Yesterday, Public Health England (PHE) released its seventh independent report on vaping in England, carried out by researchers at King’s College London (KCL), and it brings some encouraging news but also scope for improvement.
In an article on the UK government’s website, PHE announced that not only is vaping now the most popular aid used by smokers trying to quit in England, it is also the most effective, with up to 74% quit success rates in 2019 and 2020. The article declares, boldly, that vaping is now “better than nicotine replacement therapy for stopping smoking”.
There is further soothing news on vaping amongst young people, with PHE stating that “around 4.8% of young people (aged 11 to 18 years) reported vaping at least once a month – the same as last year – and most of these were either current or former smokers”. In fact, in a survey by Action on Smoking and Health which was included in the review, it was found that “not a single [11-18 year old] never smoker reported vaping daily, and only 0.5% were previous users of e-cigarettes”.
Considering much of the rhetoric trumpeted by opponents of reduced risk products centres on fears around youth vaping - and while it is certainly right that we continue to remain vigilant in this regard - these data suggest the answer to those pleading that we should ‘think of the children’ should be “what children?”.
The New Nicotine Alliance very much welcomes this latest review, but along with the good news, it also reports on the damage that irresponsible anti-harm reductionists are causing. As Ann McNeil of KCL observes commenting on yesterday’s report, “What is concerning is that smokers, particularly those from disadvantaged groups, incorrectly and increasingly believe that vaping is as harmful as smoking. This is not true and means fewer smokers try vaping.”
This is a direct consequence of shameful scare stories promoted by those opposed to vaping - regardless of evidence – and is having a tangible negative effect on public health. The lack of willingness to debate by those ideologically opposed to vaping is also increasingly proving that they have no arguments left in the face of yet more clear evidence revealed by PHE yesterday. Our view is that they should embrace new innovative options like vaping and abandon their obstructionist stance before they sink further into the realms of conspiracy theorists.
In the UK we are fortunate that PHE and KCL examine the evidence without prejudice or hostility to harm reduction and it is why we are leading the world on enlightened policy in this area, but we can improve on that to further emphasise the benefits of our approach. For example, PHE draw attention to the disappointing fact that only 11% of stop smoking services supply vaping equipment, despite the superior success they can achieve. We sincerely hope that stop smoking services, healthcare professionals, health and wellbeing managers and policymakers read this report and take note.
The NNA also passionately believes that vaping is just a test case for the principle of tobacco harm reduction and that the UK government should seize the opportunity of Brexit to cast off over-precautionary restrictions on other alternative products such as snus, heated tobacco as well as vaping, along with welcoming the promise that modern products like nicotine pouches can offer. In October, we wrote to the Department of Health and Social Care with our post-Brexit recommendations on this subject which you can read here.
Even more importantly, those governments hostile to tobacco harm reduction, and the WHO, should read yesterday’s PHE review and ask themselves how much more quickly they could drive down smoking rates if they adopted the open-minded and evidence-based approach taken in England.
The UK has seen a remarkable shift in forms of nicotine use in the past decade, with consumers themselves choosing safer products over lit tobacco. As a result, smoking prevalence in the UK has declined at an unprecedented rate at little or no cost to the taxpayer. This PHE report suggests that this should not just continue, but that the scope could be expanded.
The government has pledged to “maximise the availability of safer alternatives to smoking” in its ongoing Tobacco Control Plan (to be updated in July). This evidence shows that harm reduction is beneficial to public health – as is accepted in many other areas of policy - and we should not be shy of doing more of it when it comes to reducing the harms from tobacco use too.
Please respond to the UK government’s open consultation for the review of the legislation which applies to vaping products. Brexit gives us an opportunity to diverge from the EU’s Tobacco Products Directive (TPD) and it is crucial that we consumers tell the government what changes we want. We have lived with the consequences of the TPD, no one knows better than us!
This is an easy and quick consultation to do, as there are only 6 questions which relate to safer nicotine products. The consultation ends on 19 March.
LINK TO THE CONSULTATION:
Tobacco and related products legislation introduced between 2015 to 2016: reviewing effectiveness
Here are the questions which relate to safer nicotine products:
Questions 6 to 9 relate to vaping:
Question 10 relates to heated tobacco products:
And, lastly, Question 13 gives an opportunity to raise issues not covered in the other questions (NNA will use this space to say that the sale of snus should be legalised in the UK):
On the consultation page the government says that “there is opportunity to consider, in the future, further regulatory changes that help people quit smoking and address the harms from tobacco.”. In NNA’s submission we will call for future legislation to distinguish between combustible and non combustible products - i.e between products which are very harmful (cigarettes) and those which are significantly less harmful (vaping products, snus, nicotine pouches, heated tobacco products). The experience of snus - a pasteurised oral tobacco product which is far less risky to health than smoking - shows us that the current distinction between tobacco and non tobacco products does not benefit health.
In September we wrote to the government to suggest post-Brexit tobacco and nicotine policy reforms. Our letter might be useful to read when considering points to include in your consultation response:
NNA writes to the UK government suggesting post-Brexit reforms
Please also look at this excellent guide from We Vape on how to respond to the consultation:
UK Government consultation on vaping & related tobacco products
Do take some time out of your day to respond to this - and please let us know how you get on.
On Tuesday 17th November we wrote to Cancer Research UK to express our disappointment that they were “excited” about a Bloomberg-funded report which was designed to paint the consumer voice as somehow part of a mythical tobacco industry plot. We asked for “comments clarifying the position taken by CRUK towards consumer engagement on this matter” but have received no acknowledgement or reply. Sadly, the tweet in question still remains, celebrating consumers being marginalised when - quite rightly - objecting to opaque policymaking.
We have also complained about the original article which prompted the ill-judged reaction from Cancer Research UK, by submitting a response to the publishing journal which you can read here.
Consumers are most affected by decisions made about products which many have found beneficial to their health, so should not be treated in such a casual and dismissive fashion. We hope that these organisations will embrace consumer engagement in the future, instead of attempting to demonise us for simply making our voices heard.
Yesterday, the NNA wrote to the Parliamentary Under-Secretary of State for Prevention, Public Health and Primary Care at the Department of Health and Social Care – Jo Churchill – and the Director of the Number 10 Policy Unit – Munira Mirza – to suggest post-Brexit tobacco and nicotine policy reforms.
