UK Tobacco and Vapes Bill: a Misfire and a Backfire

New UK policies and legislation on smoking and vaping have been widely hailed as groundbreaking and game-changing. That is wrong. Closer examination shows they are likely to do more harm than good - a misfire and a backfire.

Middle-aged adults who smoke are the critical at-risk population.
For them, the legislation misfires and backfires

Misfire + Backfire – a summary

In short, the UK government has got its priorities and legislation all wrong. Its anti-smoking measures will misfire, and its anti-vaping measures will backfire.

  • Misfire. Its flagship measure, the Smoke-free Generation, addresses a problem that is already or will be solved by smoke-free alternatives, such as vaping. The people it affects are unlikely ever to suffer the main consequences of smoking. The main smoking-related harms do not begin to emerge until after the age of about 40 and following several decades of smoking. Few people born after 2008 will still be smoking by the time they pass 40 from 2049 onwards – the world will have changed beyond recognition by then. Youth smoking has been trending sharply down for many years, and, more recently, the decline is mixed with the uptake of vaping. The most important population from a public health point of view is the stock of 6.4 million UK adult smokers who are already over 18. For many of them, the risks are imminent and serious. The Smokefree Generation does not affect the critical population. It will have no effect on the NHS for 20 years and then, at best, a trivial effect.
  • Backfire. However, the critical at-risk population of adult smokers (typically entering middle age, low-income or otherwise disadvantaged) will be negatively affected by the government’s anti-vaping measures. For this group, switching from smoking to vaping offers a huge boost to health, wellbeing and welfare [see below]. But in the name of “protecting” youth from vaping, the government will make switching from smoking to vaping more expensive, more difficult and less appealing, including eroding confidence in its (otherwise excellent) Swap to Stop measure. Only slight increases in adult smoking arising from anti-vaping measures will completely overwhelm any hoped-for benefits for youth vaping because the effects of smoking on adult health are large, certain and imminent, and the effects of vaping on youth health are small, tenuous and distant.

The benefits of vaping – a reminder

But before we get into more detail, I think it is important to list what is at stake through the casual promotion of anti-vaping measures. Here’s a list of fifteen ways in which tobacco harm reduction is good for public health. It’s important because these are big benefits that are being treated carelessly by politicians, officials and tobacco control activists. In the list below, I use “vaping” because that is the subject of the Bill, but I really mean all the low-risk alternative forms of nicotine use – vaping, oral nicotine such as pouches, smokeless and heated tobacco products, and any future smoke-free nicotine products.

  1. Better health and welfare for adult smokers who switch completely from cigarettes to vaping.
  2. Reduced harm to mother and baby for pregnant women who switch but would otherwise smoke.
  3. Avoiding harmful effects of smoking for adult vapers who do not relapse to smoking but otherwise would.
  4. Avoided harmful effects of smoking for young people diverted from smoking initiation to vaping instead.
  5. Escaping the deliberately induced punitive, restrictive and stigmatising harms arising from policies designed to push users to quit smoking, notably the tax burden.
  6. For young people who do take up smoking today, vaping provides “options value” – the means to switch to vaping before they are 40 and thereby avoid almost all the serious risks of smoking, which generally take many decades to accumulate.
  7. Vaping can be part of a staged quit process, going from smoking to vaping to address the main health risks and then from vaping to abstinence to eliminate nicotine use and residual vaping risks if they choose to. They don’t have to quit nicotine to quit smoking.
  8. Reaching so-called “accidental quitters” – people who had no intention to stop smoking but gradually migrated to vaping because they eventually find they like it better or it works for them.
  9. Greatly reduced toxic exposure to workers or bystanders from “secondhand” emissions, including exposures to children at home and in vehicles.
  10. Family or household benefits that arise from parents or caregivers not dying early, not getting ill or becoming unable to work
  11. The loss of an inter-generational role-modelling effect arising from less adult smoking in families.
  12. A positive role-modelling effect that one person’s vaping has on their friends, work colleagues, and relatives who smoke – contributing to the denormalisation of smoking and normalisation of an alternative.
  13. Personal responsibility and agency: People improve their own health on their own initiative and at their own expense, without relying on public finances or significant public sector involvement.
  14. Reduced pressure on healthcare budgets and scarce healthcare resources – with more capacity to focus on other health issues.
  15. Fewer fires, fire-related deaths and injuries, and reduced risk of major incidents.

