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In late January, a research paper was published by authors from The Truth Initiative and the University of Chicago which contained wholly false allegations about the New Nicotine Alliance. We have contacted the publishing journal, Sage Journals, on several occasions yet these fictitious claims have still not been corrected. We are writing this article to put on public record that the claims by the study’s authors are fundamentally untrue, and that the process to correct them has been unduly slow.
We first contacted Sage Journals on 21 February, writing the following letter to alert them to the false statements which had been published on their pages.
Upon receiving no reply, we wrote again on two separate occasions to reinforce that incorrect statements had been left online for two months “with each passing day having the potential to cause further reputational damage to our charity.” We also copied in the Editor-in-Chief and the Deputy Editor-in-Chief in an attempt to elevate the issue.
We finally received a reply on 31 March from the Research Integrity Manager stating that they take “research integrity concerns very seriously”, and that our complaint was being “actively investigated.” We have had no communication from them since then.
For comparison, the last time such falsehoods were published by a journal, it was rectified within 10 days.
We find it unacceptable that entirely inaccurate and unfounded material should remain in a published study for over three months and would question whether this matter is being “actively investigated.” We are also curious as to why an organisation calling itself The Truth Initiative should be content with totally untrue information being promoted under its name, more than two months after we alerted the journal of the errors.
We have pointed out in our correspondence that “it should not take a responsible research journal this long to correct such blatant mistakes.”
We are heartened that our efforts seem to be such a threat to those opposed to harm reduction that they resort to such underhand tactics, but there can be no excuse for the delay in correcting demonstrably fictitious assertions.
Therefore, we wish to make it clear, once again, that there are no grounds whatsoever for these claims and that the authors and their chosen journal are abrogating their responsibilities to present accurate information.
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It was ten years ago today when the NNA first became an educational charity.
Trustees of the organisation had previously met while fighting against the European Union’s Tobacco Products Directive, alongside other European consumers, which was attempting to regulate e-cigarettes to be licensed only as medicinal products. This was a clear attempt by the EU to eradicate vaping in its infancy.
Thanks to the weight of consumer action, all of whom had quit smoking by using the new technology, and a few very brave and outspoken MEPs, the threat was avoided and the NNA formalised as a consumer association a short time later, only the second association of its kind in the world.
Over the next decade, the NNA has consistently championed the cause of tobacco harm reduction both in this country and beyond, and has become a well-renowned voice in the harm reduction debate. These are just some of the activities that NNA trustees, associates and supporters have engaged in during those years.
- Advised government departments, politicians, parliamentary groups and committees on vaping and other reduced risk nicotine products from a consumer viewpoint
- Submitted comments and consultation responses to numerous government initiatives
- Provided commentary and explainer articles to consumers on public health policy developments.
- Regularly contributed to academic research on tobacco harm reduction projects
- Produced video guides on the role of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention.
- Taken part in virtual and in-person panel discussions and produced educational and instructional webinars
- Communicated with UK consumers, on our website and via email, to raise awareness of petitions, government consultation exercises, and public health reports.
- Given expert consumer and advocacy briefings to a variety of print, TV, radio, and online media
- Developed policy proposals towards prospective government regulations
- Engaged with the British Standards Institute (BSI) to formulate standards for e-cigarettes and e-liquids.
We are also proud to have been a founder member of European Tobacco Harm Reduction Associates (ETHRA) which formed in 2019 and now represents over 27 million consumers from 24 grassroots associations in 17 European countries, including sister organisations of the NNA based in Sweden and Estonia.
Despite operating on a shoestring budget the NNA is respected, and active both nationally and internationally, punching well above our weight. We are regularly reminded of this with the numerous Freedom of Information Requests that have been lodged to read our correspondence with government departments, each one just serving to highlight the quality of the information we present.
Sadly, tobacco harm reduction has been beset during the past decade with dire misinformation which has frustrated not only consumers, but public health advocates and charities too, often by the same people and misguided agencies who should know better.
However, as we move past our first decade, we will continue to advocate for the wide availability of low risk products as a choice that consumers should be able to make for the good of public health. We know that this is the right path, as do the many millions who have benefitted from safer nicotine products, and that our actions are correct.
How you can help for the next decade
As mentioned before, we do all this on a very limited budget. All NNA Trustees are unpaid and advocate on a voluntary basis, but we endure administration costs that must come out of our finances.
We rely on you, our supporters, to help us carry on what we are doing and can only do so with your regular donations. Most consumers and responsible public health advocates believed that harm reduction would have been recognised and celebrated by now, but while there are still bad actors willing to promote misinformation, there is still work to do.
Please do consider donating to our charity, however large or small, so that we can continue to work in your interests. You can view our GoFundMe page here.
Better still, why not join the NNA and help us in the next ten years. We have produced a prospectus for those who would like to hear more about what we do here.
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The NNA is sad to report that Andy Morrison, an early adopter of vaping products and well-respected former trustee, died this week after a long illness.
NNA Chair, Louise Ross, commented on social media that Andy was “a very special friend to me and to people who wanted to switch from smoking to a safer way of using nicotine. His generosity was legendary.”
Andy was an RAF veteran who served in the Falklands War guiding air traffic control operations. He went on to a career in IT which focused on developing systems for small airports to better handle their traffic.
A lifelong smoker, he found vaping and stopped combustible tobacco use entirely. He joined NNA as a trustee a decade ago and was our Scottish expert. He gave evidence to inquiries about vaping and harm reduction to the Scottish government and spoke at political conferences on the misinformation surrounding reduced risk products.
His determination and trust in harm reduction was exemplified by an unceasing drive to help smokers to quit with less harmful products even after leaving the NNA. In a personal capacity, and without funding, he focused on homeless populations in Glasgow, helping thousands to quit smoking where public health approaches were not working.
Andy was also a talented amateur magician who revelled in playing tricks on friends wherever he met them. His infectious sense of humour and engaging personality will never be forgotten by those of us who knew him.
Andy leaves behind his wife, Lorraine, to whom we extend our heartfelt sympathies
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It is difficult to know where to start describing the fundamental flaws behind the new vape tax proposal announced in last week’s budget.
UNDERMINES THE GOVERNMENT’S SWAP TO STOP CAMPAIGN
There is a complete lack of joined-up thinking in the government spending tax receipts on encouraging smokers to quit by handing out one million free vapes, only to then disincentivise those who take up the offer by applying heavy duties to the liquids they need to actually use them. The proposed framework reveals these clear informational problems across government and a fundamental misunderstanding of the realities of vaping.
MISUNDERSTANDS SCIENCE
The government seems preoccupied by what the nicotine liquid equivalent of a cigarette is, whereas it is irrelevant how much nicotine a vape contains compared with nicotine in a cigarette because the products are completely different. Nicotine is not the element that causes the death and disease, it is the combustion. As Action on Smoking and Health explains, “puffs on vapes ARE NOT equivalent to puffs on cigarettes.”
CHILD-LIKE ASSUMPTIONS
To say the proposals are ill thought-out would be an understatement. The public should expect its government to investigate a policy area comprehensively before proposing punitive taxation which imposes significant costs on people who have quit smoking exactly as they have been encouraged to do by the NHS. It has not been done in this case.
Instead, the documents published to back up the imposition of a new vape tax are notable for being almost childlike. There is a non-existent appreciation of the difference between content, consumption, and absorption of nicotine.
IPSOS POLL CLAIM HAS NO FOUNDATION
For example, an IPSOS poll commissioned in November but only published on the day of the budget announcement makes the claim that “The average (mean) strength of nicotine used amongst current vapers was reported to be 10mg per ml (just under the strength of a typical cigarette).”
This definition has never been used before; it is not recognised in any literature on the subject. Indeed, the Tobacco and Related Products Regulations (2016) (TRPR) is the mechanism by which the government transposed regulations from the EU’s Tobacco Products Directive (2014) (TPD) into UK law.