On behalf of UK consumers of vaping and other low-risk nicotine products, we proposed steps towards creating a coherent risk-based framework for all safer nicotine products to promote a post-Brexit win for both public health and personal and economic wellbeing.
We emphasised how the proposals would meet government targets and add to the levelling up agenda, involve no additional public spending while also offering an opportunity to 'take back control’ from the mistakes of EU regulation in this policy area.
You can read our ten key proposals and the full submission below & HERE.
Please participate in this exciting new survey on nicotine use in Europe. This is no ordinary questionnaire, it has been designed by nicotine consumers, for nicotine consumers, and consumers have translated it into eleven languages.
We are asking for your help in making this the biggest survey of its kind. These are uncertain times for nicotine consumers in Europe. For EU countries, the TPD is currently being evaluated and the European Commission is looking at the possibility of including safer nicotine products in the tobacco excise directive. Here, in the UK, Brexit is giving us an opportunity to diverge from the TPD restrictions. How do you use nicotine products? How do the current regulations affect you? What changes would you like to see? This survey will be crucial, in the UK and the rest of Europe, for examining how consumers use nicotine products and what regulatory changes would benefit smokers who may wish to quit.
The survey has been organised by European Tobacco Harm Reduction Advocates (ETHRA), a consortium of tobacco harm reduction consumer groups. NNA has been very proud to partner with ETHRA since its inception, to add the UK consumer voice to that of 21 other European consumer groups.
Please take just 5 minutes to do the questionnaire yourself and then help us to get a ton of responses, by sharing it on social media.
Link to the survey:
Do please get in touch if you would like embedded links in order to put the survey on your website.
Back in October, the NNA issued a press release calling on policymakers to lift the counterproductive and unnecessary EU-wide ban on snus. This followed a decision by the FDA in the United States – based on a rigorous assessment of the available science - to categorise snus to be “appropriate for the protection of public health”.
At the time, our snus expert, Mark Oates said:
“It is inexplicable why the EU continues to perpetuate the ban on European smokers choosing to switch to snus, not only is the sale of snus permitted in the USA but they have now allowed one company to make the undisputed claim that “using snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis”, the difference in approach could not be more stark, and it is the EU which is being reckless with its public’s health, not America.”
With more and more consumers in the UK, Europe and globally opting for safer forms of nicotine use rather than combustible tobacco, awareness has grown about the existence and properties of snus. In countries where it is legally sold, substitution of smoking in favour of snus has often been remarkable, including Sweden which has an exemption to the EU snus ban and whose smoking rate is subsequently dramatically lower than all other EU member states.
However, the UK government and the EU have stubbornly refused to accept that harms from snus are negligible to non-existent, and that the continued prohibition merely denies smokers a far safer option, should they wish to quit but find it difficult by other means.
However, last week we saw positive signs in the UK with an answer to a parliamentary question on the subject from Jo Churchill, Parliamentary Under-Secretary of State for the Department of Health. Asked if the UK government will make an assessment of the effectiveness of the ban on snus products, she responded:
“The Government will consider in due course reviewing the position on snus, and whether the introduction of this product onto the UK market would promote a proportionate approach to managing risks, one which protects the young and non-smokers, whilst giving smokers access to products which may reduce harm.”
This contrasts with previous answers on the subject from the Department of Health - notably during Steve Brine’s tenure – which indicated that no research evidence was even being collated.
Whether it is a consequence of the UK leaving the EU or – hopefully – a realisation that the ban on snus is indefensible both scientifically and morally, this apparent new approach from the government is to be very much welcomed.
The UK has seen a remarkable shift in forms of nicotine use in the past decade, with consumers themselves choosing safer products over lit tobacco. As a result, smoking prevalence in the UK has declined at an unprecedented rate at little or no cost to the taxpayer. With new innovative options joining the market on a regular basis, this should surely continue.
The government has recognised this significant behavioural shift and, indeed, pledged to “maximise the availability of safer alternatives to smoking” in its ongoing Tobacco Control Plan. What better way could there be to honour that pledge than to legalise the sale of snus and finally consign to history a ban which was founded on ignorance and ideology, and is now a reactionary relic that has held back harm reduction progress for far too long.
Today saw the publication of a report by Public Health England entitled Vaping in England: 2020 evidence update summary, which you can read in full here.
It “updates on the prevalence of vaping among young people and adults and reviews literature on vaping among people with mental health conditions and pregnant women” in this country, and – crucially – draws on the latest evidence to deliver its view of how the UK government should proceed in this policy area moving forward.
It concludes that the UK’s current world-leading messaging on e-cigarettes remains valid, but it warns that misinformation is harming uptake of safer products amongst smokers and condemns the spread of doubt from outliers in the UK public health community who should behave better.
As the accompanying press release describes:
False fears preventing smokers from using e-cigarettes to quit
Current vaping use has remained stable in adults and young people since the last report. Of concern is the increasing number of smokers that now believe vaping is more harmful than smoking. This is out of line with expert reviews from the UK and US concluding that using regulated nicotine vaping products is far less harmful than smoking.
It goes on to feature quotes from PHE and others and suggests that some health activists and the media are responsible for deterring smokers from choosing to switch to products hugely safer for their wellbeing than lit tobacco. Deborah Arnott of ASH goes so far as to “urge smokers to have confidence in our regulatory system and not be put off by alarmist headlines about the risk of vaping which are not backed up by the evidence”.
Professor John Britton of UKCTAS is more robust still at the Science Media Centre, identifying “the urgent need for media campaigns to make sure that all smokers understand that switching to e-cigarettes is one of the most effective ways of quitting smoking and protecting their health.”
PHE also admirably represented consumers by pointing out the vital value of flavoured e-liquids. There has been a concerted effort to prohibit flavours worldwide, but PHE has shown it listens to those who use e-cigarettes by saying that "A ban on flavoured liquids could have adverse effects and unintended consequences for smokers using vaping products to quit". This is in stark contrast to organisations such as the WHO and EU which are stubbornly opposed to reduced risk products – and refuse any input from consumers whatsoever - so it is immensely valuable that PHE is setting out the UK’s stall prior to important meetings later in the year.