Not everyone likes to hear this, but the discourse on nicotine in society remains resolutely infantile, including the absurd assertion that no one who doesn’t already smoke should use vapes (imagine that logic applied to alcohol). So, I would add two further reasons to the list above, though these need more discussion.

  1. For new users who decide to try nicotine because they want to for whatever reason, vaping offers a relatively safe way to do it when judged against our normal tolerance for risk.
  2. Nicotine use may have benefits (real or perceived) for users. These are in three broad categories:
    (1) hedonistic – its use is pleasurable.
    (2) functional – it may help with stress and anxiety or improve cognitive performance in some people.
    (3) therapeutic – some people may be self-medicating with nicotine.

My Evidence Briefs on Vaping Safety and Vaping Displacing Smoking provide further detail and references.

Youth vaping and adult smoking in perspective

The nicotine market is dominated by adults

We should start with some ground-clearing numbers. All discussions about youth vaping should recognise that there are approximately eleven times as many adults (age ≥18) using vapes compared to youth (age 11-17). Figures for Great Britain (GB).

  • Age 11-17 population = 5.4 million (ONS 2022); vape prevalence = 7.6% (ASH/YouGov, 2023); number of vapers = 0.41 million
  • Age 18+ population = 52.2 million (ONS 2022); vape prevalence = 9.1% (ASH/YouGov, 2023); number of vapers = 4.7 million

If we look at vaping and smoking together, there are about eighteen times as many adults. This is because of the large number of adult smokers and dual users: 6.2 million adults smoke (GB, 2022, ONS) compared to around 0.2 million youth (ASH/YouGov, 2023 – 3.6%).

Youth vaping also displaces youth smoking

Even the seemingly simple idea of using policy to prevent youth vaping is naively simplistic. What about the youth who would otherwise smoke? What about the youth who will use nicotine, whatever the Prime Minister or Chief Medical Officer say? What about the majority of youth who are using vapes experimentally and will stop before long? Should we impose restrictive measures on adults to “protect” people who do not, in practice, need protection?

Source: ASH/YouGov, 2023

The ASH survey shows a pattern familiar from the experience of the United States. Most of the more frequent and determined adolescent vapers are more likely to be or have been smokers. For these adolescents, vaping is a potential benefit. It is likely that more young people will go straight to vaping in the future without ever smoking, but the question is not what they did before vaping but what they would have done in the absence of vaping. The uptake of vaping as an alternative to smoking is valuable to some young people, typically those at the highest risks of smoking – and they would generally be from more disadvantaged backgrounds.

The interests of adults and adolescents cannot be neatly separated

“My mum has cancer.”

Much of the discourse on smoking and vaping is conducted as if adults and adolescents are distinct populations and might as well inhabit separate planets. Of course, young people and adults have significant stakes in each other’s lives. Suppose, hypothetically, you only cared about children and adolescents? Well, they have a significant stake in adult life:

  • Young people suffer if their parents or other significant adults are made ill by smoking – sadness and grief, caring burdens, and a diminished experience of parenting.
  • Parental smoking is a strong predictor of youth smoking initiation: there may be intergenerational benefits from parents switching from smoking to vaping.
  • Young people are usually economically dependent on adults and are fed and clothed from a household budget that is depleted by the costs of smoking (note that this is largely a policy-induced cost given that 70-80% of the price of legally sold cigarettes is tax.
  • Vapes create “options value” for youth who smoke – they offer the means to switch later in life before the disease risks start to build up after the 40s. They reduce the life consequences of poor choices made as a teenager.
  • Children may avoid secondhand smoke exposure if their parents and significant adults switch to vaping or pouches and smoking becomes denormalised in their homes and communities.
  • When vaping displaces smoking, there are also reduced risks of household fires and resulting injuries and property loss.

Please see my Evidence Brief on Youth Vaping for a more in-depth analysis and sources.

