The use of vaping as a means of helping adults who smoke is well established in the UK and has the endorsement of the government and the NHS. But so often the headlines focus on another issue concerning vaping – with the danger that the positive message will be lost.
In years past underage smoking was common and rightly regarded as a major public health issue in the UK and many other places. Now, there is great concern in many places about underage vaping amid fears that some producers of e-cigarettes are cynically targeting children, echoing similar concerns about smoking from the past.
This is fair enough; while vaping is nowhere near as harmful as smoking, it is still better not to take it up to start with. Moreover, as with smoking or drinking alcohol, there is a minimum age of 18 in the UK (and in many other countries), so there is the not-so-small matter of the law.
A key question is not, therefore, whether a justified concern about underage vaping warrants action to crack down on it. That is not in dispute. What is more pertinent, however, is a more nuanced but highly relevant issue: can a crackdown on underage vaping avoid undermining the message that for smokers, switching to vaping reduces harm greatly and is an effective way to quit?
The answer should be yes, but not every policy approach taken by government or health authorities will get the balance right. And one of the most prominent recent initiatives has come in for a lot of criticism from some quarters.
Australia’s government recently announced new rules to ban ’recreational’ vaping, the very use of the word ‘recreational’ making it sound as if using DIY vapes is somehow on a par with snorting lines of white powder. Health minister mark Butler has banned single use disposable vapes and the import of any non-prescription vaping products.
If this sounds rather different from the British approach of openly acknowledging the benefits of vaping as a smoking cessation tool, that’s because it is. Indeed, Mr Butler, an open critic of e-cigarettes, has made it very clear that there is no chance his ministry will copy the ‘swap to stop’ scheme being piloted in the UK, in which free vaping products are to be given to smokers.
However, as news.com.au reports, the stiffer regulation and strict new rule that only pharmacies can dispense vapes at all – and that as a prescription – have divided opinion. There are certainly advocates of such an approach, such as the Royal Australian College of General Practitioners, the Alcohol and Drug Foundation and the Public Health Association of Australia.
Against that, the Australian Tobacco Harm Reduction Association is highly sceptical of the plans. Its chairman Joe Kosterich accused the health bodies favouring the legislation of “patting each other on the back,” while “people who are actually trying to give up smoking or people who have successfully given up smoking by vaping are going to be suffering”.
Noting that it is “already illegal for teens to vape, you can’t make it more illegal than it currently is”, he added that if the measures pushed buyers towards the black market, then “the black market will get even stronger because of these moves”.
Instead, Mr Kosterich suggested, the best approach would be to copy what is being done in New Zealand, where the policy is to encourage smokers to switch to vaping while also dissuading those who neither smoke nor vape from taking up either practice.
Mr Kosterich also argued against new rules that restrict vape sales to pharmacies, as this just makes them harder to obtain than cigarettes, which as the more harmful option is worse for public health.
Citing a 2016 study by the Royal College of Practitioners showing vaping only carried five per cent of the harm inhaling tobacco smoke from a cigarette did, he remarked: “You don’t need a doctor’s appointment to buy cigarettes, why do you need a doctor’s appointment to get a 95 per cent less harmful option?”
The debate will continue in Australia, but as it does so the governments of other countries may be watching closely to see how things work out down under. Others might simply seek to copy Australia as a means of showing themselves to be tough, or look to stick with the more evidence-based approach used in the UK.
A key question is whether, having just launched the ‘swap to stop’ policy, the British government might decide on a change of policy. To do so now or soon would amount to a significant U-turn in policy, not the thing a government likes to be accused of at any time, least of all when it is less than two years away from a general election and trailing in the opinion polls.
That very consideration does raise the possibility that a change of government could lead to a significant shift in policy. However, at present that is a matter of speculation. It is only much nearer the election, and perhaps only when the manifestos are published, that any proposal to shift from current policy approaches might be revealed.
However, it may not be a result of party politics but of changing attitudes, the impact of pressure groups or responses to scientific research that the current UK policy might be changed, or, alternatively, reinforced.
There is plenty of good evidence around to support taking the latter approach. Research recently published by Kenneth Warner, dean emeritus at the University of Michigan’s School of Public Health, backed the approach used by the UK and New Zealand, while questioning that of Australia and some authorities in the US and Canada.
Arguing that the evidence is clear that vaping offers the first effective new tool in decades to help smokers quit, he said researchers had concluded that “governments, medical professional groups and individual health care professionals in countries such as the U.S., Canada and Australia should give greater consideration to the potential of e-cigarettes for increasing smoking cessation”.
Far from copying the Australians, it seems the latest studies support the current UK approach as the best way forward instead.
