Tobacco and Vapes Bill

Written evidence submitted by Asthma + Lung UK (TVB74)

House of Commons Public Bill Committee: Tobacco and Vapes Bill

1. Introduction

1.1 At Asthma + Lung UK (A+LUK) we are fighting for everyone's right to breathe. We're the nation's lung charity and we're here for everyone who's living with a lung condition, regardless of what that condition may be.

1.2 We are submitting evidence to the Tobacco and Vapes Bill Committee because lung conditions are the third leading cause of death in the UK [1] and a huge number of these are being driven by smoking. We strongly support the government’s plans to stamp out smoking by raising the legal age of sale by one year every year and this submission reflects that.

1.3 This evidence submission has been informed by people living with lung conditions, respiratory clinicians, and policy experts.

2 Sale of tobacco etc

2.1 We wholeheartedly agree with Clause 1(1) - It is an offence to sell any of the following to a person born on or after 1 January 2009- (a) a tobacco product; (b) a herbal smoking product; (c) cigarette papers. Preventing the next generation from ever being able to smoke is only a good thing. There are no downsides to implementing this policy change.

2.2 In the UK around 6.4 million people smoke [2] ; and smoking kills over 80,000 people in the UK every year [3] . Through devastating ill health and disability, it impacts even more people ’ s quality of life. This is because tobacco smoke is deadly for lung health . Smoking and breathing in second-hand smoke causes many lung conditions: 72% of lung cancer cases in the UK are caused by smoking [4] , smoking causes 9 out of 10 cases of chronic obstructive pulmonary disease (COPD) [5] , it can also cause obstructive sleep apnoea (OSA), pneumonia, and people who smoke are also at higher risk of getting chest infections, including flu, pneumonia, and COVID-19. If you smoke and get an infection, you’re more likely to have severe symptoms. If smoking was made obsolete, it could free up 75,000 GP appointments each month. [6]

2.3 Tobacco smoke contains over 5,000 chemicals, including nicotine, which is well known to be highly addictive. Nicotine is harmful for the body, but much of the severe harm comes from the tar, carbon monoxide, and other chemicals in the smoke. Many of these chemicals can cause cancer. Others are poisonous. When you smoke, these chemicals damage your lungs and can pass into your blood and spread through your body.

2.4 Making smoking obsolete in England would lift 2.6 million adults and 1 million children out of poverty, [7] something that would undoubtedly improve the physical and mental health of all the nations. Respiratory disease is the biggest driver of inequity in mortality between the richest and poorest communities, [8] and smoking is responsible for half the gap in life expectancy between richest and poorest in society. [9] Action to tackle smoking is the single most effective thing that could be done to tackle health inequalities.

2.5 People exposed to second-hand smoke face the same dangers as people who smoke themselves [10] . They too inhale the same poisonous gases and thousands of toxic chemicals found in tobacco smoke. Their risk of developing smoking-related diseases will also increase.

2.6 Research also demonstrates that both the children, and grandchildren, of smokers face worse health as a result of their parents or grandparents smoking, [11] with these vulnerabilities passed down the generations. Indeed children whose parent or caregiver smokes are four times more likely to smoke themselves, and when they try to quit, they find it even harder than others, passing on addiction and poor health.

2.7 This is why 85% of smokers regret ever starting in the first place [12] , and that 84% of A+LUK supporters support the generational smoking ban.

2.8 Most people who smoke want to stop, but the addictive nature of nicotine makes that incredibly hard. With more than 4 in 5 smokers starting before the age of 20 [13] , preventing smoking in young people is vital. Increasing the legal age of smoking by one year, every year, would protect future generations from this deadly habit.

2.9 Smoking doesn’t just cost lives. It also costs money. in 2023 it was calculated to amount to around £50 bn [14] and includes productivity costs of £32 bn, covering lost earnings, unemployment, early deaths. The annual income generated by smoking through taxes comes in at just £10 bn. [15] All of these costs could be mitigated by leading the UK population into a smokefree future.

2.10 In 2022, 12.9% of people aged 18 and over smoked cigarettes [16] , more than twice the government’s Smokefree 2030 target of 5%. To achieve a smokefree 2030, bold policies need to be implemented such as this one thus is vital this legislation is implemented .

