In the days of vaping, in the UK at least, it’s difficult to imagine people smoking combustible cigarettes in 100 years time.
But the UK government is a lot more ambitious - they have announced they want to be smoke free by 2030, despite slashed funding for stop smoking services.Is it feasible? How could it be achieved? And could the policy have some unintended consequences? To learn more we have been digging away like the fevered nicotine infused moles we are. Here’s what we found out.
How does the government plan to achieve its aims?First, some of these ideas are really just ideas at present. They’re being discussed and knocked around government circles, but haven’t necessarily made it through to policy yet. With that said, here are some of the ideas being discussed and which could make it through...
1. A focus on reduced harm alternatives to smokingOne way forward is a focus on boosting reduced harm alternatives to smoking. The big one is vaping, but there is also a keen interest in other alternatives.
How is the government planning to promote these? Here’s some of the ideas making the rounds:
I. Replacing mandatory health warnings with positive messages
Currently vapes come with a health warning. This tells users that they “contain nicotine which is a highly addictive substance”. Of course, most people already think nicotine is highly addictive, but the similarity to tobacco warnings is seriously off-putting.
The government is considering replacing this with an official message which could advise smokers to switch to vaping, or state that vaping is much safer than smoking.
II. Adjusting regulations
This would see a rethink of the current regulations so that the most restrictive regulations are on the most harmful products, and the least restrictive regulations are on the least harmful products.
III. Encouraging more reduced harm nicotine products
Currently there’s not much enthusiasm for Heat Not Burn (on the basis that everything the government currently knows comes from tobacco companies rather than independent researchers), but there is a desire to have a range of tobacco harm reduction products on the market.
This could include oral tobacco. Oral tobacco is available at the moment, but the current situation sees the most dangerous products freely available and the safest products outlawed by EU regulations. Clearing out regulation here is seen as essential to achieving smoke-free targets.
IV. Messages in cigarette packs
The government is also considering including mandatory message in cigarette packs, again encouraging smokers to switch to reduced harm alternatives such as vaping.
V. Having a licensed THR option
Some in public health also think there is a need for licensed option for smokers. The aim would not be to replace current devices, but to reassure people that vaping is safer than smoking and to provide a prescription option for people who can’t afford to buy a vape kit.
VI. Tobacco company levy
Another option frequently discussed is levying the tobacco companies to raise money to help pay for the government’s campaign. The problem is that there is little consensus on how the money should be spent. Some favour increased investment in Stop Smoking Services (SSS), while others believe that vaping is doing SSS services work for them.
SSS have certainly not had the impact that vaping has had. For example, 39% of former young smokers quit with electronic cigarettes, compared to just 1% who quit with the help of stop smoking services.
Where SSS have the advantage is the ability to connect with hard to reach groups, including people on low incomes, people with mental illnesses and the homeless. Without the aid of SSS, this rump of remaining smokers could make it difficult for the government to achieve its aims. What’s more, when vaping is combined with behavioural support, almost two thirds of smokers successfully quit. However, as we’ll see later on in this article, some Stop Smoking Services believe their effectiveness is limited by their mandates.
Alternatively, the levy could be spent on marketing campaigns to spread the harm of reduced risk alternatives. The money could also be spent on research. Ironically, Philip Morris has already made a huge amount of money available to researchers, but unfortunately researchers who have accepted the money have been subjected to sometimes vicious attacks, are called tobacco stooges and have had doubts cast on their integrity of their research.Not everyone agrees that a levy should be forced on to tobacco companies, with Martin Cullip from the New Nicotine Alliance believing the cost will be pushed on to smokers already struggling with the cost of habit that costs, on average, £3000 a year.
2. Effectively outlawing smoked tobaccoAnd here’s the big controversial one! The idea is that once smoking rates reach a certain level, tobacco companies would be required to make cigarettes obsolete. (An effective ban.)
Smoking rates would need to be well down to do this. At the current rate, we’re looking at smoking rates being 5% or 6% by 2030, with 2 million plus smokers, which would not be low enough to trigger the ban. However, at some point smoking would be made illegal.
Not everyone is happy at that idea. The New Nicotine Alliance is outraged at the suggestion.
“We speak to smokers all the time, and a lot of them are willing to try vaping when it’s a choice,” Martin Cullip told me. “But they also say if they were forced they would refuse. All that’s going to happen is that people will be going to the white van man to get their cigarettes.
“It’s also reinforcing a long time fear that some smokers have had that they would be forced into vaping. I used to reassure people that this would not be the case, but the government is proving them right.
“Why does the government think they have to use a big stick to force people down the road they want them to go? Instead they need to nudge people in the right direction, learning from advertisers and the media to get the right message across and get electronic cigarette companies to work with stop smoking services, providing them with the THR products they need to help smokers.”