The UK government’s policy and legislation

The government has published a Tobacco and Vapes Bill, which is now making its way through Parliament: you can track it here. It consists of the Smoke-free Generation measure (banning sales of any tobacco product to people born on or after 1 Jan 2009) and a series of anti-vaping measures that will supposedly protect young people from taking up vaping. In addition, there is a plan to ban single-use disposable vapes by 1st April 2025 using separate environmental legislation. The Spring Budget 2024 introduced excise duties on vapes that will apply from 1st October 2026.

When the government develops significant new legislation or policy, it usually formulates an Impact Assessment. This is an attempt to assess the policy’s costs and benefits (including monetised estimates of non-monetary impacts on health, welfare, environment, etc.). It is mainly to check that regulators are not carelessly destroying businesses for no reason and that the sponsoring department has considered all angles – in other words, the legislation does not do more harm than good. The consumer group, the New Nicotine Alliance, has written a critique of the Impact Assessment for the UK Tobacco and Vapes Bill. Disclosure: I am an unpaid adviser to NNA and contributed to the critique NNA writes to the Regulatory Policy Committee [letter PDF] [Impact Assessment]

I am not going into the age of majority issues, but these have been treated in public health as inconsequential and can be waved away as tobacco industry talking points. However, they create a significant change in the relationship between the adult citizen and the state in a way that deserves far more reflection and wisdom than has been applied so far.

Why the anti-smoking measures will misfire

The Smoke-free Generation proposal will have little impact – a misfire that its proponents falsely describe as follows: “will save thousands of lives and billions of pounds for our NHS” (Prime Minister); “representing the single biggest preventative health policy in a generation” (Health Secretary); “major public health measure” (Chief Medical Officer); “positions the UK as a world leader in tackling smoking” (Cancer Research UK); [Government Press Release]. Really?

Smoking among young people will continue to decline without the measure

Firstly, smoking is already falling to low levels in young people, and this will likely continue, driven by the displacement of smoking by vaping or other new products. The Smoke-free Generation measure will attempt to constrain the choices of an ever-dwindling number of people born after 2008 who would be likely to become smokers in the first place.

Pupils who are regular smokers, England, 2021 NHS Digital

Age restrictions have limited impact anyway

Secondly, there are no grounds for believing that these age restrictions are all that effective. They have some effect, but it is more of a frictional impediment than a solid barrier to uptake. We currently have an age limit of 18, but in 2023, smoking prevalence among 16-17-year-olds was 12.2% – about 1 in 8, even though they are supposed to be unable to buy them (see chart below). We know that informal mechanisms form to supply willing customers at any age. So, the likely effect of the Smoke-free Generation measure will be to create informal mechanisms and illicit trade to supply the dwindling market for young people still wishing to smoke and continue as they age. It’s not that difficult – it already works for cigarettes below age 18 and for cannabis at any age.

Smoking Toolkit Survey, England

Benefits are grossly overstated and would be decades away

Thirdly, smoking is a slow-burn driver of serious disease. It takes decades of sustained smoking and exposure to the hazardous agents in cigarette smoke before serious harms begin to emerge and for costs to start piling up in the NHS. People who quit smoking before age 40 avoid nearly all the premature mortality risks of smoking (see Cho et al. 2024). The Impact Assessment for the Bill recognises this and does not show any benefits from Smoke-free Generation until 2044 – yes, that really is 20 years from now. So, if you think this will help to “save the NHS”, think again.

178. Due to the long-term nature of smoking and smoking related mortality, no health benefits would be expected until 2044.

Impact Assessment (para 178)

But even these distant benefits rely on two absurd assumptions: (1) without the Smoke-free Generation measure, smoking among 14-30-year-olds will stabilise at 9.2% until 2100, and (2) with the Smoke-free Generation measure, smoking somehow declines and disappears to zero. Neither is remotely realistic. This is captured in several charts, but most clearly in Figure 7 of the Impact Assessment.

Impact Assessment, Figure 7

All the hoped-for benefits arise from the gap between the two lines in the figure above, but they are a work of fantasy. The baseline counterfactual would continue to trend down, and the impact of the measure on smoking would be far less than suggested. Further, most of those who are smoking as young adults would be able to switch to vaping or pouches by the time they are 40 and avoid nearly all the risks – switching will be a fully normalised pathway by 2049 and 25 years of continued innovation will ensure that vapes or equivalent will work for everyone who wants it. The rest would be smoking because they chose to smoke irrespective of the risks. In practice, these lines would be much closer and probably indistinguishable.