Consumers and other supporters of NNA will be well aware of the shameful actions of a diminishingly small number of anti-vaping activists in this country who seem hell-bent on wrecking potential for reduced risk products which could have so much positive impact, despite their proving to be the nation’s most popular and successful quit smoking aid. You will also have heard the increasingly desperate science-lite arguments before and read the irresponsible clickbait journalism that often just parrots scaremongery from fatally ideological – and often hopelessly conflicted – merchants of doubt. They are further out in the cold after today, and the widespread take-up of this report in the press should emphasise to them that their outlandish views are miles away from the established consensus.
So we welcome PHE’s report today as a timely reinforcement of the benefits of vaping to public health, plus an encouragement to the UK government to ignore siren voices and continue along the path laid out in the Tobacco Control Plan for England and the recommendations of the Science and Health Committee in August 2018.
A take-home conclusion of today’s publications is that over half of current smokers believe vaping is equally or more harmful than smoking. It is inconceivable that there should be such damaging information being spread when the potential for the world’s public from harm reduction could be revolutionary if only policymakers were exposed to evidence-led advice like PHE has provided, instead of baseless antiscientific heckling from shady vested interests on the sidelines.
If you are a vaper; a relative of a vaper; a smoker worried about making the switch; or a citizen of any country baffled by conflicting media stories, PHE and fellow weighty public health organisations in the UK did you a favour today on the subject of vaping, and did so on the UK government’s website.
Please share the wisdom widely.
For immediate release
LONDON, February 18th, 2020: UK visitors to India who use e-cigarettes to improve their health on the advice of British health organisations are having their devices confiscated at airports.
The New Nicotine Alliance (NNA) has become aware of five travellers who have suffered hard-line and unsanctioned action, but those affected could stretch to tens of thousands more UK citizens who have chosen vaping as a way of stopping smoking.
Regular UK traveller to Goa, Fiona Hodge, reported that UK vapers are having their property confiscated both on the way in and out of India. “I had to leave £60 worth of my property behind despite possession of e-cigarettes not being an offence under the law. UK tourists are being harassed at airports, which will surely be a threat to India’s tourism industry. I certainly won’t be going back if the attitude towards vapers carries the hallmark of being designed specifically to maintain, and even increase, the number of smokers in India.”.
The NNA opposes policies which prohibit the use of safer nicotine products, but if countries pursue such misguided legislation, they should enforce it appropriately and properly inform UK citizens before they travel.
“E-cigarettes are a proven safer alternative to smoking and the UK boasts 1.9 million former smokers who have converted from smoking to exclusively vaping instead. Confiscating products which have a successful track record of diverting smokers away from combustible tobacco is crazy. Their only other option in India is combustible cigarettes, and the Indian Government owns 28% of one of the country’s biggest tobacco companies.”, said NNA Chair Martin Cullip.
“Health groups in the UK, including the NHS, rightly support tobacco harm reduction. Public Heath England also backs vaping and the Royal College of Physicians urges wide promotion of e-cigarettes to reassure and encourage smokers to use them, as does the government’s own Tobacco Control Plan. The Government’s Science and Technology Committee recommended wider acceptance of vaping as an option to switch from smoking in August 2018.
“India welcomes 850,000 visitors from the UK each year and current statistics dictate that around 6 per cent of those will be vapers. That is around 50,000 who could be affected simply for following advice to switch to e-cigarettes on the advice of public health authorities in this country".
“It is not up to the UK to dictate how India chooses to treat e-cigarettes”, said Cullip, “However, it is important that UK travellers are aware of the reception they might receive if they fly to India. We have written to the Foreign and Commonwealth Office saying that it is imperative UK citizens are aware of situations such as this in order that they can make informed decisions about whether to travel to India. Our letter asks the FCO to clarify the law with the Government of India and to update their advice to travellers accordingly.”.
We would suggest that UK citizens affected can give strength to this letter by contacting either the FCO if they are back in the UK, or one of our High Commission offices if in India. https://www.gov.uk/world/organisations/british-high-commission-new-delhi
Issued on behalf of the New Nicotine Alliance
Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation.
Law banning e-cigarettes but excluding personal use
Action on Smoking and Health survey, September 2019
Govt has banned vapes, but owns 28% of ITC – India’s biggest cigarette maker
Public Health England: “E-cigarettes aren’t completely risk free but carry a fraction of the risk of smoking and are helping thousands of smokers to quit and stay smokefree”
Royal College of Physicians: “Promote e-cigarettes widely as substitute for smoking”
UK Tobacco Control Plan: “Backing evidence-based innovations to support quitting” (page 5) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf
UK Government Science and Technology Committee report, August 2018 https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/505/50502.htm
Foreign and Commonwealth Office most recent British Behaviour report https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/363684/141013_British_Behaviour_Abroad_report_2014.pdf
In our November newsletter, we said that “2020 could present some major challenges for which we will have to be ready so please keep watching our website and social media for news very soon, we will be asking for your help”. This was no idle or generic warning.
Preparations are already underway for a review of the EU’s Tobacco Products Directive (TPD) and, this week, an upcoming meeting between the Commission and ENVI – the EU’s health department -– was announced for the 20th and 21st of January. Rumours abound that this committee will wish to talk about the vaping scare in the US and try to employ it to force a harsher regulatory landscape in Europe.
We believe there is a prevailing sentiment amongst the EU Commission that they were beaten by consumers during the debates on the last TPD between 2012 and 2014 and have not forgiven us for it. No matter that the TPD is currently delivering effective outcomes by regulating e-cigarettes relatively wisely, the EU has a collective ambition to roll the clock back to 2011 and run all the same arguments again. Consider comments from former EU Commissioner for Health and Food Safety Vytenis Andriukaitis who said in March 2019:
“If one uses electronic cigarettes as a method to stop smoking, it has to be managed by medical doctors and specialists, to be sold in pharmacies and not in supermarkets.”
This was the starting point for those trying to extinguish the potential of vaping 8 years ago, and it doesn’t seem that they are happy that medical regulations were not placed on e-cigarettes back then. He also dismissed the concept of harm reduction entirely:
“Harm is harm. No matter if it’s less or more.”
