli
• Ms. Fatima Mussa
• Ms. Hana Kokanovic
• Ms. Jessica St. Pierre

Observers/Presenters

• Ms. Jacqueline Bogden
• Mr. Denis Choiniere
• Dr. David Mills
• Mr. Nicolas McCandie Glustien
• Ms. Sheila Molnar
• Ms. Pippa Beck
• Ms. Ariane Lefrancois
• Ms. Amanda Cybulski
• Dr. Hanan Abramovici
• Dr. George Mammen

Meeting Summary

1. On June 8-9, 2021, members of the renewed Scientific Advisory Board (SAB) on Vaping Products met virtually for their first meeting. The agenda is attached in Appendix I.
2. The meeting opened on Day 1 with remarks from the Chair, Dr. Steven Hoffman, Scientific Director of the Canadian Institutes of Health Research's Institute of Population and Public Health (CIHR-IPPH). Dr. Hoffman welcomed participants and provided an overview of the history of the board and its mandate.
3. Jacqueline Bogden, Associate Deputy Minister, Controlled Substances and Cannabis Branch, Health Canada, provided opening remarks on behalf of Health Canada and acknowledged the board’s gathering took place virtually and across Indigenous lands, including the land of the traditional unceded territory of the Algonquin Anishinaabeg People.
4. The SAB Executive Secretary, Dr. Sonia Johnson, Acting Director General of the Tobacco Control Directorate at Health Canada, provided a scene-setting presentation. Dr. Johnson explained the purpose of the board and highlighted that the board is governed by the Health Canada Policy on External Advisory Bodies. She provided an overview of vaping product use in Canada and described the federal legislative framework for vaping products. She continued with an overview of objectives for the SAB and concluded with a brief list of future topics and issues that might be brought to the board for discussion.
5. Dr. Hoffman provided a presentation on behalf of CIHR. This included a general overview of CIHR’s mandate, new strategic plan, investments in vaping research, as well as the mandate of the CIHR Institute of Population and Public Health. Dr. Hoffman highlighted the significance of the SAB’s role in facilitating knowledge mobilization of research findings and the need to institutionalize the use of evidence in policymaking. He concluded by highlighting the importance of SAB advice and discussions which have helped Health Canada and CIHR understand priority research areas and identify potential mechanisms through which future Canadian investments in research on vaping could be guided.
6. The SAB engaged in a roundtable discussion about the mission and mandate of the SAB with a focus on the Terms of Reference, objectives and expectations for the SAB, and any gaps in SAB expertise. Members discussed the meaning of ‘vaping product’ and mechanisms available for public consultation.
7. SAB members were then invited to discuss issues of importance and additional priorities that the board might be able to review and discuss over the upcoming term. The list of issues included:
   • Balancing harm reduction for cigarette smokers and harm prevention for youth while avoiding unintended consequences
   • Striving for a deeper understanding of vaping products and how they can be modified
   • Understanding usage trends among different population groups
   • Exploring possible incentives for manufacturers to seek therapeutic approval of vaping products to facilitate smoking cessation
   • Depiction of vaping products through marketing and advertising
   • Health inequities
   • Data on implementation science, including comparisons across jurisdictions
   • Defining desired health outcomes
   • Reconciling inconsistencies across regulatory domains, e.g., tobacco, cannabis, vaping
   • Increasing access to clinical trials, reducing barriers to research and producing more evidence
   • The role of healthcare professionals in supporting use of vaping products for smoking cessation
   • Raising the minimum legal age for purchase of tobacco and vaping products
8. Day 2 of the meeting opened with a presentation from Nicolas McCandie Glustien, Lead, Legislative Review of the Tobacco Control Directorate at Health Canada, on the Tobacco and Vaping Products Act (TVPA) and its mandated legislative review. Mr. McCandie Glustien provided background on the legislative process of the Government of Canada and an overview of the TVPA to situate it within Health Canada’s broader approach to tobacco and vaping policy. This included a discussion on current and planned regulations on vaping products, Canada’s Tobacco Strategy, and other legislation covering vaping products. He then introduced the upcoming legislative review of the TVPA and the role of the SAB in shaping questions for inclusion in legislative review consultations.
9. Following the presentation, Dr. Hoffman facilitated a Q&A period as an opportunity for members to query Health Canada officials on the workings of the TVPA. Several members of the SAB stressed the importance of striking a balance between harm prevention for youth and harm reduction for adult smokers through the TVPA. They highlighted that the TVPA’s focus on vaping restrictions for youth populations may have unintended consequences for adult cigarette smokers. The purpose of regulating vaping products, as opposed to an outright ban, is to transition adult smokers off cigarettes. Attention should be paid to other legislative mechanisms that have achieved this balance such as cannabis legislation.
10. Members emphasized the need to consider the context of the adoption of the Act and whether the context has since changed as well as the impacts of the Act. They discussed whether the definitions and terms for tobacco and nicotine products used in the TVPA accurately reflect the products on the market and how vaping products may have changed since the TVPA came into force. Consideration should also be given as to whether legislative review is an opportunity to determine whether the Act and regulation-making authorities are appropriately nimble to address such a rapidly evolving issue like vaping.
11. With respect to public messaging on vaping products, the uncertainty about the long-term health effects coupled with the increases in youth uptake, have resulted in a cautious approach from Health Canada. Further evidence of the health effects of vaping and Canadian-specific data on the impact of vaping products on smoking cessation are needed in order to shift the public health narrative to target adult smokers. When looking at recent data, it is important to consider the potential role of the COVID-19 pandemic as a stressor.
12. The SAB then discussed their consultative approach to the legislative review of the TVPA. The following guiding questions were proposed:
    • How has the evidence regarding vaping changed since 2018? What do we know now regarding the health consequences/benefits of vaping products?
    • What are the most critical pieces of emerging evidence to consider while reviewing the current legislation?
    • Are there information gaps that are important to identify?
    Members identified the following priorities and gaps:
    • Balancing the population and individual impacts of vaping regulations should be prioritized
    • Addressing youth vaping for those under the age of 18 should be prioritized
    • Evidence is needed on population groups and whether certain at-risk groups should be prioritized
    • Further research is needed to determine the efficacy of vaping products with respect to smoking cessation, particularly in comparison to other products/medical interventions, such as nicotine replacement therapy
    • A firm understanding is needed on vaping products available on the market (composition, power, flavours, etc.) and their evolution
    • Outlining the limitations of clinical trials studying a single vaping product
    • Research on the dichotomy between opened and closed vaping systems and its impact on regulatory options
    • More data on the use of vaping products for consumption of cannabis
    • Further understanding of the evolving regulatory approach to vaping products on a global scale
    • Innovative consultative methods to understand the youth perspective
    • Further understanding of the promotion of vaping products via social media (peer to peer/influencer vs. commercial ads) and means of enforcement
13. In closing, Dr. Hoffman and Dr. Johnson provided reflections on the SAB meeting and key takeaway messages, thanking all members for their participation. The next meeting of the Scientific Advisory Board on Vaping Products will be held on November 1-2, 2021.