2.11 We also support th at this legislation cover s tobacco products; herbal smoking products; and cigarette papers as in Clauses 1, 2, 50, 54 and 68. We should maximise this opportunity to prevent individuals from accessing products that can lead to tobacco use, and therefore tobacco-based harm. And it is important to have clarity and simplicity across borders for enforcement, and to prevent cross-border purchasing.

2.12 Proxy sales are already prohibited under existing tobacco age of sale legislation, there is no reason for this not to continue with the change to the legal age of sale, thus we agree with Clause 2(1) - It is an offence for a person aged 18 or over to buy, or attempt to buy, any of the following on behalf of a person born on or after 1 January 2009- (a) a tobacco product; (b) a herbal smoking product; (c) cigarette papers.

2.13 This model is also used for other products that are unsuitable for children including alcohol, and we believe it is essential to implement consistency across prohibition legislation to make enforcement easier for retailers to enact.

2.14 Despite the current ban on proxy sales, evidence shows that proxy sales of cigarettes are a key method of sourcing cigarettes for young smokers, particularly those living in disadvantaged communities [17] , thus it is vital that there is sufficient resource for the enforcement of this legislation change.

2.15 This support extends to Clauses 50-55 for the sale and distribution of tobacco etc in Scotland, and Clauses 68-72 for Northern Ireland.

2.16 We vehemently oppose any amendments to change the age of sale to an unchanging age above 18 (e.g. 21 or 25): this bill provides an opportunity over time to completely remove a highly addictive product from the market which kills two thirds of its regular users. Such amendments should be disregarded.

3 Sale of vaping and nicotine products etc

3.1 Our position is clear: children and those who do not smoke should not vape. However, vaping can be a useful smoking cessation tool and should remain available as such.

3.2 We would like to see the use of vapes in smoking cessation as a staging post and not the final destination. We must continue working with ex-smokers to move them from vaping to an alternative smoking cessation tool and to stop vaping altogether. We want to see a smokefree and vape free society.

3.3 It is now considered with some certainty that vapes are less harmful than tobacco smoking [18] , making them a less harmful alternative for smokers looking to quit tobacco. A recent King’s College report into e-cigarettes found that the use of vaping products in place of smoking lead to a substantial reduction in exposure to toxicants that promote cancer, lung disease and cardiovascular disease. However, for those who used e-cigarettes but had not smoked, the study found some increase in exposure to these toxicants compared with non-smokers, although overall levels were still significantly lower than amongst smokers [19] .

3.4 The number of adults choosing to vape has increased by 6.4% in the past decade [20] with fewer than 10% of current vape users falling into the never smokers category. The reasons for vape use in ex smokers reinforce their important role in smoking cessation. However, the number of under 18s vaping has also increased, and so it is vital the a ge of sale C lause 10 (1) - It is an offence to sell a vaping product to a person who is under the age of 18, is maintained and enforced.

3.5 We are particularly concerned by the increase in children and young people vaping. There is some evidence that in adolescence the brain is more sensitive to its effects, and we do not yet know the full extent to the harms that these products can cause, particularly on developing lungs.

3.6 The short-term effects of vapes can include throat and mouth irritation, headache, cough, nausea. [21] The long-term effects are currently unknown. More evidence, and time, is needed to understand the real impact of e-cigarettes.

3.7 Some people with lung conditions have told us that vaping, or even second-hand vape fumes, can be a trigger for them. [22]

3.8 Evidence is clear that vaping is an effective quit tool for smokers looking to give up tobacco, and in fact more effective than traditional quit aids such as nicotine replacement therapies. [23] Therefore we believe that vapes are an important tool for people looking to quit smoking, but we only want to see vapes used as a quit tool for those looking to give up tobacco.

3.9 We believe that including nicotine and non-nicotine vaping products is essential: Vaping, whether containing nicotine or not, does not have an in-depth body of evidence to support its safe use. A harm minimisation approach to this is justifiable and we suggest that there is no way that they could be good for lung health, with the likelihood being that they would have some negative effects, and therefore should be restricted. There is no positive argument for them as there is for nicotine vaping as an aid to quit smoking cigarettes. And if we look to other jurisdictions, Australia has opted to ban non-nicotine vapes [24] .

