The Department of Health (UK/England) today released its tobacco control plan for England: Towards a smoke-free generation: tobacco control plan for England (PDF)
The embrace of vaping and other low-risk alternatives to smoking runs through the text. This is probably the first significant government policy paper anywhere that recognises and pursues the opportunities of tobacco harm reduction, rather than defining these technologies as a threat to be suppressed. For that, the Department of Health and its allies deserve considerable credit.
Some extracts on tobacco harm reduction. Quotes from the plan are in blocks…
On targets focussed on smoking…
The objectives of the tobacco control plan are to:
- reduce the number of 15 year olds who regularly smoke from 8% to 3% or less
- reduce smoking among adults in England from 15.5% to 12% or less
- reduce the inequality gap in smoking prevalence, between those in routine and manual occupations and the general population
- reduce the prevalence of smoking in pregnancy from 10.5% to 6% or less
The aim is to achieve these objectives by the end of 2022.
The focus on smoking, rather than on nicotine use or other goals is appropriate from a public health perspective, because it is the smoke that causes the harm. The way the targets are specified does not, therefore, preclude the use of reduced-risk tobacco and nicotine products to achieve the smoking-related targets.
On in-principle support of harm reduction
4. Backing evidence based innovations to support quitting
We are committed to evidence-based policy making, so we aim to:
• Help people to quit smoking by permitting innovative technologies that minimise the risk of harm.
• Maximise the availability of safer alternatives to smoking.
The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.
This embraces the opportunity of new technologies instead of defining them as threat. I suspect this is also a subtle rebuke to the Chief Medical Officer, who has consistently fought an evidence-free rearguard action against “innovative technologies that minimise the risk of harm“.
On indoor vaping
Public Health England has produced guidance for employers and organisations looking to introduce policies around e-cigarettes and vaping in public and recommend such policies to be evidence-based. PHE recommends that e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy.
PHE will support local areas looking to implement local smokefree policies differentiating the levels of harm caused by existing tobacco products including e-cigarettes and other novel products.
This recognises that decisions on vaping policy should rest with owners and managers of premises, and steers them not to include vaping in organisational smoke-free policies by default. This implicitly acknowledges that there is no justification (for example, material harm to bystanders or workers) to override the preferences of property owners with blanket vape-free laws. This is an ethically robust position to take.
On “heat-not-burn” or heated tobacco products
In addition there has been the development and very recent introduction of novel tobacco products that claim to reduce the harm of smoking. We welcome innovation that will reduce the harms caused by smoking and will evaluate whether products such as novel tobacco products have a role to play in reducing the risk of harm to smokers.
A welcome open mind to innovation that could reach more people with a product they find acceptable and pleasurable. It is unclear (to me at least) what form this evaluation will take and what decisions they could take.
On e-cigarette evidence updates
PHE will update their evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the Parliament in 2022 and will include within quit smoking campaigns messages about the relative safety of e-cigarettes.
Evidence updates (see 2015 version) that cut through the detached academic activism and media clickbait about vaping are an important role for responsible government. I very much welcome this.
On risk communication
PHE will continue to provide smokers and the public with clear, evidence based and accurate information on the relative harm of nicotine, e-cigarettes, other nicotine delivery systems and smoked tobacco, to enable informed decision-making. This will include the publication of an assessment of the risks of nicotine addiction.
There is much to do to correct erroneous perceptions of risks of vaping and other nicotine delivery systems (see dramatic misperceptions documented in this ASH fact sheet). It is good that the government recognises its own role in supporting informed consumer choice with credible evidence-based advice on risks.
On medicalisation and treatment using e-cigarettes
The Medicines and Healthcare products Regulatory Agency (MHRA) will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.
[Public Health England] will provide evidence based guidance for health professionals to support them in advising smokers who want to use e-cigarettes or other nicotine delivery systems to quit
The key issue here is the need for a positive approach by health and medical professionals – what they say needs to be realistic and patient-focussed. England already has good officially-blessed guidance on e-cigarettes for health professionals and it will be very helpful to have this routinely updated. Simplifying the medical licensing option is of lesser importance, but could provide some benefits within healthcare settings, but only as long as it remains an option.