His second in command, Arūnas Vinčiūnas, went further, saying:
“E-cigarettes may be less harmful, according to some reports, but they’re still “poison,”
Andriukaitis and his cabinet only stepped down last month, but don’t expect anything to change. Finland is currently occupying the Presidency of the EU Council, and are being lobbied hard to fundamentally change the EU’s approach to e-cigarettes:
“Mounting evidence suggests that regulating flavours in e-cigarettes to protect youth is wise although not easy. Many countries are currently considering further regulations on e-cigarettes and so should the EU.”
Much like the CDC in the US, the EU will be keen to keep the ambiguity between e-liquid regulated under the TPD and illegal liquids causing all the harms seen in the US going for as long as possible. They are smarting that they were overrun by consumers last time around and see e-cigarettes as an itch they need to scratch into oblivion this time. The US vaping scare is exactly the tool they have been dreaming of to try to get their revenge over vapers for our impudence in resisting them when they previously tried to crush vaping.
The war on harm reduction in the EU is starting again. Much sooner than you realise, minds will be closed and positions taken. By the time any of us are asked for comment on this, policy proposals will already have been made. We are expecting the first significant discussions to start in the European Parliament as soon as the end of January 2020.
Don’t think, either, that the UK leaving the EU will mean we are excluded from anything that arises out of the TPD. We don’t yet know what the trade agreement with the EU will look like, but it is quite possible that many directives will be part of “level playing field” arrangements in which the UK stays aligned with the EU, and it is highly likely that the TPD will be one of them. Politicians do not see smokers and vapers as a hill to die on, so TPD is probably not an area where divergence from the EU should be expected.
In the new year, we will be urging all UK and European consumers to be as active as possible and to replicate the intense efforts of past years and fight the same battles as before, but more intensely.
This is no time for complacency, there are real threats coming and we are going to need you to put yourselves out to protect your right to choose safer nicotine products. So, please enjoy your Christmas and New Year celebrations, but return refreshed and ready for a mighty battle in 2020 and beyond. This is, we assure you, not a drill.
ALSO SEE: BREXIT AND VAPING ,THE COUNTERFACTUAL, CLIVE BATES,
Dear Mayor Khan,
We note in your response to a London Mayoral question from Assembly Member Onkar Sahota on 22nd October that vaping adverts are currently not permitted on the London Underground, and that Transport for London “is currently reviewing its overall approach to Vaping advertising”.
While it is disappointing that a ban on advertising vaping products is in place on the tube, we are encouraged that the policy is wisely being reviewed.
In a comprehensive report, the highly respected Royal College of Physicians advised that organisations should “promote e-cigarettes widely as substitute for smoking” and that “smokers should be reassured that these products can help them quit”.
Prohibition of advertising has the opposite, damaging, effect to the RCP’s advice, so we hope you can fast-track the review to allow positive messages on the London Underground as to the benefits that vaping products could deliver to your smoking passengers.
E-cigarettes have been included as an option in the Stoptober campaign for three years now and the Advertising Standards Authority has been considering whether to amend its advice to allow health claims to be made for vaping products, as highlighted by Public Health England which has concluded they are at least 95% less harmful than smoking.
Public perception on the safer nature of reduced risk products like e-cigarettes has been on the wane recently due to alarmist tabloid media, so an intervention from TfL to permit vaping adverts across the entire London transport network would not only fit with current government health advice but could also make a significant positive contribution to the health of Londoners.
Vaping advertising is already prevalent on London buses, so it would seem consistent to also allow the same messages to be presented to travellers on tube trains too. The government’s Tobacco Control Plan aspires to “maximise the availability of safer alternatives to smoking” and recognises the potential of products which reduce harm to smokers who choose to quit. This can only be achieved by promoting the existence of those products, and you have it in your power to enable publicity of them to the millions of daily travellers on the Underground, many of whom will be smokers.
As a consumer-led charity which advocates for a wider recognition of tobacco harm reduction products and has engaged with government and public health NGOs for many years, we would welcome meeting you or your delegated colleagues to discuss the policy area in more detail. We would also ask that you add us as a stakeholder so that we may be updated on plans for vaping advertising on London Transport in the future.
For immediate release
LONDON 23 October: The Federal Drug Administration in the US has this week issued a judgement that eight snus smokeless tobacco products can be marketed with claims that they are less harmful than smoking. The New Nicotine Alliance (NNA) welcomes this development and urges the European Union to abandon its archaic and indefensible ban on the products for European smokers.
Snus is a pasteurised tobacco product with decades of epidemiological evidence proving that it presents negligible risk compared to smoking. Owing to unjustified panic in the 1980s, it is currently banned in the EU despite overwhelming evidence that it is up to 99% less harmful than smoking. Sweden – which has an exemption to the ban – enjoys by far the lowest smoking rates and tobacco-related harm in the EU.
“It is inexplicable why the EU continues to perpetuate the ban on European smokers choosing to switch to snus,” says Mark Oates of the NNA, “not only is the sale of snus permitted in the USA but they have now allowed one company to make the undisputed claim that “using snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis”, the difference in approach could not be more stark, and it is the EU which is being reckless with its public’s health, not America.”
“The FDA has recognised that there is a continuum of risk surrounding nicotine use and that snus is at the very low end of that,” Oates continued, “this decision is a welcome game-changer as it acknowledges, quite rightly, that safer nicotine products can offer great potential for smokers who wish to switch from smoking to a safer alternative. Public perception is key, and the US has decided that messaging conveying the relative risk of nicotine products is vital information that can offer great benefits to advancement of public health. By contrast, the EU is wedded to an out-of-date, unscientific and therefore indefensible ban on products which are 99% safer than smoking, while allowing cigarettes to be sold everywhere.”
“It is well past time that the EU stepped out of the 80s and followed the lead of the FDA,” Oates concluded, “there is simply no valid reason for snus to be prohibited in the EU, it is a shameful dereliction of duty which should be overturned at the first opportunity.”
Issued on behalf of the New Nicotine Alliance
Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation. We wish to see a mature public and organisational understanding of the potential of safer nicotine products for reducing cigarette smoking, including their safety and efficacy, and hence contribute to the reduction in cigarette smoking. This requires engaging with and informing a wide range of individuals and audiences – from health through to regulatory bodies.