Aimed at the wrong population – a misfire

In other words, the flagship measure is a misfire: the benefits, if any, are likely to be minimal and far in the future. The problem confronting us today is the health and welfare burden facing the several million people who have already been smoking for two to three decades – generally with lower socio-economic status, mental health or substance use problems, homelessness, unemployment, etc. The Smoke-free Generation measure completely misses the deprived populations of adult smokers that should be the central focus of tobacco and vaping policy.

Being merely pointless would not be so bad, but the anti-smoking misfire is coupled with an anti-vaping backfire: and the anti-vaping measures will harm the population at greatest risk.

Why the anti-vaping measures will backfire

Each of the measures will incrementally change smoking and vaping rates – it is very likely that the proposal will backfire, leading to more smoking than there would otherwise be. Because vaping and smoking are similar behaviours (albeit with radically different risks), extensive research now shows that cigarettes and vapes function as economic substitutes. This means that increasing the costs or reducing the value of one will tend to increase demand for the other, all other things being equal.

Any cost-benefit analysis is extremely sensitive to slight increases in smoking that arise from anti-vaping policies. The methodology used in the Impact Assessment shows how these effects could be quantified or tested in sensitivity analysis.

  • The IA uses a value per Quality Adjusted Life Year (QALY) of £70,000 and assumes that each smoker who quits or does not start generates a cost or benefit of 1.0 QALY (see para. 413). The ONS estimates 6.4 million smokers and a smoking prevalence of 12.9% in the UK. A 0.1 percentage point change in prevalence from 12.9% to 13.0% equates to an additional 49,612 smokers. Multiplying this by £70,000 gives £3,473 million.
  • That is £3.5 billion for a 0.1 percentage point variation in smoking prevalence. These are crude scale calculations intended to illustrate the extremely large impact of potential unintended consequences, but these negative consequences would dwarf any conceivable gains from reduced youth vaping because these will be distant in time. Once the benefits of vaping to young people who would otherwise smoke are deducted, there is likely to be nothing to set against the costs of unintended increases in smoking on adults.

The Impact Assessments for the legislation have not quantified these effects or even undertaken a sensitivity or “break-even” analysis (e.g. by asking how large these increases in smoking need to be to outweigh the benefits?).

I will just run through why it is plausible that the government’s measures will make smoking worse.

Banning disposables

Under primary legislation designed to regulate batteries, ministers have introduced secondary legislation to ban single-use vapes, The Environmental Protection (Single-use Vapes) (England) Regulations 2024. This ban will deny smokers the easiest, simplest, and cheapest devices to switch to from smoking. They provide a satisfactory alternative to cigarette smoking without requiring much familiarisation on the part of the user. They are likely important for reaching older people who smoke, people with capability limitations, and difficult living and working circumstances. They are priced at a low level and deliver a good equivalent experience to smoking straight out of the pack. The negative impact will depend on how the industry reacts – it could introduce similar products that are or appear to be rechargeable (Elfbar: Vape firm claims it will survive UK disposable ban). Further, it will depend on how much of the market remains or becomes illicit.

Taxing vapes

The government is consulting on the details of its Vaping Product Duty, though the most important aspects of the policy (the duty levels, the tax base and stratified design) were settled in the Spring 2024 Budget, so the main concept has escaped consultation. Vapes and cigarettes are economically linked as substitutes, and we should expect a price increase in vapes to lead to an increase in cigarette consumption, all other things being equal. The difference in price is a driver of switching, and reducing the difference will reduce switching, increase relapse and reduce diversion from smoking initiation. The government says: “The duty is intended to discourage young people and non-smokers from vaping, while maintaining the current financial incentive to choose vaping over smoking.” This is misleading. A financial incentive will remain, but it will be much diminished. The proposed tax levels will double the price of some vapes. By 2028-29 government expects to bring in £170m per year from increases in tobacco duty and £445m in vaping duty.

