Highlights from England

On this page, I set out some of the good things about tobacco harm reduction that have come from England. Updated October 2022.

• 1. National government policy statements (England)
• 1.1. Pro-harm-reduction national policy statements…
• 1.2 Independent advice
• 1.3 With support in Parliament
• 2. Realistic science
• 2.1 Public Health England (and successors)
• 2.2 Committee on Toxicology
• 2.3 Royal College of Physicians
• 2.4 Other useful scientific perspectives
• 2.5 Collaborative research approach
• 3. Practical professional guidance and public communications
• 3.1 On youth vaping
• 3.2 On quitting smoking for professionals…
• 3.3 Vaping and Pregnancy
• 3.4 Vaping and mental health
• 3.5 Public-facing communications
• 3.6 On smoke-free policy…
• 3.7 On e-cigarette advertising
• 4. Reasonable public health consensus statements and positions
• 4.1 Cabinet Secretary (Head of UK civil service)
• 4.2 Consensus statement
• 4.3 Individual organisations and people
• 4.4 UK Parliamentary inquiry – December 2017 – December 2018
• 5. High quality, timely and useful data
• 6. Engaged consumers
• 7. Groundbreaking conferences
• 8. Forthright commentators
• 9. Engaged trade associations

Also, see my book chapter (2019) on harm reduction developments in England since 2010. Tobacco harm reduction in England – England’s Tobacco Control Plan 

1. National government policy statements (England)

1.1. Pro-harm-reduction national policy statements…

Note: October 2022. A new government tobacco policy is still expected in 2022 to set out measures to meet the smoke-free goal to reduce smoking prevalence to less than 5% by 2030. The Khan review (see ‘Independent advice’ below) was supposed to feed in to this.

• Public health. All Our Health: personalised care and population health; and implementation guidance: Smoking and tobacco: applying All Our Health (October 2021) and training resource: All our health: smoking and tobacco
• Prevention Green Paper (consultative): Advancing our health: prevention in the 2020s. July 2019. Consults on Smoke-free England 2030 goal and mentions an “ultimatum for industry to make smoked tobacco obsolete by 2030, with smokers quitting or moving to reduced-risk products like e-cigarettes”.
• Vision for prevention in public health: Prevention is better than cure, 5 November 2018
• Tobacco control delivery plan: Tobacco control plan: delivery plan 2017 to 2022, 7 June 2018.
• Tobacco Control Plan for England: Towards a smoke-free generation: tobacco control plan for England(PDF) – 18 July 2017
• Blog focussed on harm reduction aspects of the Tobacco control plan for England: English tobacco control plan embraces tobacco harm reduction – world first– 18 July 2017

1.2 Independent advice

Khan Review: Making smoking obsolete (Summary) (August 2022) Full report (PDF) and press release. Note this is an advisory report to the government, not a statement of government policy. My critical review: Independent review of tobacco policy in England misses the point

1.3 With support in Parliament

• All-Party Parliamentary Group for Vaping: home; COP Inquiry (2021); UK Tobacco Harm Reduction Opportunities Post-Brexit- Achieving a smoke-free 2030 (2021)
• All-Party Parliamentary Group on Smoking and Health, home; Delivering a Smokefree 2030 (2021), Delivering the vision of a ‘Smokefree Generation’ (2019).
• House of Commons Select Committee on Science and Technology: Report on E-cigarettes, (2018). (see more detail on this extensive inquiry below)

2. Realistic science

2.1 Public Health England (and successors)

• Office for Health Improvement and Disparities (2022): Nicotine vaping in England: 2022 evidence update summary. Full report (1,468 pages – PDF). Expert reaction via the Science Media Centre. A commentary, Vaping substantially less harmful than smoking, largest review of its kind finds from the authors from Kings College London and excellent Twitter threads by Kings College and Martin Dockrell of OHID. Note: OHID is a successor to PHE.
• Public Health England (2021): Vaping in England: evidence update February 2021 (focus on vaping for smoking cessation). Press release: Vaping better than nicotine replacement therapy for stopping smoking, evidence suggests / Summary /  Report.
• Public Health England (2020):  Vaping in England: evidence update March 2020 (focus on pregnancy and people with mental health conditions). Press release: False fears preventing smokers from using e-cigarettes to quit / Summary / Report.
• UK Health Security Agency (2020): 8 things to know about e-cigarettes blog by John Newton
• Public Health England (2019): Vaping in England – an evidence update, February 2019. Press release / Executive summary / Report / Blog by Martin Dockrell
• Public Health England (2018): Evidence review of e-cigarettes and heated tobacco products 2018 Press release /Report page/ Executive summary(20 pages) / Report PDF (243 pages) / Q&A blog/ Ann McNeill video/ Training resources /Lancet editorial/ BMJ

“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know”

Public Health England, 2018

• Public Health England (2015): E-cigarettes: an evidence update, August 2015 – and press release E-cigarettes around 95% less harmful than tobacco estimates landmark review. See also: authors’ note on the claim that vaping is 95% lower risk than smoking, and my discussion: PHE says truthful, realistic things about e-cigarettes and critique of its critics, Smears or science.
• Public Health England (2014): Electronic cigarettes: reports commissioned by PHE, May 2014.