Article 18 of the TPD states that, “[n]icotine-containing liquid should only be allowed to be placed on the market under this Directive, where the nicotine concentration does not exceed 20 mg/ml. This concentration allows for a delivery of nicotine that is comparable to the permitted dose of nicotine derived from a standard cigarette during the time needed to smoke such a cigarette.”
The maximum nicotine limit allowed in vaping liquids in the UK is set at 20mg/ml, to precisely align with the EU’s definition of what they consider to be equivalent for one cigarette. Yet IPSOS has conjured up an entirely new level and does not cite any source for it.
The best we can assume as to how this level was decided is that cigarettes are limited to 12mg of nicotine content and so that is what they have gone with. It is the simplistic thinking you would expect from an increasingly misinformed public rather than a government department, but this ignorant interpretation has been accepted without question.
The EU’s definition itself was flawed by comparing what comes out of a cigarette with what goes in to an e-cigarette. They based their crude assessment on a study in 2014 which discussed nicotine absorption, the author of which wrote to the EU to complain that they had misrepresented his research and that “20 mg/ml e-liquid provides less than one-third of the nicotine delivered by one tobacco cigarette.”
THE TAX ON VAPING PUNISHES QUITTING MORE HARSHLY THAN CONTINUING TO SMOKE
So, we now have government legislating to apply a tax on vaping liquid at least six times harsher than they do for cigarettes.
Best estimate from that research was that nicotine absorption after smoking for 5 minutes is between 185% and 286% higher than the vaping devices tested after 5 minutes. There is no recognition of that science in the government’s facile justification of the vape tax. Applying duty on the contents of vape liquids and cigarettes, rather than the absorption of the products, is scientifically and morally illiterate.
In his speech, Jeremy Hunt claimed that: “Because vapes can also play a positive role in helping people quit smoking, we will introduce a one-off increase in tobacco duty at the same time to maintain the financial incentive to choose vaping over smoking.”
He has done nothing of the sort. The public consultation document released alongside the budget announcement states that users of stronger liquids (≥11mg/ml) will face a 143% price increase. Weaker liquids (<11mg/ml) will go up by 98%, and nicotine-free liquids by 48%.
The increase in combustible tobacco duty, by comparison, is around 2.5%. To put that into context. As a result of the budget, a 20 per day smoker will take 21 days to pay the extra duty that a standard vaper using 20mg/ml liquid will pay in 7 days. The Chancellor has considerably reduced the financial differential between smoking and vaping.
THE SMOKEFREE 2030 GOAL WILL BE UNATTAINABLE
The only result of this will be a significant deterrent to smokers who are considering switching to vaping, an increase in sales of illicit products, and relapse by many back to smoking cigarettes. The government’s Smokefree 2030 target is now effectively dead.
The Chancellor’s announcement cloaks itself as a health policy, and yet it shows no sign that anyone with any knowledge of smoking, vaping, nicotine or health has been consulted in its design.
The government seems overly concerned about nicotine addiction, without any appreciation that it is an entirely different thing to harm. Even if that is the case, the proposal to tax non-nicotine products which, by definition, cannot be addictive makes no sense at all.
The consultation document claims that one purpose of the tax is to “encourage consumers to choose lower strength or nicotine-free vaping products over higher strength ones due to the harms from nicotine addiction.”
This is so absurd as to be laughable. People using lower strengths use higher volumes to take in the nicotine they want. Higher volumes mean more energy and potentially more exposure to contaminants and thermal decomposition products. The government’s infantile understanding of the policy area and obsession with nicotine (which is not the harmful element of combustible tobacco use) is driving consumers to increase potential harm. Those drafting the documents could have avoided such a schoolboy error by Googling “nicotine titration” because it is clear they have never heard of it.
THE GOVERNMENT’S STRATEGY WILL COST LIVES
It is doubly counterproductive because stronger liquids will tend to be those used by people starting to vape who will now be punished at the highest level. Higher strength liquids will also be used long-term by people with poor mental health to stay off cigarettes – or at least they would have done without this new interference in what showed promise in saving the lives of people with mental health issues. The Chancellor’s insistence that “vapes can also play a positive role in helping people quit smoking” is shown to be hollow when he has erected the greatest financial barrier to the products which can most effectively play that positive role. This, after the government has also vowed to ban single use vapes which have led to the most significant declines in smoking prevalence ever seen in this country, and despite pleas from public health organisations not to do so.
SUBMIT TO THE CONSULTATION
These mistakes could have been avoided if the government consulted industry and consumer representatives who could have quickly pointed out the flaws. However, it has not done so, instead cobbling together an incoherent mess of proposals which can only do harm.
Despite the proposals – and the consultation document - being puerile, naïve and incredibly shallow, the NNA would strongly suggest that all our supporters, consumers, and others who understand harm reduction better than the government’s woeful attempt, make a submission.
Many have suggested that the Chancellor has proposed this tax purely as a cynical tax grab. We will be charitable and hope it is a genuine mistake driven by bad advice and a lack of understanding rather than prioritising revenue generation to gain election votes over public health.
With your help, maybe we can highlight to government that these comical set of proposals are an embarrassment and should be revisited. The NNA will be submitting a comprehensive consultation response in due course and will guide our followers to do the same.
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It has been widely trailed in the media that the Chancellor, Jeremy Hunt, is planning to implement an extra tax on vaping liquids in the budget on Wednesday. This would be a monumental mistake which just adds to a systematic dismantling of the government’s previous world-leading approach to harm reduction and will cost lives.
The New Nicotine Alliance is disappointed that the government is abandoning opportunity after opportunity to increase the chances of achieving its own Smoke-free 2030 goal. In just a few short weeks, the UK government has undone its former position as a world-leader in reducing the prevalence of smoking.
Ignoring expert public health organisations such as Action on Smoking and Health, the National Centre for Smoking Cessation and Training, Fresh-Balance and many others who were acutely aware of the unintended consequences of a ban on single use vapes, the government has committed to removing them which can only deter people who smoke from switching to products which could save their lives.
It is also intending to restrict many flavours which can help people quit smoking, enforce plain packaging, and severely reduce the visibility of life-saving products.
In the terms of the proposed generational ban on tobacco products, it has included heat-not-burn products which are far less harmful than combustible tobacco – according to the government commissioned Committee on Toxicology report - and have led to dramatic declines in smoking prevalence in countries where they are widely available and promoted to people who smoke as an alternative.
It is also regrettable that the government has not taken the opportunity of Brexit to legalise snus which has led to Sweden being close to achieving the EU’s target of less than 5% smoking prevalence by 2040 nearly two decades early. Worse still, there are signs that the UK is now set to apply damaging restrictions to nicotine pouches which threaten to neuter their potential to attract people who use lethal combustible tobacco to a far safer alternative with comparably negligible harm.
These mistakes are serious enough, but the suggested vape tax would be the most pernicious of all.
Vaping products compete with combustible tobacco, so it is an economic certainty that any action which deters adult smokers from switching to a reduced risk alternative will be an increase in smoking. It will also increase the already high level of illicit trade in vapes which has been assessed currently to be around half of all sales in the UK.
Complying with government duties is not a simple matter, either. It will be a new and excessive burden on small independent companies to learn tax bureaucracy compliance, one which could put many out of business altogether, whereas the tobacco industry is well-versed on handling taxes over many decades.
Michael Pesko, probably the world's most accomplished economist when it comes to applying quasi-experimental techniques to e-cigarette policies, strongly recommended against taxes on vaping products in his submission the Department of Health and Social Care consultation. The government would be wise to take his advice seriously.
The government – and media reporting on the vape tax proposal – should ask questions on the inevitable unintended consequences of such a policy.
How much extra smoking do you expect to arise from taxing vapes? To what extent will this slow progress towards and imperil the Smokefree 2030 goal?
How much extra illicit trade in vapes do you expect to arise on top of the high level we already have?
How much extra tax bureaucracy cost do you expect to create compared to the tax revenue raised?
