E-Cigarette Summit 2024 Round Up
Just a few years ago, vaping was widely accepted in the UK as a key tool for tackling tobacco addiction - a solution that, while not perfect, was vastly better than smoking.
Then, youth vaping shifted the narrative.
Now the message, at least amongst policymakers, has changed from vaping being 95% less harmful than smoking, to a habit that might be a little better than smoking - and one which is seducing a generation of young people into a lifetime of nicotine addiction.
The result is a deluge of legislation that could redefine vaping as we know it. Display bans threaten the survival of independent vape shops, flavour restrictions could strip vaping of its appeal compared to smoking, and increased taxes will have a huge impact on the cost of vaping.
As these challenges loom, the E-Cigarette Summit offers a crucial opportunity to gather leading experts from the UK and around the world. Their expert knowledge and opinions have the potential to shape both the debate and legislation that lies ahead. Whether you're a policymaker, advocate, or simply interested in the future of vaping, this summary of the Summit’s key takeaways will help you understand the challenges ahead - and the proposed solutions.
Contents
- Session 1: Context, Evidence & Government Challenges
- Session 2: Research Informing Public Health Policy
- Session 3: Regulatory Challenges & Potential Solutions
- Session 4: Challenges for Ending Smoking
-
Conclusion
Session 1: Context, Evidence & Government Challenges
Opening Keynote: Conceptualising THR and balancing clinical and population considerations
Prof Peter Selby
Giblon Professor and Vice Chair of Research, Department of Family and Community Medicine, University of Toronto.
Addiction physician Dr Selby shared insights into harm reduction strategies. Central to his talk was Project Vector - an initiative synthesising research on vaping and e-cigarette use to create actionable recommendations. Dr. Selby emphasised the importance of distinguishing absolute risk (e.g., young people starting to vape) from relative risk (e.g., smokers switching to vaping). While vaping is not without risk, for people unable to quit smoking it is a significantly less harmful alternative:
“If a young person starts vaping without ever smoking their absolute risk leaps—but the story is entirely different for a smoker unable to quit combustibles.”
Dr. Selby advocated for nuanced frameworks that prioritise both individual needs and broader public health goals. Harm reduction is ever-evolving but remains a critical tool in reducing smoking-related harm:
“A pursuit of zero risk is unrealistic, but with informed intervention, we can prevent immense harm and save lives.”
The Tobacco & Vapes Bill
Richard Boden
Deputy Director Tobacco and Vaping Policy and Legislation, Office for Health Improvement and Disparities, Department of Health and Social Care
James Dunworth
I won’t cover this in-depth, as Boden’s talk was essentially a recap of what’s in the Tobacco and Vapes Bill (summarised here).
One thing that I had missed before was the duty to consult before implementing key changes such as flavour restrictions. This wasn’t in the original Tobacco and Vapes Bill, but is key as consultation may help prevent the most harmful measures from being taken - such banning all flavours bar tobacco or menthol.
Situating e-cigarettes for harm reduction in the wider context
Prof Jamie Brown
Professor of Behavioural Science and Health, University College London (UCL)
James Dunworth
Daily cigarette smoking in England has plummeted by more than half since 2007, reaching a low of 10.5% in 2024. However, this positive news has masked a rise in non-daily smoking - which is now 25% of all smoking behavior.
"This shift is a double-edged sword. While daily smoking declines, the rise in non-daily smoking means overall progress is less steep."
Discrepancies between the STS and the Annual Population Survey (APS) - England’s official tool for monitoring smoking prevalence - further complicate the narrative. Changes to APS's smoking-related questions in 2016 likely excluded non-daily smokers from its data, presenting an overly optimistic view of the smoking landscape. For example, while the APS estimated smoking prevalence at 11.6% in 2023, the STS placed the figure at 16.5% when non-daily and non-cigarette tobacco use were included.
"We’re facing a more complicated reality than the APS portrays. A quarter of smokers now smoke non-daily, and this group is disproportionately made up of daily vapers."
The role of vaping and the perceptions of vaping in these trends is critical. In 2015, 90% of non-daily smokers who vaped believed e-cigarettes were less harmful than smoking. That’s now less than 50%. The result? Instead of only vaping, more people both smoke and vape.
“Harmful misconceptions about vaping are holding people back. We must prioritise targeted campaigns to dispel myths and encourage full transitions away from smoking.”