Phone: 0300 30 20029
FDA grants first-ever modified risk orders to eight smokeless tobacco products
Reuters: EU court stands by ban on Swedish tobacco product 'snus'
This week saw the publication of the latest survey by Action on Smoking and Health (ASH) into e-cigarette use in the UK which reveals that the number of people using e-cigarettes has swelled once more, despite the best efforts of massed ranks of anti-vaping doomsayers and irresponsible media worldwide.
ASH’s report – the latest annual survey since its inception in 2012 – assesses there to be 3.6 million vapers in the UK now, up from 3.2 million last year. It also reveals that of those there are 1.9 million who have successfully switched from smoking to exclusive e-cigarette use, once again eclipsing the number of people using vaping devices alongside lit tobacco. It is a stunning figure for the fact that there are now over half as many vapers in the country as there are smokers.
Those ideologically opposed to tobacco harm reduction have been throwing the proverbial kitchen sink at vaping in the past year, but fortunately this report shows that it isn’t deterring uptake for many people.
The main points in the new survey make interesting reading:
We are encouraged by these statistics as they illustrate that the UK’s approach to regulation of e-cigarettes is proving to be the right one; once again it demonstrates that a regulatory environment which allows safer alternatives to flourish – along with a government signed up to embracing innovation and new technological solutions – can deliver results.
But, sadly, there are also signs that opposition to harm reduction is having a negative effect. Once again, perception of the harmful nature of e-cigarettes is getting in the way. The ASH report states that “In 2018, for the first time since 2015 at least half the population agreed that e-cigarettes were less or a lot less harmful than smoking (50% in 2018 compared to 43% in 2017). However, this improvement has not been sustained, and in 2019 only 45% agreed this was the case.”. This is regrettable and those who are responsible for the fake concern and many column inches of negative coverage should be ashamed of themselves.
However, there is much positive to take from ASH’s data.
The NNA is not a prohibitionist organisation, we advocate for free choice of smokers to choose safer products – or not - on their own terms, and for availability of reduced risk products to be protected, but all smokers and vapers must be properly informed. The plethora of garish scare stories in the media have obstructed that but it is heartening to see that there is still a significant rise in consumers seeing through the noise and choosing to vape instead. It suggests that there is a culture in the UK of smokers and vapers engaging with each other to share experiences and information independent of the campaign against safer nicotine consumption.
The report also contains a salient lesson to policymakers of what could encourage more to make the switch to vaping if they are serious about reducing smoking rates. Over 50% of vapers now cite “I get a great deal of pleasure from vaping” and “E-cigarettes have improved my quality of life” as their reason for sticking to it rather than relapsing. Only 12% stated the opposite for both questions.
While health organisations frame the choice to use e-cigarettes instead of lit tobacco solely in terms of health, we have consistently advocated that enjoyment of the products is the biggest driver towards permanent use and avoidance of relapse to smoking. Recognising that recreational use of e-cigarettes is a good thing would open the door for far better uptake of reduced risk products and we hope that one day the UK government will concede that this is the case.
It is also a compelling reason why the ill-conceived recent focus on restricting flavours in e-cigarettes should be resisted at all costs in the UK. Governments worldwide should be asking vapers why – as this report shows – a majority of fully-switched e-cigarette users favour vaping over their previous smoking habit, because the answer will resoundingly revolve around the choice afforded by flavours.
If you are one of the estimated 400,000 new dedicated vapers since 2018 detailed in these latest statistics, we are very pleased that you have swelled our ranks in the UK. We have many battles left to fight but the more of us there are, the better. Welcome to all of you.
ASH Factsheet: Use of e-cigarettes (vaporisers) among adults in Great Britain
NNA is delighted to announce that we have joined with other European tobacco harm reduction groups to partner with European Tobacco Harm Reduction Advocates (ETHRA).
The challenges faced by tobacco harm reduction are not confined to individual countries but are regional and global and ETHRA meets the long standing need for a regional network in Europe.
ETHRA will give European advocates a platform for sharing information and experiences, will enable us to co-ordinate actions and will amplify the message that tobacco harm reduction is a vital strategy for many smokers.
Martin Cullip, NNA’s chair, said:
“We are pleased to be part of this new European initiative to advocate for tobacco harm reduction on behalf of nicotine consumers. We look forward to engaging with policy makers to promote the benefits of sensible regulation in delivering better outcomes for smokers and users of reduced risk products in the future.”
Read more about ETHRA here:
You may have read some pretty scary articles in recent weeks about how ‘vaping’ is causing health problems – including deaths – in the USA. We use inverted commas around the word vaping because it is by far the real story.
We have received concerned messages from supporters about this and have had reports of vapers being contacted by friends and family members saying they should immediately quit using e-cigarettes. Many of you reading this will have experienced the same first-hand or on social media.
We will not be going into detail about why these articles are irresponsible, ill-informed and wrong because others have already done so. We provide links to numerous comprehensive rebuttals below for you to send to those who have been sucked in by the negative coverage recently.
Suffice to say that vaping nicotine is not to blame for any of these episodes, but instead illegal oil-based THC liquids bought from unregulated vendors in America, not the UK. In short, drug dealers.
The advice from Public Health England – and from the NNA – remains the same.
We do however 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.
The e-cigarette market in the UK is tightly regulated under the Tobacco and Related Products Regulations Act 2016 so you, your friends and family should have nothing to worry about. Keep calm, educate them, and carry on vaping.
To stay safe, the simple approach is to only buy from reputable vendors who sell products regulated by the Medicines and Healthcare products Regulatory Agency in the UK. Don’t buy from boot sales, men in vans or people in the pub.
It is regrettable that there is so much unjustified negativity being promoted about devices which have driven down smoking rates considerably since 2012 and are making dramatic improvements to the lives of millions. Sadly, it seems that malign influences are at work.
The bottom line, though – and a line endorsed by government institutions - is that there is nothing to see here if you buy from legitimate sources. Ignore the panic-mongers and spread the word.