Big tobacco companies are set up for tax bureaucracy, what extent do these taxes penalise small vape businesses and support Big Tobacco?
If the rumours of a vape liquid tax are true, the government would be fighting itself. It has been recently reported that 400,000 vaping products – the first of one million promised by the government last year - will be handed out free of charge under the Swap to Stop campaign. The Chancellor taxing them on the pretext that they are harmful will surely cancel out much of that investment by sending mixed messages.
The government’s own consultation document in October stated that “swapping to vaping is already helping 50,000 to 70,000 smokers in England quit each year - saving thousands of lives.” This tax will be a significant obstruction to that progress.
Just last week, a long-running Cancer Research UK funded study found that there were “substantial misperceptions about the harms of vaping compared with smoking” and emphasised “the need to clearly communicate the risks so that adults who smoke can make informed choices about the nicotine products they use.” The rumoured tax on vaping liquids will only add to these damaging misperceptions.
The NNA hopes that wise voices are advising the Chancellor of the extremely damaging consequences that a tax on vaping liquid will have for public health, and that he draws back from announcing the proposal on Wednesday. Thousands of lives depend on it.
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As has been widely reported, new data published last week by the Office for National Statistics (ONS) reveals that the smoking rate for over 18s in the UK in 2021 declined to a record low of 13.3%. The ONS described the drop in smoking numbers since the previous year’s rate of 14.0% as statistically significant and concluded that vaping had played “a major role” in the reduction.
This is great news at the end of a difficult year for many, but also a ringing endorsement of vaping as a successful nicotine alternative for millions of people wishing to quit smoking. As advocates for tobacco harm reduction, we are obviously encouraged by these data which align with the experience of our trustees and many of our associates and supporters who have managed to quit combustible tobacco by using vaping products instead.
However, we are by no means surprised by the latest figures. It has become abundantly clear that wherever lower risk nicotine products are regulated sensibly, smoking rates decline faster than in countries where they are banned or restricted unnecessarily.
In the UK, the public is used to hearing about vaping in the media and the increasing numbers of vapers mean that most people will know a friend or family member who uses some form of vaping product. In other countries, vaping is not so well-known but other options such as snus and heated tobacco are producing the same results.
Japan and South Korea are seeing dramatic reductions in cigarette sales since heated tobacco products hit the market. In the case of Japan, by over 50%. Similarly, in Scandinavia, where snus is the dominant cigarette substitute, smoking rates are significantly lower than in the rest of Europe where it is unwisely prohibited by the EU. There is also considerable potential for further drops in smoking numbers by the recent introduction of nicotine pouches to markets around the world.
This is why we will continue to campaign for wider availability of all safer nicotine products in the UK, not just e-cigarettes. It is laudable that the UK government leads the world by embracing vaping and recommending smokers switch, with positive messaging coming from smoking cessation services and on the NHS website, but we would like to see more recognition and acceptance of other alternatives for those for whom vaping doesn’t work.
Ultimately, we would like to see the government regulate products on the basis of the relative risks they present and put in place a tobacco and nicotine policy which distinguishes between combustible and non-combustible products rather than whether or not they contain tobacco.
The new ONS report shows that encouraging smokers to switch to alternative products is a successful strategy for driving down cigarette use, so just imagine how much better the results would be if more people were aware that vaping is not the only option out there. We have imagined that and have put forward twenty proposals for going “all in” on low-risk products to transform nicotine use in the UK from the most harmful option, combustible cigarettes, to products which are orders of magnitude safer.
The latest smoking prevalence data is some good news at the end of 2022, and on that note, we would like to wish all our enthusiastic and generous supporters a merry Christmas and a happy new year. We hope that 2023 can bring more good news and a positive government stance on all tobacco harm reduction products for the good of both consumer choice and public health.
The UK’s experience with vaping proves that harm reduction works, so let’s do more of it.
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Last month, the BBC reported that health campaigners had called on the government to close a “loophole” in how nicotine pouches are regulated to prevent under 18s from being able to buy them legally. The report referenced Action on Smoking and Health spokesperson Hazel Cheeseman asking the government “to ban free samples and sales to under-18s, introduce limits on strength and to restrict marketing of the pouches.”
Although the lack of an age limit for pouch sales is not technically a loophole, it is merely that one has not been set as pouches have been regulated under General Product Safety Regulations and do not have their own regulatory framework, the NNA welcomes some of the proposals publicised by the BBC.
We wrote to Health Secretary, Matt Hancock, in February and August, 2020, and again to Public Health Minister, Jo Churchill, in January 2021 on the subject of nicotine pouches regulation. Our letters emphasised the significant potential benefits of nicotine pouches but observed that there was a need to install regulations in order to clamp down on “unscrupulous sellers in the UK who are acting recklessly.” We also noted that although “there is no evidence that currently these nicotine pouches are in the hands of under 18s”, it is necessary to put in place a minimum age of sale to pre-empt any difficulties that could arise in the absence of clarity that the products are intended for adults who wish to use a safer nicotine product.
We also suggested that it would benefit the government to commission a toxicological study by the Committee on Toxicity (COT) to fully assess the potential of these products, as has already been done for e-cigarettes and heated tobacco. This report has now been commissioned and a first draft statement was published in July this year. The same process is happening in Germany where the BfR (German Risk Institute) has conducted a toxicological assessment of pouches which produced positive conclusions.
We would also agree that there should be a stated limit on the strength of nicotine pouches, and also a standard measure for consumers to understand what strength of product they are purchasing, as currently different manufacturers convey the product strength in different ways. We understand that nicotine strength is not the only factor in how consumers can safely ingest nicotine from snus and non-tobacco nicotine pouches, and that quality of manufacture and ingredients also play a part, but until a more sophisticated regulatory assessment of all these factors can be put in place, a set limit can act as a sensible barrier to help remove unregulated and irresponsible online sellers from the market.
Our friends at ETHRA tell us that there is already a precedent for this in Europe. In October, the Slovak Parliament unanimously approved a bill regulating nicotine pouches. The bill introduced a definition for nicotine pouches, regulated their composition, assigned health warnings and determined a nicotine limit of 20 mg/pouch, amongst other measures.
However, we do not agree that samples should be banned as they can be a very useful way of attracting, especially, smokers towards pouches, and would also disagree that marketing of the products should be prohibited. Action on Smoking and Health’s latest report on e-cigarette use in Great Britain found that only 3.9% of the public have ever tried a nicotine pouch. If we are to genuinely move towards Smokefree 2030, it is important that all reduced risk options of nicotine delivery are known to the public and it serves no good purpose to ban advertising for them while over 14% of the adult population still smokes.
In letters we have sent to the Department of Health detailing our overall strategy towards harm reduction in the UK, and also to the recent Khan Independent Tobacco Review, we have suggested establishing “a proportionate regulatory regime for nicotine pouches and other non-tobacco oral nicotine products based on consumer welfare and protection.”
It is good to see some of our long-held suggestions on nicotine pouches regulation being taken up by health groups, but it is important that the government does not go too far and over-regulate to the point that potential benefits of the products are lost.
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On Sunday, the Observer published a very negative editorial which repeated all the tired arguments put forward by ideological anti-vaping activists. It ignored the recent comprehensive review by the Office of Health Improvement and Disparities, instead choosing to amplify cherry-picked science, half-truths and hypothetical risks. It has been criticised by public health community experts in harm reduction for smoking cessation and is a perfect example of the irresponsible journalism that many public health groups have blamed for the poor perception of vaping and other lower-risk products amongst the public.
We have written to the Observer’s Reader’s Editor section to strongly condemn the editorial and also sent a shorter letter for publication as a letter to the Editor. You can read our full response here.
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The Dutch Government has opened a public consultation on the final stage of a proposal to ban vaping liquid flavours in the country by proposing an amendment to the Tobacco and Smoking Products Order. The consultation will run until 28 September and can be accessed at this link.
