Australia and New Zealand: A Natural Experiment in Vaping Policy

June 24, 2024

A vast natural experiment has been unfolding Down Under. Resembling a large-scale controlled trial, it has much to teach us about the impacts of diametrically opposed regulatory approaches to nicotine vaping.

The subjects of this experiment are the respective populations of Australia and New Zealand. The two countries have broadly comparable tobacco policies, demographics, quality of life and population health—similarities that increase the likelihood of differing outcomes on tobacco use and related harms being caused primarily by vaping policies.

If this were a clinical trial, the negative outcomes for the people of Australia are so severe that it would be unethical for researchers to allow it to continue.

On June 24, the Australian government announced that it would water down its stringent restrictions on vapes. But the move, while welcome, is too little, too late.

 

Regulatory Approaches

In 2020, New Zealand adopted a progressive and supportive approach by legalizing and regulating vapes. The Ministry of Health encourages vaping as a smoking cessation aid through various government initiatives—including an educational website called “Vaping Facts,” the “Vape to Quit Strong” campaign, mass media education, and clear advice for health professionals.

Vapes are sold as adult consumer products in New Zealand through licensed retail outlets, with strict age verification. A wide range of flavors is available, although nicotine levels are capped at 28.5mg/ml. Both disposable vapes and advertising of vaping products are banned.

Australian public education campaigns predominantly focus on the harms of vaping, with minimal encouragement for adults who smoke to switch.

In contrast, Australia has implemented a highly restrictive, purely medicalized approach to vaping. Nicotine liquid is classified as a medicine, requiring a prescription from a doctor or nurse practitioner. Nicotine and vaping products can only be legally purchased from pharmacies, with flavors limited to tobacco, menthol, and mint. Recreational vaping and personal importation are banned. Vapes have become so difficult to obtain legally that these policies effectively amount to prohibition.

Australian public education campaigns meanwhile predominantly focus on the harms of vaping, especially to young people, with minimal encouragement for adults who smoke to switch to vaping as a harm reduction measure. The health minister has said he aims to “drive the vaping industry out of the country.”

That health minister has just been forced to strike a political deal with the Australian Greens, however. As a result, people will be able to purchase vapes from pharmacies without a prescription, starting in October. But only three flavors will be available, with a poor choice of hardware and at high cost. Furthermore, the powerful Pharmacy Guild has strongly opposed any involvement with the proposal, and it remains to be seen if this model will get off the ground without its support.

Still, it can be read as a belated, tacit admission that the status quo hasn’t been working.

 

Public Health Outcomes

New Zealand has historically had higher smoking rates than Australia. However, this trend has recently reversed.

Since the regulation of vaping in 2020, New Zealand has experienced an unprecedented decline in its daily adult smoking rate: from 11.9 percent in 2020 to 6.8 percent in 2023—a total drop of 43 percent, or about 14 percent per year.

Significant reductions were observed across various demographic groups, including Māori and Pasifika communities and those with lower socio-economic status. As smoking has fallen, vaping has risen, with 9.7 percent of the adult population now vaping daily. And the smoking decline has been most pronounced among young adults with the highest vaping rates, those aged 18-34, supporting the notion that vaping has contributed to this reduction.

By 2023, Australia’s daily smoking prevalence was significantly higher than New Zealand’s.

Thanks to this rapid decline in smoking, New Zealand is now on track to achieve its target of becoming smoke-free by 2025.

In contrast, Australia has seen a much slower decline in its smoking rate, with a 6 percent annual reduction from 2020 to 2023. By 2023, the daily smoking prevalence was significantly higher than New Zealand’s at 8.3 percent, with 3.5 percent of the adult population vaping daily. 

 

Youth smoking has continued to decline in both countries, with only 1.2 percent of New Zealand youth and 0.3 percent of Australian youth smoking daily. But youth vaping rates have raised concerns, particularly in New Zealand. In 2023, 10 percent of 14-15-year-olds in New Zealand were vaping daily.