Although favouring a combination of direct policies and ‘nudging’, Stop Smoking Manager Julia Robson agrees that you can’t force people into tobacco harm reduction.
“We don’t tell people what to do because we know it doesn’t work. What works is providing information, advice, expert assistance and the right message.”I'm tempted to agree with them. At a recent PHE conference I was surprised that sugar, salts, sweet, biscuits and cakes had been banned from the canteen and conference. I usually eat healthily, but was hit by a sudden desire to eat very unhealthily, a desire I assuaged with a number of sugary biscuits as soon as I got back to the office! Sometimes we just want to do the very things we are not allowed to do...
3. Increasing the age restrictions on smokingA third option which has been considered is increasing the mandatory age for smoking. This could go to 21 or even to 25. If implemented, the government is minded to do this in one fell swoop rather than do it in stages which wouldn’t hit current smokers. The age at which people are allowed to use reduced harm alternatives such as vaping would either stay the same or be increased but at a lower age than the legal smoking rate.The government believes that the previous age increase (from 16-18) was a great success, leading to a halving in the smoking rate amongst 16-18 year olds. But the New Nicotine Alliance is sceptical, with NNA trustee Martin Cullip pointing out that many people start smoking in their mid teens and buy their cigarettes illegally.
4. Change health care professionals attitudes towards reduced harm productsPart of the government's tasks lie in persuading the medical front line that vaping, smokeless tobacco and the ilk are a better alternative to smoking. As we’ll see, that’s a huge task!
Obstacles to a Smoke Free EnglandThe goal is both laudable and ambitious. If achieved, it could mean that millions of people have a better quality of life, a longer life - and more money in their pocket. That doesn’t mean the path will be easy, though, and there are some big obstacles in the way.
1. EU regulationsMuch of the government’s plans depends on being free of the EU regulatory framework, which are the ones that impose both restrictive regulations on vaping and ban the safest forms of oral tobacco such as Snus. Sure, Brexit looks more and more likely it is going to happen, but that’s no guarantee we won’t be tied into EU regulations in the future.
At one vape forum, THR commentator Clive Bates argued that eventually we will need to do some sort of deal with the EU, even if it is not from the outset, which is likely to mean we once again have to adhere to EU regulations. Even worse, we’re unlikely to have any say in those regulations - pretty serious considering that if it hadn’t been for pressure from UK MEPs, vaping would have been effectively banned in the UK.As a side note, it’s also a potential disaster for European neighbours and friends who smoke and/or vape to lose the most pro-vaping country in the EU.
2. Smuggled tobaccoIllicit tobacco is already a huge barrier to the government’s smoking bans. In fact, one stop smoking service advisor told me that she has a hard time switching people to vaping, because illegal cigarettes were cheaper than vaping in her (coastal) area. A tobacco rep in the same area told me he couldn’t see new brands of rolling tobacco to shops, because all the smokers bought their tobacco down the pub.
Hard facts back this up. Smuggled cigarettes accounted for 17.8% of the cigarette market in 2017, costing the government 2.8 billion pounds in tax revenue. And the costs aren’t just financial - pesticides, arsenic and even rat poison have all been found in illegal cigarettes.Like other markets, the smugglers responds to demand, and with Trading Standards suffering the same cuts as everyone, the tools to battle the black market has been reduced. Smuggled tobacco is likely to become a much bigger problem if tobacco cigarettes are banned, although as mentioned the government doesn’t plan to ban tobacco cigarettes until smoking rates are very low - the 5% currently forecast wouldn’t cut it.
3. International/US Opposition to VapingIn contrast to the UK, many countries and organisations abroad are very opposed to reduced harm alternatives to cigarettes. We’ve already seen that Snus is banned in the EU, and the WHO is vehemently opposed to vaping.
What’s more, the US is about to ban most vaping products. That in itself is likely to have a real impact on independent manufacturers of vaping hardware in China. With a massively reduced customer base, this could impact on supply and will impact on innovation and research budgets spent on vape products.The UK, along with a handful of other nations such as Canada and New Zealand, has pushed on with a more liberal policy, but real damage so far has been in the negative stories created by a sophisticated and well-financed campaign against vaping. Perhaps the most recent is the worst, with the use of illegal drugs and oils (known to cause respiratory illnesses when vaped) being deliberately conflated with vaping legal e-liquid.
4. Media scare stories and medical misinformationMany people continue to smoke cigarettes in the face of public health advice because of media scare stories. It’s not just smokers, either - I’ve heard stop smoking services complain they switch people from cigarettes to vaping only from them to go to their doctor and be told they could get popcorn lung.a negative news cycle has hammered the vaping industry, leading to a 15-30% drop in sales and a 30-60% drop in the purchase of starter kits. PHE has helped to mitigate these stories, but clearly continued negative media stories could hamper PHE's ambitions.
