Relative harms of vaping nicotine products
Criteria include mortality, morbidity and economic costs, which contribute to the overall score
While stressing that e-cigarettes are not free from risk, PHE now believes that e-cigarettes “have the potential to make a significant contribution to the endgame for tobacco”.
The message was backed by the government’s chief medical officer, Dame Sally Davies, who nevertheless cautioned that “there continues to be a lack of evidence on the long-term use of e-cigarettes”. She said they should only be used as a means to help smokers quit.
“I want to see these products coming to the market as licensed medicines. This would provide assurance on the safety, quality and efficacy to consumers who want to use these products as quitting aids, especially in relation to the flavourings used, which is where we know least about any inhalation risks.”
The 111-page review raises concerns about the length and cost of the the government’s licensing process, which is a key part of the revised strategy to cut tobacco use.
No e-cigarettes have yet been licensed, unlike other nicotine-replacement therapies such as gums, lozenges and patches. Pilot schemes in Leicester and the City of London allow stop-smoking specialists to offer free e-cigarette starter kits, but smokers elsewhere cannot be offered e-cigarettes on prescription.
The Medicines and Healthcare Products Regulatory Agency began its work in this area more than two years ago, and manufacturers have complained that it costs them millions to go through the process.
Jane Ellison, the public health minister in England, reminded smokers that the best thing they could do to avoid falling victim to the country’s number one killer was to quit completely.
“Although we recognise the e-cigarettes may help adults to quit, we still want to protect children from the dangers of nicotine, which is why we have made it illegal for under-18s to buy them,” she said.
The review found that almost all of the 2.6 million adults in the UK now thought to be using e-cigarettes are current or former conventional smokers, most using them to help them quit tobacco or to prevent them going back to smoking.
There was no suggestion that the products were a gateway into tobacco smoking, with less than 1% of adults or young people who had never smoked becoming regular cigarette users.
The PHE decision comes after carefully choreographed moves by anti-tobacco campaigners and public health specialists to help move the NHS towards offering better smoking cessation support and to be less negative about e-cigarettes.
Services are being urged to follow those in the north-east of England in offering behavioural support to those wanting to quit tobacco and using e-cigarettes to try to do so.
Smoking kills about 100,000 people a year in the UK, most of those in England where there are thought to be eight million tobacco users. But official figures suggest smoking is now at its lowest prevalence since records started in the 1940s.
Rates are highest in many of the most deprived areas of England, and getting smokers off tobacco is increasingly seen as one of the best ways of reducing health inequalities.
Worryingly for many of those behind the policy change, increasing numbers of people – up to 22%, compared with 8% two years ago – think e-cigarettes are equally or more harmful than tobacco. This is leading some smokers to avoid switching, studies have suggested.
Tobacco reduction campaigners say the public needs to be educated to recognise that although e-cigarettes, like tobacco cigarettes, contain addictive nicotine, they do not contain more dangerous chemicals such as tar and arsenic.
PHE is also advocating careful monitoring of the e-cigarette market, particularly of companies closely involved with or part of big tobacco companies. It says the government must meet its obligations “to protect public health policy from commercial and other vested interests of the tobacco industry”.
Kevin Fenton, director of health and wellbeing at PHE, said: “E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm.
Vaping is ever more popular, but is it a smoking cure or a new hazard?
“The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting. Local stop-smoking services should look to support e-cigarette users in their journey to quitting completely.”
Peter Hajek, of Queen Mary University, London, one of the independent authors of the review, said: “My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health. Smokers differ in their needs and I would advise them not to give up on e-cigarettes if they do not like the first one they try. It may take some experimentation with different products and e-liquids to find the right one.”
Ecita, a trade association of e-cigarette manufacturers, said: “There could be huge long-term benefits to taxpayers and the NHS as well as to former smokers and their families. The proposed ban in public places across Wales is very worrying, as are many of the bans in pubs and restaurants across the UK. This appears to be driving a growing number of people to think the harm is the same, deterring smokers from moving to e-cigarettes, and damaging public health.”
The smokers group Forest questioned whether prescribing e-cigarettes on the NHS would be a justifiable use of taxpayers’ money. Simon Clark, its director, said promoting them “as a state-approved smoking cessation aid ignores the fact that many people enjoy vaping in its own right and use e-cigs as a recreational not a medicinal product.”
He said e-cigarettes had been successful because the consumer, not the state, was in charge. “If they want more smokers to switch to e-cigarettes, public health campaigners should embrace consumer choice and oppose unnecessary restrictions on the sale, marketing and promotion of this potentially game-changing product.”
The switch in policy towards e-cigarettes coincided with publication in theJournal of the American Medical Association of research from Los Angeles suggesting that high school students who had use e-cigarettes are more likely to go on to try tobacco.
But Hajek said this did not show that vaping leads to smoking. “It just shows that people who are attracted to e-cigarettes are the same people who are attracted to smoking. People who drink white wine are more likely to try red wine than people who do not drink alcohol.”
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