Banning flavours

Under the Act, ministers would have the power to make regulations restricting or limiting flavours in vaping or nicotine products (Section 62). A ban on characterising flavours degrades a key aspect of the “value proposition” of vaping – an interesting and enjoyable alternative to cigarettes at vastly reduced risk. Though young people use flavours, so do adults – these are inherently flavoured products. The likely reaction to a vape flavour ban is three-fold: (1) adverse behaviour change, including reduced switching, increased relapse, and decreased diversion; (2) illegal trade in banned flavours or flavour ingredients; (3) potentially risky workarounds such as home mixing for personal use and to sell to friends and acquaintances. These responses are also likely to apply to young people. There is compelling quasi-experimental evidence that vape flavour bans cause increases in smoking where they have been implemented in the United States (see A Yale-led study shows that e-cigarette bans boost traditional cigarette sales, November 2023, for access). A new UK-based study, Khouja et al 2024, found

If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking.

Khouja, J. N., Dyer, M. L., Havill, M. A., Dockrell, M. J., Munafò, M. R., & Attwood, A. S. (2024). Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: Findings from a UK-based mixed methods study. Harm Reduction Journal, 21(1), 90. https://doi.org/10.1186/s12954-024-01003-z

Plain packaging

Under the Act, ministers would have the power to make regulations on the packaging of vaping and nicotine products (Section 61). Much depends on how restrictive the rules would be. The first problem is the much larger stock of at-risk adults needs to find alternatives to cigarettes attractive, and making them look like generic medicines would work against that. The second problem with standardised packaging and large warnings is the implicit risk communication. The only other product that has this design requirement is cigarettes, and a rational consumer would assume there must be equivalent risks associated with vaping to justify the measure. Risk perceptions are a form of anticipated cost or loss of an expected benefit. In either case, an adverse change in risk perceptions would likely increase smoking at the expense of vaping. Risk perceptions are already wildly inaccurate, and this measure would reinforce that among adults.

Retail display restrictions

Under the Act, ministers would have the power to make regulations limiting the display of vaping or nicotine products in stores (Section 11 for England) The justification and evidence base for cigarette display bans is that they make cigarettes less accessible, remove visual cues, reduce exposure to branding, reduce the likelihood of impulse purchases, and contribute to “denormalisation”. That’s all well and good with cigarettes and may prevent adolescents from taking up smoking, though the evidence for impact is thin, to say the least. Not much can go wrong when applying these restrictions to the most dangerous products. But what about applying these ideas to vaping products? Unfamiliarity is a barrier to switching for adults.

Including non-combustible tobacco products in the anti-smoking measures

Despite substantial evidence that snus has had a transformative effect on smoking and smoking-related disease, the government has determined that snus should remain banned and be caught in the Smoke-free Generation measure. Despite the finding of the U.S. Food and Drug Administration that at least one heated tobacco product is “appropriate for the protection of public health” and that communication about its reduced risk is “appropriate for the promotion of public health”, the government, with the fulsome support of anti-tobacco groups has determined that these smoke-free products should be included in the Smoke-free Generation measures. It shows that the legislation (and its tobacco control cheerleaders) is more anti-tobacco than pro-health. Again, the issue is mostly about signalling and risk perceptions.

Impact on “Swap to Stop” and pro-vaping measures

The government does have some positive policies, such as the Swap to Stop scheme and guidance using vaping in stop smoking services. However, the implicit miscommunication of vaping risk and nicotine harm arising from the measures themselves and from the irresponsibly false and misleading statements of ministers and witnesses to the Bill Committee will have a dampening effect on these efforts. [See examples of falsehoods and abject lack of scrutiny from Day 1 and Day 2]

For more background on vaping policies and unintended consequences, see my Evidence Briefing on Policies for Novel and Emerging Products

What should be done to limit youth vaping?

It is important to remember that the market for tobacco and nicotine products is dominated by adults compared to youth, in a ratio of approximately 18:1. Even in the market for disposable vapes, there are nine times as many adult users as youth, drawing on the most recent data available. We also have to be mindful that adolescents will inevitably try things that adults use, and it is not possible to create a boundary at age 18, 21 or any age at which the harm reduction benefits of vaping (etc) can be switched on.  Nevertheless, youth vaping is a politically emotive subject, even if the health risks to youth are low and distant. 