On regulation for harm reduction
[The Department of Health] will, based on the evidence reviews undertaken by [Public Health England], review policy and regulation of nicotine delivery systems to provide an environment that facilitates smokers taking action to improve their health and the health of those around them, whilst minimising any risk of new nicotine addiction in children.
[The Department of Health] will monitor the impact of regulation and policy on e-cigarettes and novel tobacco products in England, including evidence on safety, uptake, health impact and effectiveness of these products as smoking cessation aids to inform our actions on regulating their use.
I hope and expect that this means the government will monitor for harmful unintended consequences of regulation, and respond accordingly. The words smokeless and snus do not appear in the document – but the ban on snus is one of the worst examples of harmful regulation.
On Brexit and reconsidering measures in the Tobacco Products Directive
Over the course of this Tobacco Control Plan, the government will review where the UK’s exit from the EU offers us opportunities to re-appraise current regulation to ensure this continues to protect the nation’s health. We will look to identify where we can sensibly deregulate without harming public health or where EU regulations limit our ability to deal with tobacco.
In particular, the government will assess recent legislation such as the Tobacco Products Directive, including as it applies to e-cigarettes, and consider where the UK’s exit provides opportunity to alter the legislative provisions to provide for improved health outcomes within the UK context.
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. We remain committed to a comprehensive and robust tobacco control strategy which protects the population of England.
Commendable! Though the flexibility to do anything unilateral will depend on the terms of the final post-Brexit trading arrangements between the UK and European Union. I wish we were trying to fix the TPD from within the European Union, and even more that our ministers and officials had not agreed to such a mess of pointless and incoherent regulation when the TPD was being negotiated at the end of 2013.
The new plan takes a more positive and enabling approach to tobacco policy than I would say is the norm. I believe this is the first coherent statement of government level support for embedding low-risk alternatives to smoking and the concept of tobacco harm reduction in a major policy paper anywhere in the world.
I haven’t yet done an in-depth look for any mad ideas in the plan. That’s for another time.
35 thoughts on “English tobacco control plan embraces tobacco harm reduction – world first”
This is certainly a very encouraging development. There is an extraordinary opportunity to fundamentally change the forecast of future smoking related deaths, disease and disability. We’ve known for decades that a key component to accomplishing this is ridding consumers of the need to inhale smoke to get nicotine. While most governments are still failing a ‘vision test’ it is great to see England recognising the opportunity, following the science, respecting consumer rights and showing leadership.
In my experience, good policy is contagious. We can only hope England has developed something that spreads quickly.
Hope it spreads to Northern Ireland quickly. If we ever have a working government here again!
“I wish we were trying to fix the TPD from within the European Union”
This reminds me of a man protesting as he is dragged outside to be shot by the KGB: “But I’m a party member! There’s been a mistake. Ask Comrade Stalin!”
Clive, you’re a smart man, what’s it going to take for you to face the fact that the EU is not going to be reformed? Insofar as it’s going to change in the future, it will not be in a direction that you or I will approve of and certainly not when it comes to tobacco policy. They’ve had 25 years to rethink the ban on snus and have done nothing about it because it is a corrupt enterprise that is only concerned with extending its power.
Britain has as much chance of ‘fixing’ the TPD from outside the EU as from within it, ie. none whatsoever. The EU does not have the slightest interest in reform.
Well, I too am not optimistic about the EU in this area of policy. But…
If left to its own devices, the UK would have followed the policy of requiring a medicines marketing authorisation for e-cigarettes – something it announced independently of the EU in June 2013, and then supported in the TPD negotiations. The only reason we don’t have that is the reversal achieved in the European Parliament in October 2013. UK ministers, officials, mother of parliaments, loyal Opposition, European scrutiny committee and anyone with a say were enthusiastic backers of the TPD. UK made it that way, and we could have done it differently.