Non-cigarette tobacco products like cigars and waterpipes, historically rare in England, have also grown in popularity, particularly among vapers. These trends, coupled with the underreporting of non-daily smoking in official statistics, pose a significant challenge to England’s smoke-free 2030 target.
In closing, Jamie Brown emphasised the need for robust public health interventions. Supporting non-daily smokers - especially vapers - to quit entirely must be a top priority, alongside targeted media campaigns to correct vaping misinformation. He concluded:
"The 'last mile' of tobacco control is proving more complex than we anticipated."
Cochrane Review evidence: Updates on e-cigarettes for quitting smoking and emerging evidence on ways to quit vaping
Dr Nicola Lindson
Associate Professor in the Centre for Evidence-Based Medicine, University of Oxford
James Dunworth
The evidence from Cochrane is clear: e-cigarettes are more effective than Nicotine Replacement Therapy (NRT), leading to an additional four successful quitters per 100 people. What’s more, so far the review has found no conclusive evidence of greater harm associated with e-cigarettes compared to NRT, although more research is needed.
One unexpected insight is the sustained use of e-cigarettes among those who quit smoking with their help. Cochrane data shows that six months after quitting, 70% of successful quitters were still vaping. Linsson suggested that this long-term use might actually underpin e-cigarettes' effectiveness, as many smokers fail to use NRT consistently or for a sufficient duration.
What about those who want to eventually quit vaping? Lindson introduced ongoing work on a new review, one focused on interventions for quitting vaping. Preliminary findings from nine studies suggest higher-than-expected quit rates for vaping cessation—ranging from 24% to 38%—compared to interventions for smoking cessation.
This raises an intriguing possibility: Could it actually be easier to quit vaping than smoking?
The US youth data supports this, showing a dramatic decline in vaping prevalence in U.S. high schools, from 27.5% in 2019 to 7.8% in 2023. This is unprecedented in the world of tobacco and nicotine addiction.
There is a danger - people who quit vaping could return to smoking, leading Lindson to conclude:
“Quitting vaping shouldn’t lead to a return to smoking, so we need evidence-based pathways for both smokers and ex-smokers.”
Effective public health protection needs sound scientific evidence: The avoidance of unintended consequences
Prof Alan Boobis, OBE
Emeritus Professor of Toxicology & Chair, UK Committee on Toxicity, Imperial College London
James Dunworth
Although smoking’s prevalence has declined, it still accounts for 15% of UK deaths and costs public finances approximately £13.5 billion annually. We still need to encourage cessation and e-cigarettes have succeeded where NRT fell short - offering an effective alternative to smokers through both biological and behavioral avenues.
What about flavours?
So far, evidence has not shown that flavourings cause significant adverse health effects. The majority of the flavour compounds are also common in food products. We know these will not be harmful when absorbed into the bodies. There is the possibility of harm to the lungs, but exposure levels are low. Flavour properties can change when heating, but this is also true when food is cooked. Temperatures in vaping are also much lower than in cigarettes.
The presenter also addressed high-profile health scares, including the 2018 U.S. EVALI crisis and ‘popcorn lung’, which linked regular vaping with serious diseases. These debunked myths create a crisis of credibility because anyone can quickly find out the truth.
Ultimately, the speaker argued that fears around the health impact of flavourings are misaligned.
“[The real concern] is their appeal to young, non-smoking demographics”. A nuanced approach is crucial - policies must balance protecting youth while ensuring smokers retain access to effective cessation tools like vaping. Accurate, science-based communication is key to achieving this balance.”
“Poor risk communication has real consequences. It’s essential that public health messages avoid needless panic while maintaining credibility.”
Part 2: Complex problems, clumsy solutions and the court of public opinion
Prof Sanjay Agrawal
Professor of Respiratory Science, University Hospitals of Leicester NHS Trust, Special Advisor on Tobacco, Royal College of Physicians
James Dunworth
Prof Agrawal emphasised that vaping and tobacco control present intricate challenges shaped by interconnected factors like addiction, dual use and youth uptake. These are "not binary problems," and clumsy solutions - imperfect yet viable - are often the best way forward.
The Royal College of Physicians (RCP) report offers 50 recommendations across four key areas: products, price, promotion, and purchase. These recommendations aim to align nicotine product regulation with varying health risks, recognising "nicotine as part of the solution for cessation," a stance that diverges from stricter nicotine-regulation policies in other countries.
