Harm reduction policies are widespread, and generally work, are safe and cost-effective.

But since 2011, Australian Governments have vehemently rejected vaping, a form of tobacco harm reduction, although the evidence for the effectiveness and safety of vaping has become overwhelming.

Harm reduction means never letting the best be the enemy of the good. It’s about happily accepting a certain silver medal when winning a gold medal is unfortunately beyond reach.

Harm reduction policy approaches are ubiquitous in Australia. Australia has had car seat belts for more than half a century and even made wearing them compulsory because they are so effective at saving lives, preventing serious injuries and saving billions of dollars. Ditto for airbags and motorcycle helmets. Harm reduction in road safety does not mean accepting any number of car crashes. It means trying to reduce car crashes and also trying to prevent drivers and passengers in a crashed car being thrown through the windscreen or colliding with the car interior. Road crash deaths per million in Australia fell by more than 80% in the last half-century with harm reduction contributing greatly to this triumph.

Harm reduction is now in every Australian playground for children. Concrete playground floors disappeared long ago and were replaced by softer, spongy materials. Kids still fall off swings and slides, but now they just get a bad bruise rather than a broken bone.

Australia not only has fabulous beaches and a wonderful climate, but also one of the highest rates of skin cancer in the world. For years, the Cancer Council sensibly promoted pragmatic but effective advice: “Slip, Slop, Slap.” Australia doesn’t try to stop people swimming but we do what we can to encourage people to swim between the flags where there are lifesavers and no rips.

There’s also plenty of harm reduction in Australian pubs. These days many pubs serve food and also sell non-alcoholic beverages. These slow the increase in blood alcohol, thereby reducing intoxication and violence. In some pubs, heavy furniture is bolted to the floor so that drunken patrons cannot lift them up and throw them at others. Drinks containers in pubs are now often made from plastic rather than glass, so that drunken customers cannot break the glass into shards to be used to stab people. For more than 30 years, Australia required flour to be fortified with tiny quantities of vitamin B1 to reduce the incidence of a particular kind of brain damage (Wernicke-Korsakoff syndrome) known to occur in heavy drinkers with a poor diet. That condition, often requiring expensive lifelong institutional care, is now much less common than it used to be.

In the 1980s, Australia was threatened by a serious epidemic of HIV infection. Men who had sex with men, people who bought or sold sex and people who injected drugs were at the highest risk of HIV. Effective prevention and treatment was not known initially and, for years, many young people died agonising deaths. Experts at the time were also extremely worried about the possibility of large numbers of low-risk Australians acquiring HIV because this could have led to large numbers of people dying from HIV. To reduce the spread of HIV among and from people who injected drugs, Australia rapidly expanded and liberalised its methadone programs, started needle syringe programs and warned people who injected drugs to “never share needles”. Efforts to reduce the supply of illicit drugs in Australia continued (despite their high costs and limited effectiveness) alongside effective and cost-effective efforts to reduce the harm from drugs. Condom use was promoted in the full knowledge that achieving indefinite universal sexual abstinence was an impossibility.

Smoking causes 21,000 deaths a year in Australia and is still the most important cause of preventable death and disease. Smoking rates have been declining slowly for half a century. But Australia refuses to consider a range of excellent harm reduction options which have now been readily available for decades in some countries where they have accelerated the decline in smoking. Australia still insists on only using the same policies it has used for many years.

Countries which have high rates of use of tobacco harm reduction options have seen their smoking rates plummet while smoking rates in Australia have only continued to decline slowly. Snus, a moist, pasteurised, powdered tobacco in a sachet placed between the upper gums and cheek, has been popular among Swedish men for more than 200 years. Pasteurisation dramatically reduces the risk of cancer. Sweden is the only country in the European Union where people are allowed to use snus and has the EU’s lowest rate of cancer. The adult daily smoking rate in Sweden in 2024 fell to 5.4%, which means Sweden now has the lowest smoking rate in any high income country. Snus has now become popular in neighbouring Norway where the smoking rate has also recently plunged.

In 2014, Japan allowed heated tobacco products to be sold for the first time, while continuing to ban all other forms of safer, smoke-free nicotine products. HTPs involve a stick of compressed tobacco being inserted into a device which heats, but does not burn the tobacco stick. The annual change in cigarette sales increased from -1.5% between 2011 and 2015 to -10.5% between 2015 and 2018. Cigarette sales in Japan fell by more than 52% between 2011 and 2023.

For many years, Australia and New Zealand had very similar tobacco policies and very similar outcomes. This changed in 2020 when New Zealand decided to make low-risk nicotine vaping more available than high-risk cigarettes. After the introduction of the new vaping policy, smoking rates plummeted in the majority population and fell even faster among Māori and other disadvantaged groups.

Since 2011, both sides of Australian politics have persisted with a failed and futile hostility to safer, smoke-free nicotine options despite compelling evidence that better policy options are now available and can be combined with current policy. As Gough Whitlam said in 1972 when facing a tired and ineffective government, “It’s Time!”.

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