2.2 Committee on Toxicology

• Committee on Toxicology (2020): Statement on the potential toxicological risks from electronic nicotine (and non-nicotine) delivery systems (E(N)NDS – e-cigarettes) Expert reaction to this review: Science Media Centre.
• Committee on Toxicology (2017): Statement on the toxicological evaluation of novel heatnot-burn tobacco products

2.3 Royal College of Physicians

• Royal College of Physicians (2021): Smoking and health 2021: A coming of age for tobacco control?
• Royal College of Physicians (2016): Nicotine without smoke: tobacco harm reduction, April 2016 – and press release. Landmark quote:

“Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure“. (Section 5.5 page 87)

Royal College of Physicians, 2016

For a discussion of key quotes from this document, see my submission to the Government of Ireland: Vaping and tobacco harm reduction in Ireland – consultation response in five quotes– February 2017.

2.4 Other useful scientific perspectives

• Dr. Sharon Cox. University College London. Are we ready to achieve a smoke free future? BMJ 2021. Also see her talk on The Truth About Vaping, and the English approach below (2020).

• Dr. Lynne Dawkins, South Bank University – E-cigarettes: an evidence update – all on a guest blog. Myth busting lecture on the science of vaping (slides). November 2018.

• UK Centre for Alcohol and Tobacco Studies: Commentary on WHO report on ENDS, October 2016. A blistering critique of WHO’s vaping science.
• British Psychological Society: Changing behaviour – electronic cigarettes, October 2017

2.5 Collaborative research approach

• Cancer Research UK, UKCTAS, Public Health England, UK research councils: UK Electronic Cigarette Research Forum

3. Practical professional guidance and public communications

3.1 On youth vaping

• Action on Smoking and Health: ASH brief for local authorities on youth vaping (August 2022)

3.2 On quitting smoking for professionals…

• National Centre for Smoking Cessation and Training;
  • Advice for stop-smoking services on making e-cigarettes available (2021)
  • E-cigarettes: a guide for healthcare professionals (2018)
  • Electronic cigarettes: A briefing for stop smoking services, February 2016
• National Institute for Health and Care Excellence (NICE): Tobacco: preventing uptake, promoting quitting and treating dependence NICE guideline NG209. (2021)

3.3 Vaping and Pregnancy

• Smokefree Action – Pregnancy : Smoking in Pregnancy Challenge Group– Using e-cigarettes before, during and after preganancy. see Guidance and policy reated to smoking in pregnancy.  Main advisory report Use of electronic cigarettes before during and after pregnancy: A guide for midwives and other healthcare professionals (2019)
• Royal College of Midwives. Position statement: Support to quit smoking in pregnancy, May 2019.

3.4 Vaping and mental health

• Smokefree Partnership – Mental Health and Smoking Partnership: E-cigarettes and mental health / A guide for health professionals v2 (2020)

3.5 Public-facing communications

The national healthcare provider, the National Health Service endorses the use of e-cigarettes to stop smoking. Annual stop-smoking campaigns encourage users to quit or switch.

• National Health Service “Live well” advice: Using e-cigarettes to stop smoking
• PHE public information video (below) with basics on why vaping is so much safer than smoking – and related BBC coverage. With Lion Shahab and Rosemary Leonard.

• Stoptober: The annual government-backed stop-smoking campaign Stoptober embraced e-cigarettes in October 2017 – see BBC Quit smoking campaign Stoptober backs e-cigs for first time.
• Stoptober. 10 years of Stoptober – review article by Jamie Brown and Martin Dockrell, Spectrum Consortium, 2021.
• The Switch – inspiring video accounts of real vapers talking about quitting smoking

• Yorkshire Cancer Research: Vaping demystified (2021)

3.6 On smoke-free policy…

• Public Health England. Use of e-cigarettes in public places and workplaces including Advice on evidence-based policy-making (PDF) and a 5-point guide to policymaking on this issue.
• Action on Smoking and Health. Will you permit or prohibit e-cigarette use on your premises? October 2015

3.7 On e-cigarette advertising

These reflect the view that vaping policy should be a matter for the owner or manager of the premises, not subject to a blanket legal ban.

These very sensible industry codes govern the advertising that is not banned by the wholly disproportionate EU Tobacco Products DirectiveArticle 20(5) as it applies in the UK.

• Committee on Advertising Practice: E-cigarettes: Non-broadcast Code Section 22 / Broadcast Code Section 33
• Committee on Advertising Practice: Claims about health in e-cigarette advertising– this allows for truthful health statements to be made in e-cigarette ads.