5. Confused messagingWhile I was writing this article, a family member was taken ill and I spent many hours at my local hospital. And when I popped outside for a vape I was faced with no smoking, no vaping messages (ignored by both smokers and vapers). Not just no vaping in the building, but no vaping on hospital grounds.
While some trusts are pro-vaping, other hospitals are implementing a total abstinence policy, with neither smoking nor vaping allowed. Julia Robson believes this is one area that could confound the government’s ambitions:“Lumping cigarette smoking and vaping together sends the wrong messages to smokers - it tells them that vaping is no better than smoking.”
6. Restricted stop smoking servicesMost Stop Smoking Services are currently restricted by a narrow mandate, which is to get smokers to quit smoking for at least four weeks. However, Julia believes this is just part of the puzzle, and that to achieve the government’s smoke free goals there needs to be a much broader “total population” campaign.
For example, stop smoking services are being asked to provide training, but as they are only paid to deliver ‘four week quits’, it’s impossible to meet the demand. Julia has provided some limited training, but has requests for training come in from all over the country. Stop Smoking Services simply can’t justify diverting their resources from what they are paid and mandated to do.
What’s more, the number of experts in stop smoking services has been decimated. Julia believes that the loss of experts who can “change hearts and minds” is a key reason why so many institutions are banning both smoking and vaping. To ultimately achieve the government’s aims, Julia believes there needs to be a combination of training, support and campaigns as well as the one-to-one support SSS currently provide. Instead, she argues, the combination of funding cuts and restrictions on what SSS can do is hampering progress.There are exceptions to the rule, and Julia pointed that where greater investment has been made (e.g. in the North East as well as in specific councils) progress has been much more rapid.
Implications for the independent vaping industryIn theory, government support for tobacco harm reduction should mean more smokers switching to vaping, a plus for both public health and the independent vaping industry. But it does get a little more complicated than that.
What’s particularly alarming is the potential for the legal vape age could be raised. If, for example, the smoking age was raised to 25 and the legal vaping age was raised to 21, many smokers who have switched to vaping would have no legal access to electronic cigarettes. To see what could happen if those vapers looked to non-legal alternatives, we only need to look to the US, where people using alternatives to legal vapes have suffered a cluster of serious respiratory illnesses that have lead, in some cases, to death.
Announcing that tobacco products will be made obsolete could encourage tobacco companies to focus even more on reduced harm alternatives. The tobacco industry is particularly keen on the higher margin Heat not Burn segment, but this just hasn’t caught on in the UK. In the US, the tobacco industry is being saved by stricter regulations on vape products, which means both the cigarette and vape industry will be dominated by tobacco industry, but in the UK the vape market continues to be dominated by the independent industry.
This could lead to stiffer competition, and if this is combined with a relaxation in advertising laws, independents could really suffer. It could also see an increase in acquisitions.
David Pattison, who analyses the vape industry for Plimsoll, told me the factors for both an increased rate of failure and an increase in mergers and acquisitions are already in place.He’s seen growth in the industry slowing, with profit margins coming down from above 10% to around 3%, and companies increasingly chasing market share at the expense of profit. As a result, he believes, the likelihood is an increased number of business failures and an increase in acquisitions as larger players seek to control the market.
Change is coming, whether we like it or not...Some vapers and vape companies long for an environment in which vaping can continue working its magic, unhindered by political influences. After all, in its early years vaping succeeded in slashing smoking rates without any political help. That’s partly because of a vibrant industry that is close to its customers and has innovated to provide the devices and flavours smokers needed. It’s tempting to call for the government to leave what’s working well alone.
Yet in reality vaping was never going to be left alone. The vaping industry simply threatens too many organisations and people who benefit either from smoking or the fight against smoking. As a result of those interests, and a voracious campaign against vaping, the number of smokers switching to vaping is fizzling out like a cigarette on its last puff. As a result, tens of thousands of smokers in the UK, and millions worldwide, could die an earlier death.
At least in the UK we have a government organisation which is a powerful ally to vaping and tobacco harm reduction. Public Health England has also shown a willingness to engage and debate the issues. If we want to influence how the government helps smokers and vapers, we will need to speak up.
Note: The majority of this article was based on interviews, but the following sources were also used.
HM Government Advancing our health prevention in the 2020’s July 2019,
IBVTA: Confused Vaping Stories that Cost Lives, Aug 2019
Oliver Bennet, The Guardian How counterfeit cigarettes containing pesticides and arsenic make it to our streets Aug 2018,