On products, the RCP report calls for enhanced standardisation of emissions, packaging, and labelling to improve both safety and transparency for users. It also highlights the environmental impact of disposables, urging regulation to mitigate waste.
Price regulation was another key focus. “Keeping e-cigarettes affordable for smokers while deterring youth uptake is critical,” said Agrawal. Recommendations include introducing measures such as minimum pricing and bans on multi-buy offers. However, he warned against unintended consequences like cross-price elasticity, where higher vape prices could push users back to cheaper alternatives like cigarettes - as observed in the US.
Promotion and purchase proposals tackled youth-targeted advertising and point-of-sale visibility, alongside endorsing enforcement of youth sales restrictions. Prof Agrawal was particularly critical of industry influence, stating that tobacco companies see youth vaping as "new entrants into the nicotine market" rather than a harm-reduction tool - making the removal of industry input essential.
Session 2: Research Informing Public Health Policy
Maximising benefits. Minimising unintended consequences
Dr Jasmine Khouja
Senior Research Associate, University of Bristol
Martin Dockrell
Tobacco Control Programme Lead, Office of Health Improvement & Disparities, (OHID)
James Dunworth
Dockrell began by acknowledging the risks associated with e-cigarettes, particularly among young people, Referring to the “Four Horsemen of the Tobaccalypse” - death, disease, disparity, and dependence, he underscored the importance of careful intervention design.
For example, we can see from countries like the US that there are proven ways to reduce youth vaping, such as taxes and flavour restrictions. However, these methods have unintended consequences, such as increasing smoking rates.
“Even a very small increase in smoking would completely offset any benefits in reducing vaping due to the significant harm disparity between the two.”
Dr. Khuja walked us through a “decision-making tool,” designed to assist policymakers with a snapshot of potential trade-offs. Using this, the tool suggests approximately 125,034 non-smokers in the UK are drawn into vaping through flavours. 48,784 would potentially transition to smoking as a result - but Khouja said the major caveat is that this isn’t universally true” as there is evidence against the gateway theory.
On the other hand, an estimated 460,200 adult smokers might quit smoking via e-cigarettes if flavours remain available, with 381,102 adult ex-smokers potentially relapsing if flavours became unavailable.
“In both estimations—whether looking only at youth vaping or at youth who go on to smoke - restricting flavoured e-liquids in the UK appears to have negative consequences for public health.”
The results of interviews with 18-30s on how they would react to a disposable ban were particularly interesting:
“Many reported they would smoke more or even start smoking because it seemed "disgusting," making it easier for them to quit smoking than vaping. Others expressed excitement about stronger and cheaper illicit products becoming available, particularly from abroad. These responses highlight the complexity of unintended consequences and underscore the need for continued research.”
To avoid unintended consequences, policymakers must be guided by robust, ongoing research, and ensure that actions to curb vaping among young people don’t backfire by driving them - and adults - to cigarettes.
Or, as Dockrell put it:
“Careful, research-informed policy design is essential to tackle death, disease, and disparities without creating new problems for public health.”
Vaping & illicit drugs: Promises and pitfalls
Dr Tom Freeman
Director, Addiction and Mental Health Group, University of Bath
James Dunworth
Freeman started by pointing out that the main harm from cannabis is from smoking and if people vaped it instead of smoking, it would be significantly safer. There is a considerable opportunity here.
We can take a look at Canada as an example. In a country where cannabis is legal, vaping cannabis is starting to make a dent on combustible use. The importance of having legal, regulated devices available is demonstrated by the disease EVALI (caused by the use of illegal cannabis products).
Cannabis is a very safe drug when compared to tobacco, and we are not going to see people die from it. The situation is very different with synthetic cannabinoids such as spice, which can have very serious adverse effects - including death.
Unfortunately, these drugs are becoming prevalent in the UK. They are now responsible for half of all non-natural deaths in UK prisons, and they have been found in over 70% of the UK’s schools with severe reactions being reported.
Part of the problem is that most young people think they are buying cannabis vapes (which are relatively safe). However, it is difficult to make cannabis e-liquids and much cheaper and easier for the illicit market to make synthetic cannabinoid vapes.
Things are likely to get worse before getting better, with emerging trends suggesting other drugs like Ketamine will be used in vapes. As things evolve, it will be crucial to consider the broader impacts of illicit drug use.