This proposal goes further than any flavour ban seen in other countries. The National Institute for Public Health and Environment (RIVM) and Ministry of Health have set out a list of 16 'approved' substances which can be used to make tobacco flavoured e-liquids. This effectively means a de facto ban on all e-liquids. All current e-liquids on the market, including tobacco flavours, would be prohibited and new flavours would have to be developed using only the 16 approved substances. Dutch vaping advocates have investigated the likely outcome and found that this would make it impossible for manufacturers to formulate any flavours at all and would effectively signal the end of the legal vaping market in the Netherlands. Consequently, it would also set a very dangerous precedent for the rest of the EU.
Although we currently have sensible regulations on flavours in the UK, a revision of the EU Tobacco Products Directive is upcoming and developments in the Netherlands could have an impact on its drafting. It is true that the UK has now left the EU but as we have emphasised before, politicians are influenced by what happens in other countries and it may put pressure on UK lawmakers to follow suit. It is also worth remembering the words of Clive Bates in a webinar we held in June 2020.
I would not count on [UK authorities] choosing [vaping] to be a particular hill to die on for divergence from EU regulations. I would not be complacent about this; you have a huge superpower on the doorstep. If [the EU is] going to go negative on this, it’s going to affect the whole world and the whole region including the UK. It’s our fight in the UK, not just for international reasons, although it is that as well, but also for UK reasons.
The NNA will be making a submission to the consultation, and we would urge our supporters to consider adding their own. Also, please encourage others on social media to do the same using the hashtag #smaaknoodzaak. Over 650 submissions have been registered so far which can be viewed here. To help with the process, European Tobacco Harm Reduction Advocates (ETHRA) has produced an excellent guide on how to submit a response in just a few simple steps which you can read here.
Just to reiterate, the closing date is Wednesday 28 September so please act now and beat the deadline.
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Last week, the EU Commission launched a call for evidence to assess its legislative framework for tobacco control. Its purpose is to evaluate if current tobacco control legislation has fulfilled its goals and whether or not it will further aspirations in Europe’s Beating Cancer Plan to achieve a tobacco free generation by 2040.
Various EU voices have been speaking of a “rapid rise” in emerging products such as nicotine pouches, heated tobacco, and nicotine free e-liquid which are not covered under the last Tobacco Products Directive (TPD) in 2014. They are also raising concerns about online sales and there is a sense amongst some that there is unfinished business from the last TPD. Many have expressed their wish for vaping to be treated in the same way as smoking. There is also much talk of bans on flavours, plus other restrictions on where products can be sold and used.
UK consumers may feel that this does not concern us now that we have left the EU but what emerges from this consultation will guide a review of the TPD which will be very influential globally and could have an impact here too. If you are a consumer reading this from an EU member state it will be a clear and present danger.
We hope many of you will take the opportunity to have your say by accessing the initiative here where you will also find a PDF file with extra information, available in 23 languages. Here is how to respond.
- Create an account and choose a password
- Click “give feedback”
- Choose your preferred language
- Type your comments in the box provided (up to 4000 words) and there is also an option to attach a file, should you wish.
- Then, once you are done, click to submit. Your comments will be instantly published.
The call for evidence runs until 17 June, after which a 12-week consultation process will take place.
It is important that the consumer view is respected in an exercise such as this, so please do tell the EU your story and emphasise why the TPD review should embrace harm reduction, rather than imposing restrictions which will make reduced risk products less accessible and less appealing for smokers who may be considering trying them.
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A fortnight ago we saw the publication of the government’s post-implementation review of the Tobacco and Related Products Regulations 2016 (TRPR). These are the regulations which govern vaping in the UK after having been transposed from the European Union’s Tobacco Products Directive.
The government has decided that the regulations “met their original objectives and they could not be better achieved through alternative regulatory measures”.
While it is disappointing not to see immediate signs of regulations being relaxed post-Brexit, such as the limits on tank and bottle sizes and a recognition that the limit on nicotine concentration is inadequate as we have commented on before, we are pleased that the UK has not been seduced by more restrictive regulations which are being pursued in other countries.
However, the report did signal amendments to the legislation could be implemented in the future.
“However, the Government will consider further regulatory reforms to TRPR as part of its plans towards meeting its Smokefree 2030 ambition, and to protect future generations from the harms of tobacco. This includes those reforms suggested by respondents to the consultation. Any proposed changes will be based on robust evidence and support improvements to public health.”
We would, of course, hope that any future reforms will be sympathetic to reduced risk nicotine options, but the summary does not exclude putting up more barriers.
As consumers who have experienced the benefits of harm reduction in our own lives, the NNA believes the arguments for relaxing regulations are far more evidence-based than those put forward in favour of imposing more restrictions.
It should be recognised that, although regulations remain as they are for now, by doing so the government has clearly signalled that vaping is beneficial to public health in the UK and that there is no cause for alarm despite misinformation rife in media and elsewhere.
However, we believe the regulations could be improved by relaxing pointless vaping controls which only serve to inconvenience vapers and deter smokers switching, but also by better acknowledging the positive contribution other harm reduction options can provide.
As we explained in our submission to the ongoing Independent Tobacco Review, which you can read here, the only credible approach which would achieve the government’s Smokefree 2030 goal is to go "all in" on tobacco harm reduction to encourage mass-switching to all smoke-free alternatives to cigarettes, not just vaping. Heated tobacco and nicotine pouches are available on the market, but many smokers know little about them, while snus has delivered remarkable results in Scandinavian countries but is subject to an unjustifiable EU-wide ban which should be lifted now we have left the European Union.
We hope that regulations will be amended in the future to remove some of the pointless restrictions on vaping, but also to enable more accessibility and publicity for all non-combustible lower risk products. The NNA will continue to advocate for harm reduction in all its forms as a powerful tool in attracting smokers to safer alternatives.
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Last month, newly appointed Minister for Brexit Opportunities and Government Efficiency, Jacob Rees-Mogg, invited the public to suggest petty regulations that should be abolished now that the United Kingdom has left the EU.
Writing in The Sun newspaper, he said that “Brexit opportunities and government efficiency have the same ambition: Making the lives of British people easier.”, adding “I implore you all to write to me with the regulations you want abolished.”
The NNA has written to Mr Rees-Mogg to make the following suggestions which we believe would make life easier for millions of UK vapers and also help the government in its goal of achieving smokefree status for the UK by 2030.
- Eliminate pointless restrictions on vaping tank and refill container sizes
- Remove the 20mg/ml limit on the strength of nicotine e-liquid
- Lift the EU-imposed ban on snus
You can read our letter here or below.
Supporters and followers can also make suggestions by emailing Mr Rees-Mogg at
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Today is No Smoking Day, an annual event which seeks to encourage smokers to consider making an attempt to quit. This year’s theme is “Don’t give up on giving up. Every time you try to stop smoking, you’re a step closer to success.”
As the theme suggests, many smokers have made repeated attempts to quit without achieving their target. Currently, nicotine replacement therapy (NRT) options such as patches and gum are the first products offered to smokers and often fail to lead to the desired conclusion. It is good that vaping is increasingly recommended by smoking cessation services and the NHS but often it is considered only as a last resort.
We believe that people who smoke stand a much better chance of stopping smoking if they are comfortable in doing so, which is why we advocate for wide availability of reduced risk products as options for those who choose to quit. Combusted tobacco is the cause of harms, not nicotine, so devices which deliver nicotine in a safer manner should be widely promoted.
Unfortunately, we feel that current alternatives are being unnecessarily limited and that many smokers are either unaware of the products or have been misinformed about their safety and effectiveness.
Studies have shown that vaping is more effective for helping smokers to quit than traditional NRT and therefore public health organisations should be more willing to recommend vaping products to smokers, not just when all else fails. Many smokers are not comfortable with the clinical nature of NRT and smoking cessation services, as they do not consider themselves ill and requiring medical treatment but could more easily quit if reassured that a visit to a vape shop is not something they should be wary of.