The snus ban also has its origins in Britain and UK has supported it in 1992, 2001, 2014 and now in 2016/17 as it contests the no-brainer legal action. So we are one of the foremost architects of stupid EU policy.
I still think there is a finite probability that business will finally get off its arse and convince the country and the troupe of gaudy clowns in charge of Brexit what a wrenching dislocation it will be, how the poor will suffer, and how we need immigration and benefit from it, whatever a subset of Leavers wish to believe. In that event, we may end up with an EEA-like relationship lasting for several years or indefinitely in which we comply with single market legislation and have no say in introducing it or amending it. This would apply to the TPD Article 28 review scheduled for completion in May 2021, which will happen after we have left but while we are in a transitional (sorry, implementation) agreement with the EU, which will last 5-10 years while a final FTA is negotiated. So all the shite and none of the say for most of the next decade.
Even if a soft transition does not happen, and we do a “hard Brexit” and take the pain, it is still the government’s policy to negotiate a “new, comprehensive, bold and ambitious Free Trade Agreement” (T May) with the EU. It is likely that a trading relationship that does what they say they want will draw UK into compliance with EU standards and single market legislation. The reason is that it is easy to do that, because we are already compliant the EU acquis.
I tried to quit smoking with e-cigarettes but I didn’t feel comfortable with them (there is a lots of studies which shows that e-cigarettes can be dangerous) and went back to smoking cigarettes. And also my GP said that we don’t know enough about health effects of e-cigarettes just yet and recommended me to stick with the devil we know (smoking) if I can’t stop smoking with other approved smoking cessation methods. I am a smoker for 15 years now and GP said to me that I have clear lungs because smoking takes decades to hurt human body and I have time to wait for long-term studies from using e-cigarettes, so I can decide later if I want to switch. I just feel safer sticking to cigarettes for know…
PHE documents alone should give you confidence that switching to e-cigarettes represents a huge reduction in harm from smoking. This is backed up by Cancer Research UK’s long term study.
“This study adds to growing evidence that e-cigarettes are a much safer alternative to tobacco, and suggests the long term effects of these products will be minimal.”
I also suggest your doctor look at the latest guidelines on ecigs from the National Centre for Smoking Cessation and Training.
Best of luck.
Thank you Daniel Sussex for this link. I had a long debate with my GP about e-cigarettes and he said to me that we can’t be sure if e-cigarettes are really safer than smoking tobacco. He said that we don’t even know what effect does main solvents in e-cigarettes have on human lungs long-term, not even considering flavours in liquids. He said that smoking cigarettes is also not dangerous in short-term, it takes few decades of smoking to have an effect on human body. I also told them about England experience with e-cigarettes and he said that he doesn’t trust England research on e-cigarettes because of conflicts of interests. He said that risk for lung-cancer is probably the same for vaping as for smoking, because anything we take in our lungs (except air) will have a carcinogenic effect over the time. It’s true that I am not from England and our Ministry of Health and Public Health Institute doesn’t support e-cigarettes for harm reduction so I think my GP gets informations about e-cigarettes from them. I am not sure what to do, I want to be comfort with e-cigarettes but after I talked with my GP about that topic I am just more confused about them.
I’m not sure what country you live in, but I also think that your doctor is giving you partially out-of-date information.
It is true that it takes some years for people to ruin their lungs through smoking. And it’s true that some people never do ruin their health – they remain healthy. We don’t know why. But its a gamble. Some people are lucky, some people not.
It is really YOUR choice and nothing really to do with your doctor. It’s YOU that needs to weigh up the pros and cons of either smoking, or vaping.
If you love smoking, like I did, you might feel the pleasure it gives you is worth the cost you might have to pay in the future – a future you cannot know.
But your doctor is not accurate in his assesment of vaping.
We DO know the effects of the ‘solvents’ used in e liquids. They are vegetable glycerine and propylene glycol and we DO know about them. After the Second World War, these were pumped into hospitals, children’s homes, offices, and many institutions for many years to clean the air. Many of us have already breathed these chemicals in when we were younger. They are used in asthma pumps and inhalers. The vapour is used in nightclubs and stage shows.