E-cigarettes for smoking cessation among people experiencing homelessness (Project SCeTCH)
Dr Sharon Cox
Principal Research Fellow, Tobacco and Alcohol Research Group, University College London (UCL)
Dr Cox’s presentation highlighted the human reality of smoking cessation - particularly amongst the homeless population. With homelessness up 10% in England in the last year alone, she reminds us that, while 95% of homeless people don’t ‘sleep rough’ outdoors, the majority still report poor respiratory health. This can be at least partly explained by the staggering smoking rates amongst the homeless population - 76% compared to 12.9% nationally.
However, the positive message is that 50% of this group express a desire to quit.
The SCeTCH trial measured the effect of e-cigarettes as a smoking cessation aid over 24 weeks with over 477 homeless participants - with half receiving a vape kit and e-liquid (EC group), and half receiving ‘usual care’ of an NHS quit smoking leaflet (UC group).
Keen to dispel the notion of homeless people as ‘hard to reach’, Dr Cox emphasised that 277 participants were available for the 24-week follow-ups.
Results showed that while quit rates remained low, the group given e-cigarettes showed higher reductions in cigarette use and seven-day quit rates, while ‘risky smoking behaviours’ were reduced in both groups.
However, Dr Cox was keen to emphasise that there is a place for both strategies in smoking cessation.“E-cigarettes hold promise…but we can’t disregard the value of usual care either”.
The presentation ended with a video that emphasised the real-world effects of the trial, with participants describing their personal experiences and the benefits of switching - from smoking fewer cigarettes and better respiratory health to just smelling better!
Understanding & addressing harm perceptions
Dr Katie East
Research Fellow, Society for the Study of Addiction (SSA) Griffith Edwards Academic Fellow, Nicotine Research Group, King's College London
James Dunworth
Nearly 70% of adults who smoke in England now incorrectly believe that vaping is as harmful or more harmful than smoking - a perception that has more than doubled among youth over the past decade.
The key contributors? Media sensationalism and misleading public health campaigns (particularly during the EVALI outbreak). These started in the US, but are now being adopted in the UK, particularly in places like schools. Another factor is a deep-rooted misunderstanding about nicotine's role in health harms. Dr East stressed that scare tactics aimed at dissuading youth from vaping could backfire, as evidence shows they don't yield long-term behaviour change and may perpetuate misinformation.
Misconceptions may deter youth vaping, but we don’t know if youths will take up smoking instead. They are also damaging for adult smokers as they:
- prevent smokers from switching to vaping
- hinder quit attempts
- increase the likelihood of smoking relapse.
Encouragingly, Dr East shared promising results from a new intervention: TikTok-style videos featuring academics debunking myths like “vaping causes cancer.” A randomized trial with 600 young adults showed these short, evidence-based clips effectively improved accurate perceptions in the short term, with some spillover benefits to related beliefs.
Her conclusion? Tackling misinformation is essential to support harm reduction efforts, and innovative, youth-focused strategies like social media campaigns could be the way forward.
Packaging, flavours and nicotine descriptions on nicotine and tobacco products
Dr Eve Taylor
Research Associate, Nicotine Research Group, King's College London (KCL)
James Dunworth
Eve Taylor’s presentation is worth a brief mention, if only to bring home how extreme some current suggestions are going. Her research looks not just at the prospect of using plain packaging and simplified packaging names but of potentially replacing flavour names with codes. She concluded:
“Research shows that standardising packaging - using plain designs and simplified flavour names - reduces youth interest in vaping without significantly deterring adult smokers… However, it may increase youth misperceptions, leading some to believe vaping is as harmful as smoking. ”
Panel Discussion with Q&A: Identifying effective interventions to minimise unintended consequences
Chair: Prof Ann McNeill
Panel: Dr Jasmine Khouja, Martin Dockrell, Dr Tom Freeman, Dr Sharon Cox, Dr Katie East, Dr Eve Taylor, Alizée Froguel
James Dunworth
A combination of time and streaming issues prevents us from covering these panel discussions in depth. However, one particularly interesting point came from a Brazilian guest who pointed out that five million people in Brazil are using illegal vapes, as legal vapes are banned.
What should they do, asked the guest? “Legalise it”, said Sharon Cox. Dr Tom Freeman also pointed out that the situation is the same with cannabis in the UK. In countries where cannabis is legal, such as in Canada, countries do not have problems with spice.
Session 3: Regulatory Challenges & Potential Solutions
What next for vaping in the UK?