Additionally, although UK authorities should be applauded for leading the world in seeing the benefits of e-cigarettes, which has brought very successful results by way of a significant decline in smoking prevalence in the past ten years, vapes are not the only lower risk choice out there.
It has been disappointing to note the reluctance of the UK government in recent months to fully recognise the potential of products such as nicotine pouches and heated tobacco, and it does not make any sense to perpetuate the European-wide ban on snus now we are no longer in the EU, as seems to be current government policy.
For smokers to be spared repeated failures, as this year’s No Smoking Day tacitly concedes, there needs to be better awareness given to the full range of reduced risk products on the market, not just the ones that government feels at ease with.
Many smokers who have tried vaping but found that it does not work for them may fare better with the more tobacco-like experience of heated tobacco, but as advertising of these products is banned, large sections of the smoking public are simply unaware that they exist. Nicotine pouches are on sale as a consumer product but there is little information about them from health groups as to how they may help people to quit combustible tobacco.
There also needs to be a more concerted campaign to counter the misinformation and confusion about reduced risk alternatives. The public has been so bombarded by scare stories about vaping that Public Health England’s latest Vaping in England report stated that 38% of current smokers believe vaping is as harmful as smoking when we know it is orders of magnitude safer. There is similar, if not worse, negative coverage of heated tobacco, especially, but also nicotine pouches.
Lastly, it is also important to understand that smokers continue to smoke because they find it pleasurable. Reduced risk options which can replicate or exceed the enjoyment smokers get from combustible tobacco are more likely to lead to quitting. Not all people are the same and what works for some may not work for others, so all safer nicotine products have a role to play in order to maximise the number of people who successfully transition away from lit tobacco.
No Smoking Day’s theme is a good one, as it is right to encourage persistence if a person who smokes would rather not. However, for best results, we believe that all safer nicotine products should be made widely available, including lifting the ban on snus; smokers should be made fully aware of the variety of options on the market; and there needs to be far more emphasis on debunking misinformation about all reduced risk products.
If we want to help smokers to fast-track their way out of smoking, instead of enduring numerous failed attempts, let’s make every choice accessible and limit none.
To learn more of how we believe tobacco harm reduction can help more smokers quit and contribute to the Smokefree 2030 goal, read the 20 proposals we put forward to the government’s Independent Tobacco Review here.
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The Scottish government has launched a public consultation exercise for a new policy paper entitled “Tightening rules on advertising and promoting vaping products”. As the title suggests, the proposals seek to place unnecessary obstacles in front of raising awareness about vaping products in Scotland. The EU Tobacco Products Directive, which the UK ratified prior to Brexit, already stipulates bans on vaping adverts on TV, in newspapers and in magazines, but this new initiative from the Scottish government aims to treat vaping products the same as cigarettes by prohibiting in-store promotional displays as well as ads on billboards, bus stops and anywhere else currently permitted. The plans would also prohibit vape companies from sponsoring any event or activity and ban free or cut-price samples.
This threatens to make vape products effectively invisible and would mean Scotland having the most draconian advertising regulations for vaping products in Europe. The Scottish government claims to be committed to a policy of being smokefree by 2034 yet are now proposing making the most effective cessation devices in recent years hidden from smokers.
In short, these proposals from the Scottish government will protect the cigarette trade by making safer alternatives less visible, less accessible, and by raising doubts in many people’s minds as to their relative risk compared with smoking.
The NNA will be submitting a comprehensive response to this misguided set of proposals, but it is open to individuals too, so we encourage all to respond. Here is our guide on how to do so.
Consultation details:
The closing date is 28th April. Be sure not to miss the deadline or your response will not be considered.
The online form is available at this link and will not take too long to submit. If you do have time, though, we would encourage you to make good use of the opportunity to fully explain why you chose your responses in the further comments box provided for every question.
You can also email your response to
The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016
Consultation on Regulating Domestic Advertising and Promotion of Nicotine Vapour Products in Scotland
Tobacco Control Team
Scottish Government
St Andrews House, 3E Regent Road
Edinburgh
EH1 3DG
Questionnaire:
The consultation consists of 10 questions after an initial declaration of whether the respondent has any direct or indirect links to the tobacco industry. We have provided a rough guide of the questions below with our thoughts on the issues involved:
Question 1: Do you agree that we should be seeking to limit use of these products as a cessation aid and restrict exposure to non-smokers?
The focus throughout the consultation is on vaping being treated “purely as a smoking cessation aid” with a view to “gradually quit[ting] completely”. Indeed, the Ministerial Foreword specifically states that “Vaping products should only be used as a tool to help people stop smoking tobacco. They are not a lifestyle accessory.”. This fundamentally misunderstands the appeal of vaping as an alternative to smoking and would render vaping products far less effective. While it is unwise for non-smokers to take up vaping, too heavy a focus on preventing them doing so would also deter smokers from switching. Furthermore, viewing vaping as just a different kind of nicotine replacement therapy takes away one of the most attractive features of vaping, which is that it enables smokers to continue enjoying nicotine but in a far less harmful way. Vaping also works for many people who did not intend to stop smoking but ended up doing so, known as accidental quitters. If vaping is marketed only as a smoking cessation device those people may never try vaping and would continue to smoke.
As with all the questions, a box is provided to explain why you chose yes, no, or don’t know as your answer. In this instance the NNA will be answering no due to the reasons we have given above.
Question 2: Do you agree with proposal to extend restrictions on advertising these products in the ways described above?
The consultation document prefaces this question by saying that the Scottish government is taking a precautionary approach due to “the limited evidence on the long-term health impact of vaping”. We would argue that making safer alternatives less visible to smokers is reckless rather than precautionary as it will mean fewer smokers being aware of vaping or, worse, more believing that vaping is as harmful as smoking. Vaping products have been available in the UK since 2007 with negligible evidence of any resulting harms. Restricting all marketing of the most popular aid to quitting combustible tobacco because of future harms that have not been seen in a decade and a half is a gross over-reaction. The NNA will be answering no to this question.
Question 3: Do you agree with proposal that in-store promotional displays should be banned?
Again, this would make vaping products less visible to smokers. The Royal College of Physicians has stated that e-cigarettes should be promoted “widely as substitute for smoking” so this proposal is counter-productive and would lead to fewer smokers switching. Vapers also need information as to which products are available in the marketplace to improve their experience and prevent relapse. The NNA will be answering no.
Question 4: Do you support the proposal to make brand-sharing an offence?
This measure seeks to “prohibit vaping products from either carrying another product’s brand on a device or packaging or have the branding of a vaping product on any other products”. This would mean vaping manufacturers could not produce branded items such as T-shirts, baseball caps or any other promotional item. This treats vaping exactly the same as cigarettes which can only persuade many people that they are equally harmful. The consultation document admits that this measure is just copied from regulations on combustible tobacco. It is important that a clear distinction is made between smoking and vaping so the NNA will be answering no to this question.
Question 5a: Do you support the proposal to make free distribution of vaping products an offence?
Question 5b: Do you support the proposal that nominal pricing of vaping products should be an offence?
Vaping products are new and competing with well-established incumbent products - cigarettes. Marketing and promotions are needed to highlight the products and to provide information on how they work and how to use them, especially for new users. Many vapers will have initially switched from smoking after sampling a vape product, redeeming a coupon or taking advantage of a cheap deal. This proposal would make these illegal. The consultation document says that “Restricting free distribution and nominal pricing would stop businesses giving away to the public any product or coupon where the purpose or effect is to promote a vaping product”. There is a specific exemption for the NHS and charities which means the Scottish government is aware that such promotions are useful for attracting smokers to vaping. It is therefore counterproductive to ban methods by which smokers may be tempted to start vaping instead. The underlying message this proposal seeks to send is that vaping is for health professionals to give out, not businesses. Much of the appeal of vaping is precisely because smokers do not view themselves as sick and needing treatment and many favour a vape shop over a clinic. It is irresponsible to take away options for smokers and vapers in an attempt to recast vaping as purely for cessation rather than pleasurable too. The question comes in parts a and b, but it’s a no from the NNA to both of them.