Science Media Centre, expert reaction to Trump’s decision to ban flavourings in e-cigarettes
Dispersing the clouds of the vape panic myth
Is Vaping Really Killing People? Here are the Facts, Lee Johnson
The world responds
British vapers are safe, claim health experts after deaths in US
LONDON 30th July: The World Health Organization’s recent report on the global tobacco epidemic will do little but perpetuate smoking by making non-combustible alternatives to smoking like electronic cigarettes less accessible, more expensive and less consumer friendly, the New Nicotine Alliance (NNA) said in a statement Tuesday.
The latest iteration of the WHO’s report on the global tobacco epidemic, called “Offering help to quit tobacco use”, advocates for stricter legislation of e-cigs, asserting there is no proof they help smokers quit their habit, and could even be a gateway to tobacco addiction for young people.
Whilst the NNA, a leading educational charity concerned with improving public health through a greater understanding of risk-reduced nicotine products, supports an effective regulatory environment for nicotine delivery devices, it is our strong view that this new report from the WHO completely ignores credible third-party scientific evidence, including Cancer Research UK and Action on Smoking and Health (ASH), of the harm reduction potential afforded by such products.
Public Health England research has shown that vaping is at least 95 percent safer than cigarette smoking and 2-3 times as effective as traditional nicotine replacement therapies in helping smokers to quit, confirming the UK Royal College of Physicians’ view that vaping has "huge potential to prevent death and disability from tobacco use". A recent study, funded by the leading cancer charity, Cancer Research UK, found that people using e-cigarettes to quit smoking are about 95 per cent more likely to report success than those trying to quit without help from any stop-smoking aids.
The WHO report reiterates the discredited argument that e-cigarettes are a gateway for young people to start smoking. Yet only last month, research published by anti-smoking charity, ASH, found that vaping remains uncommon among young people and is almost exclusively confined to current or past smokers.
Most teen vaping is experimental and short-lived, with Deborah Arnott, chief executive of ASH, saying at the time: “We need to be vigilant and continue to monitor e-cigarette use among young people. However, smoking prevalence among children and young adults in Britain has fallen substantially since 2010, which doesn’t indicate that vaping has been a gateway into smoking.”
On the WHO report on the global tobacco epidemic 2019, NNA Chair Martin Cullip said:
“The UK boasts some 1.7 million former smokers who have converted from smoking to exclusively vaping instead. It is extremely likely that this behavioural shift has been driven by the availability of e-cigarettes and their promotion by public health in the UK. If the WHO truly wants to drive down smoking rates, it must consider the growing body of evidence that vaping is an effective way to help people to quit. The WHO and the tobacco control lobby seem to have abandoned health altogether in favour of just attacking industry.”
Issued on behalf of the New Nicotine Alliance
Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation. We wish to see a mature public and organisational understanding of the potential of safer nicotine products for reducing cigarette smoking, including their safety and efficacy, and hence contribute to the reduction in cigarette smoking. This requires engaging with and informing a wide range of individuals and audiences – from health through to regulatory bodies.
Phone: 0300 30 20029
The NNA was a founder member of the International Network of Nicotine Consumer Organisations (INNCO) since its inception in 2015. We regret to announce that yesterday we ceased membership of INNCO due to differences concerning future strategy, including funding arrangements.
We wish INNCO – and all its global consumer association members – the very best for the future and hope they are successful in all endeavours they embark upon in pursuit of prudent regulatory recognition for reduced risk products in jurisdictions throughout the world.
The NNA Board of Trustees
Issued at the Global Forum on Nicotine on 14 June 2019
Removing e-liquid flavours from sale threatens the proven success of e-cigarettes to help adult smokers switch, warns the New Nicotine Alliance
WARSAW, June 14th, 2019: Banning flavours in e-cigarettes could be detrimental to public health, warns leading consumer charity, the New Nicotine Alliance (NNA).
The role of flavours for e-cigarettes and whether they are a positive or negative for public health has been the focus of much discussion in public health, scientific and media circles around the world. The NNA argues that removing all flavours except tobacco would be a disastrous move.
The NNA and other leading experts at the Global Forum on Nicotine (GFN) in Warsaw – an event featuring over 500 delegates from academic, research, industry and consumer organisations - said today that removing flavours from sale would be a deterrent to the increasing number of smokers who are quitting by choosing to use less harmful products.
“E-cigarettes are a proven safer alternative to smoking. The UK boasts 1.7 million former smokers who have converted from smoking to exclusively vaping instead. Flavours have been a big driver of that success, by distancing smokers from tobacco and providing an incentive to switch, with a wide selection of different options to suit their preferences”, says NNA Chair Martin Cullip, who to+day hosted a briefing at the GFN on the subject.
Sharon Cox, Research Fellow at London South Bank University, said:
“Policy needs to reflect real user behaviour, be context specific, make best use of evidence, and involve consumers to serve the public to make informed choices. The evidence suggests flavours are one of a few key components, important to both the new vaper and the experienced vaper, which help people abstain from smoking.”
James Dunworth, blogger on e-cigarettes and owner of Welsh retailer E-Cigarette Direct, said:
“Vaping works because it's fun. Take the pleasure out of vaping and it will stop working. Key to that pleasure is flavour. Because of demand, there are a huge number of flavours, meaning there's something for everyone - and when someone finds their perfect flavour, they’re highly unlikely to go back to smoking.”
Dr Christopher Russell, of the Centre for Substance Use Research, said:
“There is growing evidence that suggests adult smokers increasingly prefer to use vapour products that are not flavoured like tobacco. Evidence from our own research suggests that a significantly higher proportion of smokers who prefer to vape non-tobacco flavours go on to completely quit smoking cigarettes within three months. Restricting adult smokers’ access to flavoured vaping products would therefore very likely result in fewer smokers trying vaping as an alternative to continuing to smoke, in substantially fewer smokers attempting to switch to vaping, and ultimately, in substantially fewer smokers succeeding in their attempt to switch to vaping.”
Nancy Sutthoff, a consumer advocate, agreed:
"The availability of choice is what makes using safer nicotine products so effective - especially when it comes to flavours. Most people who switch go through a learning curve, and a range of flavours that the individual enjoys make the process simpler and more enjoyable. Personally, I know that being able to vape a flavour that I enjoyed helped me immensely in leaving behind my tobacco habit.”
