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Last week saw the publication of an article at the American Journal of Public Health (AJPH) entitled Balancing Consideration of the Risks and Benefits of E-Cigarettes, written by no fewer than 15 past Presidents of the Society for Research on Nicotine and Tobacco (SRNT). SRNT is a globally respected organisation dedicated to evidence-based research on tobacco and nicotine use.

The lead author is Professor David Balfour from the UK, and Professor Robert West, Emeritus Professor at University College London is also a signatory, but their colleagues are based in the United States where debate over vaping has been fractious at best, and wildly inaccurate at worst.

We expect it is frustration which has prompted such prominent experts to produce a document which criticises the prevailing focus of debate amongst the public health community, and which makes the bold statement that “this article’s authors believe that vaping can benefit public health, given substantial evidence supporting the potential of vaping to reduce smoking’s toll.”.

This should not be controversial, but it speaks to the level of misinformation and ideology that has been at play that it should need to be said at all.

The article explains how the handwringing about youth use of e-cigarettes is harming public health by reducing options for adult smokers who would otherwise choose to quit with safer alternatives.

While accepting that youth vaping is a concern, the authors describe why this aspect has been overblown and how it is damaging to the public’s overall health in the long run. They also, quite rightly, emphasise the opportunities that are being lost while harm reduction deniers are allowed to run riot.

“While evidence suggests that vaping is currently increasing smoking cessation, the impact could be much larger if the public health community paid serious attention to vaping’s potential to help adult smokers, smokers received accurate information about the relative risks of vaping and smoking, and policies were designed with the potential effects on smokers in mind. That is not happening.”

In the UK we are blessed with an establishment understanding of how reduced risk nicotine alternatives can help those who choose to quit smoking. But there is a great deal of hysteria and ideological objection in the rest of the world which is unnecessary and contrary to the evidence which continues to mount up in favour of harm reduction as a successful policy option.

The AJPH article is backed up by an editorial from Martin Dockrell and John Newton of Public Health England which welcomes the report, stating that “These eminent authors conclude that the “singular focus of US policies on decreasing youth vaping” has been a distraction from the larger goal of tobacco control, namely reducing smoking and its harms”.

It is easy to forget that we consumer advocates in the UK are talking a different language to those in other countries who are embattled by an avalanche of misinformation, slurs, and ideological sophistry which seeks to dismiss legitimate advocacy for products that we know will work for many smokers.

Bans on use and supply, restrictions on where people can vape (or use snus or nicotine pouches), and even imprisonment for possession of vaping products are a reality for many consumers of reduced risk products in a lot of countries. The demonisation of people who have quit using safer alternatives is objectionable and wrong, but it happens anyway.

So, we welcome wholeheartedly this intervention by the 15 former Presidents of SRNT. Their credentials are beyond reproach and their message should be listened to.

We hope that this will lead to a greater global understanding of the benefits that e-cigarettes and other safer nicotine products can foster. 

The UK has led the way in realising the benefits of allowing tobacco harm reduction to do its work. If the US were to join us in a special relationship agreeing the same principles, it would send a powerful message to the rest of the world to follow suit.

We hope that the AJPH article is well-received and that the ensuing debate can then become one of how we extend the benefits of reduced risk products worldwide, rather than how it is best to ignore and restrict their potential on spurious grounds. 

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