The organisation which replaced Public Health England, the Office of Health Improvement and Disparities (OHID), released its final Vaping in England review in the latest series last week and overall it is largely positive.

Stretching to a hefty 1,468 pages, this review is the most comprehensive yet and covers a wide range of evidence on the use of vaping products amongst adults and youth, as well as brief commentary on heated tobacco and nicotine pouches.

The review’s main finding, much reported in the media, is that using vaping products “poses only a small fraction of the risks of smoking” with OHID re-emphasising that it estimates that vaping to be “at least 95 percent less harmful” than combustible tobacco. This is important because those who are bitterly opposed to vaping continually attempt to discredit this statistic. OHID has doubled down on previous reviews by confirming that it is still “broadly accurate”.

The importance of flavours was also acknowledged, with there being “evidence to suggest that non-tobacco flavours, particularly sweet flavours, may play a positive role in helping people switch from smoking to vaping.”

Among other observations, OHID also found that vaping is more common among disadvantaged adult groups in society which corresponds with smoking prevalence in those areas, strongly suggesting that vaping is a direct substitute for smoking, as we have consistently argued.

Although emphasising that vaping is not risk-free, OHID reported that evidence is showing there to be significantly lower relative exposure from vaping compared to smoking in biomarkers for cancer, heart and lung disease. As a result, the review advises that people who smoke should be encouraged to switch completely to vaping as a way to stop smoking. To do so, it calls for there to be accurate information about the “magnitude” of relative risk between vaping compared to smoking. This, it claimed, could help to address much of the misperception about vaping which is prevalent in society.

Additionally, OHID found that 98.3% of young people who had never smoked were also not currently vaping, and that fruit and menthol flavours are the most popular amongst adults, making up nearly 60% of the total. It also reconfirmed that vaping products remained the most common method used to quit smoking.

We were pleased to see that OHID recognised the potential of higher nicotine strengths, reporting that “higher nicotine concentrations might increase the … appeal of vaping”, and that “this could help someone completely substitute tobacco cigarettes for vaping products”. The NNA has consistently called for the nicotine limit imposed on the UK by the EU’s Tobacco Products Directive should be revisited; this observation by OHID tends to add weight to our proposal.

OHID also commented on the World Health Organisation’s approach to harm reduction, listing a host of dangerous and damaging proposals in recent WHO reports such as bans on flavours and advertising, high taxation, and treating vaping and smoking the same. Specifically, it highlighted the WHO’s repeated call for a ban on devices which allow users to control device features and liquid ingredients, commonly called open systems. The review commented that this “would seriously restrict what vaping products are currently being used by adults in England” and implied it could protect cigarette sales.  

The UK is a shining example of how freeing up the potential of safer nicotine alternatives to smoking can deliver incredible results. In light of the conclusions in this part of OHID’s review, the UK government should double down on this success by sending a strong delegation to meetings such as the WHO’s COP10 next year in Panama to show that we are proud of our success and that the WHO should follow our lead.

Lastly, the OHID review called for more research in a number of different areas, including into how vapers vape, both nicotine and non-nicotine products, and regular monitoring of the use of flavours to track use over time. It also recommended further independent studies on heated tobacco to be commissioned on smoking prevalence and cessation, and also proposed implementing proportionate regulation of nicotine pouches in the Tobacco and Related Products Regulations as we have called for previously.

The NNA welcomes this report, noting that it is largely positive about vaping and confirms that the UK’s recognition of tobacco harm reduction has been a big success in that respect. We would like to see further roll out of policies which embrace this principle, which we have detailed in correspondence prior to the Independent Tobacco Review earlier this year (see our 20 recommendations here). The OHID review has comprehensively highlighted the potential benefits of reduced risk products with its support for vaping, but other options such as nicotine pouches, heated tobacco and snus could also be useful alternatives for people who are looking to reduce their use of combustible tobacco.