Tobacco and Vapes Bill

Written Evidence Submitted by the Asian Consultancy on Tobacco Control to the Tobacco and Vapes Public Bill Committee (TVB62).

Dear Chair and Members of the Committee,

My name is Dr Judith Mackay, and I am a British medical doctor based in Hong Kong since 1967 and have worked on tobacco control in Hong Kong and throughout Asia since leaving hospital medicine in 1984. I am a Senior Policy Advisor to World Health Organization. I am a Fellow of the Royal Colleges of England and Scotland, and was awarded Doctor Honoris Causa by the University of Edinburgh. In addition to many honours and medals for example from China, Thailand, the UK and USA, the TIME 100 Award, I am also the first recipient of the Lifetime Achievement Award from the British Medical Journals’ Group.

I listened with interest to the oral evidence sessions on 7 January 2025.

I am writing as I feel it might be helpful to inform t he Committee of :

a) a global perspective and what action other countries and jurisdictions have taken on E-cigarettes, and

b) the recommendations of World Health Organization. 

A. The global picture

England, New Zealand and Canada have followed a different path from most jurisdictions in the world in initially embracing E-cigarettes, and continuing to believe they are useful for quitting ordinary cigarettes.

The rest of the world has been much more cautious, concerned that allowing these products on the market could lead to a new epidemic of nicotine use among the young. To protect youth, more than 100 countries have already taken strong measures on E-cigarettes and more than 40 have outright bans on E-cigarettes, in the face of strong opposition by the industry.

For example, Hong Kong banned manufacture, importation and sale of E-cigarettes in 2022. With a prevalence rate of smoking already down to single digits at 9.1%, Hong Kong clearly shows that traditional smoking prevalence can be reduced without using E-cigarettes.

 

Why have other countries taken much stronger measures, particularly to protect children?

1. Unknown ingredients : E-cigarettes contain some known ingredients but thousands of unknown ingredients, including chemical flavourings , as reported by Johns Hopkins University (See Appendix) . Labelling was also found to be seriously inaccurate in some countries.

2. Harm : Although there has been an accumulation of knowledge on the harms of E-cigarettes, including explosions, links with cancer, heart and lung disease, gene DNA changes, toxic waste and more. Because these are new and constantly evolving products, there are also unknown future harms.

3. They are trendy products , attractive to youth, as outlined by the witness from the Secondary Headteacher Reference Group to your committee. Parents, teachers and young people themselves supported bans.

4. Gateway effect – young people are 3 times more likely to move on to combustible cigarettes if they vape compared with non-vaping youth.

5. Cessation: There has been little evidence to show that E-cigarettes lead to sustained cessation of combustible cigarettes (ie for 6-12 months,  not just 1 month as some pro-vaping studies have shown). However they do maintain prolonged dual use with tobacco, which Nicotine Replacement Therapy does not.

6. Renormalization: These products renormalize nicotine and tobacco use, just as the combustible cigarette use is falling worldwide.

7. Advertising, promotion and sponsorship: E-cigarettes advertising is clearly directed to young people, not to middle aged smokers.

8. Once the ‘ Genie is out of the bottle’ it would be much more difficult to regulate and legislate later.

9. The tobacco-nicotine industry has twice previously claimed they had a safer products (low-tar, filters) which turned out to have no health benefit. This is the industry’s third attempt to promote itself as pro-health.

B. World Health Organization

World Health Organization has stated:  "E-cigarettes as consumer products are not shown to be effective for quitting tobacco use at the population level. Instead, alarming evidence has emerged on adverse population health effects.  Based on the current evidence, it is not recommended that governments permit the sale of e-cigarettes as consumer products in pursuit of a cessation objective ."

Ref: www.who.int /news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes

WHO clinical treatment guideline for tobacco cessation in adults, July 2024

This recent guideline provides recommendations on the use of behavioural support, delivered in both clinical and community settings, including digital tobacco cessation interventions, pharmacological interventions, and system-level interventions and policies to enhance the adoption and implementation of tobacco cessation interventions. E-cigs are not currently included as the evidence remains not strong enough to recommend at population level. 

Ref: WHO clinical treatment guideline for tobacco cessation in adults. Geneva: World Health Organization; 2024. https://www.who.int/publications/i/item/9789240096431

 

WHO call to action on e-cigarettes: World Health Organization (2023) Electronic Cigarettes: Call to action. WHO. December 2023. Ref: Electronic cigarettes: call to action . Technical note:  https://www.who.int/publications/m/item/technical-note-on-call-to-action-on-electronic-cigarettes

I have an encyclopaedic amount of referenced information on E-cigarettes from around the world on my computer and would be happy to share any part of this information that the committee might like to see.

January 2025.