Vaping has grown exponentially over the past decade. Vaping shops have proliferated along British high streets, the global market for vapes has increased 8,000-fold since 2016 and vape manufacturers sponsor football and Formula One teams. But it divides opinion sharply.
On the one hand, the tobacco industry – and, to some extent, Public Health England – argues that vaping is a much safer alternative to smoking and that it helps smokers give up. On the other, public health experts, including the World Health Organization, point to its dangers, for children and young people in particular, and urge much more caution than the liberal approach that the UK has decided to take.
While the proportion of people smoking has fallen significantly in recent decades, it remains the single biggest cause of preventable illness and disease in the UK. Cigarettes are the one legal consumer product that if used as recommended by the manufacturer will kill most of their users. So anything that helps reduce levels of smoking and overall levels of harm is to be welcomed.
Despite the claims of the tobacco industry, the evidence on whether vaping helps smokers give up is mixed. The WHO concludes: “To date, evidence on the use of e-cigarettes as a cessation aid is inconclusive.” It is worrying, therefore, to see Public Health England overstate the evidence on vaping and smoking cessation.
There is also growing evidence that e-cigarettes carry significant health risks. While they do not contain the dangerous tar of conventional cigarettes, they do contain nicotine, a highly addictive chemical with health risks. Some studies suggest it is associated with cardiac and neurological diseases and with negative impacts on brain development for children and young people. E-cigarettes could be associated with acute lung injuries; there are rare but terrible stories of young people who use vapes suffering from collapsed lungs.
Public health experts worry that, compared with the use of gums and patches designed to wean people off smoking, vaping encourages long-term nicotine dependency. There is also evidence that it can act as a gateway to smoking for young people who have never smoked. The WHO concludes that e-cigarettes are harmful to health and not safe and that it is too early to understand the long-term risks. Public Health England’s claim that vaping is 95% safer than smoking has been subject to much criticism.
In the UK, unlike some other countries, e-cigarettes are very lightly regulated, though research suggests that vaping liquid can contain many times the amount of nicotine that is claimed on the packet, as well as other harmful chemicals. Advertising is rife, with manufacturers finding ways to circumvent rules designed to limit direct marketing to children on social media platforms such as TikTok, using bright colours and offering multitudes of children-friendly flavours. Although it is illegal to sell e-cigarettes to under-18s, levels of vaping among 11-to-18-year-olds have almost doubled in the past three years, as smoking levels have stayed constant.
As long as the long-term risks are unknown, it is wrong for the UK to take such a permissive approach to vaping. Vapes should be available as part of smoking cessation programmes, but outside these programmes sales should be tightly regulated, with no advertising, plain packaging, health warnings and a ban in public spaces. And ministers should invest far more in smoking-cessation programmes that evidence shows are more effective in helping people give up.