3.10 As above, it is essential Proxy sales are prohibited, as tobacco and other age restricted products are ( C lause 11 ) .

3.11 We strongly support C lause 15 (1) – A person commits an offence if the person-( i ) gives away a product or coupon to a member of the public or sells a product or coupon at a substantial discount, or (ii) causes or permits that to happen. F ree distribution of vapes to under 18s is a driver of their consumption evidenced by nearly half ( 46% ) of young people sourc ing vape s by being ‘ given them ’ [25] . This is, in part, being facilitated by the loophole that allows vapes and other nicotine products such as nicotine pouches to be given to children for free despite it being illegal to sell them to under 18s. N o amendments to this clause are acceptable ; we have a zero-tolerance approach to this.

3.12 We support C lause s 1 3 , 14 , 61 and 79 - Displays of products and prices, which give the Secretary of State powers to prohibitions, requirements or limitations on retailers in relation to the display of tobacco, herbal and nicotine products. We believe vapes, like tobacco products, must be kept behind the counter and cannot be on display. Vaping products need to be available for those wanting to use them as a smoking cessation device and should therefore be no less accessible than tobacco, however they should not be displayed in any way that promotes their uptake by children and young people, and those who do not smoke. Physical stores hold 74% of the market share, and ASH data shows that 48% of under-18s who are current vape users are buying them from a shop suggesting their in-store presence is a key opportunity to impact their purchase and use.

3.13 There are restrictions on the advertisement and promotion of vapes including being banned from TV and newspapers and magazines [26] . However, research has shown that point-of-sale displays have a direct impact on young people’s smoking [27] , [28] , [29] , [30] and as such the advertising of tobacco products is illegal, and so is displaying tobacco products in general retail outlets; this is a technique that works.

3.14 Recent research by Cancer Research UK found that high visibility and exposure to e-cigarettes had a normalising effect and colourful displays were the main aspect of disposable e-cigarette packaging that appealed to all ages, particularly in windows and at point-of-sale in shops [31] . It is well recognised that in-store visual merchandising is hugely powerful in influencing purchasing choices and driving sales, therefore these visual marketing techniques must be restricted to reduce the appeal of vapes and thus their use by young people. Keeping them behind counters and out of view provides an obvious solution to achieve this.

3.15 Furthermore, under current regulations, specialist tobacconists can display and advertise tobacco products inside their shops provided they are not visible from outside. The same should apply to specialist vape shops.

3.16 Strict advertising restrictions, in line with tobacco restrictions, should stop the promotion of vapes in both traditional and social media. Social media content should be tightly regulated to ensure it is not promoting vaping as a positive recreational activity and social media platforms should be mandated to implemented safety policies such as warnings on content that contains vaping content, or that appears when searching for vape content.

3.17 We welcome that the Bill bans commercial advertising but permits public health promotion of vapes which should help to address harm misperceptions.

3.18 Clauses 13(1c) and 14(1c) allow the regulation of the display of prices of vaping products or nicotine products. When applied to cigarettes through the Tobacco Advertising and Promotion (Display) (England) Regulations 2010, this was part of a package of measures which were effective in reducing uptake amongst children and young people.

3.19 In addition to the tax of £2.20 per 10ml of e-liquid due to be introduced from October 2026, further measures to control the minimum price of vapes would also be highly effective in reducing uptake. The price of vaping is significantly cheaper than the cost of smoking: the majority of high street disposable vapes cost around £5 for 600 puffs (the equivalent of ~40 cigarettes), with some disposable vapes being available from as little as £1-£2. This is further driven by the ability to have discounts and deals on vapes; something that is prohibited for tobacco products [32] , but regularly seen on vaping products. These pocket money prices are not a barrier to young people accessing these products, and although children do not report price as a motivator to vape, a substantial body of evidence demonstrates that children are highly price sensitive.

3.20 Reducing the affordability of tobacco was highly effective in reducing smoking rates [33] and affordability has the most impact on those who are most price sensitive, such as low SES smokers and younger smokers [34] . It therefore seems reasonable to assume the same relationship applies to vaping. Furthermore, there is specific evidence that young people are highly responsive to changes in the price of vapes: a US study showed an increase of e-cigarette prices and taxes was associated with significant reductions in past 30-day use as well as reductions in the intensity of use [35] .

