Image by Mohamed Hassan from Pixabay

When the definitive history of tobacco control is written, it will record a most peculiar phenomenon. British tobacco control experts cannot help themselves from schooling Australian colonial numbskulls about where we are going so very wrong with vaping. Britain really has better vaping policy than Australia, they keep telling us.

This is quite amusing because as we’ll see below, some 10 years after the major boom in vaping commenced, vaping prevalence is higher in Britain than in Australia and you could put a cigarette paper between the smoking prevalences of the two countries.  And in the last 30 years, Australia has always had the gall to implement nearly every major policy change ahead of  Britain. So that’s quite a herd of elephants in the room.

Pro-vaping English researchers and advocates have often written submissions to government enquiries in Australia where they tried to explain England’s superior track record.  It’s all a bit like the equivalent of Britain’s fanatical one-eyed Barmy Army cricket supporters who insist that England – not Australia – really won the 2023 Ashes series; that England’s Jonny Bairstow should not have been given out stumped in the 2023 second test at Lords; that England really were the best team at the 2023 One Day World Cup, despite coming seventh below even the Afghanistan minnows while Australia humiliated an apparently invincible India in the final.

This has been going on for some time, Australia and England have met in 361 test matches since 1877. Australia has won 152  and England 112, with  97 ending in draws.

So what about smoking and vaping? With tobacco control, there is almost  nothing in recent decades that the Poms had the initiative or mettle to  introduce before Australia showed them the way. They have always been the bridesmaids. Here are a few examples:

Graphic health warnings: Australia followed the 2000 lead of Canada in introducing graphic picture health warnings on packs in 2006. Britain implemented them in Oct 2008.

Pub smoking bans: Australian states and territories began banning smoking in pubs from 1998, Britain did it in July 2007

Plain packaging: Australia implemented it Dec 1 2012, the world’s first. Britain: in May 2017.

Smokeless tobacco ban: Australia June 1991; Britain in 1992 (following a EU Tobacco Products Directive)

Price of cigarettes: Australia #1 in the world ($US25.88 a pack); UK #2 ($US15.83 – 39% less)

Retail display bans: NSW got the ball rolling in July 2008, with all states subsequently following. England and Wales: from 26 May 2015.

English apoplexy over Australia’s prescription access to vapes

On Jan 6, 2024 following earlier investigative journalism revelations about marketing of vapes to children The Times published a letter from 17 UK senior paediatricians calling on the UK government to implement three measures:

“[F]irst, rigorous enforcement of the ban on vapes and snus sales to children and young people under 18, with punitive measures for non-compliance; second, ban the sale of snus and vapes to adults except when prescribed for smoking cessation, as, in our experience, wider availability enables them to fall into children’s hands; and third, introduce a total ban on disposable vapes.”

All three measures are central to Australia’s recently announced policy on vaping.

So how did England’s leading tobacco control advocacy group react to this call? Deborah Arnott, chief executive of health charity Action on Smoking and Health (ASH) was quoted in a press report on the paediatricans’ letter as saying: “ASH wants action to curb youth vaping, but making vapes only available on prescription won’t help, after they tried this in Australia underage smoking and vaping both went up … Australia’s aggressive anti-vaping policy opened the door to illegal vapes, conflated the harms of vaping with smoking and left tobacco cigarettes, which are far more harmful, on sale everywhere. ASH supports evidence-based measures to curb youth vaping, by prohibiting branding and marketing appealing to children. The disposable vapes that have surged in popularity in recent years are available for pocket money prices on every street corner and they’re currently packaged more like a sweet or a toy than a smoking cessation device. This is unacceptable and must change.”

So let’s take a look at Arnott’s ignorance of what has actually happened in Australia, and her formidable abilities to walk on both sides of the street at once.

She says Australia “tried this” (ie prescription access to vapes) and then “underage smoking and vaping both went up”.

Yes true, in 2021 Australia’s last conservative health minister Greg Hunt did indeed implement a prescription access policy in concert with a ban on personal imports of vapes. However, within weeks, 28 members of his backbench – led by a National Party Senator whose party still takes tobacco industry donations —  lobbied successfully to have the import ban scrapped. It was stillborn.

Predictably, this saw the surviving prescription access component fail to be taken up by nearly all Australian doctors and vapers. Why would smokers bother to go to a doctor to get a script for vapes when they – plus legions of non-smokers including kids who were “recreationally vaping” — could buy vapes easily right across the country?