So vaping such ‘solvents’ as you call them, is safer than drawing smoke from burning leaves into your lungs.
But your doctor has a point about flavours. That we don’t know so much about. It’s possible that some flavours might cause us harm – but diacetyl is not used in good e liquid and maybe your doctor has heard horror stories about ‘popcorn lung’. We breathe in diacetyl everytime we fry stuff. When butter goes brown and starts smelling absolutely deeelicicious – that is the diacetyl!
But it is absolutely possible – and indeed very pleasant to vape vegetable glycerine alone with NO flavouring in it AT ALL. And many vapers do.
So vaping could certainly be a really pleasing alternative to smoking. Your doctor might not be aware of how possible it is to vape safely. He might simply be regurgitation anti- vaping propaganda that he heard put about by Tobacco Control.
In the end, I believe what you do with your body should be YOUR decision. Don’t chuck out the idea of vaping. It can be just as pleasurable as smoking. You will just be replacing a risky gamble with a safer bet!
Sounds like your doctor has been misinformed by tobacco control. Not sure what conflict of interest your doctor is referring to, but does it make sense for PHE and Royal College of Physicians to publish a major report on ecigs recommending them as a healthier alternative to tobacco and risk their reputation as the leading authority on health? Not really.
If you think about it, even if they are as bad as tobacco, you have lost nothing by switching, but you get to enjoy lovely flavours like strawberry banana cream and you wont smell like an ashtray. :)
Give it a go, you can always quit vaping once your free from tobacco.
Rusher, your experience is pretty common in Australia. If you are Australian, I’d suggest you and your Doctor look at Dr Colin Mendelsohn’s website http://colinmendelsohn.com.au/.
Colin has expressed his willingness to speak to any Doctor in Australia so you could certainly suggest your Doctor contact him.
Rusher I would advise you find another doctor as he is seriously misinformed.
You’ll be a lot safer/healthier if you change your GP.
Hmm…. OK, you say 15 yrs of smoking and that you have read a lot of studies saying e-cigs “can be” dangerous? …and your GP said something like “we really don´t know yet” and recommended you “to stick with the devil we know” that he knows kills 50% of smokers. You even decided that you had “time to wait for long-term studies”, well, waiting period in about 30-50 years or so! – I´m sorry you got me really laughing there, but….. it´s not over yet.
That´s a good choice to make isn´t it, a 50-50 kill? And it´s safer for you to trust the studies that say maybe, possibly or with your best of guessing it could even probably maybe disclose of something horribly dangerous in the future – instead of belief anything from the studies that say highly unlikely or 95-99% safer than smoking, if any harm at all from vaping? You must be joking or something, not real at least :-)
Haha, no GP is that stupid, sorry, recommending you to continue smoking to a sure death of 50-50%. GP´s are most likely to be those doctors to know anything about the matter, but not even other specialists are that stupid. And that you have been debating with this GP tells me that you have been reading more than you tell us here. Also that you know a little bit of what this e-cig thing is about and that you are not really asking for anything here on this site, instead just trying to put in some nonsense of your own opinion or agenda.
And your story gets even better, you “debated” with your GP! About what? … “told them about England experience with e-cigarettes and he said that he doesn’t trust England research on e-cigarettes because of conflicts of interests”. Do you have many or just one GP whom you are talking to? …and what country is that GP of yours supposed to work in? What conflicts of interests in UK studies? Do you belief that?
And you also chose to belief that lung cancer is “probably the same”…. “anything we take in our lungs (except air) will have a carcinogenic effect over the time.” Anything in any amount? Scary isn´t it? Do you mean that diacetyl, formaldehyde or one of those naughty little VOC´s that measures in the same amount in vapers, NRT´s and non-smokers? Paracelsus who? I´m sorry, did I say measured in the same amount in non-smokers (air inhalers) as vapers/NRT? Yes, I did :-)
Or, was it something else not found today but maybe will in the future because we really don´t know yet, or the precautionary principle of just in case anything does appear that does? Scary isn´t it, not?