Issued on behalf of the New Nicotine Alliance (NNA)
Note to Editors: The NNA is a registered UK charity staffed by consumer volunteers, formed to increase understanding about the benefits of “new” risk-reduced nicotine products and a better recognition of long-term recreational use of nicotine as a powerful incentive for smoking cessation.
Research forthcoming from CSUR (CSUR press pack available in GFN media bags).
This week, Public Health England released the first of three reports it had commissioned as part of the government’s Tobacco Control Plan for England. This particular report focussed on how e-cigarettes are being used by the public and revealed some mixed results.
Its main findings were that:
Despite PHE emphasising that e-cigarette use is simply not a major problem in this country – as you can see from their graphic above – it was disappointing to see that much of the media preferred to sensationalise the rise in youth vaping rather than the far more significant figure of 0.2% of never smokers aged 11 to 18 being regular users. This tells us that the vast majority of youths are either just experimenting with e-cigarettes or, if they are regular users, have smoked before so could be doing so to quit conventional cigarettes. Even the paltry 0.2% of never smokers is not worrisome if you factor in that many of those may well have been smoking instead in the absence of safer alternatives.
It is disappointing to note that regular e-cigarette use among adults has plateaued, but hardly surprising after the onslaught of irresponsible and misleading click-bait journalism we have seen in the past couple of years each time even minor and obscure negative study results are published. There is still a stubborn rump of ideological opponents of harm reduction in public health circles despite their number steadily tailing off into insignificance, but PHE’s report shows that their regular insincere outbursts are arguably deterring smokers from switching and are harming the public’s health.
The report also goes to great lengths in recommending more smoking cessation efforts to encourage vaping. PHE recommends that Stop Smoking Services should do more to encourage smokers that want to quit with the help of an e-cigarette and calls for stop smoking practitioners and health professionals supporting smokers to receive education and training in the use of e-cigarettes in quit attempts.
While this is to be welcomed, it is important for public health institutions and clinicians to realise that, for many, it is precisely because e-cigarettes are not a medical device that they have been so initially successful. We are pleased that PHE is encouraging Stop Smoking Services to recognise the potential of vaping, but they should also be aware that many smokers would not choose a clinical setting for seeking advice on e-cigarettes and that reputable vape shops have much to offer and should be firmly part of the mix.
All in all, this is a welcome report from PHE although we worry that the focus on youth use of vaping products is distracting from more important aspects of the role e-cigarettes can play to the benefit of public health. We hope this is not in response to the wild irrational panic currently taking place in the USA where attitudes towards less healthy choices are completely different to the UK and where the system of politics lends itself to overblown reactions. The UK is getting the balance mostly right with harm reduction and we look forward to PHE’s other two reports for, hopefully, more encouraging news and recommendations which can carry the success of e-cigarettes for public health further onwards.
At a session in the Parliament of Estonia (Riigikogu) on the 13th February, members gave overwhelming support to major reforms of current Estonian tobacco legislation. Proposed amendments included limiting e-cigarette restrictions (July 2019 flavour ban, e-liquid excise tax and domestic online sales ban). The Parliament also overwhelmingly supported to correct the long term failure of Estonian Government to regulate novel smokeless products to enter the Estonian market. The amendments were supported by almost all political parties – ‘Conservatives’, ‘Centrists’ and ‘Liberals’ - only the Social Democrats voted against policies which supported tobacco harm reduction.
NNA Estonia was delighted to see that the benefits of tobacco harm reduction has finally been recognised by so many MPs - it’s been hard work and a long time coming! Apart from continuous public awareness raising one of our recent initiatives included staging a Tobacco Harm Reduction conference in Parliament house in which leading International THR scientists and specialists: Prof.Martin Jarvis, Prof.Peter Hajek, Louise Ross, Dr. Karl Snæbjörnsson and Judy Gibson presented facts and discussed the benefits of e-cigarettes to an invited audience.
Whilst disappointed that the Social Democrats felt unable to support the amendments (a fact which vapers in Estonia may wish to consider when voting in the Parliamentary elections on 3rd of March ), we are very encouraged by our overall progress. Lives depend upon it!
The ‘break in the ice’ was reflected in MP’s comments:-
MP Tarmo Kruusimäe (Conservative)
The law on tobacco is undergoing a Parliamentary review. Whilst detailed methods of tracking [combustible] tobacco ‘like Sherlock Holmes’ is important, it is even more important to reduce the risks from cigarettes and passive smoke - but the the relaxation of the regulations of e-cigarettes and allowing heat-not-burn products to enter the Estonian market provide an alternative opportunity to achieve it.
MP Madis Milling (Liberal) stated that, over the last four years, the debates in Parliament on tobacco law have made alternative products more expensive and also more difficult to obtain than conventional cigarettes, and that, together, it has also made it more difficult to quit smoking. Milling said that the explanations provided by the Ministry of Social Affairs officials, according to which it is claimed that no studies have been carried out on alternative products and that, at the same time, they appear to be as harmful as conventional cigarettes, remain difficult to understand. Milling pointed out that, where innovation is usually supported, in tobacco policy this is not the case and that hundreds of research studies carried out abroad are neglected.
MP Aadu Must (Center Party) had an idea to make Estonian university town Tartu the first smoke free town in Estonia. He envisioned Estonia ten years from now when people would not believe anymore that anybody in such a recent past actually smoked burning cigarettes when less harmful alternatives were already available.
The debate in Parliament was overshadowed by a threat from the Social Democrat Minister of Health, by which she promised to suspend the debate on the bill if Parliament approved the proposals to reasonably regulate less harmful alternatives to smoking that were unsuitable for her.
This wasn’t quite the end…
It is customary in Estonia for the initiator of a bill to control its passage insofar that if substantial changes are made the initiator has the right to withdraw it. The core legislation contained within the Tobacco Bill was required to pass in order to comply with the EU Tobacco Directive.
