On June 25, the United Kingdom’s National Institute for Health and Care Excellence (NICE) published new draft guidelines encouraging health care professionals to disseminate clear and up-to-date information for smokers who want to use vapes to quit cigarettes.
Developed with the help of Public Health England (PHE), the UK’s leading health agency, an expert committee advises that nicotine-containing e-cigarettes are “more likely to result in people successfully stopping smoking” when combined with behavioral support; notes that vaping is “similarly effective” to short- and long-acting nicotine replacement therapy (NRT); acknowledges that e-cigarettes are “significantly less harmful than smoking” although long-term health effects remain unknown; and calls for the funding of further research. The guidance consolidates and updates eight previous guidelines on smoking and is out for consultation until early August.
“This should have a considerable impact on the level of confidence among health care professionals, some of whom have until now been uncertain or reluctant to support patients to switch from extremely harmful smoking to something significantly safer,” Louise Ross, the former manager of the Stop Smoking Service in Leicester and the current business development manager for a smoke-free app, told Filter.
Over the past few years, the UK has transformed into a model for tobacco harm reduction (THR), and activists have been hopeful that public health officials there will continue down that path, especially in a post-Brexit regulatory landscape. In one promising development there among many, a collection of UK universities recently launched a trial in which they’re providing free e-cigarettes to hundreds of homeless people, a population with a high smoking rate; the research will judge how effective vaping products are at assisting them in quitting cigarettes.
The NICE recommendations are not necessarily a surprise. Indeed, a study published in the New England Journal of Medicine in 2019 found that vapes were not as effective for quitting as NRT, but much more effective—somewhat disappointingly for some activists, NICE does not go as far to declare vapes superior cessation tools. Still, the guidelines represent a victory for THR advocates. They can now be cited to health organizations and agencies that oppose vaping at all costs in favor of an abstinence-only approach to nicotine.
“We know that vaping is a really popular and effective way to stop smoking.”
Advocates are not particularly optimistic, however, that the guidance will stretch beyond the UK’s borders. As recent as May, ahead of World No Tobacco Day, the World Health Organization (WHO) reasserted its anti-vaping stance, stating that the tobacco industry has “promoted e-cigarettes as cessation aids under the guises of contributing to global tobacco control” and that “switching from conventional tobacco products to e-cigarettes is not quitting.”
“The new draft guidelines recommending that UK physicians should promote safer nicotine vapes (‘e-cigarettes’) for adult smokers should be a wake up call for the World Health Organization,” Dr. Charles Gardner, the executive director of INNCO, a global nonprofit that supports the rights and well-being of adults who use safer nicotine, told Filter. “The WHO continues to believe that reducing harm is an evil Big Tobacco plot. NICE and PHE have no industry influence. They look at evidence. INNCO compliments them on their courageous stance against current tobacco control dogma.”
The UK strategy is a stark contrast to that in the United States—and in many other countries that follow the US example. Misinformation about the benefits of e-cigarettes for adult smokers still plagues much of the public conversation in the US. Many former smokers who switched to vaping have been persuaded that a string of “vaping-related” lung injuries reported in 2019 were related to vaping nicotine—not illicit, adulterated THC cartridges as was in fact the case. Many seem to be returning to cigarettes.
“This should all be part of a consistent message to people who smoke, encouraging them to give vaping a try,” Ross said of the NICE recommendations. “We know that vaping is a really popular and effective way to stop smoking.”
“Now,” she continued, “we have evidence from yet another credible source that we should all put our efforts into getting more people to try it.”
Both INNCO and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World. More information about The Influence Foundation’s funding is available here. Filter’s Editorial Independence Policy applies.