Vaping as a recreational alternative to smoking - an holistic approach to tobacco harm reduction and smoking cessation (and pleasure).

vapefest2The UK is now a world leader in recognising the health benefits for smokers of switching to vaping on both an individual and population level. As a result the UK Government is taking a relatively liberal approach to implementation of the EU Tobacco Products Directive (the ‘TPD’) and seeks to impose only the bare minimum requirements therein. Despite this the new regulations will still be extremely damaging to public health, but the situation is better than it might have been. The achievements in the UK, such that they are, are largely down to a huge effort by vapers to educate politicians, regulators and those who influence them about the ways in which vaping has improved their health, lives and outlook.  

This might not have been possible were it not for the fact that among the public health community in the UK there are a number of individuals and key influencers who listened to consumers and were brave enough to step outside of the tobacco control party line and take a pragmatic view of tobacco harm reduction in order to achieve the potentially massive public health gains on offer via vaping. However, as time has gone by the discussions have been dominated by arguments over often misleading reports of trivial potential harms and the efficacy of vaping products for cessation. We stand a good chance of losing sight of the very essence of why vaping works as a way of reducing smoking. This would be a shameful waste of a great opportunity.  

Vaping is a consumer driven free market solution to the problems inherent in smoking tobacco. Naturally the public health community, including many of those who are pro-vaping, seize upon harm to health being the problem to be solved and a casual observer could be forgiven for thinking that is the only issue. This leads to a disproportionate amount of time and resources being expended on arguing the toss over whether vapour devices are efficacious as smoking cessation tools (millions of vapers world wide are proof that they are) or whether they will annihilate generations to come through nicotine addiction and the so far mythical gateway effects. Of course health is the most important consideration for those who come from a medical or health background, and indeed for many smokers, but it is not the only consideration for the ordinary smoker on the street.  

Tobacco taxes have made smoking extraordinarily expensive. Smokefree laws have made it inconvenient. Those policies, together with messaging around denormalisation, have led to the stigmatisation of not only smoking, but also of smokers such that there are now those within otherwise polite society who think nothing of abusing smokers and painting them as selfish, stupid, stinking child / cat killers. The ‘untermensch’ to be despised, the lepers without bells.

A rethink is required. Smokers are fellow human beings who make choices in life based on risks and benefits just as everyone else does, albeit free choice is made more difficult in the context of tobacco dependence. Like it or not, for many people smoking has value which outweighs the risks and that value cannot be replaced by bland medicinalised products. Concentrating on health benefits and promoting vapour devices purely as tools of smoking cessation whilst simultaneously brow beating smokers into submission fails to capitalise on many of the reasons smokers may have to switch to the safer alternative and may be off putting for those who do not see smoking as a medical problem, or themselves as patients.  

An holistic approach to vaping would recognise that its success as a popular alternative to smoking is not simply down to whether particular devices deliver sufficient nicotine to relieve cravings (although that is an important factor). To pretend otherwise is a mistake. Vaping is a thing of many parts, and the neglect of any one of them is to the detriment of the whole. It is a recreational activity in its own right and brings pleasures of its own. It is also both a movement and a community with its own peer to peer support mechanisms. It is a hobby, an opportunity for socialising and a way to relax. Switching to vaping is empowering for many smokers, who often feel alienated by the constant nagging from the medical community, and would prefer to find their own solution with the help of those who have trodden the same path.

At a recent meeting of the All Party Parliamentary Group on E-cigarettes Professor Gerry Stimson asserted that vapour product manufacturers, vendors and vapers themselves are the new frontline in smoking cessation. I’m sure that statement rings alarm bells in certain public health circles. Decades of tax, prohibition and denormalisation have had an effect on smoking prevalence but at great cost – both financial and social – which smokers bear more than anyone. And yet nearly one in five people in the UK still smoke. Gerry is of course absolutely right in his assertion above, but this was never the main intention of vapers or the vapour industry. They have filled a gap left by the failure of public health to deliver a solution. Why are they succeeding where others have failed, and without the need for stigma or cost to the public purse? Because of their holistic approach. Because they recognise the benefit of offering an attractive alternative instead of coercion. Because they were smokers themselves.  

If public health wants to capitalise on the health benefits of smokers switching to vaping it must accept all that it entails and not just the parts that suit its own agenda. It must accept vaping for what it is and not what it would wish it to be, and stand alongside vapers in the fight against those who would deny them the choices they've made. It must listen to vapers when they describe the damage the TPD will do, they have first hand knowledge of the issues and no vested interest other than their own wellbeing. Vaping is the sum of its parts and any attempt to separate those parts will end in public health failure.  


Sarah Jakes, NNA Trustee 18/02/16