4. Reasonable public health consensus statements and positions

4.1 Cabinet Secretary (Head of UK civil service)

Blog by Sir Jeremy Heywood: How the Nudge unit threw light on lighting up 2015

4.2 Consensus statement

2016 statement by Public Health England, Action on Smoking and Health, Association of Directors of Public Health, British Lung Foundation, Cancer Research UK, Faculty of Public Health, Fresh North East, Healthier Futures, Public Health Action (PHA), Royal College of Physicians, Royal Society for Public Health, UK Centre for Tobacco and Alcohol Studies, UK Health Forum

• E-cigarettes: a developing public health consensus, July 2016

4.3 Individual organisations and people

• Public Health England – blogs giving e-cigarette positions
• Cancer Research UK: E-cigarettes – what we know and what we don’t / Is vaping harmful? (2021)
• Action on Smoking and Health: ASH Briefing on E-cigarettes,
• Royal College of General Practitioners with Cancer Research UK: E cigarettes Non combustible inhaled tobacco products (Sept 2017)
• British Medical Association: Tobacco policy (including e-cigarettes) / In depth position: E-cigarettes: balancing risks and opportunities (2017)
• Royal Society for Public Health: Smoking cessation and e-cigarettes
• British Heart Foundation:  Is vaping safe / The BHF view on vaping? (2019)
• British Lung Foundation: E-cigarette policy / E-cigarette resources
• PHE official Martin Dockrell blogs about tobacco harm reductions on Public Health Matters

Professor Ann McNeill, the lead author of 2018 Public Health England E-cigarette evidence review, discussing the review:

UK experts talking sense about vaping and harm reduction – on video (Ann McNeill, John Britton, Robert West, Deborah Arnott, Ian Gray) and see many of the same experts on The Switch (2017) below:

Professor Linda Bauld of Cancer Research UK and Dr Richard Roope of Royal College of General Practitioners and CRUK Cancer Clinical Champion, addressing key concerns that GPs have voiced about e-cigarettes.

4.4 UK Parliamentary inquiry – December 2017 – December 2018

The House of Commons Select Committee on Science and Technology inquiry into e-cigarettes took evidence in December 2017. See:

• All evidence submitted
• Committee report (PDF)
• Government response to recommendations (December 2018)

Some highlights from the submitted evidence.

• Oral testimony
• Public Health England
• University College London, Tobacco and Alcohol Research Group (West, Brown, Shabab)
• ASH UK
• Royal College of Physicians
• British Heart Foundation
• Cancer Research UK
• Royal Society for Public Health
• British Medical Association
• Cochrane group
• UK Centre for Tobacco and Alcohol Studies
• National Institute for Health and Care Excellence (NICE)
• Smoking in Pregnancy Challenge Group
• Mental Health and Smoking Partnership
• New Nicotine Alliance
• Department of Health (England)
• Peter Hajek
• Caitlin Notely, Lynne Dawkins, Emma Ward and Richard Holland
• Leicester City Council (Louise Ross)
• Independent British Vape Trade Association
• Institute for Economic Affairs

My contribution and a better-formatted version here

5. High quality, timely and useful data

• Office for National Statistics & Public Health England.Adult smoking habits in the UK Statistical bulletins (reports and analysis – annual – July)
• Office for National Statistics. Smoking habits in the UK and its constituent countries (data – annual – July)
• Office for National Statistics. E-cigarette use in Great Britain (data – annual – July)
• Smoking in England: Top line findings / Smoking Toolkit Survey: latest statistics/ all  documents (monthly tracking, contains e-cigarette data)
• data.gov.uk. Statistics on smoking in England
• Public Health England: Local tobacco control profiles for England – (updated annually – July)
• ASH Fact sheets (current menu)
• ASH Briefings (current menu)
• ASH / YouGov surveys (current menu) annual surveys – includes Use of e-cigarettes among young people in Great Britain; Use of e-cigarettes among adults in Great Britain)
• Commentary on 2018 data: Duncan Selbie, Turning the Tide on Tobacco: smoking in England hits an all-time low.  Public Health Matters blog, Public Health England, 3 July 2019.

6. Engaged consumers

• New Nicotine Alliance – a consumer advocacy group
• Vapers.org.uk – with excellent daily news digest
• Vapers in Power (blog) – political movement
• The Switch – vapers talking about their experience of vaping

7. Groundbreaking conferences

• The E-cigarette Summit (annual in London since 2013) and since 2016 in the United States
• Global Forum on Nicotine (annual in Warsaw) – also produces the Global State of Tobacco Reduction.

8. Forthright commentators

• Nicotine Science and Policy
• Velvet Glove, Iron Fist – Chris Snowdon
• Dick Puddlecote
• New Nicotine Alliance blog
• Planet of the Vapes (UK)
• Facts do matter – vaping – Paul Barnes
• The Counterfactual by me.

9. Engaged trade associations

• UK Vaping Industry Association (UKVIA)
• Independent British Vape Trade Association (IBVTA)

Please add suggestions for additions (with links please) in the comments…