Hazel Cheeseman
Chief Executive, ASH (Action on Smoking & Health)
James Dunworth
Half of UK smokers who have quit in the last five years did so by vaping. As vaping rates have gone up, smoking rates have not decreased as fast. There are a numerous reasons for this, including:
- The perception that vaping is more harmful than smoking
- The idea that you are just swapping one addiction for another
- Worries over youth vaping spilling over into public domain
- The perception that vaping is more expensive
This is going in the wrong direction, and we need to do something to change that.
Cheeseman thinks we need to create a far less visible market for vaping. We need to:
- Reduce visibility of vaping to public without damaging its appeal.
- Limit how flavours are described and how they are displayed
- Make vaping about smoking cessation
- Reach people via public health campaigns and professionals
We also need to think about whether products are safe enough, and if there is more we can do, as we now have a large group of people who just vape, some of whom have not smoked before. We can all agree that vaping is less harmful than smoking, but how safe is safe enough?
Regulations could help make better and safer products, drive out rogue elements and offer alternatives to vaping.
What will happen if smoking is eliminated? We need to consider what smokers and ex-smokers will need in the future.
UK regulations & enforcement
Craig Copeland
Head of E-Cigarettes, Healthcare, Quality and Access Group, MHRA - The Medicines and Healthcare products Regulatory Agency
Kate Pike
Lead Officer for Tobacco and Vaping, Chartered Trading Standards Institute
Kayleigh Jenkins
Craig Copeland explains that the fast-moving, shifting trends of the past year have led to increased challenges in vape regulation. While a decrease in disposable vape usage has been positive, regulators have faced an influx of new alternatives including multi-tank and ‘2+10’ devices.
These products confuse regulators because they never conceived of or legislated for multi-tank products, making it hard to say whether they are legal or not. ‘2+10’s’ with refill containers packaged alongside the device also muddle the concept of legal separation - as they are technically 2 notified products that can be both compliant and non-compliant with regulators and with the market.
Measures taken to navigate these products include working with the CTSI Vaping Expert Panel to ensure detailed guidance to improve the submission process - with requirements for schematics, packaging images, usage videos, and even physical samples aiming to evaluate products more effectively and give real-time feedback.
From an enforcement perspective, Kate Pike explains that, while over 1.2 million illegal vapes were seized inland in 2023 alone (with many more at ports and borders), along with significant efforts to reduce underage sales, vape enforcement still faces challenges in terms of consistency.
The number of individual local authorities working within regional budgets and priorities means that, while some authorities lead aggressive crackdowns, some barely touch vaping regulation - leading to an unbalanced enforcement landscape.
Trading Standards and regulators can also only work in the confines of the law and under the power they have - unable to hand out fines or be responsible for criminal action.
In terms of new regulations, Kate explains that multiple organisations including Defra, Trading Standards and HMRC will work to provide clarity and structure. Proposed measures include additional enforcement officers being placed to help reduce the number of illegal products on the market, funding to help retailers reduce waste in light of the disposable vape ban and a licensing scheme to help regulate the market and remove ‘bad actors’.
Disruptor, disaster, or distraction? Vaping and smokefree New Zealand
Ben Youdan
Director, ASH New Zealand
Kayleigh Jenkins
Ben’s annual update on New Zealand’s ambitious Smoke-Free goal showed great progress - with an emphasis on the pivotal role played by vaping. Boasting one of the world’s most rapidly declining smoking rates, New Zealand is aiming to reduce daily smoking to just 5% by 2025.
Originally aimed to reduce smoking rates in Mauri communities, initial progress was slow. However, in the past 5 years rates have significantly reduced nationwide despite no major policy interventions since 2018.
This downturn coincided with a significant increase in vaping - giving smokers an alternative to cigarettes and helping to yield impressively reduced smoking numbers.
This was most significant in Maori women where daily smoking numbers have almost halved in 5 years, leading Ben to state: “I don’t think I’ve ever seen such a rapid rate of decline in smoking for any population group anywhere in the world,”
Other impressive figures revealed that 27% of New Zealanders now live in smoke-free (under 5% smoking rates) neighbourhoods, compared to just 3% 5 years earlier.
This correlation between increased vaping and reduced smoking is too strong to ignore….but why aren’t we celebrating? Why is New Zealand’s stop-smoking success not global news?
Ben attributes this to political disruption, a fixation on youth vaping and “harm reduction policies being painted as tobacco industry conspiracies.”
