• Despite decades of public policy aimed at reducing smoking, there remain 7 million smokers in the UK (14.1% of adults, down from 14.7% in 2018)

• According to ONS data the average annual decline in the smoking rate from 2011 to 2019 was 0.76 percentage points.

• The UK’s public health consensus in favour of e-cigarettes as a smoking alternative has played a significant role in accelerating the decline in smoking rates over the past decade

• But for the first time since e-cigarettes were introduced to Great Britain their use has declined from 7.1% to 6.3% of the adult population.

• The Cochrane review found that for every 100 people using nicotine e-cigarettes to stop smoking, 10 might successfully stop compared to just 6/100 using nicotine replacement therapy or 4/100 with no support or behavioural support only.

• Even with the current rate of decline, the Government’s ‘2030 smoke-free’ goal will be missed.

• Brexit and the new Tobacco Control Plan “provide once-in-a-generation opportunity to create and implement evidence-based policy” says Rt Hon David Jones MP

• Any missed Brexit opportunities to reduce restrictions on sale and advertising of alternative products risk lives lost to smoking related illnesses.

In the UK, around 78,000 people die every year as a consequence of smoking with and many more live with the misery of debilitating smoking-related diseases. While the number of smokers has fallen in recent years the Government is not on track to meet its target of being ‘smoke-free by 2030’, which means having an adult smoking prevalence of 5% or less.

Even under optimistic assumptions, the Government will miss its target by a whole percentage point on current trends. This is the warning today by the free market think tank the Adam Smith Institute in a new report. Previous forecasts have predicted an even higher degree of failure, with Cancer Research UK suggesting that England would hit the target 7 years behind schedule while Scotland was only predicted to reach the target in the latter half of the century.

The neoliberal think tank argues that decades of policies designed to reduce smoking prevalence are at risk have only started to bear fruit after a squeeze on incomes against inelastic consumption of nicotine via higher taxes was also met with options to switch away from cigarettes to less harmful alternatives such as e-cigarettes.

It is the poorest that will suffer, they argue and are joined in that opinion by the Rt. Hon. David Jones MP who argues that “poorer communities across the country are being left behind, and the problem, currently, is only getting worse.”

The free market think tank says that the government has so far failed to make the best use of Brexit to reduce the barriers to products like e-cigarettes that are proven to reduce the harms of smoking.

Over the past decade the success of our harm reduction approach has seen an average annual decline in the smoking rate from 2011 to 2019 of 0.76 percentage points.

More worryingly the recent spate of people quitting cigarettes during the pandemic is likely to be short-lived and a result of young people having reduced time to spend with friends and at events, falling disposable incomes and job insecurity, and COVID-related health worries — all of which are both intended to be reversed by the government and society at the end of the pandemic. The free market think tank says that even in the best case scenario where these COVID-induced quits are long-term — a questionable assumption since young people tend to relapse at higher rates — they represent a one-off event rather than shift in the overall trend. 

E-cigarettes’ reputation as an effective way to stop smoking is borne out by the evidence. In October 2020, a Cochrane medical science research review of 50 completed studies summarised that “for every 100 people using nicotine e-cigarettes to stop smoking, 10 might successfully stop, compared with only six of 100 people using nicotine-replacement therapy or nicotine-free e-cigarettes, or four of 100 people having no support or behavioural support only.” A wide consensus of UK public health bodies and NGOs also maintain that they are significantly less harmful to health than tobacco cigarettes.

The Adam Smith Institute argues that the recent plateauing of e-cigarette use by smokers since 2016 — hovering at just under two-thirds of all adult smokers and despite the fact that almost all (94%) of smokers having heard of of e-cigarettes — means nearly one-third of UK smokers have still never used the UK’s most popular (and arguably most effective) quit method. 

When Britain left the European Union powers and advertising rules over nicotine products like cigarettes, cigars, vaping, and heated tobacco returned to the Westminster level from Brussels. With that came a chance to reform things like warnings to be product rather than sector specific, advertising alternative products within cigarette packets, and nicotine levels in certain products that are both safe and more likely to act as a direct replacement for long-term smokers. With no movement shown in the 13 months since, and despite a cardio-vascular disease pandemic, the think tank warns that the opportunities of Brexit are being squandered. 

However, the Government can signal their intent to continue the liberal approach to regulation, product development and access at the Framework Convention on Tobacco Control’s COP9 later this year — the UK’s first time unbound by the EU’s common position. 

If the Government is to achieve its target of a sub 5% smoking rate by 2030, it will best do so by continuing and expanding a liberal and consumer-welfare focused approach to access of alternatives to smoking, as well as seizing the opportunities that Brexit presents. 

Report author and ASI Head of Programmes Daniel Pryor, says:

“For a decade, the UK has been a world leader in using tobacco harm reduction to encourage smoking cessation. But until now, EU restrictions limited how far we could pursue this path. If the Government doesn't take advantage of Brexit to change its approach to vaping and other low-risk smoking alternatives, they'll miss the Smokefree 2030 target and squander a golden opportunity to help British smokers make the switch.

“We need to make these changes now. Many smokers aren’t switching to safer alternatives like vaping because of widespread misperceptions about relative risk or because they are simply unaware that other options exist. Others are put off by outdated product rules and even outright bans on things like snus that our newfound Brexit freedom gives us the opportunity to revise. 

“Global Britain should also leverage its newly independent position to push for the World Health Organisation to adopt a more sensible approach to reduced-risk products at COP9 later this year: especially in light of our decision to increase their UK taxpayer funding. If we don’t make these changes now, what was the point of Brexit?”

Notes to editors:  

For further comments or to arrange an interview, contact Matt Kilcoyne: matt@adamsmith.org | 07904 099599.

The report ‘The Golden Opportunity: How Global Britain can lead on tobacco harm reduction and save millions of lives’ is available here.

Daniel Pryor is Head of Programmes at the Adam Smith Institute. The Adam Smith Institute is a free market, neoliberal think tank based in London. It advocates classically liberal public policies to create a richer, freer world.