So you decided to continue to smoke, the sure thing (50%) that kills you instead of choosing the probability of alternatives that could safe you. OK, and that appear to sound OK with you and your GP!
You sure know how to play your wishful Russian-roulette, or should I say an imaginary one on this site. Because of all that you mention, and how you speak about it, it´s most likely that you have never been a smoker or ever tried any vaping either. Sorry, the whole story of yours does not fit the profile or the story of reality.
But thanks for the fun, because sometimes I like to indulge, for a short time, in this kind of nonsense, though just in moderation and absolutely just in micro-doses. The best to you too
He is almost certainly a deliberate spreader of ‘Confusion ‘, – in fact could even just be an cut and paste algorithm- some of the components that make up his statements such as “anything we take into our lungs” are identical to the statements of another ‘troll’ that pops up on other similar sites.
Agree with you John, as I state clearly in my last sentences. Some call it a troll, but I call it a fun, but, only in micro-moderation :-)
But Donna above in her comment thinks this kind of nonsense resembles the views in Australia, well, hopefully just with some chaps down there and the AMA AU president haha. I´m really sorry for the Aussies about that resemblance to those chaps in AU :-)
The situation in Australia is a mixed bag.
Under federal law importing for personal use is legal.
And there is a medical operation where you can quite legally get eliquid prescribed , then made up by a compounding chemist and posted to you. In NSW the use of ecigs is quite legal and is not covered by the laws restricting where people can-can’t smoke. And the AMAs submission to the standing committee copped quite a bit of public flack from Mendelssohn and others.
On the other hand in Queensland possession of ecigs containing nicotine could result in a fine of thousands of dollars ( seriously). And I think it’s similar in WA- though I’m not sure whether simple possession is actually a criminal offence, but WA is certainly not friendly to harm reduction.
And I gather that while you can import Snus for personal use ,it is subject to our very high tobacco excise-currently around $960 AD a kilo and rising. As for the quality of medical advice have no personal knowledge, suspect it would depend on the individual doctor.
And we of course have Mr Chapman and his endless sneering and insinuating lies.
My prayer is that Chapmans days as a powerful figure are running out , he and Glantz etc ,are old and I think increasingly ‘out of use by date’ politically .
I have learned in working with people on the internet that some trolls appear so because of language and educational limitations, different cultures or countries of origen.
A good answer to a troll that is at least in command of some language can be educational to others reading the comments.
Some trolls are not trolls
Some trolls can be useful
Blatant trolls should not be fed
‘UK would have followed the policy of requiring a medicines marketing authorisation for e-cigarettes’ Are you implying we got ‘rescued’ by the TPD?
‘The Medicines and Healthcare products Regulatory Agency (MHRA) will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.
PHE will provide evidence based guidance for health professionals to support them in advising smokers who want to use e-cigarettes or other nicotine delivery systems to quit.’
Yes – another waste of money! What do Health Care Professionals actually KNOW about the best devices for vaping? They should just get out of the way and leave the market alone. Anything that gets medicinal approval will have been usurped by better stuff before the T’s are crossed or the i’s dotted on the licence.
How can we make ‘the robust tobacco control strategy which protects the population of England’ GO AWAY! The people they are protecting are jobs for themselves and so called ‘Health Professionals. The whole thing is vile.
And the smoking bans will go on applying to vapers too, because, by now, everyone has been brainwashed by Tobacco Control that vaping normalises smoking. And vapour is as dangerous as the manufactured Second Hand Smoke myth.
I despair for smokers AND vapers.
But at least YOU are optimistic!
don’t think this will make any difference to vaping where I work the landlord considers vaping the same as smoking, not only within the building but also in the considerable amount of land owned outside.
as a result vapers are forced to use the same area to vape as the smokers use and as a result often end up breathing their second hand smoke and going home smelling like an old ashtray, two of the main things I was hoping to avoid by vaping.
so we would not be allowed to vape inside even if the management agreed to it in principle which is vary unlikely also.
If you don’t want to be around smokers, just say it. Don’t fall back on vapid nonsense like “second-hand smoke.”