Question 6: Do you support the proposal to make sponsorship agreements in respect of vaping products an offence?
There may be certain activities where it may be unwise to apply sponsorship from vaping manufacturers, but by no means all. Under the guise of protecting children and non-smokers, this proposal states that “Vape products should not be associated with clubs, events, activities, individuals or groups”. Again, the consultation document draws parallels with the tobacco industry in an attempt to demonise businesses which are helping smokers to quit. There are many events and activities where vaping sponsorship would be perfectly acceptable. We will be answering no to this question too.
Question 7: Do you support the proposal to introduce exemptions to allow advertising at trade-only events?
It is essential for any business to advertise within the trade in order for products to improve over time, so the NNA will be answering yes to this question. However, it is worth noting that this exemption does not include public days at Vape Shows and Expos.
Question 8a: Do you support the proposal that fines and penalties should mirror those already in place for tobacco products?
Question 8b: Do you support the proposal that defences should be as laid out as above?
Question 8c: Do you support the proposal that officers of local authorities should be responsible for enforcement?
Question 8 relates to punishments for contravening the new advertising restrictions. Question 8a specifically states that the proposals intend to mirror those applied to cigarettes. Numerous health bodies have advised that the distinction between vaping and smoking should be made clear, yet the Scottish government wishes to treat both products the same throughout these proposals. On the basis that we disagree with the advertising restrictions being proposed in this consultation, we would also disagree that business should be fined for attempting to help smokers to quit so the NNA will be answering no.
Question 9a: Please indicate the impact the proposed policy would have on individuals.
Question 9b: Please indicate your view on the impact of the proposed policy on people living with socio-economic disadvantage?
Question 9c: Please identify communities or groups who may be impacted by these proposals
Question 9 attempts to assess the impact these new regulations would have on the public. It is clear that if advertising is prohibited fewer smokers will be attracted to switch to safer products. Smoking is far more prevalent in lower socio-economic communities and taking away information will only lead to fewer of those smokers quitting by way of vaping. The proposal would also have a significant impact in convincing large swathes of the public that vaping is as harmful as smoking. We can only see negative consequences arising from the proposals, so the NNA will be choosing “negative impact” from the choices provided.
Question 10: Further comments
This question is an invitation to add your comments on the proposals in general. If you are a vaper, take this opportunity to tell your own story and how restrictions on advertising may have prevented you from switching to vaping in the first place. You may wish to point out that Scotland’s goal of being smokefree by 2034 will be threatened by these measures by hiding vaping products from adult smokers who may benefit from being made aware of them via advertising channels. You may also wish to comment on any aspects of the evidence provided in the consultation document which you find questionable. Much of the narrative seeks to present vaping as a harmful activity by cherry-picking sources and over-emphasising the threat of children taking up the products despite all surveys to date concluding that youth use of vaping products in the UK is very rare in those who were not former smokers. You could emphasise that the allure of vaping to very many is precisely that it is not considered as solely a smoking cessation product, but as an alternative way of consuming nicotine which is orders of magnitude safer than smoking. Or you may wish to comment on the potentially damaging consequences to the public perception of reduced risk products by treating vaping in the same way as smoking.
We hope you will take the opportunity to respond to this consultation as the tone and content of the proposals are sinister and can only result in less favourable outcomes than the status quo. If you choose to respond, make your case clearly and firmly but please remember to be polite and constructive.
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Although other priorities have occupied politicians for many months, government minds are beginning to focus on other policy areas which have been side-lined during the pandemic. On 31st January, it was announced that there would be a refocus on advantages to be gained from the UK leaving the European Union with the release of a report entitled The benefits of Brexit - how the UK is taking advantage of leaving the EU. Page 83 of this report spoke of the government’s tobacco policy and potential post-Brexit reforms:
Helping people to quit smoking. The UK is already recognised as a world leader in tobacco control and has made good progress reducing smoking rates. However, with around six million smokers in England and stark health disparities associated with smoking, more still needs to be done to help people to quit smoking. We have now launched a rapid independent review to identify which policies and regulatory reforms will be most impactful in supporting our 2030 Smokefree ambition, including where it may be beneficial to go further than the EU’s Tobacco Products Directive allowed us to. We will set out proposals for our regulatory reforms in a new Tobacco Control Plan due to be published later this year.
Furthermore, just a couple of days later a new long-awaited levelling-up white paper was launched which includes a series of medium-term “missions”, or targets. Amongst them is a goal of reducing the gap in healthy life expectancy between the richest and poorest areas and improving wellbeing in every area of the country.
Tobacco harm reduction can play a significant role in advancing both these government agendas and the NNA has already formulated a set of proposals which will do exactly that if they are adopted.
We wrote to the Department of Health and Social Care and the Number 10 Policy Unit to suggest post-Brexit tobacco and nicotine policy reforms in October 2020 and followed up with another letter in May 2021 with proposals set out a wider policy agenda along the same lines.
Our recommendations are just as relevant now – in fact more so considering the announcements this week – as they were then and fit both post-Brexit reform and the levelling-up initiative well. Based on driving behaviour change through consent and consumer choice rather than what some members of the public see as coercion, the proposals are simple, involve minimal cost to the taxpayer and we believe they would be effective in aiding the government’s Smokefree 2030 aspiration. Namely:
1. Lift the ban on oral tobacco (snus) and properly regulate all smokeless tobacco
2. Raise the limit on nicotine concentration in vaping liquids to allow vaping products to compete more effectively with cigarettes
3. Replace bans on advertising of vaping products on TV, radio, internet and in publications with controls on themes and placement
4. Replace blanket bans on advertising of low-risk tobacco products with controls on themes and placement
5. Replace excessive and inappropriate warnings on vaping products with risk communications that encourage smokers to try switching
6. Replace excessive and inappropriate warnings on non-combustible tobacco products
7. Allow and enable candid communication of relative risk to consumers
8. Adopt a fresh approach to pack inserts for both vaping products and cigarettes to encourage switching to lower risk products
9. Remove wasteful restrictions on vaping product tank and e-liquid container size that have no discernible purpose
10. Recognise and regulate novel oral nicotine products
You can read our previous communications here and here.
On the opportunities presented by Brexit, the government has many more options for helping people to quit smoking now we are out of the EU, but we have seen very little appetite for taking advantage of these so far. In fact, we have noticed a worrying trend of parliamentary messaging which seems to be favouring vaping but moving away from harm reduction in all its other forms. The regularly repeated government mantra that “all tobacco products are harmful” fails to recognise the huge difference in risk between combustible tobacco and far safer non-combustible alternatives such as heated tobacco and snus.
As our proposals set out, the UK government now has the option of removing some of the arbitrary rules imposed on vaping products under the Tobacco Products Directive such as bottle and tank sizes which serve no valid purpose except to frustrate vapers and deter smokers who may otherwise choose to switch, and the UK could also choose to liberalise the cap on nicotine strength which we believe is set too low under TPD regulations to adequately attract hard-to-reach smokers.
There is also still no reason whatsoever for perpetuating the EU ban on snus in the UK. Sweden and Norway – where snus is widely available – both recently reported even lower smoking rates than ever with combustible tobacco becoming a niche product as people switch to snus instead. Smoking prevalence in Sweden is now down to an enviable 6% while Norway looks to be on the verge of a smoke-free generation as smoking among 16- to 24-year-olds has dropped from 12% to 1% in a decade.
On levelling-up, research has consistently shown that smoking is more prevalent in lower socioeconomic groups. The government can seek to improve economic conditions for less well-off communities but to achieve the levelling-up of life expectancy and improve wellbeing, ensuring wide availability of all reduced risk nicotine options for smokers – and, crucially, ensuring they are aware of them - is not just a wise idea, but also a cost-effective one.