Post General Election, the repeal of anti-cigarette laws that championed vaping as a cessation aid in March 2024 led to mass protests and accusations of tobacco industry influence on policy.
Despite a downturn in youth vaping and smoking, these statistics rarely make the headlines or are completely ignored, with the press more likely to focus on the dangers of nicotine.
Ben concludes with plans for the future - with an imminent new bill looking to assert new measures including disposable vape bans, increased penalties for underage sales, advertising restrictions and more.
Finally, Ben questions whether New Zealand can reach Smoke-Free 2025:
“We can, IF we behave ourselves… [but if we] focus on ideological differences rather than public good, we risk sabotaging ourselves.”
Ben concluded with a call to stay focused on what matters: saving lives.
Australia’s unique nicotine regulatory framework – can light touch medicines regulation work?
Prof Coral Gartner
Professor, School of Public Health, University of Queensland, Australia
James Dunworth
Professor Gartner covered Australian vaping legislation in painstaking detail - too much detail to cover here. The key things to know are:
Australia used ‘light touch’ (read brutal) medicine regulations to regulate and allow access to vaping. It didn’t work - youth vaping increased and nearly 90% of vapers now buy vapes illegally. So Australia is now trying harsher regulations, which also don’t seem to work.
EU Regulations: Vaping, pouches & flavours
Pablo Cano Trilla
Head of Legal Analysis, ECigIntelligence
James Dunworth
Pablo showed that fruit, beverage, and sweet flavours dominate vapers’ preferences globally, while tobacco-flavoured options are significantly less popular. In the U.S., for example, only 1% of vape products are tobacco-flavoured, with similar trends observed across other markets, including nicotine pouches.
But what happens when flavours are banned? Evidence from countries like Lithuania and the Netherlands paints a complex picture. While bans on domestic sales have reduced availability locally, they’ve fueled cross-border purchases and online imports, undermining enforcement efforts and shifting tax revenue to neighbouring nations.
The EU faces a pivotal moment. Proposed flavour bans and outright restrictions on nicotine pouches highlight stark regional divides. Nordic countries like Sweden advocate regulation, emphasizing the role of alternative products like snus in reducing smoking. Meanwhile, countries like France lean towards prohibition, raising questions about access to harm-reduction tools.
Ultimately, the data underscores that flavours are essential for vape users, with bans likely driving unintended consequences rather than meeting public health objectives.
Session 4: Challenges for Ending Smoking
U.S kids no longer smoke. Why aren’t we celebrating?
Prof Kenneth Warner
Avedis Donabedian Distinguished University Professor Emeritus and Dean Emeritus, School of Public Health, University of Michigan
James Dunworth
Adolescent youth smoking has basically disappeared. It’s one of the greatest public health achievements in the US. Daily smoking has gone from a quarter of high school seniors to 0.7%. This is the smoke-free generation, but no one has paid any attention to it.
What caused this?
Some of it is likely down to changes in social norms and policies. But what about vaping? We can’t know for sure, but Professor Warner thinks it was a factor, highlighting the rapid increase in cessation after vaping had been introduced.
Why aren’t we celebrating?
Because there is a concern about tobacco and nicotine use in any form. If you believe smokeless tobacco is as dangerous as combustibles (which most Americans do) this is problematic. Plus, most Americans believe nicotine is the cause of smoking diseases - including US doctors.
Then there’s the special case of e-cigarettes. Originally there was a fear of renormalising smoking, but the opposite has happened. However, parents, teachers and others are still worried about the dangers of vaping, especially as vaping has been taken up by more wealthy, educated white students.
Evaluating the fears
Addiction - This is likely to be far less prevalent amongst e-cig users.
Damaging young brains - This fear is based on animal laboratory studies that are 20-30 years old. Why are we hearing about it now when we are talking about much less dangerous products than when kids were smoking?
Youth vaping: Nicotine vaping peaked in 2019 at nearly 20% but has now plummeted to around 5.9% Daily vaping is also plummeting, in 2023 less than half what it was four years previously.
Have we won?
We’ve won a major battle against combustion, but smoking could come back. The current generation will have substantially lower levels of illness and death including cancer, heart disease and COPD. Smoking remains a problem for adults, especially for disadvantaged groups.
When unintended consequences are the main consequence: Rethinking regulation
Clive Bates
Director, Counterfactual Consulting Ltd
James Dunworth
Summit organiser Amanda thoughtfully placed Clive Bates near the end of the day - I suspect because after hours of listening to sometimes complicated and certainly mentally tiring presentations, Clive always manages to wake people up.