This failure had nothing to do with the prescription access component, but everything to do with the useful idiots in the far right of politics and their urgers in vaping advocacy who held the national door open for unrestrained illicit trade.

Notably too, all this happened  during the COVID pandemic, when state and federal governments seconded thousands of health department hands to be on deck for COVID-related duties. As a result, the requirement that vapes could only be sold to those with a prescription was almost totally ignored by retailers, knowing that its policing was being accorded all but zero priority by health departments. You could buy vapes almost anywhere. Just like you have always been able to do in Britain. Imagine what would have happened if pharmacies decided to ignore the law and sold prescribed drugs to anyone wanting them. Pharmacists would have been struck off, or even jailed.

Arnott appears to have dined out on the huge propaganda campaign designed to discredit the politically gutted prescription policy internationally, straight from the industry’s playbook it tried (and badly failed) to use in stopping the spread of plain packaging legislation

And then she says that Australia shockingly “left cigarettes on sale everywhere” while it attempted to implement prescription access. Ermmm … just like Britain and every other nation in the world has left them on sale everywhere! This is the same old populist knee-jerk reaction we have seen about every significant piece of tobacco control policy “this is window-dressing! If you’re really serious about stopping smoking, why don’t you just ban cigarettes”.

I dealt with the wittering myopia of this argument in an earlier blog. The argument that you cannot seriously regulate vapes (as Australia is now doing) for as long as cigarettes are sold to anyone over 18 would have to be among the most cringeworthy, forelock tugging pieces of defeatism in contemporary public health.

I have often heard public health leaders say “If cigarettes were invented today, and we knew all we know about their dangers that we know now, not a country in the world would allow them to be sold.” Well, Trump’s America might. It took more than half a century of smoking for us to understand the full risks of smoking. Those who run this argument are effectively saying “let’s learn nothing from the history of smoking-caused disease and its control, let’s just let vaping rip like we did with cigarettes and cross our fingers about any down-the-track consequences”.

Restricting access to vapes through prescription allows smokers with serious intent to quit smoking another option. Importantly, a homeopathically small number of doctors would issue children or non-smokers with scripts for vapes, whereas they can access them with ease under Arnott’s preferred policy.

Opponents of prescription access – especially those interests centred on selling vapes to as many people as possible – have megaphoned the alleged “failure” of Australia’s prescription policy. It speaks volumes about the arrogance of English tobacco control, that the head of its oldest advocacy agency is apparently so clueless about what actually happened in Australia.

ASH England supports “adults only” targeted vaping marketing

She continues: “ASH supports evidence-based measures to curb youth vaping, by prohibiting branding and marketing appealing to children.”

This is truly gob-smacking stuff. When I started in tobacco control in the late 1970s, the main challenge was getting rid of tobacco advertising and promotions. The tobacco industry ran the argument on repeat for over a decade that there was such a thing as tobacco advertising that appealed to adults but not to children. We should let that bloom, they argued, but jump on not ads that beguiled kids. Some never-specified, surely magic barrier prevented “adult” advertising messages from ever penetrating the orbits of children. No one in the advertising industry had ever heard of such barriers.

UK legislation on permitted vaping advertising is classic, absurd “half pregnant” policy: ads are banned on radio, television and magazines, but not in cinemas, posters, leaflets or  bus sides. The UK Government has been advised that British kids apparently never go to the movies, see billboards or see buses when they pass.

In 2024 Deborah Arnott has climbed in her tardis, inviting us to believe in the same tooth fairy “evidence-based” controls when it comes to neutering vape marketing to kids.

And then we need to ask why, if vaping is as benign to health as its advocates claim it is, do they nonetheless feel bound to say that they want to “curb youth vaping”. Why not treat vaping like yo-yos, hula hoops, fidget spinners and other harmless childhood fads, as a leading pro-vaping Australian advocate once suggested. Seriously.

So how do the two nations compare today?

Smoking In 2022, 12.9% of people aged 18 years and over smoked cigarettes in Britain.

In Australia in 2022, one in ten (10.6%) adults were current daily smokers. This rate has steadily declined from 22.4% in 2001. This report did not provide data on less than daily current smoking prevalence. However an earlier (different) national survey showed that another 1-2% smoke not daily but less than monthly. So the two countries are about the same.

Vaping In Britain 8.7% of adults currently vape daily or occasionally, an increase from 2021 where 7.7% of people reported daily or occasional e-cigarette use. Vaping is highest among those aged 16 to 24 years in Great Britain; the percentage of people in this age group who were daily or occasional vapers in 2022 has increased to 15.5%, up from 11.1% in 2021.

