The British government’s main public-health body has put its weight firmly behind e-cigarettes as a solution to the problems caused by smoking, calling for them to be available to consumers through the National Health Service, for smoking cessation services to support vaping, and for light-touch regulation.
A scientific report commissioned by Public Health England (PHE) also suggests that the process for medical licensing of e-cigs might need to be overhauled, and that the government should beware of inadvertently stifling the market through its implementation of the European Union’s Tobacco Products Directive (TPD).
PHE says in a policy paper issued this week, accompanying the scientific report, that “the potential of e-cigarettes to help improve public health depends on the extent to which they can act as a route out of smoking for the country’s eight million tobacco users, without providing a route into smoking for children and non-smokers. Appropriate and proportionate regulation is essential if this goal is to be achieved.”
In particular, it says, “local stop smoking services provide smokers with the best chance of quitting successfully and we want to see them engaging actively with smokers who want to quit with the help of e-cigarettes”.
The organisation, part of the government’s Department of Health, also wants “to see all health and social care professionals providing accurate advice on the relative risks of smoking and e-cigarette use”, and “looks forward to the arrival on the market of a choice of medicinally regulated products that can be made available to smokers by the NHS [National Health Service] on prescription”.
The NHS offers largely free healthcare throughout British society, although some patients pay a small fee for prescriptions, unrelated to the actual cost of the products they receive. The advisory remit of Public Health England does not cover Wales, Scotland or Northern Ireland, the other regions of the UK with varying levels of autonomy. However, its points will undoubtedly be taken note of by authorities in these areas.
Backing up PHE’s policy paper, a separate scientific report by academics from the UK Centre for Tobacco & Alcohol Studies – commissioned by PHE and issued at the same time – contains barely-veiled criticism of the process for pharmaceutical licensing of e-cigarettes operated by Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA).
As yet no medically-licensed products have appeared and few applications have been made, yet such approval will presumably be necessary if PHE’s goal of making e-cigs available on the NHS is to be achieved.
“Much of England’s strategy of tobacco harm reduction is predicated on the availability of medicinally licensed products that smokers want to use. Licensed [e-cigarettes] are yet to appear. A review of the…licensing process therefore seems appropriate, including manufacturers’ costs, and potential impact,” says the scientists’ report for PHE. “This could include a requirement for MHRA to adapt the processes and their costs to enable smaller manufacturers to apply, and to speed up the licensing process. The review could also assess potential demand for the [e-cigarette] prescription market and what types of products would be most appropriate to meet that demand.”
It adds: “The fact that no licensed [e-cigarettes] are yet on the market suggests that the licensing route to market is not commercially attractive. The absence of non-tobacco industry products going through the MHRA licensing process suggests that the process is inadvertently favouring larger manufacturers including the tobacco industry, which is likely to inhibit innovation in the prescription market.”
It’s not smoking
Also questioned is the approach of some public bodies in the UK in prohibiting vaping on their premises. There is no national vaping ban across the UK as there is on smoking, although Wales is introducing one.
E-cigarettes “should not routinely be treated in the same way as smoking. It is not appropriate to prohibit [their] use in health trusts and prisons as part of smokefree policies unless there is a strong rationale to do so,” the scientists say.
Indeed, they seem to imply, regulation of e-cigs can become too risk-averse.
Acknowledging the need for child-proofing, they nevertheless add that “whilst protecting non-smoking children and ensuring the products on the market are as safe and effective as possible are clearly important goals, new regulations currently planned should also maximise the public health opportunities of [e-cigarettes]”.
A similar attitude could be taken toward labelling, they suggest. “The accuracy of nicotine content labelling currently raises no major concerns,” they observe, adding that “general labelling of the strength of e-liquids, along the lines used for example indicating coffee strength, provides sufficient guidance to consumers”.
Overall, they propose, “regulatory interventions should ensure optimal product safety but make sure [e-cigarettes] are not regulated more strictly than cigarettes and can continue to evolve and improve their competitiveness against cigarettes”.
To this end, they urge the government to take care in its transposition of the TPD into British law: “An assessment of the impact of the TPD regulations on the UK [e-cigarette] market will be integral to its implementation. This should include the degree to which the availability of safe and effective products might be restricted.”
The report team was led by professors Ann McNeill of King’s College London and Peter Hajek of Queen Mary University of London, two of the best-known British e-cig researchers.
What This Means: As ringing endorsements go, PHE’s is deafening, portraying e-cigarettes as an almost unmitigated public-health boon.
It will not bring the debate over e-cigs to a close, but coming just days after similar pronouncements from the Royal Society for Public Health it should leave the government in little doubt of the arguments in favour of e-cigarettes.
The heavy media coverage already being given to it may even help to win over some of the 45% of Britons who, as PHE’s scientists report, do not realise that e-cigarettes are much less harmful than smoking.
And in the slightly longer term, it could well lead to an important change of attitude within the NHS’s smoking cessation services. Yet, as the PHE papers imply, making the most of this will also necessitate care with the TPD implementation and possibly some changes at the MHRA. We can expect more debate to come as a result of these papers, but in time we can also expect action.
– Barnaby Page ECigIntelligence staff
Photo: Janet Ramsden