3.21 We suggest an additional minimum unit price that applies to nicotine and non-nicotine containing vapes that would raise prices of all vapes to be at least £10. A minimum price of at least £10 remains cheaper than an average pack of cigarettes, and would make no difference to the reusable vaping market, where prices are already higher, while significantly impacting the single-use market.

3.22 This must be accompanied by expansion of the Swap-to-Stop scheme, which should be partly funded by the funds recouped from this tax, to ensure vapes remain an accessible smoking cessation tool for adults on low incomes.

3.23 Price promotions, such as buy one get one free, should also be prohibited as part of this Bill.

3.24 These statements also apply to Clause 61 for the sale and distribution of vaping and nicotine products in Scotland, and Clause 79 for Northern Ireland.

4 Retail licensing – tobacco and nicotine products

4.1 There are no other legal products on the market that cause as much harm as tobacco which may be sold without a licence. Licensing is a valuable tool which would enable government agencies to enforce regulations , and which would support the already effective illicit tobacco strategy.

4.2 As the ban on disposable vapes and e-liquid duty come into force, licensing will provide an important additional tool to ensure th at legislation is followed, and taxes levied as intended .

4.3 There are also significant issues at retail level regarding the sale of vaping products. The sale of products that do not meet UK standards is widespread. While better controls are needed throughout the supply chain, stronger enforcement powers at retail level will support compliance.

4.4 T he retail setting a major source of underage products , and despite t he introduction of progressive age of sale restrictions , b usinesses that flout the law now are likely to continue doing so when new regulations come into force. As such we support the introduction of retail licen s ing.

4.5 It is important that the Government has wide-ranging powers to ensure the scheme remains flexible and adaptable , allowing Local Authorities to shape their preferred retail environment.

4.6 Contrary to claims by the tobacco industry, tobacco is a declining driver of "footfall" in small retailers, and t he majority of retailers are supportive of incoming government regulations with a survey, conducted by ASH in 202 2 , f inding strong retailer support for regulatory action - 81% support ed the introduction of a tobacco licence . [36]

4.7 To be successful the new registration scheme will require sufficient funding, access to expertise, ability to require detailed pre-market information from those registering products, close links with enforcement agencies and sufficient powers to remove products from registration as necessary. These should be key considerations as DHSC develop this scheme following royal assent.

5 Enforcement

5.1 We support the proposed enforcement functions in Clauses 32-36.

5.2 We also support Clauses 37-39 Fixed penalty notices. On the spot fines appear to be a sensible approach , freeing up the time and capacity of trading officers . However, on the spot fines mean no criminal record is made and this must be considered as limiting the deterrent-potential of this policy.

5.3 Sufficient funding and capacity for enforcement of these restrictions must be considered to ensure there are no loopholes, and that they do not foster the growth of an illicit market. As the proceeds from fixed penalties will be paid into the relevant consolidated fund, we suggest a Smokefree Fund be introduced.

5.4 A Smokefree Fund, an industry levy, would raise an estimated £700 million a year [37] , which can be ringfenced for smoking and nicotine cessation services, and enforcement functions. It is reasonable to expect such a harmful industry to pay for the damage it is creating through a levy on their products.

6 Product Requirements etc

6.1 With respect to Clauses 90-91 - Retail packaging and Features of products (of tobacco and nicotine products), any quality of a tobacco product that would make it appeal to consumers should be prohibited.

6.2 Historically, the branding of tobacco products made them more appealing to children, this led to the government introducing standardised packaging across tobacco products in May 2016, requiring cigarettes and rolling tobacco to be sold in standardised green packs, with the brand name in standard font and no brand imagery or logos [38] . This has been effective for reducing the appeal of tobacco cigarettes, particularly among young people [39] , [40] . The Standardised Packaging of Tobacco Products Regulations 2015: post-implementation review found evidence that suggested the ban on branding reduced the appeal of tobacco products to children, with young non-smokers and occasional smokers potentially affected the most [41] . This evidence base should be applied to vaping products and be an opportunity for action against under-18s vaping.

