Governments supportive of tobacco harm reduction
The scientific studies and reports completed in the UK have served as guidance for government and the private sector. In a report by Public Health England, 1 the authors confirmed the extremely low risk posed by e-cigarette vapor to bystanders and advised managers of public places and work places to consider this in crafting their policies that will cover e-cigarette use:
“International peer-reviewed evidence indicates that the risk to the health of bystanders from exposure to e-cigarette vapour is extremely low. This is in contrast to the conclusive evidence of harm from exposure to secondhand smoke, which provides the basis for UK smokefree laws. The evidence of harm from secondhand exposure to vapour is not sufficient to justify the prohibition of e-cigarettes. Managers of public places and workplaces should ensure that this evidence informs their risk assessments.”
The UK House of Commons Science and Technology Committee declared that the body of evidence is clear that e-cigarettes are significantly less harmful than cigarettes2:
“The Department of Health and Social Care argued that ‘[t]he best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.”
“Ultimately, however, any judgement of risks has to take account of the risk of not adopting e-cigarettes – that is, continuing to smoke conventional cigarettes, which are substantially more harmful than e-cigarettes.”
In 2015, Dr David Halpern reflected on the UK’s positive experience with “light touch” regulation of e-cigarettes and projected that consumer-acceptable, safer alternatives to cigarettes could finally make smoking obsolete:
“[O]ne of the most interesting twists to the e-cig story may be yet to come. E-cigs offer, perhaps for the first time ever, the prospect of eliminating (or even banning) smoking altogether. With a plausible, seemingly safer substitute in place, the public health community might want to ponder whether e-cigs, however ambivalent they feel about them, might enable societies to get rid of smoking for good. Given that smoking is the leading cause of preventable deaths in the USA and many other countries in the world today, this would be a remarkable achievement.” 3
Canada initially had a de facto ban on e-cigarettes, defining this product category as poison or medicine.4 However, the recently passed “Tobacco and Vaping Products Act provides a balanced framework for vaping products by protecting youth and non-users of tobacco products from nicotine addiction and inducements to use tobacco, while allowing adults to legally access vaping products as a less harmful alternative to tobacco.”5
The Government of Canada, on its web page, “Vaping,” (May 2018)6 declared that vaping is less harmful than smoking and that smokers who switch from cigarettes to vaping products will reduce their exposure to many toxic and cancer-causing chemicals:
“The Tobacco and Vaping Products Act (TVPA) became law on May 23, 2018. Adults can now legally get vaping products with nicotine as a less harmful option than smoking.”
“Vaping is less harmful than smoking. Many of the toxic and cancer-causing chemicals in tobacco and the tobacco smoke form when tobacco is burned. Vaping products do not contain tobacco and do not involve burning or produce smoke. Except for nicotine, vaping products typically only contain a fraction of the 7,000 chemicals found in tobacco or tobacco smoke, and at lower levels. Switching from tobacco cigarettes to vaping products will reduce a person’s exposure to many toxic and cancer-causing chemicals. As a step towards quitting cigarettes, many smokers may go through a transition period when they use both cigarettes and vaping products. Studies have shown short-term general health improvements in those who have completely switched from smoking cigarettes to vaping products.”
The European Union’s Tobacco Products Directive7 harmonises rules for introducing e-cigarettes in the 28 E.U. Member States, regulating e-cigarettes as consumer products and not as medicines. The Directive provides for a system of pre-market notification for both e-cigarettes and novel, non-combustible tobacco products along with category-specific safety and quality standards and tailored regulation. As a result, they are widely available in many countries in Europe.
The Directive establishes separate provisions for electronic cigarettes (which generate a nicotine-containing vapour without tobacco) and non-combustible tobacco products.8 It establishes a separate category for novel tobacco products in recognition that new forms of tobacco products would be made available to consumers in the future.9 Additionally, the TPD revised the definition of “smokeless tobacco product” to reflect tobacco products “not involving a combustion process.” According to the 2012 Impact Assessment accompanying the TPD:
“Novel categories of tobacco products are currently being developed but they are not yet placed on the EU Market. Most of these products are expected not to involve a combustion process and therefore would fall in the product category of [smokeless tobacco products].”10 Therefore, pursuant to the TPD, which has been transposed into national law in most E.U. Member States, heated tobacco products placed on the market after 19 May 2014 are considered “novel smokeless tobacco products” and labelled accordingly.11
New Zealand has initially banned these products but has recently changed its approach. Colette Devlin of the Ministry of Health has given its support behind vaping as a way to quit smoking12:
“Fears around e-cigarettes have gone up in a puff of smoke, as health officials say they could be a valuable weapon in the country’s fight to become smokefree.
The Ministry of Health legalised e-cigarettes in March, but stopped short of endorsing them as a safe means of quitting smoking, saying the evidence wasn’t there.
This month, the ministry changed its stance, stating a Cochrane review found evidence that e-cigarettes could help people to quit smoking, and they could be a valuable tool to achieving the ministry’s Smokefree 2025 goal.”
The website13 of the Ministry of Health of New Zealand now actively encourages smokers to switch to vaping products to reduce their health risks and those around them:
The potential of vaping products to help improve public health depends on the extent to which they can act as a route out of smoking for New Zealand’s 550,000 daily smokers, without providing a route into smoking for children and non-smokers.
The Ministry of Health encourages smokers who want to use vaping products to quit smoking to seek the support of local stop smoking services. Local stop smoking services provide smokers with the best chance of quitting successfully and should support smokers who want to quit with the help of vaping products.
Expert opinion is that vaping products are significantly less harmful than smoking tobacco but not completely harmless. A range of toxicants have been found in vapour including some cancer causing agents but, in general, at levels much lower than found in cigarette smoke or at levels that are unlikely to cause harm. Smokers switching to vaping products are highly likely to reduce their health risks and for those around them.
When used as intended, vaping products pose no risk of nicotine poisoning to users, but e-liquids should be in child resistant packaging. Vaping products release negligible levels of nicotine and other toxicants into ambient air with no identified health risks to bystanders.
1 Public Health England, Use of e-cigarettes in public places and workplaces: Advice to inform evidence-based policy making (July 2016) [link].
2 UK House of Commons Science and Technology Committee, E-cigarettes, 17 August 2018 [link].
3 David Halpern, Inside the Nudge Unit: How Small Changes Can Make a Big Difference, (2015), p. 196.
4 E-cigarettes, vaping, and public health, A summary for policy makers, Clive Bates, February 2015.
6 Government of Canada, Web page, “Vaping,” (May 2018) [link].
7 Directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco and related products and repealing Directive 2001/37/EC (EU TPD).
8 Directive 2014/40/EU, arts. 19-20.
9 See Impact Assessment accompanying the document proposal for a Directive of the European Parliament and of the Council, 19 December 2012, available at http://ec.europa.eu/health/sites/health/files/tobacco/docs/com_2012_788_ia_en.pdf.
10 Impact Assessment, p. 10.
11 The line between the two categories is neither distinct nor static. As described above, e-cigarettes may contain liquid solutions or solid nicotine; vape products may contain tobacco, nicotine liquid or both; and the entire category is continuously evolving. We believe a single category, defined by the absence of combustion, is a better way to “future-proof” legislation. See Policy Options for the Regulation of Electronic Cigarettes: A consultation document, 2 August 2016, p. 8 (describing “the need for future-proofing legislation”).
12 Colette Devlin, “Ministry of Health throws support behind vaping as a way to quit smoking,” Stuff (NZ) (October 2017) [link].