Bates started by reminding us why people use nicotine; it’s a psychoactive drug that is immensely popular and makes people feel like they’re feeling better. It explains why nicotine is so popular, and why that demand is not going away and cannot be wished away.
Tackling the theme of unintended consequences, Bates argued that these are not merely peripheral issues - they are central to the effectiveness (or failure) of tobacco regulation.
His key message? Policies that fail to account for behavioural responses risk causing more harm than good.
"If smoking is 20 times as dangerous as vaping you can't just say, 'Well, we've saved a bit of vaping, we've caused a bit more smoking.' The net harm is enormous."
Bates underscored the importance of understanding that nicotine use, overwhelmingly an adult phenomenon, will not simply "disappear" through wishful policy.
He categorised unintended consequences into three areas:
- Adverse behaviour change: Regulations that push people back to smoking - such as vape bans or tax hikes - represent a public health setback. For each vaper who returns to smoking, the net harm skyrockets.
- Illicit trade: Prohibition fuels black markets, which not only lack oversight but also often draw young people into dangerous supply chains.
- Workarounds: When regulations tighten, innovation persists. From illegal flavourings to DIY vape kits, the landscape adapts, often undermining safety.
Bates warned that outdated approaches to tobacco control no longer work in a world reshaped by globalization, social media, and rapid innovation.
“The tools we had in the ‘80s and ‘90s were designed for ads, factories, and cigarettes. Now we’re up against encrypted communications, cryptocurrency, and billions of social media users."
He illustrated global policy failures, including Australia's thriving underground vape market under stringent regulations (94.5% of vapes imported illegally) and similarly the US's inability to curb unregulated vapes despite FDA oversight. In the UK, the 1992 snus ban painfully highlighted what’s at stake - denying access to a proven harm-reduction product.
On the proposed generational smoking ban, he remained sceptical. Despite being hailed as “historic,” Bates deemed its public health impact negligible, with benefits unlikely until 2044. “As 80,000 people die annually from smoking-related diseases, saving 2,000 lives over a decade is merely a drop in the ocean."
His solutions? Risk-proportionate regulation, maintaining lawful markets, responsible marketing, age-secure retailing, and, critically, protecting children - not just by preventing youth vaping but by helping parents quit smoking. Bates concluded with a clear plea:
"Let’s think pragmatically. The ones most at risk need smarter, measured policymaking."
Where great opportunities met reality. Lessons from the U.S. regulatory experience
Jeff Weiss
Writer & Commentator, Former Chief Engagement Officer of NJOY
James Dunworth
Jeff delivered a searing critique of the U.S. regulatory approach to nicotine vaping products, singling out the FDA’s handling of pre-market tobacco applications (PMTAs). Despite being four years into the regulatory process, just nine products have been authorized. In stark contrast, 90% of the U.S. vaping market operates illicitly and misinformation about vaping continues to erode public understanding.
“Alarmingly, only 10% of respondents in the U.S. correctly identify nicotine vaping products as less harmful or much less harmful than smoking.”
Conley juxtaposed the FDA's stringent regulation of vaping products with its lax stance on combustible tobacco, noting that menthol remains a lawful cigarette flavour. He accused the FDA of failing to combat misinformation with the same vigour it applies to other public health issues.
Conley traced this failure back to 2018, when concerns about youth vaping derailed a promising nicotine harm reduction strategy. Youth vaping rates soared, prompting then-FDA Commissioner Scott Gottlieb to call it an “epidemic.” Adding fuel to the backlash, Michael Bloomberg launched a $160 million campaign targeting flavoured vaping products. Conley argued that Bloomberg’s influence effectively dismantled the harm reduction consensus built over decades, replacing it with policies that misrepresented vaping as equally dangerous as smoking.
“Even after youth vaping rates fell below pre-2017 levels, Bloomberg awarded another $140 million to continue his campaign. The discourse has shifted, with e-cigarettes dismissed as merely trading one harmful addiction for another.”
This U.S.-centric issue, Conley warned, is cascading globally. Misinformation originating in the U.S. has contributed to 50% of U.K. adults incorrectly believing vaping is as harmful as smoking. Bloomberg’s strategy even extends to the WHO, whose tobacco control policies now align with his anti-vaping stance.
So, how do we chart a new course? Conley called for a return to public health principles grounded in science, truth, and harm reduction.
