Australia’s health policy in relation to vapes is in disarray. Yet this deeply flawed approach is currently supported by all state, federal and territory governments.

Vaping nicotine was developed in 2003 by a Chinese chemist Hon Lik – a heavy smoker who was desperate to find an effective way to quit smoking after his father died from lung cancer.

Vaping was marketed in 2007 and within a few years it became increasingly popular, especially in America and the United Kingdom.

In Australia, the availability of vapes has been severely restricted, first in 2013 by requiring a doctor’s prescription, and then from October 2024, requiring legal vapes to be purchased from pharmacies.

In contrast, high-risk cigarettes continue to be readily available from over 40,000 outlets throughout Australia.

Low-risk smoke-free options for smokers are much less accessible than high-risk combustible cigarettes. Moreover, in Australia the supply of vapes and cigarettes has been dominated by a black market that has become increasingly violent.

While vaping among young people is certainly not ideal, a number of prestigious scientific organisations, including the Office for Health Improvement and Disparities in the UK Department of Health and Social Care; the Royal College of Physicians in London; and Cancer Research UK have concluded that vaping nicotine is far less risky than smoking.

The aim of Australia’s public health policies should be to minimise smoking-related deaths and disease as fast as possible, by stopping young people from starting to smoke and helping smokers to quit smoking or switch to one or more of the four low-risk smoke free-options now available. Vaping is the best known of these low-risk options.

Smoking among young Australians has already dropped to extremely low levels, and substitution of smoking by vaping has made an important contribution.

Helping smokers to quit is well worth supporting, although quit smoking aids such as nicotine replacement therapy only have modest success. In countries where the use of smoke-free alternatives to cigarettes has reached high levels, smoking has plummeted. Prime examples are Sweden, Norway, Japan, UK and New Zealand.

In Australia, many smokers want to continue taking nicotine but via a much lower-risk method. First a trickle of smokers, then a flood, have switched from deadly cigarettes to low-risk smoke-free options. Tobacco companies realise that the cigarette is becoming obsolete, and many companies are switching rapidly from cigarettes to safer smoke-free options. For example, Philip Morris International, the world’s largest traded tobacco company, only earned $US 0.2 billion net revenue from smoke-free options in 2015. But this had increased to $US 14.8 billion in 2024, when it represented 40% of the company’s net revenue.

A veteran of many drug harm reduction campaigns, Dr Alex Wodak AM, rightly regards vaping nicotine as primarily a harm reduction intervention.

In 1986, Dr Wodak and some colleagues resorted to civil disobedience to start Australia’s needle syringe program. This triggered government legalisation of programs providing sterile needles and syringes which helped minimise the spread of HIV among, and from, people who inject drugs. In 1997, Wodak and his colleagues helped establish Australia’s first Medically Supervised Injecting Centre, in the basement of the Wayside Chapel in Sydney.

Wodak explains: “In both cases we were demonised and ostracised for years, despite strong and growing evidence that these interventions saved many lives and billions of dollars. The consensus view today is that the harm reduction advocates were right and our critics were wrong.”

A critical decision made early in Australia’s HIV epidemic was to make sure people at the highest risk of HIV infection, that is men who had sex with men, commercial sex workers and people who injected drugs, were meaningfully involved in decisions involving HIV policy and implementation. This undoubtedly contributed to Australia’s effective response to the epidemic, just as ignoring people who smoke or vape has contributed to the disarray of Australia’s vape policy. Harm reduction works, but it is often very hard initially to get politicians to accept compelling evidence.

After New Zealand in 2020 made low-risk vapes easier to buy than high-risk cigarettes, overall adult smoking declined from 14.5% in 2016 to 6.8% in 2023. In New Zealand’s lowest socio-economic quintile, it fell from 26.2% to 10.7%, and among the Māori population smoking more than halved from 35.5% to 17.1%.

In Australia, overall adult smoking declined from 12.2% in 2016 to 8.3% in 2023, while among the most disadvantaged quintile it fell from 17.7% to 13.4%. But among First Nations Australians, smoking only fell from 37.4% in 2019 to 28.8% in 2023.

Compared to Australia, New Zealand has experienced a more significant decline in smoking across all groups. The decline is particularly notable among the Māori population.

So what should Australia do now?

First, establish a regulated, readily accessible legal market for lower-risk nicotine products such as nicotine vapes, nicotine pouches, heated tobacco units and snus, available through licensed, age-restricted outlets, subject to appropriate safety and quality standards.

Second, implement a public health messaging campaign encouraging people who smoke cigarettes to switch to vaping: “If you smoke, you should switch to less harmful vapes; if you do not smoke, you should not start vaping. Vaping is not without risk and should be avoided by people who do not smoke.”

Third, reduce tobacco excise to at least pre-2020 levels. A reduction in the price differential between legal and illicit products would reduce the burgeoning black market in cigarettes and tobacco.

Fourth, meaningfully involve people who smoke or vape in policymaking. The principle of “nothing about us without us” means including individuals with experience in the development, implementation and review of tobacco and nicotine policy.

Crucially, governments should shift resources from enforcement to regulation. Enforcement alone is insufficient to reduce illicit trade. The more effective low-risk nicotine options are made available, attractive, and affordable, the faster smokers will switch to low-risk smoke-free options and the faster smoking-related-deaths will fall. Surely this is a matter of critical importance to public health and the quality of life in Australia.

The views expressed in this article may or may not reflect those of Pearls and Irritations..