To cut a very long story short:-
1. The Minister of Health didn’t like the proposed amendments - not one little bit.
2. She reacted by threatening to take back the bill in a letter of intent to the speaker. including all those really important bits needed to comply with EU TPD directive. (Hint: she was later found to have overstepped the mark ;-)
3. Those bits if not implemented within a time period may incur financial sanctions (Ooops)
4. Parliament took not a blind bit of notice of her threat - THR was winning (Yesss!)
5. A legal furore ensued resulting in Parliament being suspended for several hours (which is something of a first in Estonia).
6. Meanwhile The Social Democrats (Booo!) persuaded the Prime Minister to give his approval to their proposal to suspend the passage of the Bill - despite the overwhelming approval of the new amendments (Don’t ask).
7. The imminence of elections has resulted in the bill being postponed - so the whole thing will have to debated all over again under a new Parliament, the EU may decide to impose sanctions and if you ever thought Brexit was bad - welcome to Estonia!!
Let me explain..
MPs were disturbed by such a threat, because Estonia is a parliamentary democracy, where laws are created by Parliament and not by the government. By her letter, the Minister set a trap for Parliament, because if the debate on the Tobacco Act is interrupted, Estonia will not be able to implement the EU Tobacco Directive’s Articles 15 and 16 for tracking and tracing at the right time and may be subject to sanctions.
Despite the knowledge of such a letter from the Minister of Health, Parliament decided to support the amendments that help reduce public health damage from cigarettes and encourage smoking cessation. The Parliament’s Board had to accept the Social Democrat Minister of Health request for a suspension of the reading of the Tobacco Act.
The Minister's request caused a legal dispute during the Plenary because the MPs were not convinced that the Minister had the right to suspend the discussion of the draft. As a result of the dispute, the work of Parliament stopped for 1,5 hours which has not happened for similar reasons never before.
Later it turned out that the Minister of Health does not have such a right on her own, such a proposal can be made by the Minister only if she has the support of the Government. During the parliamentary debate, the Social Democrats had persuaded the Prime Minister to support suspending the draft, despite the fact that a large majority of the MPs in his Center party had also voted in favour of the amendments. From media it appears the Prime Minister confirmed his support to suspension by an sms (!!) to the Parliament’s Board member.
The debate on the Tobacco Act in the Estonian Parliament was interrupted and, as Parliament has completed its work due to the elections this Sunday, the new Parliament must start with discussions from scratch. At the same time, Estonia will most likely not be able to implement the EU Tobacco Directive at the right time and may be subject to sanctions.
Mid-August saw the publication of a report by the influential House of Commons Science and Technology Committee on what the government’s approach to vaping and other safer nicotine alternatives should be. It was by far the busiest day of the year for the NNA as our spokespeople were in demand on media from morning till night, as we described in our newsletter that month.
The NNA was well prepared for the report and issued not one, but two, embargoed press releases to coincide with its publication. You can read our welcome for the report here and our release specifically on the issue of snus here. We also published a blog on the day describing the committee’s report as a potential “catalyst for a step change in the UK establishment’s approach to e-cigarettes and other safer nicotine products” which you can read here.
In line with the widespread media coverage the report attracted, NNA representatives were busy all day with media appearances. Supporters Doug Phillips and Niamh O’Farrell spoke on BBC Radio Five Live Breakfast and Channel 5 News respectively, while NNA Chair Sarah Jakes appeared on BBC2’s mid-morning current affairs show, Victoria Derbyshire, which you can watch here.
That wasn’t the end of it, though, Sarah went on to give another 9 interviews to regional BBC radio stations and Martin Cullip also spoke to BBC Radio Scotland. They are too numerous to mention here but you can view all our extensive media spots at the day’s NNA twitter stream here.
In the aftermath, NNA trustee Martin Cullip also wrote an article at Spiked countering the fears of those who were averse to the idea of vaping being allowed in public places following lurid and excitable tabloid headlines.
The opposition to the committee’s common-sense recommendations were mostly doomsayers from one institution because the BBC and others struggled to find people who could find a reason to go against the considered conclusions that Norman Lamb’s group of MPs had come to.
So, it is very encouraging to see that yesterday the government issued its response to the committee’s recommendations and accepted every single one of them.
In all there were seven.
About maintaining the government’s planned annual ‘evidence review’ on e-cigarettes and extending it to also cover heated tobacco products to be overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, the government accepted the suggestion and said that it is “firmly committed to more research in this area”.
On reducing barriers to e-cigarette suppliers by way of MHRA being more receptive to vaping, the government also agreed, but added that “it is a commercial decision for e-cigarette manufacturers to make whether or not to apply for a medicinal licence. Despite the lack of a medicinal approved e cigarettes, there are around two and a half million e-cigarette users in England alone, which suggests that growth of the e-cigarette market has not been hindered due to e-cigarettes not being available on prescription”.
The recommendation that NHS England should appoint someone to include provision for e-cigarettes as part of the government’s tobacco control plan was also accepted, as was the proposal from the committee that NHS England “should set a clear central NHS policy on e-cigarettes in mental health facilities”.
Talking of opportunities post-Brexit, the government also broadly agreed that there are advantages that could be explored “in those areas identified by the Committee, such as the 20mg/ml maximum nicotine refill limit, a size restriction of 2ml on the tank, a block on advertising e-cigarettes’ relative harm-reduction potential and the notification scheme for e-cigarette ingredients”.
The government’s response also conceded that the Science and Technology Committee was correct in calling for a tax regime which favours reduced risk products according to a continuum of risk and also – admirably – committed to reviewing the counterproductive ban on snus, stating that “The Government’s goal will remain to achieve a proportionate approach to managing risk, one which protects the young and non-smokers, whilst giving smokers access to products which will reduce harm. As part of this the Government will consider reviewing the position on snus and whether the introduction of this product onto the UK market would promote that kind of proportionate harm reduction approach.”
There is very much to welcome in the government’s response and it is to Sir Norman Lamb’s credit that his gravitas has started a conversation which could lead to significant benefits to the public health of the country by way of a more enlightened thinking about nicotine and ways of reducing harm for those who find it hard to choose to quit smoking.
The NNA heartily congratulates the government on its response to the committee’s report. We hope that the acceptance of the recommendations will one day translate into government policy offering pragmatism for a future in which novel alternatives for smokers are recognised and embraced.
Norman Lamb at the APPG on Vaping, November 2017