“Are we soldiers in a war against a despicable enemy, or are we rescuers aiming to save lives? A war mentality tolerates misinformation and collateral damage. A rescuer mindset prioritizes science and saving lives. This distinction is critical.”
Finally, Conley emphasized the need for independent oversight to protect tobacco control policies from all vested interests—not just industry players. For meaningful progress, he concluded, regulators must reground their efforts in science and consensus, shedding the polarizing war narrative that currently dominates.
Accelerating the end of smoking
Prof Robert Beaglehole
Emeritus Professor, University of Auckland, New Zealand & Chair ASH - Action for Smokefree 2025, NZ
Kayleigh Jenkins
A harm-reduction advocate for almost 50 years, Professor Beaglehole’s presentation focussed not only on the global crisis caused by smoking, but the progress being made and the urgent solutions needed.
With smoking still claiming lives, Prof Beaglehole emphasised that ‘business as usual’ will not solve the problem. Despite progress being made from the likes of the Framework Convention on Tobacco Control, barriers still remain.
Global targets lack ambition and are still falling short on addressing chronic illness rates, while key interventions such as increased tobacco tax remain underutilised.
Arguing for integrating harm reduction into global strategies, Beaglehole points to success stories from New Zealand, Sweden, and Japan and encourages the WHO to recognise the role of harm reduction in ending smoking.
Ending on a personal note, Prof Beaglehole cited his four grandsons as his motivation to see a smoke-free future. A challenge that is immense - but achievable.
Closing Keynote: Real people living in real communities: Are we doing enough to make a smoke-free future a reality for everyone?
Ailsa Rutter OBE
Director, Fresh and Balance
Kayleigh Jenkins
After a conference filled with scientific studies and statistics, Alisa Rutter’s powerful closing keynote address was the perfect way to end this year’s summit - reminding us of the real world, human cost of tobacco use and the reasons harm reduction groups exist.
Representing Northeast England’s FRESH tobacco-control organisation, Ailsa reflects on the Northeast’s decade-long leadership in tobacco control and the successes seen. The region has experienced the largest drop in smoking rates and, according to APS data, now boasts the second-lowest smoking rates in the country.
Talking of Fresh’s main goals Ailsa stated “We want as many smokers as possible to give quitting a go every year, using the most effective, evidence-based methods.” and named vaping as a critical tool in a multi-system approach to quitting.
However, despite this progress, there is still stark inequality - with the toll of tobacco use still mostly affecting the most disadvantaged groups.
This was highlighted in a series of emotional videos depicting the real-life stories of those who had lost parents to smoking. Drawing on her own experience of losing her father to COPD, Ailsa emphasises the importance of personal stories in driving change.
With such an emphasis on the dangers of youth vaping, it was both sobering and important to hear a speaker discuss the impact of smoking on children and families.
“This is about families. I don’t ever want kids to lose their parents too soon. I want parents and carers to live long, happy lives—not just for themselves but for their families.”
Conclusion
There’s a troubling disconnect between the evidence presented at this (and other summits) and the policies the UK is moving towards. To summarise, we’ve been told:
- Vaping is 20 times safer than smoking, and there’s no evidence it causes smoking diseases such as lung cancer.
- Youth vaping is increasing, but smoking rates amongst both adults and children are plummeting. The USA’s and New Zealand’s experiences offer hope that youth vaping will fall.
- Vaping is less addictive than smoking.
- Vaping is more effective than NRT and is involved in 50% of quit attempts.
Yet in this country, we are considering banning flavours, introducing plain packaging and putting a tax increase on vaping (while at the same time increasing the cost of smoking by a paltry 2p per cigarette). Speakers from this year’s summit estimate just one of these measures will lead to hundreds of thousands of additional smokers.
A few weeks ago, I mentioned to a colleague that I missed the days when we could feel like heroes. Back then, we were helping thousands of people switch from smoking to vaping. And the stories we heard back from our customers were heartwarming - with people who could barely walk up the stairs able to breathe better, start exercising and even running again.
Nowadays, I dread the question of “What do you do for a living?” To mention you are in the vape industry instantly labels you a pariah, a peddler of harm rather than an agent of change.
It’s a sign of the times, and part of the reason is that too few people listen to experts who care about the science and the harm caused by smoking. For that reason, I am immensely grateful for Amanda’s annual efforts in putting the E-Cigarette Summit together and providing at least one avenue for honest and informed debate to take place.