Blueberry bubblegum. Lemon pie. Caramel cheesecake. Sickly-sweet concoctions that are just a fraction of the dessert-flavoured nicotine vapes available to buy in newsagents for not much more than a high-end chocolate bar, in bright packaging often adorned with cartoon illustrations designed to appeal to children. It is a huge red flag that something has gone seriously amiss in the rules that govern e-cigarette marketing and sales in the UK.
What makes the question of how to regulate vaping more complex than cigarettes or alcohol is that, unlike with the latter two substances – where a collective fall in consumption would be an unambiguously good thing for the nation’s health – public health experts want to encourage smokers to switch from cigarettes to vapes while keeping non-smokers, particularly children and young people, well away from vaping.
That’s because it’s almost certainly the case that vapes are significantly less harmful to human health than cigarettes, which are the most lethal consumer product known to man and kill at least half of those who regularly smoke them. There is also growing evidence that nicotine-based vapes are more effective in helping people give up smoking than traditional nicotine-based replacement therapy such as gums and patches; a review of 78 research studies, including 40 “gold standard” randomised controlled trials, found that using nicotine e-cigarettes helped between eight and 12 smokers per 100 give up, compared with six per 100 for nicotine replacement therapy.
But vaping is not without risks, particularly for children. Nicotine is highly addictive, and the World Health Organization says it has a “deleterious impact” on children’s brain development. There has been an increase in the number of children vaping over time, and the proportion of children aged 11 to 17 experimenting with vaping has jumped by 50% in just a year. Earlier this month, the Royal College of Paediatrics and Child Health issued a strong warning about the risks of an “epidemic” of vaping among children on their lung development.
While it’s illegal to sell nicotine-based vapes to under-18s in the UK, they are in practice easily bought underage in shops and, although there are regulations about how much nicotine and other harmful substances they can contain, the market is flooded with illicit products from countries such as China, some of which contain dangerous levels of lead, nickel and chromium. But children also benefit from adult smokers switching to vaping: there are around 5,000 hospital admissions of children each year related to exposure to tobacco smoke.
Worryingly, public misperceptions about the risks of vaping have increased even as the evidence it can help people give up smoking has grown; a third of people wrongly believe that vapes are as dangerous as cigarettes. This is probably partly a product of a spate of vaping-induced lung injuries in young people in the US in 2019, later found to be associated with a chemical used to cut cannabinoids in vaping liquid that is not permitted in UK. But it is also likely that we have, to some extent, psychologically baked in the known but profoundly awful impacts of smoking, which prematurely killed as many people as Covid in 2020, and find it more difficult to compute the fact there is some inherent certainty about the long-term impacts of vaping because it simply hasn’t been around long enough.
The confusion around a complex public health message – vaping is safer than smoking and can help you give up but is still bad for you, so if you don’t smoke, don’t start – is further mired by the involvement of the tobacco industry, with companies like British American Tobacco and Philip Morris heavily invested in vaping. The global e-cigarette market is estimated to be worth $22bn (£17.3bn). Since 2005, the WHO has operated a convention that signatory governments must limit contact with tobacco firms to the absolute minimum following revelations about the “tobacco playbook” strategies deployed by the industry in spreading disinformation and biased research to undermine the scientific understanding of smoking harms.
Concerns that tobacco companies are vape-washing to get their lobbyists back in the room are well founded, particularly in light of evidence that researchers with industry-related conflict of interests are less likely to find that vaping is associated with harms; and the UK vaping industry association has funded and provided the secretariat to the all-party parliamentary group on vaping. It also doesn’t help when public health bodies make loose claims that get amplified by opportunistic companies: Public Health England has been widely criticised for saying that vaping is 95% safer than smoking, a claim the Lancet called “extraordinarily flimsy”. The industry has latched on to it, and it has generated a distracting debate that undermines trust in reliable public health advice that vaping is safer than smoking.
Ultimately, the regulatory framework needs to enable adult smokers who want to give up to access vapes, while discouraging everyone else from taking it up and preventing children from getting hold of vapes altogether.
In making vapes prescription-only – and so more difficult to access than cigarettes – Australia has gone too far in the other direction. But there is so much more that the government could do to clamp down. It should ban all forms of marketing, including in stores and in sports, and require vapes to come in plain, standardised packaging, and insist that shops should be licensed to sell them.
It needs to take the cheap disposable vapes that are so attractive to children, and so terrible for the environment, off the market; some have suggested an outright ban. Others suggest a £5 tax should be imposed on them because children are highly price sensitive and making them excisable would mean the Border Force could hold on to illicit vapes it confiscates to avoid them entering the market.
It isn’t beyond the wits of policymakers to design a regulatory system that sees vapes purely as smoking cessation aids, rather than allowing them to proliferate as dangerous and addictive consumables for children.
Governments benefit from a wealth of knowledge derived from decades of regulating cigarette sales. But it has taken the government three years just to commit to the no-brainer of closing a legal loophole that allows vaping companies to hand their products out to under-18s for free. This is a staggering level of inertia that is causing real harm to children.
• Sonia Sodha is an Observer columnist
