After nearly a decade advocating for vaping as a tobacco harm reduction strategy in Australia, I am stepping away from the field to retire. Witnessing Australia’s descent over these years, from its former status as a global leader in tobacco control to the current slow-moving train wreck, has been profoundly distressing.
Where vaping is seen by other Western democracies as a huge opportunity for public health, successive Australian governments have framed it as a threat. The ensuing prohibitive regulations have neutralized the potential benefits and led to troubling and escalating unintended consequences.
More Smoking and a Rampant Illicit market
Australia’s unique prescription-only model for vaping has not resonated with adult vapers. Less than 10 percent hold a nicotine prescription, which is hard for many to obtain. Many have returned to smoking. Of the rest, the vast majority turn to the illicit market.
This illegal trade, estimated at 100 million vapes annually, is controlled by organized trafficking networks that import and sell unregulated products, with no consumer protections or age verification. Increasingly, the illicit nicotine and tobacco trade is associated with violence, with reports of extortion, fire-bombings and public executions from turf wars over market share.
Health Minister Mark Butler’s response to this clear failure is further harsh prohibition.
Most importantly, adult smoking rates declined by only 5 percent over the four years from 2018-2022. In comparison, the prevalence of smoking has fallen sharply over the same period in similar countries where legal vapes are readily accessible: by 39 percent in New Zealand, 33 percent in Great Britain and 18 percent in the United States.
Why such disparity? The answer lies largely in Australia’s precautionary approach to vaping.
Worryingly, while other Western countries report a decline in youth smoking associated with the rise of vaping, smoking among Australians aged 14-17 has increased substantially: from a rate of 2.1 percent in 2018 to 6.7 percent in 2022. When youth are given the message that vaping is unsafe, they tend to conclude that they might just as well smoke cigarettes instead.
Health Minister Mark Butler’s response to this clear failure is further harsh prohibition. Changes for 2024 included a doubling down on the prescription and pharmacy model; a complete ban on disposables and on the personal importation of vapes; and harsh restrictions on flavors, nicotine strength and pharmaceutical-like packaging. All of this will make legal vaping even less appealing, less accessible and less affordable.
A Masterclass in Science Denial
Vaping is opposed in Australia by a tight network of all state and federal health departments, health charities, and medical and public health associations. These groups dismiss and undermine the established science of vaping through scaremongering, disinformation and cherry-picking.
Even our most prestigious health organizations distort and deny the evidence. In 2022, I led a review of the Position Paper on vaping by Australia’s leading health and research body, the National Health and Medical Research Council (NHMRC).
Our findings, authored by 11 leading Australian and international experts and published in the journal Addiction, found that the NHMRC’s assessment contained serious scientific flaws, misinformation and grounds for concerns about bias. We concluded that it “fails to meet the standard expected of a leading national scientific body.” Yet our review received little media attention and was dismissed by the NHMRC.
A further government-commissioned review, led by Professor Emily Banks at the Australian National University in 2022, was equally flawed. But our peer-reviewed critique in Drug and Alcohol Review was similarly ignored, and the ANU report is regularly referenced today as the gold-standard guide for Australian policy.
Tellingly, repeated invitations to anti-vaping advocates to debate the evidence have also been refused.
The official narrative is further amplified uncritically by the mainstream media, which focuses on alarmist and negative messaging around vapes.
Underlying Reasons for Opposition
Tobacco control in Australia is driven by a small network of influential insiders who desperately attempt to maintain their control. Tobacco harm reduction is a threat to their traditional approach and to their legacy. Their entrenched abstinence-only ideology and irrational fear of nicotine has led to moral outrage over the continued use of this “addictive” drug. Nicotine is framed as the problem, rather than the deadly harms from smoking.
Vaping threatens the very existence of the tobacco control industry. They have prior positions to defend and organizations to run. Vaping threatens the ongoing funding for their research, conferences, wages and their largely ineffective abstinence-based programs.
Governments are driven by minimizing political risk. Kudos can easily be gained by appearing to be “tough on the tobacco companies” or “protecting our children.”
Once tobacco companies entered the vaping market, the focus of tobacco control shifted to attack vaping in order to punish the tobacco industry, understandably its historical enemy. It prioritized this to the detriment of the primary goal of preventing smoking-related deaths from cancer, lung and heart disease.
Rather than openly admitting these unacceptable motivations, opposition is often framed as publicly acceptable arguments, with superficial appeal but little supportive evidence.
Governments are driven by minimizing political risk, and it takes great courage for political leaders to oppose these powerful and united forces. In contrast, kudos can easily be gained by appearing to be “tough on the tobacco companies” or “protecting our children.”
A case study is how Health Minister Butler frames his proposed harsher crackdown on vaping as youth protection. Despite the evidence to the contrary, he repeatedly claims that “vaping is a gateway to smoking.” He states that, “Vaping is creating a whole new generation of nicotine dependency in our community,” when Australian studies show that among youth who don’t smoke, less than 2 percent vape nicotine weekly or more.
And he describes youth vaping as a deliberate strategy of the tobacco industry—”what the tobacco industry has done here is tried to find a product that will recruit a whole new generation of nicotine addicts”—when none of the vaping products widely used by youth in Australia are made by tobacco companies.
Personal Experiences: The Cost of Advocacy
My evidence-based advocacy and the efforts of others are undermined with smears, insults and harassment.
Attempts have been made to block my teaching, media articles and presentations. For example, an invitation to speak on vaping at a leading Sydney Hospital was withdrawn after a false claim by a respiratory specialist that I “was funded by a tobacco company,” despite this being comprehensively denied.
These and other cowardly incidents have caused me intense aggravation and frustration. My support for tobacco harm reduction is undiminished. But I have had enough.
Anti-vaping advocates have twice made complaints about my advocacy to the health regulatory body (Health Care Complaints Commission), both of which were dismissed.
Opponents attempted to have my peer-reviewed paper on vaping retracted from a leading medical journal on the basis of a purported conflict of interest. The journal supported the retraction even after the alleged conflict was explained as false. It was only after I engaged a lawyer and spent thousands on a legal challenge that the matter was resolved and the article retained.
A recent television program on vaping claimed that I was “a friend of Big Tobacco” and implied that I was acting for them. I also had to engage a lawyer to challenge this attack on my integrity.
These and other cowardly incidents, and the persistent denial of the science, have caused me intense aggravation and frustration. My support for tobacco harm reduction is undiminished. But I have had enough.
As I retire, my hope, still, is for a balanced, evidence-based approach to vaping in Australia. It won’t come soon. The latest regulatory crackdown will need to run its course and fail again before much-needed reforms are possible.
Then we will need to move beyond the echo chamber of Australia’s tobacco control groupthink, if we’re to recognize vaping not as a “public health menace,” but as a powerful ally in the fight against tobacco-related harm.
The future of public health in Australia depends on it.
Photograph via NARA & DVIDS Public Domain Archive
Inset graphic by Colin Mendelsohn