Vaping represents a historic opportunity to dramatically reduce Australia’s annual loss of 21,000 lives from smoking. But understandable intense hatred of tobacco companies and a strong preference to eliminate nicotine use has contributed to a hostility to vaping in Australia which is irrational and unsustainable.
Smoking remains Australia’s most important long term public health issue. After control of COVID has become more secure and stable, attention will once again return to trying to reduce deaths, disease and costs of smoking by reducing the number of smokers and the damage to smokers and bystanders from inhaling tobacco smoke. Lower smoking rates will in time translate to reduced healthcare expenditure. Making it easier for smokers to switch to vaping nicotine will accelerate the decline in Australia’s smoking rate while also reducing the harm from inhaling deadly tobacco smoke. Persistent ferocious opposition has delayed the acceptance of vaping in Australia but will be overcome eventually.
Opposition to vaping in Australia is deeply entrenched and universal among Australian Health Ministers, Health Departments and health organisations, health charities and most medical associations. Australian main-stream media, medical journals and mainstream media outlets are also generally hostile. The World Health Organisation is also opposed to tobacco harm reduction including vaping (as it was also opposed to needle syringe programs in the 1990s). The Royal Australian and New Zealand College of Psychiatrists was the first major health organisation in this country to support vaping.
However, there are good reasons for optimism.
First, the extreme resistance to vaping in Australia follows the pattern of all new drug harm reduction interventions. Methadone treatment, needle and syringe programs and drug consumption rooms were all vigorously opposed initially using preposterous arguments before being eventually accepted and implemented. Vaping and other tobacco harm reduction options will follow the same pattern.
Second, the arguments used to oppose vaping do not withstand scrutiny. Australian vaping opponents avoid debate or discussion with vaping supporters as they know they cannot defend their arguments. The evidence that vaping is much less risky than smoking and is the most effective and most popular quit smoking aid is already impressive and continues to improve.
Third, smoking rates are declining faster in countries with higher vaping rates such as the UK, US and New Zealand compared to Australia. Since 2013, smoking rates in Australia have been declining annually at 0.3% while the decline in the same period has been 0.9% in the UK and 0.8% in the US.
Fourth, the transition from combustible cigarettes to smoke free ways of inhaling nicotine is a disruptive innovation. Other examples of disruptive innovations include the transition from manual to electric typewriters, and from electric typewriters to personal computers; film to digital cameras; records to cassette tapes to compact discs to streaming; internal combustion engine to electric vehicles and fossil fuels to renewable energy. Traded tobacco companies are transitioning from combustible to smoke free options though with varying speed. The share price of tobacco companies rose spectacularly for many decades. After reaching a peak in 2017, tobacco company shares dropped by more than half over the next three years, even though these companies continued to be extremely profitable. The share price of tobacco companies transitioning more rapidly from combustible to smoke free options, such as Swedish Match and Philip Morris International, are higher than companies making a slower transition. The proportion of profits of PMI accounted for by smoke free options increased from 0.2% in 2015 to 30.7% for the final quarter of 2021.
Fifth, as in many other areas, China could and probably will be critical to the vaping debate. The largest tobacco market in the world is China, followed by India, Indonesia and the United States. China is home to a third of the world’s smokers, produces 40% of the world’s cigarettes and 90% of the world’s vaping devices. The China National Tobacco Corporation, 100% owned by the Chinese government, is the world’s largest tobacco company and holds more international patents for tobacco harm reduction than any other company. Building this collection of international patents on tobacco harm reduction must have cost many billions of dollars. It is hard to believe that the CNTC does not intend to use these patents. ITC, formerly the Indian Tobacco Company is 28% owned by the Indian government. It also has a large investment in tobacco harm reduction although India has banned vaping.
Sixth, smoking and smoke-free options such as vaping products are economic substitutes. In markets where governments have provided a level playing field between cigarettes and smoke free options, consumers have shifted rapidly from deadly cigarettes to a range of safer options. Sweden is the only European Union country to allow the sale and use of snus, a pasteurised, low risk form of moist oral tobacco. Compared to men in other EU countries, Swedish men have the lowest rates of smoking, smoking-related diseases, and smoking-related deaths. Snus use has begun to increase among Swedish women and Norwegian men and women with a corresponding decrease in smoking rates. In Japan, vaping is banned but after Heated Tobacco Products, another form of tobacco harm reduction, were permitted, cigarette sales dropped 43% in five years.
Seven, according to the National Drug Strategy Household Survey, the estimated number of Australians vaping increased from 240,000 in 2016 to 520,000 in 2019. This is a compound annual growth rate of over 23%. The number of people vaping globally is doubling at least every ten years. Vaping is a huge health and financial issue for vapers and their families. For many, vaping is a vote changing issue. As the number of vapers increases, so too will their political impact. Vaping is unlikely to be a vote changing issue for more than a few vaping opponents.
As with debates about previous newly introduced drug harm reduction interventions in Australia, opposition to vaping seems like an impregnable fortress. But almost all drug harm reduction interventions in Australia get accepted eventually.
Dr Alex Wodak, AM, is a physician and has been a Director of the Alcohol and Drug Service at Sydney's St Vincent's Hospital, President of the Australia Drug Law Reform Foundation, Board Member of Australia21 & the Australian Tobacco Harm Reduction Association.
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