Appendix I – Meeting Agenda

Scientific Advisory Board (SAB) on Vaping Products

Meeting #1 – June 8 & 9, 2021

Day 1

11:00am – 12:30pm: Introduction to the SAB

• Welcome from the Chair (Dr. Steven Hoffman)
• Brief introductions (All)
• Welcome from Health Canada and scene setting presentation (Jacqueline Bogden & Dr. Sonia Johnson)
• Presentation from CIHR (Dr. Steven Hoffman)
• Q & A period (All)

12:30pm – 1:00pm: Break

1:00pm – 2:30pm: Do we have a common view of our mission, mandate and key issues?

• Roundtable discussion: Terms of Reference & SAB objectives, expectations, expertise (Dr. Steven Hoffman / All)
• Dialogue between HC and SAB members: Issues of importance and additional priorities (Dr. Steven Hoffman / All)

2:30pm – 3:30pm: Wrap up of Day 1

Day 2

11:00am – 11:10pm: Welcome back (Dr. Steven Hoffman)

11:10am – 1:00pm: Introduction to the TVPA & legislative review

• Presentation from Health Canada: Introduction to the TVPA & legislative review (Health Canada)
• Q & A period (All)

1:00pm – 1:30pm: Break

1:30pm – 2:45pm: Legislative review (cont'd)

• Presentation from Health Canada: Overview of consultation approach (Health Canada)
• Discussion (All)

2:45pm – 3:00pm: Conclusion