True. One way of helping to correct the perceptions in the group that most needs it i.e. current smokers, is to swap out a proportion of the current ‘graphic warnings’ on cigarette packs with messages based on this graphic.
Correcting perceptions in other groups (e.g. landlords, employers, family members, councils..) is another matter. Any suggestions are welcome.
Andrew it’s probably a bit academic but that ‘5%’or less figure is itself, a tad misleading.
Truth is smoke is so extremely qualitatively-chemically different to every other thing that humans have ever consumed ‘en mass’ that trying to measure the risk of non smoke products using smoke as the yard stick, is similar to trying to use the distance: Earth to Alpha Centuri , as the yardstick with which to measure the distance : Earth to Jupiter.
For example worth remembering that the estimate of risk for regular eating a of processed meat isa few extra deaths in a thousand, in comparison the estimate for regular smoking is somewhere between 300 and 500 extra deaths per thousand
What a brilliant idea!
The graphic warnings are what I call criminal nocebos. Subliminals like that should be a crime. Yet the crime only covers TV and film in the UK. This is one of the reasons I am so against Tobacco Control – they set out to twist peoples’ minds with psychological violence. It’s quite shocking to me that it can be legally allowed. The graphics are seen by smokers and non smokers and the negative mental ‘infection’ MUST harm health.
I do like your graphic! There could be others suggesting snus – even patches for god’s sake. Of course – vaping has not been allowed promotion.
I actually agree with you about the images. To top it off most of the images they use are not from smokers at all, but whatever image they can find to make their point. Smokers lungs are not actually black for example, but how many images of black lungs have we seen. This zealotry and lies should stop.
Imagine if that advertising space could be used to send a good message instead, like the fact that vaping is *at*least* 95% safer than smoking.
I do like your graphic!
.. There could be others suggesting snus ..
..even patches for god’s sake.
.. vaping has not been allowed promotion.
Leaving aside the ethical downsides,the Plan explicitly targets smokefree hospitals,prisons & MH institutions (together with teasing suggestions of outdoor places) but makes no specific proposal for allowing vaping in these places.
At least in places where the department controls the purse strings,they could have been a little more forceful in encouraging ecigs.Those hospitals,etc that ban both smoking and vaping from the whole of their sites are sending the message that both are equally bad.
As with snus,fine words from the top of TC need to be turned into practical proposals!
This is certainly an important development, possibly a ground breaking event in the shift of nicotine regulation towards a harm reduction paradigm. However, for it to succeed it must be made more attractive to smokers, the real smokers, not the ones that many regulators and physicians imagine (as they have never smoked).
In particular, a policy that aims at promoting the substitution of smoking for vaping should also address the social aspects of smoking, an issue that often remains unattended in the sidelines with respect to our focusing on health risks, toxicological studies, etc. The current tobacco regulation has over the last two decades progressively decreased (and even eliminated) the social spaces where smokers socialized while smoking. Many smokers recent this, so if the social spaces for vaping are equally restricted as the ones for smoking, much fewer smokers may undertake the transition to vaping. I know this very well as a vaping advocate and as a current dual user (I still smoke a cigar/pipe every 2-3 days).
Notice that vaping represents a shift in the mechanics of smoking cigarettes: vaping gear is not disposable, requires maintenance, it is much bulkier than a fag, etc. In my experience a lot of cigarette smokers dislike this. Changing to a new habit or a new product or technology always involves a change in the mechanics and in the rituals, but these changes do occur (from old telephones to mobiles, from typewriters to laptops, from carriages to cars, etc). However, for these shifts to occur successfully there must be a gain to entice them (the proverbial “carrot”). In the case of the desired shift smoking -> vaping, health improvement is not (in itself) sufficient carrot. Recovering the social spaces can be. A first step in this direction could be legally and openly allowing publicans to decide (without government meddling) if vaping is allowed or not in their pubs and restaurants. I believe this could trigger a fantastic carrot to entice smokers currently exiled outdoors (in possibly foul weather) to try vaping in warm indoors.