We intend to write again to the government soon to re-emphasise the value in our proposals and how they dovetail with this week’s policy announcements. We invite NNA supporters to do the same by contacting their MP and directing them to our sensible proposals.
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Tobacco: preventing uptake, promoting quitting and treating dependence
In a world where tobacco harm reduction, specifically vaping, is stigmatised daily by policy-makers and scientists desperate to search for harms and dangers of a technology that, if adopted and supported worldwide, could have already slashed rates of smoking, the new NICE guidance Overview | Tobacco: preventing uptake, promoting quitting and treating dependence | Guidance | NICE published 30.11.21 is a welcome breath of fresh air. Although conservative and cautious, as NICE guidance has to be, based on evidence rather than testimony or optimism (as my Stop Smoking Service’s vape-launch was in early 2014), this provides a clear message to the rest of the world that here in the UK at least, there is support for the use of vaping to stop smoking. Vaping for recreational purposes is not considered, of course; that is outside the scope of the guidance, but longer-term nicotine use is addressed, and that is welcome.
NG209 provides a disclaimer about medically-licensed products:
"At the time of publication (November 2021), no nicotine-containing e-cigarettes were licensed as a medicine for stopping smoking by the Medicines and Healthcare products Regulatory Agency (MHRA) and commercially available in the UK market. All nicotine-containing e-cigarettes in the UK that are not licensed as a medicine by the MHRA are regulated by the Tobacco and Related Products Regulations 2016, and cannot be marketed by the manufacturer for use for stopping smoking."
Whether a product ever gets a medicinal license remains to be seen. The barriers are high and the costs even more so. Opinion is divided on whether this helps get more ‘respectability’ for the category, but it cannot be denied that being able to prescribe to young smokers, or those in hospital, could be a benefit.
The NICE take on nicotine is something that other countries’ medics, researchers and policy-makers could well heed:
Provide the following information about nicotine:
- smoking is highly addictive mainly because it delivers nicotine very quickly to the brain and this makes stopping smoking difficult
- most smoking-related health problems are caused by other components in tobacco smoke, not by the nicotine
- nicotine levels in medicinally licensed nicotine-containing products are much lower than in tobacco, and the way these products deliver nicotine makes them less addictive than smoking.
The references are about licensed nicotine-containing products, because that’s where the evidence is found, and the emphasis on relative harms of smoking and non-combusted nicotine use serve to strengthen the argument for nicotine without the smoke.
"Provide the following information about the effectiveness and safety of medicinally licensed nicotine-containing products:
- any risks from using medicinally licensed nicotine-containing products are much lower than those of smoking; nicotine replacement therapy (NRT) products have been demonstrated in trials to be safe to use for at least 5 years
- lifetime use of medicinally licensed nicotine-containing products is likely to be considerably less harmful than smoking"
The language used by NICE makes a positive and welcome contribution to de-stigmatising the use of nicotine, and the term ‘dependence’ has begun to replace ‘addiction’. Even more importantly though, there is a distinct move towards an open-minded and person-centred approach, not regarding vaping as an option of last resort. It also recommends that extra information on how to make that first step wouldn’t go amiss.
"Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it.
Advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:
- varenicline (offered in line with NICE’s technology appraisal guidance; see stop-smoking interventions in the NICE Pathway on tobacco use)
- a combination of short-acting and long-acting NRT
- nicotine-containing e-cigarettes"
A criticism that I would raise is the assumption, below, that youth vaping leads to youth smoking. This confuses correlation with causation and should be corrected; many factors influence the uptake of smoking and must be taken into consideration.
"The committee wanted to discourage e-cigarette use among young people and young adults who do not smoke because evidence shows that use of e-cigarettes is linked with a higher chance of ever smoking later in life. The committee members agreed that ideas about smoking and what is normal can start from a young age so the recommendation should also apply to this age group."
The simple statement below should be noted, especially where evidence reviews cherry-pick research to ‘prove’ that vaping does not help smoking cessation. If more was done to give people who smoke the confidence that vaping can help, and is not the same as smoking, more people would switch.
"They also agreed that offering behavioural support to people using nicotine-containing e-cigarettes would increase their chances of stopping smoking.
Evidence showed that nicotine-containing e-cigarettes can help people to stop smoking and are of similar effectiveness to other cessation options such as varenicline or long-acting and short-acting NRT.
There was a small amount of evidence about short-term adverse events of e-cigarettes that did not show that they caused any more adverse events than NRT, e-cigarettes without nicotine or no treatment."
On health harms, the guidance is clear that so-called EVALI outbreak was restricted in place and time, and the risks controlled by effective regulation.
"The committee discussed the outbreak of serious lung disease in the US in 2019, which US authorities identified was largely caused by vaping cannabis products containing vitamin E acetate. They also noted there has been a Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update highlighting serious lung injury with e-cigarettes issued in January 2020 (E-cigarette use or vaping: reporting suspected adverse reactions, including lung injury). The committee discussed that the UK has well-established regulations for e-cigarettes that restrict what they can contain. Experts from the MHRA described to the committee the monitoring process for both short- and long-term harms of using e-cigarettes. Monitoring is ongoing and the evidence may change in the future, but the committee was not aware of any major concerns being identified."
The following paragraph could have been strengthened, in my opinion. Less harmful – good to emphasise, and I sincerely hope that the healthcare community takes note of this, instead of telling their patients that vaping is as bad as, or worse than, smoking. The caveat about only as long as they need is a mixed message. Some people will need that for life. I’ve seen too many people lapse even years later, and if vaping keeps them smokefree forever, that’s a win. However, pleasure from vaping (outside the scope of NICE guidance), should also be recognised, especially when put in the context of pleasure from enjoying alcohol, eating chocolate and drinking coffee.
"The [committee] agreed that because many of the harmful components of cigarettes are not present in e-cigarettes, switching to nicotine containing e-cigarettes was likely to be significantly less harmful than continuing smoking. So the committee agreed that people should be able to access them as part of the range of interventions they can choose to use. They also agreed that people should be given up-to-date information on what is known about e-cigarettes to help them make an informed decision about whether to use them. The committee agreed that with the limited data on effects of longer-term use, people should only use e-cigarettes for as long as they help prevent them going back to smoking. They also agreed that people should be discouraged from continuing to smoke when using e-cigarettes, even if they are smoking less, because there is no information on whether this will reduce their harm from smoking."
I was concerned about the guidance for healthcare professionals that they should talk to patients about:
- How long the person intends to use nicotine-containing e-cigarettes
- Using them for long enough to prevent a return from smoking and
- How to stop using them when they are ready to do so
No one really knows how long they intend to vape – as experience develops, minds are changed. An individual may decide to stop sooner than they really should, and risk going back to smoking, or they could choose to continue vaping for the foreseeable future. They will not know, within weeks of switching, how their choices will change. Also, there are certain or universally-applicable ways of stopping vaping; clinical experience in my service demonstrated that people are generally comfortable with reducing the strength of their vape, and stopping if that’s their choice, without any intervention from support services.
The statement below is a hidden gem, appearing as it does towards the end of a very long document. Not enough nicotine is one of the primary reasons for failure when trying to stop smoking. Even would-be quitters who use a vape tend to think they are better off with a non-nicotine vape, and wonder why they cave and grab a cigarette. Use enough, people!
"The committee discussed that it is more likely that people will not get enough nicotine to help them stop smoking, than get too much. They agreed that not getting enough nicotine is likely to increase the risk that the person will return to smoking, so they recommended that people should be encouraged to use as much as they need and told how to use the products effectively."
And finally, an appeal to the interests of commissioners and providers: a little extra effort could increase success in quitting, and save money in treatment costs for smoking-related illness.
Extra time may be needed to discuss e-cigarettes with people who are interested in using them. If these recommendations lead to more successful quit attempts, this may mean fewer appointments per person and substantial savings in downstream costs associated with smoking.