6.3 Marketing of vapes, including their packaging, has been found to influence the appeal of vaping products to youth and adult smokers [42] , [43] , the use of cartoon characters being a clear example of packaging used to appeal to younger customers. Thus a similar approach to standardising the packaging that vapes come in could impact the appeal of vapes to young people. This is supported by a 2023 study that when compared with fully branded packaging, green standardized e-cigarette packaging with no brand imagery was associated with decreased interest in trying the vaping products among youths but not adults [44] , therefore restricting packaging designs in this way should be used to reduce the appeal of vaping to young people, whilst having little impact on adult smokers’ interest in using the products to quit smoking. As the packing of vapes is often quickly discarded, unlike cigarette boxes, these restrictions need to be applied to the vape device itself as well as the packaging it is purchased in.

6.4 We support Clause 92 - Contents and flavour, which gives the Secretary of State powers to regulate the ingredients and flavour of tobacco and nicotine products.

6.5 In the case of vape flavours, we suggest that flavours be limited to those that appeal most to children and young people.

6.6 There is clear evidence that the growth in children vaping is in part being driven by their flavours: 12% of those under-18 who have never smoked, choose to vape because they ‘like the flavours’ [45] .

6.7 There is some evidence to suggest health risks of the chemicals used to flavour e-cigarettes, e.g. the flavouring ‘cinnamaldehyde’ is a cause of concern [46] , and flavourings linked to Bronchiolitis Obliterans were subsequently banned from e-cigarettes [47] .

6.8 However, the evidence-base on whether different flavourings affect health, and long term smoking cessation is limited.

6.9 While we agree in principle with restricting vape flavours to tobacco, menthol, and mint, we welcome further evidence showing these regulations effectively deter young people vaping without undermining the role of vaping in smoking cessation. This ensures flavours appealing to children are removed without reducing its cessation benefits for smokers.

6.10 As part of the consultation for these regulations, we would like to see comprehensive evaluation of international regulations on flavours and their impact.

6.11 Generic flavour descriptions should be implemented immediately as a simple and quick way of reducing the appeal of flavours of vaping products. This has been done in New Zealand, and a similar mandated list of simple flavour names should be used.

6.12 We are also supportive of Clause 92(1c), which could be used to close loopholes to the ban on pre-rolled menthol-flavoured cigarettes by prohibiting any and all products designed to impart a flavour to previously un-flavoured tobacco products (e.g. "menthol cards").

7 Smoke-free places, vape-free places and other free-from places

7.1 We support extending the ban to outdoor spaces where there are likely to be people particularly vulnerable to the effects of cigarette smoke, such as outside hospitals, schools and playgrounds, other formal education settings such as universities, and outside public buildings such as libraries.

7.2 It is well established that second-hand smoke can cause disease including lung conditions. [48] It can also trigger people’s lung conditions, and we want to see people with lung conditions protected from the effects of second-hand smoke. 

7.3 As such, we would also support extending the ban to hospitality outdoor spaces. Both patrons and staff in these spaces have no choice about exposure to second hand smoking. The government must balance the potential economic impact of hospitality-based outdoor restrictions, but it should be noted that when the 2007 indoor smokefree legislation was introduced, there was little to no economic impact on hospitality [49] . However, there were significant improvements in public health, including a reduction in hospital admissions for childhood asthma [50] .

7.4 We support extending places that are currently smoke free to also become vape free, especially in areas where there are children and young adults. 

7.5 Vaping indoors should be restricted, in line with tobacco smoking, to drive down the recreational use of these products.

7.6 Where an outdoor smoking ban is introduced, vaping should also be restricted. This is because people with lung conditions have also told us that second hand vapour can trigger their lung condition . W hile we recognise that the evidence base on the health impacts of second hand vaping is currently limited, our beneficiaries tell us that people vaping near them can have serious consequences for them and their lung condition.

7.7 W e welcome the Bill’s flexibility to adjust over time when more evidence on this becomes available , and encourage continued robust evaluation of emerging evidence to respond appropriately .

7.8 Research on the harms of passive vaping both indoors and outdoors is vital to better understand this, and further restrictions may be required if conclusive evidence is found about the harms on outdoor passive vaping.

8 References