By Giovanni Carucci
Tobacco harm reduction is a public health policy focused on reducing the adverse health effects associated with smoking. For smokers who want to continue using tobacco or nicotine products, it includes encouraging them to switch to an alternative source of nicotine with lower health risks than conventional cigarettes. Many in the public health community believe, based on science, that e-cigarettes offer this potential.
Yet disparity in the way EU countries are approaching this policy, and going beyond rules set out in EU legislation, may affect whether all EU consumers benefit equally.
Today the UK has one of the most progressive approaches to tobacco harm reduction and vaping. As a result, out of the nearly 6 million vapers in Europe, 2.9 million of them live in the UK. In addition, 1.5 million of those in the UK who made the switch are now ex-smokers. Authorities proactively conduct research and support vaping based on the evidence they find. The country also has one of Europe’s lowest smoking rates, and a recent report says vaping is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country. Public health organisations actively communicate their evidence-based results in consumer-oriented campaigns, including scientific estimates that vaping poses a small fraction of the risks associated with smoking.
What is Europe doing?
EU rules surrounding e-cigarettes are set by the Tobacco Products Directive. During its most recent revision, it clearly set e-cigarettes apart from traditional tobacco products by providing a separate category altogether, and by setting out strict rules around e-cigarettes’ appropriate use, safety and design. These rules should be sufficient to show member states how to regulate the products, but many are going beyond the rules and introducing measures such as extra taxes, which trickle down to consumers and keep them smoking instead of switching to alternatives. This is a missed opportunity to – on a large scale – potentially reduce the harm associated with smoking across Europe.
Perhaps more alarming than this is the gap between what is known about the relative potential reduced risk of e-cigarettes and what consumers believe about their risk profile. According to the last EU Eurobarometer survey in 2017, over 50% of respondents believe that vaping is harmful, a proportion that has increased in almost all countries since the previous survey in 2014. And in spite of existing EU rules providing a solid framework for e-cigarettes, those surveyed said rules around the products “should be tougher.”
This can only be described as a crucial knowledge gap. The European institutions should send a clear signal to the member states that these products are well-regulated, and that they are not the same as traditional tobacco products. There is fast evolution in this relatively new and growing category, and EU authorities must be more active to stimulate greater alignment in approaches across the EU if consumers are to reap the potential benefits.
On this note, the Eurobarometer survey gives some insight into the impact public communication can have to address this. When asked if they had seen advertisements of e-cigarettes, nearly a quarter (23%) of those in the UK said "yes." In other countries where smoking rates are higher, less than one in ten respondents said they had seen these advertisements often. Smokers in all EU countries should have clear, balanced and scientifically-based information and access to potentially reduced risk products that can inspire them to switch to potentially less risky alternatives.
Addressing consumer misperceptions
Today, UK research has shone a light on many of the doubts that originally came along with this new product category. For example, it suggests that nicotine plays a very minor role in the harmfulness of smoking, and that there is no conclusive evidence showing a gateway effect for young people or those who have never been smokers. It also recommends that consumers’ misperceptions about the relative risks of e-cigarettes and nicotine versus tobacco need to be corrected, and that tax policy should ensure e-cigarettes remain affordable for consumers.
According to the EU’s own data, Europeans are largely unaware of the potential to reduce the associated risks of smoking by switching to e-cigarettes. The relevant authorities in member states and at EU level may therefore find it useful to inform themselves of the latest evidence and to address consumer misperceptions on that basis. An evidence-based approach is called for that looks at the substantial reduced risk potential that e-cigarettes can have, and better communication that the products are well-regulated and different to traditional products.
_Giovanni Carucci is Vice-President of EU Affairs at British American Tobacco (BAT)._
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