The increasing number of people using e-cigarettes, presents a significant policy challenge to governments in Wales, the UK, and elsewhere. We look at the differing measures governments around the world are putting in place.
In the UK, 9.1% of adults reported using e-cigarettes in 2023, equal to around 4.7 million adults. Some see this as good news, as over half of e-cigarette users are ex-tobacco smokers, highlighting the potential for e-cigarettes to help reduce tobacco use and deliver significant benefit for public health.
However, there has also been an increase in the use of e-cigarettes among children and young people: over 20% of children aged 11 to 17 years old in the UK have tried vaping, rising from around 14% in early 2020.
This is a problem. While e-cigarettes are less harmful than smoking, they are not risk-free, and there is some evidence to suggest there may be additional risks to brain development in adolescents exposed to nicotine. NHS advice states that “non-smokers and young people under 18 should not take up vaping”
Almost half of children in the UK who have tried vaping have never smoked a cigarette. Vaping is becoming a substitute for tobacco smoking for both ex-smokers, and children and young people. Governments now need to make policy decisions which strike the right balance between the potential benefits of reducing the smoking rate through e-cigarette use, and preventing harms caused by increased use of them among young people and/or non-smokers. There is a clear tension between these goals: a double-edged sword between reducing smoking rates and enabling easier access to e-cigarettes.
Making evidence-informed decisions in this area is made harder by powerful and well-funded lobby groups, the contested nature of the evidence, and a lack of long-term evidence on the potential harms of vaping. Nevertheless, other countries have already acted to both reduce their smoking rates and restrict access to e-cigarettes.
The UK Government recently has outlined plans to bring forward legislation to ‘create a smokefree generation’ in a new White Paper – annually raising the minimum age required to purchase tobacco products. This pioneering approach has already been implemented in New Zealand. It, however, does not apply to e-cigarettes. The New Zealand government announced new policies in June this year, including reducing the maximum nicotine strength in vaping products due to concerns over youth vaping rates. Despite the pioneering anti-smoking legislation, New Zealand has still needed to take action to curb youth vaping to mitigate the risk of a new generation of ‘vapers.’ It’s likely that other governments will also have to approach this problem from both angles.
In the same White Paper, the UK Government outlines several other policy initiatives elsewhere which have aimed to reduce smoking and vaping rates. At the same time, the UK Government is also implementing a ‘swap to stop’ scheme, providing smokers in England looking to quit with an e-cigarette starter pack, alongside behavioural support. Pilot schemes provided approximately two weeks’ supply of e-cigarette liquid, meaning that those taking part will likely have to rely on the commercial market to replace liquids and avoid relapse.
Evidence suggests that ex-smokers have benefitted from the existing commercial market for e-cigarettes, and that the commercial route will likely continue to be an important factor in encouraging smoking cessation via e-cigarettes. Given this scheme’s reliance on the commercial market for e-cigarettes, this highlights the likely continued presence of e-cigarette products on the market, and potential access (and subsequent risks) for non-smokers taking up vaping.
Australia has taken a different approach to smoking cessation, rejecting e-cigarettes as a smoking cessation tool, and preventing access to nicotine-containing e-cigarettes without a prescription. The approach taken to smoking cessation policy has a significant impact on the availability and perception of e-cigarettes in the market, and the UK Government is somewhat of an outlier in providing e-cigarettes as a smoking cessation tool. Indeed, the Welsh First Minister Mark Drakeford has stated that he is “attracted” to the Australian policy of restricting the sale of e-cigarettes to those with a prescription, indicating a key divergence from the UK Government’s position.
What does this mean for Wales? Devolved governments in the UK are able to make their own decisions through the devolved NHS on the prescription of e-cigarettes, but it is unclear whether they have the powers to make unilateral decisions on product availability. Other sub-national governments have developed more restrictive policies to prevent access to e-cigarettes: Quebec, for example, has prohibited the sale of e-cigarettes online. While the UK Government has followed Scotland in considering a ban on disposable vapes, it was previously unclear whether the Scottish Government had the power to do this on their own. Devolved governments have previously gone further in restricting access to addictive products on public health grounds, in areas where devolved powers are complex. The best example of this is the implementation of minimum unit pricing in Scotland and Wales (although this was not straightforward). In a complex public health issue like this, who has devolved power matters: can the Welsh Government act as it best sees fit, or does it have to follow the lead of UK Government? Regardless, any action taken by devolved governments would have to consider the impacts of cross-border trade and market availability.
It is clear that governments need to take action to reduce both smoking and vaping rates. But they also need to consider the relationship between smoking and vaping, both in ex-smokers and young people, and make evidence-informed decisions that consider the potential unintended consequences. This will be challenging, given the contested nature of the evidence base, and the lack of mature evidence on the long-term risks of vaping.