I believe that the committee worked extremely hard to get the balance right, and I’m sure that some members deserve a special round of applause for their determination to have the vaping category included. It would have been so easy to default to licensed medications only, thus missing an exceptional opportunity to push down rates of smoking, by recognising that switching to vaping will save lives.
Louise Ross, December 2021
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On Tuesday the Office for National Statistics – the UK government’s official agency for assessing economic and social behaviour – released their latest statistical bulletin on smoking prevalence. It made for interesting reading:
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- The proportion of current smokers in the UK has fallen significantly from 14.7% in 2018 to 14.1% in 2019.
- In Great Britain, 5.7% of respondents in 2019 said they currently used an e-cigarette, which equates to nearly 3 million adults in the population.
The number of vapers in the UK has not changed much since previous assessments, but smoking prevalence continues to decline at a significant rate.
Many of the direst predictions of the effect of safer nicotine products – not just here but in other countries - have often focussed strongly on the possibility of a ‘gateway’ from vaping to combustible tobacco use, especially amongst youth. However, in the UK where regulations on reduced risk products are arguably the most liberal in the world, this is simply not happening.
These figures seem to endorse the government’s willingness to allow vaping and other safer nicotine delivery systems to flourish. Who knows how many dual users have now transitioned entirely to vaping amongst that static population of 3 million e-cigarette users? Additionally, how many of the statistically significant number of smokers have switched to other safer products not studied in this analysis such as heated tobacco and tobacco free nicotine pouches which are now sold in UK supermarkets?
One thing that seems certain is that if anywhere was to see a big gateway effect from widespread use of vaping products and other alternatives, it would be here in the UK. But there is no apocalypse as predicted by negative soothsayers, it would appear that normalising alternative products merely normalises switching away from smoking.
It is also worth noting that this decline is in the face of some atrocious media headlines and heavy funding of bad news from conflicted sources. One can only conclude that if the fear merchants would stop spreading myths and half-truths to the British public, the declines could be even more impressive than they already are.
So, it seems that the end is not nigh at all if a government supports tobacco harm reduction; these statistics suggest the complete opposite is true.
It is a shame that other nations are not enlightened enough to recognise the benefits of vaping and other reduced risk products, and that their governments refuse to take their blinkers off and look at the overwhelming scientific evidence in favour of alternatives to smoking. The ONS has just added to that evidence and there must surely come a time when common sense prevails not just here but in other jurisdictions too.
If anything, this news should encourage the UK government to be even bolder and further relax restrictions on safer nicotine products to make them more visible to the 52.7% of smokers who the ONS has concluded want to quit. Outside of the EU, this is an eminent possibility for the UK, and we hope that the opportunity will be embraced.
Franklin D Roosevelt is famously quoted as saying that, sometimes, there is nothing to be feared except fear itself. This latest evidence shows that this is especially true of tobacco harm reduction policies.
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It has come to our attention that Kind Consumer – the company behind medicinally licensed smoking cessation device, Voke – is exploiting deaths attributable to black market THC liquids in the USA to promote its product.
A slide presentation to investors by the company made the claim that Voke is preferable to e-cigarettes because there have been “numerous recent cases of lung disease and death in individuals who use vape products”. This is completely untrue of legal vaping products and we unreservedly condemn their approach.
We realise that business is business and Kind Consumer wish to differentiate their new product from vaping, but repeating information that they know very well is false is not the way to do this. It is especially scurrilous when you consider that they are using the fraudulent information to raise significant levels of funding to the tune of tens of millions of pounds.
There is room in the safer nicotine market for many players, and we would ordinarily welcome Voke adding a new option for smokers wishing to quit. However, they should not be trying to build their success by shoving vaping under a bus.
Kind Consumer should instruct their fund-raisers and marketers to abandon this approach. It is unhelpful and shameful opportunism. If their product has merit, they should not have to sink to employing baseless scare stories which have deterred large swathes of smokers from switching away from lit tobacco.
As we said in September last year on this subject:
We … condemn the many bad actors who are fanning the flames of this false panic. Whether it is journalists chasing click-bait or ideologically driven harm reduction sceptics in the UK health community, they are actively deterring many thousands of smokers from either opting to switch to a far safer form of nicotine consumption or guiding those who may be using e-cigarettes to move back to smoking, based on no proper evidence whatsoever.
This is not a game. Their crass conflation of vaping with illicit, unregulated and deadly illegal drug-containing liquids will cost lives and they should be thoroughly ashamed of themselves.
It is sad to see Kind Consumer endorsing such a shabby business model and we hope that they will ensure that it is not pursued any longer.
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There is much talk of further measures to control the outbreak of Coronavirus, but closure of vape shops should on no account be considered.
We are living through extraordinary times, with restrictions on personal freedoms – understandably - not seen since the second world war. It is essential that all of us observe the advice of the government, but the NNA hopes that if a rumoured ‘lockdown’ were to happen, vape shops would be excluded on public health grounds.
We have seen other countries such as France and Italy recognise this by exempting premises supplying vaping equipment and liquids from their general order for businesses to close. They have acted wisely, and we would urge the UK government to follow their lead.
These are very stressful times and access to safer nicotine products must be maintained. Supermarkets do sell some vaping products, and - while they are very helpful to many former smokers - they are expensive, with little variety, and do not cater for a large sector of society. Vaping has made a large contribution to the UK’s public health by attracting smokers away from combustible tobacco, and furthermore preventing relapse. It is important that this continues.
Vape shops are typically low key and do not attract crowds, so there are sensible social distancing measures which can easily be taken to ensure that vapers can continue to access the products they have found so useful in reducing risks to their health. There are online options for purchasing vape products, but it would be irresponsible to deny those who are not ‘net savvy’ the services that a bricks and mortar outlet gives them.
The NNA represents all current and future consumers of safer nicotine products, not industry, but we agree with trade bodies IBVTA and UKVIA who have both indicated that vape shops are a key resource and should remain open. The last thing we need during a public health crisis is to encourage another by closing off reduced risk options and leading many to return to smoking widely accessible tobacco.
We hope all our supporters stay safe during this difficult time and that availability of the supplies you need are considered as essential by government as we all know they are.
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Last week we reported on a quite shameful ITV ‘investigative’ programme – broadcast during prime time – which smeared e-cigarettes and vaping products without editorial balance, and seemed to have been put together without any serious investigation whatsoever.
We said that ITV should be ashamed of the misinformation that they thrust on the public and described it as “scientifically ignorant scaremongering” which “misled millions of people with the message that they should just carry on smoking”.
You can watch the appalling show at this link, and if you are inclined to complain to OFCOM about its shockingly poor standards – as many others have - you can do so here.
Fortunately, genuine investigative journalism – not the unthinking tabloid kind exhibited last week by ITV - has not yet fully died in favour of ignorant and sensationalist clickbait, as The Economist has proved with this very astute guide to vaping, published last week.
See the video below for something far more sensible.
- ITV should be ashamed of misleading the British public
- Vaping bans are harmful, it's official
- Government’s Green Paper is the wrong approach
- A fear that stubbornly refuses to be a problem
- TV doctor’s orders are that e-cigarettes are good
- My challenge to an NHS hospital’s vaping policy
- Vapers should prepare to steer clear of Hong Kong
- Urgent need for health professionals to be better educated about nicotine
- The many reasons why the #VApril campaign should be supported
- Government messages are still not getting through to NHS trusts
- E-cigarettes Priority Setting Partnership questionnaire
- PHE releases new film to encourage freedom of choice
- Truth allowed in advertising for e-cigarettes
- Dundee City Council take heavy handed action against smokers and vapers
- It shouldn't matter who makes safer products
- Italian vapers say people matter more than money
- Today’s Science and Technology Committee report is a step change in the UK’s approach to harm reduction
- NNA reacts to today’s vaping non-story
- Challenging a bad tobacco law: the legal challenge against the EU ban on snus
- Open letter to Pfizer
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