In Australia in 2022, just 4% of the adult population were currently vaping, less than half the current rate in Britain.

Youth vaping

In Britain in 2023, 20.5% of children 11-17 had tried  vaping,  up from 15% in 2022 with 7.6% currently vaping, up from 6.9%.

In Australia, there has been a far more  dramatic increase   between 2017 and 2022/23 in both “ever” vaping and current (past month) vaping in school children aged 12-17. Just under 30%  of Australian school students have now tried vaping. The figure below shows a significant fall in exclusive smoking that is in line with the historic trend downward. In 2017 9.7% of students were either exclusively vaping or vaping and smoking (dual using) while in 2022-23 this had shot up to an alarming 16%, more than 1 in 6.

Given that only 7.3% of students were exclusively smoking and/or dual using in 2017, it follows that the lion’s share of the  increase in vaping has occurred in children who had never smoked: they had taken up vaping not as a substitute for smoking, with some  undoubtedly also then also taking up smoking  (longitudinal studies show that children who take up vaping have a three-fold greater probability of later taking up smoking).

As we saw above, Britain has played catch-up with Australia on almost every tobacco control policy. Like Australia, it has seen rapid growth in vaping by children, many of whom have never smoked. And like Australia, it has seen historic falls in smoking by children which long preceded the advent of vapes. Our adult smoking rates are about the same, while Australia’s adult vaping prevalence is half that of Britain’s.

This all raises serious questions about which population groups are being most affected by vaping. Vaping prevalence is rising far more than smoking prevalence is falling. So claims that vaping is a population-wide game changer in smoking cessation are clearly hype. But there is unequivocal evidence that the present arrangements for vaping access are seeing massive rises in kids being exposed to the addictive highly drug nicotine. This is no accident but as central to the vaping industry’s business plan as securing smoking in successive cohorts of teenagers was to the tobacco industry (where today, every company is heavily invested in vapes).

These data underscore the importance of the Australian government’s policies to get vapes out of the reach of kids by making them prescription access only. 

Other blogs in this series

Vaping theology: 1 The Cancer Council Australia takes huge donations from cigarette retailers. WordPress  30 Jul, 2020

Vaping theology: 2 Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping theology: 3 Australia’s prescribed vaping model “privileges” Big Tobacco WordPress Feb 15, 2020

Vaping theology: 4 Many in tobacco control do not support open access to vapes because they are just protecting their jobs. WordPress 27 Feb 2021

Vaping theology: 5 I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

Vaping theology: 6 There’s nicotine in potatoes and tomatoes so should we restrict or ban them too? WordPress 9 Mar, 2021

Vaping theology: 7 Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping theology: 8 I hide behind troll account. WordPress 29 Jun, 2021

Vaping theology: 9 “Won’t somebody please think of the children”. WordPress 6 Sep, 2021

Vaping theology: 10: Almost all young people who vape regularly are already smokers before they tried vaping. WordPress 10 Sep, 2021

Vaping theology: 11 The sky is about to fall in as nicotine vaping starts to require a prescription in Australia. WordPress 28 Sep, 2021

Vaping theology: 12 Nicotine is not very addictive WordPress 3 Jan 2022

Vaping theology 13: Kids who try vaping and then start smoking,would have started smoking regardless. WordPress 20 Jan, 2023

Vaping theology 14: Policies that strictly regulate vaping will drive huge
numbers of vapers back to smoking, causing many deaths. WordPress 13 Feb, 2023

Vaping theology 15: The government’s prescription vape access scheme has failed, so let’s regulate and reward illegal sellers for what they’ve been doing. WordPress 27 Mar 2023

Vaping theology 16: “Humans are not rats, so everybody calm down about nicotine being harmful to teenage brains”. WordPress 13 Jul, 2023

Vaping theology 17: “Vaping advocates need to be civil, polite and respectful” … oh wait. WordPress 3 Oct, 2023

Vaping theology 18: Vaping is a fatally disruptive “Kodak moment” for smoking. WordPress Oct 30, 2023

Vaping theology 19: Vaping explosions are rare and those who mention them are hypocrites. WordPress 17 Nov, 2023

Vaping theology 20 : Today’s smokers are hard core nicotine dependent who’ve tried everything and failed – so they need vapes. WordPress 14 Dec, 2023

Vaping theology 21: Australia’s prescription vapes policy failed and saw rises in underage vaping and smoking. WordPress 10 Jan, 2024