The British government has promised to examine the EU Tobacco Products Directive (TPD) to ensure that e-cigarettes have the maximum positive impact on public health, which it hopes will include a key role in reducing smoking in England.
The UK Department of Health (DoH) outlines the role it envisages for e-cigs in its newly-published tobacco control plan for England, entitled Towards a Smoke-free Generation.
It is aiming to reduce English smoking rates by at least 20% by 2022, cutting them from the current level of around 15.5% of the population to less than 12% in five years.
Innovative technologies are key to this, minimising the risk of harm while maximising the availability of safer alternatives to smoking, according to the DoH.
And while medication in combination with support remains the most effective technique, the role of e-cigarettes needs to be acknowledged, it believes. The DoH estimates that in 2016, there were 2m former smokers who had quit completely through vaping, while a further 470,000 were in the process of using e-cigs as a cessation aid.
The DoH also wants to reduce the proportion of 15-year-olds regularly smoking from 8% to 3%; cut smoking rates among pregnant women from around 11% to 6% or less; and close what it sees as an inequality gap separating groups with high smoking prevalence from segments of the population with lower prevalence.
Reviewing the TPD
The DoH has promised to review Britain’s TPD-based legislation in order to ensure that England reaps the benefits of vaping, and will consider whether the UK’s forthcoming exit from the EU provides an opportunity to alter legislation.
Many in the vaping community have hoped for that, although others have warned that revising the domestic laws that transposed the TPD might be very low on any post-Brexit government’s priorities.
“The government will continue to embrace developments that have the potential to reduce the harm caused by tobacco use and as such we will consider if the current regulatory framework strikes the right balance, and whether there is more we can do to help people to stop smoking,” the DoH said.
The Independent British Vape Trade Association (IBVTA) welcomed the acknowledgement of the role vaping has played in smoking reduction and the promise to review the TPD. However, it was unhappy that there was no pledge for advertising to combat what it believes is misinformation about the relative safety of e-cigarette products.
The DoH also has more concrete proposals which could give e-cigs a fillip.
It is recommending that vaping not be included in smoke-free policies created by both public authorities and workplaces. It welcomes the introduction of “novel tobacco products” – most likely meaning heat-not-burn devices – and says it will continue to evaluate whether such products have a role to play in reducing the risk of harm to smokers.
And it wants the Medicines and Healthcare Products Regulatory Agency (MHRA), the body governing medical licensing, to ensure that there is a path for e-cigs to be approved and potentially made available for National Health Service (NHS) prescriptions– in which case they could be provided by the UK’s state-run medical service at only a small cost to individual consumers.
Attendance at stop-smoking services has been on the decline since 2011-2012, the DoH said. In order to address this, it wants Public Health England (PHE) – the government body responsible for public-health issues in England – to ensure full training of all health professionals nationally on effective quitting options, but to devolve tobacco control strategies to local areas.
Yet the doctors’ body the British Medical Association (BMA), while broadly welcoming the plan, argues it is more important to prevent local funding cuts to stop-smoking services.
“If we’re to stop the 79,000 annual deaths in England attributed to smoking, smoking cessation services and tobacco control measures must be adequately funded yet local authorities are reducing stop-smoking budgets, merging services into unwieldy departments or cutting services altogether,” said Parveen Kumar, BMA Board of Science chair.
“Cuts to these highly cost-effective services will only increase health inequalities and demand on tomorrow’s GP surgeries and hospital wards,” said Kumar.
Action on Smoking and Health (ASH), an anti-smoking charity with significant policy influence in the UK, also welcomed the tobacco control plan – particularly as the last one expired in 2015. But it, too, criticised the DoH for failing to address funding issues and was unsure whether individual local authorities would have the economies of scale necessary to deliver public-health improvements.
According to research quoted by ASH, a decline in national funding for public health has meant that local tobacco control activities face budget reductions of 30%, with stop-smoking services among the most popular candidates for cuts. This could be countered by increased “sin taxes”, ASH suggested.
“Funding must be found if the government is to achieve its vision of a ‘smoke-free generation’,” said Deborah Arnott, ASH chief executive. “The tobacco industry should be made to pay a through a licence fee on the ‘polluter pays’ principle. Tobacco manufacturers are some of the most profitable companies on earth; they can easily afford the costs of radical action to drive down smoking rates.”
And there’s more
The DoH’s array of tobacco control measures is wide-ranging. It has promised to work with other government departments to ensure that regulations on plain packaging, as well as duties on tobacco, remain in place and are enforced. And it plans to continue national anti-tobacco advertising campaigns, such as those promoting the Stoptober smoking cessation event.
Smoking in pregnancy will be combated through the use of carbon monoxide monitors to check whether women are smoking, and changing the default position for those who are smoking to an “opt-out” of stop-smoking services instead of an “opt-in”.
And the DoH wants to create better smoke-free policies for mental health services. “For any hospital setting, becoming smoke-free is more than simply telling patients, staff and visitors where they can and cannot smoke,” the DoH said. “It is about Trusts working to end cultures in which smoking is used as a way to build relationships with patients or whereby cigarettes and smoking breaks are used as incentives or rewards.”
What This Means: Although there are inevitable differences of opinion, Britain (and particularly England) is already among the most e-cig-friendly of major jurisdictions, in terms of both regulation and public-health attitudes. Now vaping is evidently to play an even greater role in the future of English public-health policy, although whether the other constituent countries of the UK will have the same enthusiasm remains to be seen.
This reiterated support for e-cigs also means that, just perhaps, the prospect of a revision to the UK implementation of the TPD is not such a forlorn hope.
But even if it does not come to pass – and it should certainly not be counted upon – greater backing from the health establishment will in itself be positive news for much of the industry.
– Freddie Dawson ECigIntelligence staff