Three main strategies should be adopted to address youth vaping:

  • Lawful supply. If the market does not meet the needs of the much larger market of adult consumers, it will become more saturated with illicit goods and workarounds. The criminal networks involved will supply a wide range of illegal products, engage young people in supply, and not observe any rules regarding age or responsible corporate behaviour. It is essential to design the legislation in a way that does not expand a lawless market. The government’s policy will likely expand illicit trade, expand the unregulated criminal market, and reduce the share of the market that is under the control of youth prevention and consumer protection policy. This is the worst outcome for youth, and for society more generally. We have seen the effects in countries where inflexible anti-vaping regulation has been taken to extremes: in the United States and Australia, over 95% of the vaping market is technically illegal.
  • Age-secure retailing.  It should be much harder for underage users to buy tobacco or vaping products, and the consequences for retailers should be more serious.  The Bill is a missed opportunity to introduce a licensing scheme that would improve retailing behaviours in several ways, including through training, checking ID and licensing conditions on how the products are displayed. A more measured approach to age restrictions would be to increase the age of sale for combustible tobacco products to twenty-one instead of creating age stratification among adults. There is good evidence to support a “C-21” measure, an age-of-sale restriction applied to combustible products only. See Pesko M. F. (2022). Combustible tobacco age-of-sale laws: An opportunity? Addiction, 117(3), 514–516. https://doi.org/10.1111/add.15685
  • Responsible marketing. Here, it is essential to balance the need to communicate with and engage smokers in switching to new and unfamiliar products with an effort to prevent marketing targeted at youth. The Committee on Advertising Practice has managed such a balancing act for advertising in its Code for Electronic Cigarettes. The same concepts could be applied to packaging imagery, branding, trademarks, and flavour descriptors. Any approach to flavours should focus on flavour descriptors, not the sensory characterising flavour itself – the element of a flavour that is a form of marketing. These descriptors should become more literal and mundane, not just to curtail marketing but to more accurately describe the product.

To conclude: “It’s the smoking, stupid.”

The real problem is that the hostile policies on vaping do adversely affect the main at-risk population: current adult smokers. Because smoking is so much more dangerous than vaping, and the smoking risks are more imminent in the at-risk population, only small adverse changes in smoking arising from anti-vaping measures would completely blow the cost-benefit case apart.  Any health benefits arising from the Smoke-free Generation measure or youth anti-vaping measures are likely to be distant and minor and, therefore, count for very little. Not only that, they are likely to be offset by the loss of substantial benefits arising from youth vaping among those who would otherwise have smoked. 

We need to focus on smoking and people who smoke today.

The legendary American political strategist James Carville (“The Ragin’ Cajun”) coined the term “It’s the economy, stupid.” to keep Bill Clinton focused on what mattered for winning the 1992 presidential election. 

Right now, here in Britain, we need to adopt the mantra “It’s the smoking, stupid.

It’s not the vaping, the pouches, the heated tobacco, or the snus. It’s not the disposables, not the flavours, not the nicotine… it’s the smoking. And it’s not distant hypothetical smoking decades in the future – it’s the smoking here and now. It’s the millions of adults at imminent risk of serious disease.

If the government wants to match its own rhetoric about protecting the NHS, then the critical population is middle-aged adults who smoke. However, its anti-vaping measures will serve to protect the incumbent cigarette trade, prolong the smoking epidemic, and increase the health and productivity burden of smoking.

For those at risk, the anti-smoking measures are irrelevant – a misfire – but the anti-vaping measures will obstruct their transition to safer nicotine use – a backfire.

I feel we have lost our way. 

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1 thought on “UK Tobacco and Vapes Bill: a Misfire and a Backfire”

  1. Great post as always Clive explaining a subject that sadly the vast majority of the public and politicians can’t seem to understand. Whilst 8 million die prematurely from smoking.

    I think there may be a typo

    “The Smoke-free Generation measure will attempt to constrain the choices of an ever-dwindling number of people born after 2008 who would be likely to become smokers in the first place.”

    Assume you mean unlikely?

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