Italy has seen the worst outbreak of COVID-19 outside of China, after cases first appeared in the Lombardy region but quickly spread to other regions. At publication time, the country had almost 28,000 confirmed cases and over 2,100 deaths. The Italian national healthcare infrastructure is under enormous strain because of the number of people who need intensive care.

To stem the spread, the government adopted some of the most stringent measures in the world, banning all public gatherings, closing schools and shutting down most commercial businesses, including bars and restaurants. Vape shops were originally included but are now exempt. And the country has one man in particular to thank for that.

“I got a little bit cross. And the next morning I launched a number of declarative statements.”

Dr. Riccardo Polosa is a world-renowned scientist and researcher on vaping and tobacco harm reduction. He is the founder of the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR*) in Catania, Italy. He has published dozens of studies on topics related to vaping, and is featured in this Filter video. I spoke with Dr. Polosa about the lockdown in the country and how it was affecting people who vape or smoke.

Helen Redmond: How many people vape in Italy?

Riccardo Polosa: Close to 1 million people vape and about 16 million smoke cigarettes.

The Italian government closed most businesses, including vape shops. How was that decision reversed?

On March 11 our Prime Minister Conti announced a complete shutdown of commercial activity including bars and restaurants. The only exceptions are pharmacies, supermarkets, newsagents and tobacconists.

I got a little bit cross. And the next morning I launched a number of declarative statements. I thought it was terribly wrong to keep tobacconists open and vape shops closed for the simple reason that in a situation of high anxiety and stress, people will smoke a lot at home where they are confined and they will expose a lot of bystanders to the risks of tobacco smoke. Particularly young babies, kids.

On top of that, there are hundreds of thousands of vapers across Italy and because of the stress of the COVID-19 epidemic they would have gone back to smoking to maintain their nicotine needs. I thought that is going to be extremely dangerous from a public health point of view. And I pointed that out to the government.

“Hundreds of thousands of vapers would have been at risk of gatewaying back to smoking.”

I called the National Association for Electronic Smoking (ANAFE) which is the most important organization of producers of electronic cigarettes and e-liquids in the country, and they have political links and connections with the government, and through them I signaled these problems. And the fact that it was extremely unfair for smokers to not be able to have the chance to switch to reduced-risk products.

Most importantly, hundreds of thousands of vapers would have been at risk of gatewaying back to smoking. It was an issue of public health in my opinion. Also, many vapers with respiratory diseases have seen a curtailment of their symptoms by vaping, and by stopping vaping we would have seen a rise in acute exacerbation in respiratory disease. This would have been extremely detrimental to the national health system at a time when you have ICU beds occupied and not available for anything else.

By switching back to smoking, patients with respiratory disease who are vaping who have seen extreme beneficial effects in their symptoms they would have seen exacerbation in their disease.

What happened next?

On March 13 the Ministry of Health and the Prime Minister clarified the situation and they said besides tobacconists, vape shops can stay open to provide for the needs of people who vape. And probably a factor was the taxes on vaping products, but in a situation where the country is losing billions of dollars I don’t think this was the main reason.

I was very glad to see that the government was extremely receptive. In a matter of days they responded and said vape shops can remain open.

That is amazing!

It’s an indication that the government really understands the value of vaping vs. smoking when there are no ideological issues in the middle.

You were the only one who raised this issue and made the calls?

I don’t think I have a lot of power, but a lot of people listen to what I have to say because I try to be objective in my evaluation in these situations. So I have some credibility but at the same time there have been other actors playing a role in this process. The most important thing is that the government has acted promptly to make sure that vape shops have reopened very quickly.

We have set an example worldwide that even our government that has had yo-yoing attitudes toward vaping products has been extremely positive in response to the COVID-19 emergency. So they have been taking very seriously the needs of vapers in Italy and by doing so they recognize the importance of vaping and it’s relative safety.

Here in the US there are people who are saying you are at higher risk of getting COVID 19 if you smoke or vape.

There is no evidence for that. That is just a game that is trying to create a new hysteria.

You’ve done studies that have shown harm reversal in smokers who switch to vaping.

We’ve done a number of studies with asthma, COPD and high blood pressure patients. In all these patients, but particularly with the COPD patients, we have found evidence from our studies that shows consistent improvement.

One of the problems in proving the tobacco harm reduction paradigm in healthy smokers is that it’s difficult to show the risk reduction in a sensible time frame. It will take decades to show the impact of switching from combustible to reduced risk products. However, if you consider people who have already developed smoking related diseases particularly those at the early stages, by switching to reduced risk products it’s easier to show improvements in their health outcomes.

For example, people who develop COPD, we’ve shown that by switching exclusively to vaping they will improve a number of objectives and subjective respiratory outcomes. We call it harm reversal rather than risk reduction, there isn’t reduction in risk because they’ve already developed the disease, but maybe you will reduce the risk of other smoking-related diseases, for example cardiovascular disease or cancer.

The point I’m trying to make is for people who have already developed a smoking-related disease, this is good news. They can feel for themselves the beneficial effects of the switch.

* CoEHAR has received grants from the Foundation for a Smoke-Free World. The Influence Foundation, which operates Filter, has also received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.