Could Brexit End Up Boosting UK Tobacco Harm Reduction?

    In June 2016, months before Donald Trump would win the presidential election in the United States, the United Kingdom narrowly voted to leave the European Union (EU). Since the decision to Leave and the long, fraught start-and-stop departure that followed, some observers have labeled the decision as “out of date”—a poorly timed move that echoes the anti-immigration impulses of other elections around the world and will serve to isolate the nation.

    Joe Biden, in his first 100 days as US president, has emphasized a renewed need for cooperation between allies. With the UK finally, officially out of the EU in January 2021, international critics and British Remain voters warn that the complicated divorce will eventually and inevitably spell financial disaster. In many ways, the economic repercussions, obfuscated by the COVID-19 pandemic, have yet to be fully realized.

    Another implication, however, is that the UK now has an unrelated and probably unintended opportunity: to evolve into the model for tobacco control. No longer under the EU’s Tobacco Products Directive, the country can potentially improve its already-empathetic stance on smoking cessation and transform into the world leader in tobacco harm reduction (THR). 

    THR experts emphasize that the UK government could now make two important reversals.

    The government aspires to be “smoke-free” by 2030—an objective typically understood as getting adult smoking rates below 5 percent—and THR advocates have seized on the chance to push for fresh regulations to arrive at that target. To do so, the government should make sure it has “every tool in the toolbox,” Harry Shapiro, the author and executive director of the Global State of Tobacco Harm Reduction reports, told Filter. “You want to take away all the barriers that are in the way of people switching.” 

    “Leaving the European Union opens up new opportunities for tobacco policy reform and an increased focus on tobacco harm reduction in the UK, untrammeled by the constraints of EU law—on which UK law has previously been based,” Gerry Stimson, a leading UK harm reductionist and cofounder of Knowledge-Action-Change, wrote in International Journal of Drug Policy.

    THR experts emphasize that the UK government could now make two important reversals: first, by allowing snus, a smokeless form of tobacco significantly less harmful than combustible cigarettes that’s currently banned by the EU; and, second, by removing nicotine caps in e-liquids. (Recent studies have shown that higher nicotine levels in vapes, by better mirroring the nicotine intake of a cigarette, could allow smokers to switch more easily.)

    Advocates are begging politicians to take notice. In October 2020, the New Nicotine Alliance (NNA) sent a letter to Jo Churchill, a parliamentary undersecretary of state at the Department of Health and Social Care, and Munira Mirza, one of Prime Minister Boris Johnson’s political advisors.

    It calls for what Clive Bates, a co-author, told Filter are “pretty radical” proposals: lifting the ban on snus and other oral, smokeless tobacco products and regulating them; raising the limit of nicotine concentrations in vapes, and removing “wasteful restrictions” on tank and bottle sizes; allowing controlled advertisements for vaping products to appear in media and in cigarette packs, urging smokers to switch; permitting ads on low-risk tobacco products; removing “excessive and inappropriate warnings” on e-cigarettes and other low-risk products, which discourage current smokers from switching; and “enabling candid communication” of relative risk to consumers.

    “We’re in a ridiculous situation,” Shapiro emphasized to Filter. “Tobacco companies are currently not allowed to put notes inside their own packaging recommending that people switch. It’s hardly encouraging young people to vape if you place notes inside cigarette packs.”

    “These health benefits are not allowed to be expressed,” he continued. “Except buried in a big, thick report by Public Health England.”

    There are signs that British politicians are receptive. In early April, an all-parliamentary group—including members of parliament from all political parties—called on the UK government to challenge the World Health Organization (WHO) and its opposition to vaping at an upcoming global tobacco control conference.

    British THR supporters are, in short, optimistic. The ethos is there: Public Health England (PHE), which is undergoing a transition into the more robust UK Health Security Agency, has maintained for years that vaping is “95 percent less harmful than smoking.” And the fear of youth initiation has not rattled policymakers and parents as much as it has in the US—where the narrative of a teen vaping “epidemic” dominates the conversation and influences policy. As the Biden administration pushes forward with plans to prohibit menthol cigarettes and flavored cigars, US cities are banning flavored vaping products and taxing the devices at exorbitant rates to discourage use.

    “People think if you ban vaping and heat-not-burn products, [tobacco companies] are just going to fall over,” Shapiro said. “The actual percentage of turnover from these products is tiny compared to what they’re making selling cigarettes. If they get legislated out of existence, they’ll just shrug their shoulders and go back to what they do best. Because nobody is suggesting banning cigarettes.”

    For the most part, the UK has approached vaping and many other lower-risk products rationally. Case in point: In England, according to PHE, “1 in 3 cigarettes is smoked by a person with a mental health condition,” so getting them to stop smoking has become an “overriding priority.” Consequently, a majority of mental health trusts allow the use of vaping products, and many even provide e-cigarettes free to their patients. After some hospitals banned smoking on their premises, some allowed vape shops to open on the property, in an effort to help people quit. And a new pilot will hand out free vaping products to smokers who attend emergency rooms at a number of British hospitals.

    As of 2018, a survey revealed that there were 3 million British vapers—a number four times higher than the total in 2012. At the time, nearly half of those vaping stated that they were former smokers, while the rest engaged in dual use—meaning they vaped and smoked, an indication that they could be in the process of switching to only vaping, or that they were smoking significantly fewer cigarettes.

    With the number of former smokers who now vape in the millions, and with the potential for THR-friendly policies to boost this number further, it seems likely that the UK will provide the world’s best real-life example of the better health outcomes and saved lives that such policies can achieve.

     


     

    The Influence Foundation, which operates Filter, has received donations and restricted grants (to support tobacco harm reduction reporting) from Knowledge-Action-Change, which also produces the Global State of Tobacco Harm Reduction reports.

    Photograph of a vape shop in Birmingham, England by Elliott Brown via Flickr/Creative Commons 2.0

    • Alex is a staff writer at Filter. He previously worked as a reporter and copy editor at VICE, and has been published in The New York Times MagazineThe Columbia Journalism ReviewThe Nation and The Daily Beast, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. Alex is currently based in Los Angeles.

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