Most of New Zealand’s increase in youth vaping occurred before regulation commenced, however. Since regulation took effect, the youth vaping rate has begun to level out. This rate is expected to decline as the novelty of vaping wears off, as we have seen in the United States.

In Australia, daily youth vaping was at 3 percent in 2023, and anecdotal reports suggest that youth vaping is continuing to rise rapidly. The unpopular prescription-only model means that illicit vapes dominate the market, and these are readily accessible to young people.

 

Illicit Markets and Economic Impact

Most of Australia’s 1.7 million vapers have rejected the medical pathway. Fewer than one in 10 have a nicotine prescription. The difficulty in finding doctors who will write nicotine prescriptions and the limited range of products stocked by pharmacies have driven 90 percent of Australian vapers to the illicit market.

An estimated 120 million disposable vapes are illegally imported annually and sold from retail outlets, on social media and the internet. These unregulated products pose potential health risks and are sold freely to youth. Nicotine vapes are now the second largest illicit drug market in the country, after cannabis.

This illicit market is largely controlled by organized trafficking networks and outlaw biker gangs. The result has been a violent turf war to control market share. Over the past 18 months, there have been over 80 firebombings of tobacco and vape shops, three public killings and regular extortion. Vulnerable children are being used to light fires and commit other crimes on the gangs’ behalf.

In response, the government has set up a special crime force, Operation Lunar, and increased Border Control and policing efforts. However past experiences with drug wars suggest that these measures will have little long-term effect on supply and use.

Under New Zealand’s consumer model, costly doctor visits are unnecessary, and the country avoids the expense of trying to police a substantial illicit market.

In contrast, New Zealand’s legal and regulated vape market means that the country has seen very little evidence of an organized illicit market. The legal market offers substantial economic benefits, including tax revenue from vaping products, stimulation of the retail and manufacturing sectors, and government savings from reduced health care costs. Under New Zealand’s consumer model, costly doctor visits for nicotine prescriptions are unnecessary, and the country avoids the expense of trying to police a substantial illicit market.

The demise of Australia’s retail vape industry is another harmful effect of its harsh medical model, depriving people who smoke of the valuable support and advice previously available from vape shops.

Even under Australia’s new plan, given the continuing relative difficulty of obtaining a restricted number of unappealing vaping products from pharmacies only, the illicit market will continue to thrive.

 

A Clear Winner

This analysis supports New Zealand’s harm reduction-oriented, consumer-based approach to vaping. The most striking benefit has been the accelerated decline in smoking rates, with predictable improvements to public health to follow.

While New Zealand is now on track to achieve its smoke-free target in 2025, modeling suggests that Australia will miss its own smoke-free goal by a wide margin.

While New Zealand’s approach is not perfect, it offers a far more effective strategy for reducing total harm.

Besides obstructing progress on smoking cessation, Australia’s restrictive model has handed control of the vaping industry to illicit operators—doing away with consumer protections and age restrictions, and creating further dangers from the resulting turf war.

While New Zealand’s approach is not perfect, particularly with higher youth vaping rates, it offers a far more effective strategy for reducing total harm. Enhanced compliance measures could further stabilize youth vaping, although the net harms from youth vaping are debatable and certainly not comparable to smoking.

Australia has just recognized, to a limited degree, the urgent need to reverse course, and abandon an approach that incurs high costs, creates violent chaos and demonstrably impedes public health goals. The country has much further to go to ensure low-barrier access to vapes for everyone who smokes.

 


 

Top image by US Geological Survey via Picryl/Public Domain. Inset graphics by Colin Mendelsohn, based on public data.

Colin Mendelsohn

Dr. Colin Mendelsohn is the founding chairman of the Australian Tobacco Harm Reduction Association health promotion charity. He is a medical doctor with a special interest in tobacco treatment and is a member of the committee that develops the RACGP Australian smoking cessation guidelines. He is the author of the book Stop Smoking Start Vaping. He lives in Australia.

Disqus Comments Loading...