Boris Johnson is now our Prime Minister. He has a lot to do, but one of his jobs should be to water down his predecessor’s misguided proposals towards e-cigarettes and other safer nicotine products.
On Monday, the Cabinet Office and Department of Health and Social Care joint-released their intentions in a Green Paper, reportedly forced through by outgoing Theresa May against her Secretary of State’s advice.
We are setting an ambition to go 'smoke-free' in England by 2030. This includes an ultimatum for industry to make smoked tobacco obsolete by 2030, with smokers quitting or moving to reduced risk products like e-cigarettes.
While it is welcome that the government has exhibited confidence in reduced risk products, these proposals are extremely problematic and fail to understand the regulatory landscape, as well as the appeal of products like e-cigarettes which have been so effective at drawing smokers away from combustible tobacco. They should be revisited, if not scrapped in their entirety.
It is implied that a first ever developed world ban on smoking is on the cards. This is not only a dangerously naïve idea but could further distance current smokers from considering vaping as an option. Many smokers are suspicious of vaping because they feel it may just be a tool that government might use to coerce them into quitting; these proposals simply reinforce that fear.
For years, we have seen perception of the relative safety of vaping decline, and an idea such as this may dispel that amongst some smokers, but many more will see this as use of a stick instead of a carrot and reject it.
It is the quit or die mantra all over again but with added menace. Before, smokers were told they should use pharmaceutical products or else be abandoned to a lifetime of smoking, but they were free to make that choice. The suggestion now is more sinister. They are being told quit or we will force you to quit because we will make your chosen products illegal.
One reason that e-cigarettes have been successful since they went mainstream about seven years ago is that they are not seen as coercive. Smokers feel they are making their own choice rather than being forced into it. The same effect has been seen in Scandinavia where snus has transformed nicotine consumption to the point that lit tobacco use is becoming a rarity. Government has not encouraged the use of snus, nor mandated it, but smokers have chosen to use far safer snus instead.
If politicians want to see increased uptake of safer nicotine substitutes for smoking, they should do so by optimising the choice of alternatives such as e-cigarettes, snus and heat not burn products, not by the blunt tool of coercion and prohibition. A policy like that suggested in the Green Paper would instantly remove the allure of safer products for many smokers.
There are other impracticalities too that have either not been considered or ignored.
A demand that the tobacco industry force people onto safer products can only work if government institutions and public health acknowledge the role that the industry can play in this transition. Yet currently, industry is prohibited to even talk to policymakers and the public health community has spent the last decade attacking not only the tobacco industry for producing risk reduced products, but also portraying it as a sneaky covert campaign to further prolong smoking.
So are these public health organisations now going to come on board and engage with industry as to how to make these proposals work, because if not the proposal is dead before it has even begun.
Are we going to see UK public health groups now standing up to their global counterparts in defending industry and the reduced risk products they make because government has mandated that industry should focus on them? We very much doubt it.
Even if they do, how will this play internationally? The WHO and FCTC has set itself against harm reduction. If our public health organisations truly support this initiative, they have a reckoning ahead of them. They will have to divorce themselves from the overwhelming opposition from global tobacco control institutions and say they are now engaging with Big Tobacco, by order of the UK government. This is not remotely likely.
Will a set date of 2030 for prohibition remove objections from the WHO about involvement of tobacco companies in supplying vaping products to attract smokers? If tobacco companies were full square behind the government’s proposals, would this change the landscape between industry and NGOs? It’s another no.
E-cigarettes have become popular because they are not a medicine and are not seen as a government-mandated solution. Smokers do not see themselves as sick, they do not require treatment, so the use of coercion will only turn smokers off the products and prohibition will simply create a big black market in tobacco. France is not far away as we have seen before with high taxation.
A better policy from the government – if it truly wishes to tempt smokers from combustible tobacco – would be to stand up strong at COP9 in The Hague next year and strenuously defend reduced risk products against the contrived hysteria which is prevalent the world over and perverting debate about safer products globally. On a local level they could instruct their civil service to object to the EU ban on snus and demand that it be lifted now rather than later.
Reduced risk products have a huge role to play in moving towards a smokefree society, but they will not be helped by government committing to a blunt and misguided policy such as this.